Gut Health

SOLO 137 | Gut Health


Peter McGraw speaks to Awais Spall about what the gut is and why it is important to physical and mental health and addresses some of the ways to improve their gut health.

Listen to Episode #137


Gut Health

In this episode, I speak to Awais Spall, a functional medicine practitioner who combines the ancestral wisdom of Ayurveda with cutting-edge regenerative medicine to help people optimize their microbiomes. We talk about what the gut is, why it’s important to physical and mental health, and address some of the ways to improve gut health. This topic is still new. There are more questions unanswered than answered, but I think the conversation is a good start if you’re thinking about non-obvious ways to optimize your health. Typical caveats apply. This is not intended to be medical advice. Please see a medical provider as needed. I hope you enjoyed the episode. Let’s get started.

Welcome, Awais.

Thank you. It’s great to be here.

Folks who frequent the show know that there are a variety of different types of episodes. Some episodes highlight a remarkable solo and look at their lives as a source of inspiration and new ideas. Some episodes look at single living and what it is like to be single in this world. The last type of episode is designed to help people live more remarkable life. This is one of those episodes. I say this a lot to myself and others. I certainly say it to the community. I asked them, “Is your health number one?”

I use this metaphor of a safety briefing on a plane. It says, “Oxygen mask may fall from the ceiling. Put yours on before helping others.” I do believe that if we’re going to make the world a better place for our friends, family, any sort of relationship or even the broader community, we have to be doing better, to begin with. Health is one of those foundational elements. That’s where you come in. You and I have been working together a little bit as a bit of an experiment. I got this idea from talking to you about investigating gut health. You know more about gut health than anyone else I know in the world. Here we are. What is the gut, before we get to the health part of it?

A lot of people will talk about their stomachs. They have a relationship to that like, “My stomach feels off. I’m getting butterflies in my stomach.” Our gastrointestinal tract starts with our mouth. The very idea of you thinking about food, your mouth is producing enzymes to break down certain foods. Amylase is an enzyme that’s going to break down starches and carbohydrates. The very thought of you thinking about a delicious bowl of rice, your mouth is making that enzyme, then your digestive tract goes into your throat, esophagus, stomach, small intestine, and large intestine in a very reductionist breakdown.

The esophagus is where a lot of people have sort of reflux disorders. They’re getting reflux. It’s very misunderstood in the literature what people think is happening in their bodies. They talk about something wrong with their heart. You feel the pressure right here because the esophageal nerves are connected to your upper body more than your stomach, which is supposed to have a very low pH. The massive misunderstanding among lay people is, “I have too much stomach acid.” The stomach is supposed to be low pH, and then you have the small intestine, which is not supposed to be very diverse in terms of the microbiome. It’s supposed to move things through and into the large intestine, where the majority of the microbiome resides.

These days, there’s an imbalance and people have lots of stuff going on in their small intestines like fungal and bacterial overgrowth. You then have the large intestine. We’re talking about the gut, but the microbiome peripherally is much greater than that. You have an oral microbiome. Women have a vaginal microbiome. That’s going to influence your general gut microbiome, but they’re all related.

What you are saying is when someone says, “The gut,” the average person thinks about your stomach or maybe your intestines, but it’s this entire system that involves ingesting food, liquids, calories, nutrients and so on, extracting the valuable parts of that, and then getting rid of the not so valuable parts of that in this whole system. I think you’re right that people have a strong connection to their mouths. They know what’s going on like bad breath or something like that, their stomach whether they feel full, comfortable or distended, or the pressure that they may have in their bowels because they have to go to the bathroom.

We’re going to unpack some of these things that you talk about like pH and microbiome. Some of these terms are familiar to people in part because in the last few years, suddenly out of nowhere, your gut matters to more than just your gut. It matters to a whole wide array of other health and even psychological phenomenon. What was the origin of this recognition? Why is it that suddenly, smart people are talking at dinner parties about their guts?

How did this research start making it into people’s imagination and becoming a part of their bodies so that they recognize the relationship? A microbiologist, Kiran Krishnan, used to say this thing, “We know less about the gut microbiome than we do about the Mariana Trench, 2.5 or 3 miles below the ocean surface.” I don’t know if he would still say that today, but it’s remarkable how much we find. There’s a gap between us discovering things in research, clinical data, clinical experience, my experience working with people who have experienced gut imbalances or want to optimize their gut, and then the lay people’s imagination.

What started happening is some of these websites like MindBodyGreen or Gwyneth Paltrow with Goop, it’s not necessarily just the marketing behind probiotics. People are realizing, “My gut feels better with a probiotic.” We’ve all taken some amount of antibiotics. It doesn’t even matter if you’ve taken antibiotics. Just drinking water. A lot of people are beginning to become aware that we are exposed to antibiotics that are killing our microbiome. Should we be doing something to restore that? People have taken probiotics or probiotic-containing foods where they will begin to feel a sense of, “This is what it feels like to have a nice feeling in the gut and the stomach area. I feel better from it. I think I want to do a little more here.”

There are two things I want to highlight here. I think where we’re going to be playing some mix between the limited amount of research that’s been done and the experience of experts, the people who are prescribing various interventions and paying attention to how their clients or their patients are responding. You’re familiar with both. You know the research, but then you’re boots on the ground dealing with this stuff. I don’t want to call it the Wild West, but it is the leading edge. There’s a lot more that’s not known than is known. When someone reads this a few years from now, they may be rolling their eyes at some of the insights because we’re just doing the best that we can.

The other thing is I think you’ve nailed it, and that is this. Even the average smart person who cares about their health and body, if you say, “What do you know about the gut?” They’ll say, “It’s surprisingly important for good health. I should eat more yogurt or fermented foods because that’s good for my gut.” If you ask them, “What’s the microbiome?” They would say, “I have no idea but I think it’s pretty important.” Let’s start with what a microbiome is and then we can get into why it is pretty important.

In a nutshell, the microbiome is the microbe that inhabits our body. As a person, you are your own cells and microbial organisms that live inside of you that have symbiotically evolved to support your physiological functions. We cannot exist without them. An example of an organism that’s perhaps a little bit more mammals that are more extreme in this way are gorillas who are consuming volumes of leaves or pounds of leaves every day. That’s microbes in their gut that break them down and turn them into nutrients. In our case, we have microbes everywhere that are doing these physiological functions. There are some lay myths floating around about how much of us is microbe and how much of us is human.

I’ve seen some people say something like, “For every one-part human, there are ten-part microbes.” That’s not quite accurate. They weren’t calculating the red blood cell volume and the somatic cells. It’s closer to one-to-one, which is pretty incredible to think about. One part of you and your identity is coming from these microbes. The simplest way to think about this arena is you have a bacterial biome, viral biome, fungal biome and parasitic biome. Now we’re finding new species of organisms and bugs, some called bacteriophages, which are technically viruses. Some parasites are now being relabeled as mutualists because they have mutual functions. That arena is our microbiome. It can be a little bit reductionist. In a nutshell, some of these bugs are good. Some of these bugs are bad.

When I work with somebody and once we rebalanced the good bugs, and they take certain good bugs, they will be like, “This is what it feels like to have this good bug inside of me.” When you have a bad bug inside of you, it feels a certain way. They do bad things. Some skin disorders are microbiome disorders or imbalances in the microbiome and they can cause skin lesions. In a nutshell, you can think about it like that. Is this bug physiologically supportive? Is it commensal in that way? Is it a positive outcome or is it pathogenic? That’s a whole spectrum.

Anybody who has traveled abroad and picked up some bacteria from a meal or water and gets diarrhea knows what it’s like to have a bad bug. The body is good about clearing that and you end up getting over it. What I think is interesting is the average person has no idea what it means to have a good book in a sense. They know when something is awry, and there are obviously some solutions to dealing if you have a parasite or a bacterial infection and so on to get back to baseline. I don’t know if that’s correct to say.

You always are interested in much more than going back to baseline. The work that you’ve been doing and the conversations we’ve been having are about enhancing life. We should keep that in mind as we kind of talk through here. Why is it important that we’re doing this episode? What you’ve said is these organisms in our body, most of the time they’re our friends. We can do things that might hurt our friends. We might do things that might help our friends. What is it that our friends are doing beyond just helping us digest?

I appreciate you bringing up this idea of optimization. A term that has been being floated around right now is salutogenesis, which is optimization beyond baseline function. That is a whole area where we don’t even have the language to talk about it because we often talk about health as the absence of disease. This question that you’re asking is, “What is our microbiome beyond the digestion of different foods and what is it beyond digestive capacity?” Our microbiome interacts on one level with our nervous system. You have this nerve called the vagal nerve, which runs across your body. It is one of the most important regulators of the nervous system. There’s a whole area of study around it called Polyvagal theory.

We were suspecting many years ago that maybe gut bugs can stimulate the vagal nerve because it runs through the intestine. We were thinking it would be indirect, but some of these bugs or microbes are directly stimulating the vagal nerve. They can directly put you in a fight or flight response. If you have a lot of pathogenic bugs like the Clostridium difficile, some of these types of dangerous bugs. They can put your nervous system in that shocked state. There are some bugs like the different bifido, Akkermansia, and healthy Clostridium that can put your body in that parasympathetic state.

When you were talking about these different bugs, being in an optimal state, and what does optimal feel like? Optimal feels calm and collected, being able to access my higher self, cognitively perform, and feeling creative. That’s not just a neurological meditation state that I achieve after going to my Zen monastery. That is a relationship with my gut bugs, and then producing neuro-transmitters that my brain can then utilize.

This is incredibly fascinating to me. Until I met you, I never considered this. When you talk about psychological health and emotional health, it’s very easy to say, “We have stressors and context.” Anybody who frequents the show knows that I’m a pretty peaceful man. I don’t have anger problems or a problem with depression. I’m a happy person, but I skew anxious. What’s fascinating is that I felt like when I look back on my life, there was a moment in time when my anxiety level kicked up and it never completely went back down. I don’t feel like I was anxious in my twenties, even though there were plenty of things to be anxious about. Once I got into my 30s and 40, it certainly was a bit of a bugaboo.

What I would have described this as is the context I put myself in, highly competitive, highly evaluative, academia, achievement-oriented and high stakes. I might attribute it to my own mental state. I’ve learned a set of cognitive patterns that create more anxiety rather than lessen it. The idea that there might have been something that changed in my gut around that time alluded to me. It’s not an intuitive idea in any way. The idea that you might be able to enhance your mental health by creating a better relationship with your friendly biomes is a revolutionary idea. I hope what you’re saying is true. I’ll share an anecdote later about that personally, which suggests that may be the case.

Even if it’s placebo based, I don’t care. Whatever the path to this is. We’re going to return to the psychological stuff. If you say to me that eating good foods helps you feel better. When you feel better, you can be more creative and handle stress better. If you exercise, that’s going to improve your mood and your health so you can handle stress better. It’s going to help your immune system. None of that is controversial to me. The idea that your physiology affects your psychology is not a controversial idea. It seems new and a little far out. For the person who is crossing their arms and scrunching their nose, this seems a little skeptical. What might you say to them before we get to some of the other benefits?

There is now an incredible amount of clinical and human data on this area called Psychobiotics. Psychobiotics are probiotics that enhance cognitive function. It’s one thing for me to have data looking at cognitive changes in the client populations that I work with that are utilizing the gut optimization, clearing the bad bugs and optimizing the good bugs, but we have quite a bit of research looking at monotherapies where we look at, “This is not necessarily a probiotic that is only good for the gut. This is a neurologically enhancing probiotic, so then that gets called a psychobiotic.” I have a psychobiotic here that I’ve been utilizing with people dealing with anxiety. Once their gut is a little bit more optimized, the changes are truly profound. What people have reported to me is that it’s comparable to a certain psychiatric medication they’ve taken. I think that’s truly remarkable.

I’ll talk about my own personal experience. I started working with you and your partner Shri in part as an experiment. I’ll be honest. I’m interested in this notion of longevity and aging. I’m in my 50s now. I’m no longer a young man. I’m trying to maintain some youth and vigor to be trained for 80, 90 or who knows, maybe 100. I’m an optimist. I feel like I especially need to do that because I’m on my own. I don’t have the cushion that other people may have. I do all the things. I exercise. I am committed to sleep. I generally eat well. I’m on a growth path. I do a lot of things pretty well. I’m not in the place where I’m in deficit.

If I go to a run-of-the-mill doctor and I get a physical, my doctor goes, “You’re in perfect health.” It’s not, “You’re in perfect health,” you’re just not in bad health. That’s the medical thing. You did some blood, urine and stool tests. As part of that, you identified some deficiencies that I had. One of the things very early on I remember you talking about is how this can help with anxiety. I’m good at adherence. I followed and take the supplements that you sent. I’ve adjusted my eating, which we’ll talk about because there are many ways to affect these microbiomes. I have noticed my anxiety level is better.

It’s difficult because this is not a randomized double-blind clinical or research study. I’ve changed a lot of other things. I’ve been taking mushrooms and I’m working on a project that brings out the best in me. It’s summer, so I’m not teaching. I tend to be more anxious and so on. Nonetheless, I have noticed it in some sense. I find that to be exciting and good regardless of the cause. Behavior is multiply determined anyways. It’s probably a bit of all of this kind of stuff. I’ll let you comment on that. I’m guessing that you have plenty of experience with people reporting similar results.

It’s a fascinating area as people begin to optimize beyond health as the absence of disease. Health is not the absence of disease. It is a state of being. It is you getting in touch with parts of yourself, feeling into who you are, and having energy. In one sense, health is how much mental energy and physical energy you have to do the things that you love or to discover the things that you love to do. In general, a healthier gut is a less anxious gut.

Our language is on the money. When we say butterflies in the stomach, you look at certain gastroenterology clinics that are working on and address gut infections that are serious like Clostridium difficile or E. coli. Patients there will say very often, “I don’t know what’s going on. I feel very anxious. I feel this anxiety in my stomach.” You have neural tissue in your gut. When you optimize your gut, start taking care of it, and start having those healthy neurotransmitters, that tissue that is our second brain begins to reciprocate and then you feel significantly better.

This is such a powerful big idea. It sounds far out to a lot of people. You mentioned energy. My own personal experience is sometimes I’ll eat something. It’ll make me tired and low energy because it’s not the time I eat something. It’s just some things. What is going on there with that digestive system that’s either helping or hurting your kind of energy level?

I’ll break it down into three quick bits. One is the food like pizza. You have gluten and dairy in there. There is gluten morphine. Usually, the dough that pizza is made on has a lot of gluten morphine in them, and then you have cheese, which is casomorphin. That’s another morphine. Now you have this opioid-rich food. Some people who are on a strong anti-opioid detox protocol are advised not to eat pizza because it is so opioid-rich.

The gluten and dairy question is different, but on one end, I do not like the stimulation of endorphins from food in that way. I don’t think it’s a good pathway to go down. On the one hand, that’s why people feel very tired and relaxed. You can go to sleep after eating pizza. A second reason you can feel that way is the blood sugar crash. If you’re spiking the blood sugar, it’s going to crash and then you’re going to feel low energy. The third is going to be inflammation, which is food that is very inflammatory that we don’t know is inflammatory like seed oils. This is a whole other topic, but seed oils are the inflammatory vegetable oils that we were told were healthy, but we’re finding out that their structure is modified.

What are some seed oils?

An example would be when you buy canola oil, vegetable oil, and soybean oil that we were told were heart-healthy. Sometimes you go, “I love Thai food. I love Vietnamese food.” At least in the US, sometimes these Thai restaurants are using a ton of soybean or vegetable oil that they’re frying everything in. The rice noodles and meat is soaking all of that up. When you feel bad after that, your body is having to detox the seed oils, which are super inflammatory. They’re causing inflammation to you. Your body is going into a little bit of shock trying to see how it can detox those sorts of post-inflammatory responses.

What you are saying is there are some things that we eat. Sometimes it’s heavily processed food, but it also might be the way it’s prepared with these types of oils where you essentially have some inflammation, difficulty digesting it, sugar spike, and these things can affect your energy level. This is independent, perhaps of your gut biome, where it may be interacting. We’re going to get into food. We’re going to talk about supplements here in a moment, but we’ve talked a little bit about some of these mental, psychological and emotional effects. You’ve talked about the effects of energy that your gut system can have. Are there any other positive or negative effects that are relevant to the gut?

You have the peripheral microbiomes. One is the vaginal microbiome, which is very important for everybody because we all come into this world through the birth canal. The vaginal microbiome is what constitutes our external microbiome. That’s a very important part of having a healthy birth and healthy postnatal care as it’s called. The imbalances that we’re seeing in the gut can impact and create imbalances in the vaginal microbiome, which leads to many challenges. A lot of women go to doctors and then they end up getting prescriptions for antibiotics, which is damaging their healthy microbiome. There is often nothing being addressed to, “This is what we need to do to rebalance your healthy microbiome. If we’re doing this, we’re trying to kill this one pathogen.”

That’s the problem. Someone gets chlamydia, they have a UTI, or they get some other infection and then they take antibiotics for this one thing, and then it’s affecting a whole bunch of other things. Once you are healthy again, there’s a need to restore. My guess is some of this happens naturally, but there are some things that you can do to help facilitate this.

I’m going to take the liberty to say something controversial. Why are you prescribed antibiotics? It is not because you always have a bacterial imbalance, but it’s because antibiotics are extremely profitable. It’s a bigger industry than antifungal drugs. There is quite a bit more research on bacterial imbalance, but a percentage of your biome is fungal. That’s why I spent a lot of time studying and researching the vaginal microbiome. A lot of women have been prescribed antibiotics when they have a fungal imbalance. The technology that they’ll use to diagnose is outdated. They will not even run diagnostics a large percentage of the time. That creates a lot of damage because the antibiotics create more fungal overgrowth. In the long run, people feel even worse.

We’re going to get into resources, but if there’s someone concerned about this, my guess is that they have to find the right OB-GYN or the right person if they want to investigate this idea and look at some alternatives.

There are functionally trained OB-GYNs. There are functionally trained naturopaths and MDs that are focused on women’s health that can certainly do this.

This can feel a little like the Wild West, and you can talk about all these things, but I want people to have some actionable ideas that are here. Anything else in terms of effects on the gut that we should talk about before we start getting into the optimization side of things?

We talked about the good neurotransmitters being produced by the gut like the Gaba. It’s a very important neurotransmitter. It makes you feel relaxed and calm. You can buy Gaba supplements in about any store, Sprouts or Whole Foods. They sell it everywhere because we know that that’s important. The best way to get Gaba is through the gut bugs. The anxiety is not just the absence of good bugs. The anxiety that people feel is often certain bad bugs that produce certain biotoxins or they’ll secrete out certain organic acids that can actually bind to NMDA receptors, which is an anxiolytic receptors in the brain. You can just begin to overstimulate the anxiolytic system. Many bacterial toxins and other toxins can do that.

There are multiple reasons why someone may experience anxiety. There may be genetic predispositions, for example. We talked about that there are contextual ones, and the idea that your physiology is off is one that I had never considered prior to meeting you. Let me see if I can paint this picture and let’s talk a little bit about intervention here. This gut is a complex system. It’s obviously necessary not only for our survival but also for us to live a remarkable life. It’s influenced by many things. My guess is that the interventions are some of those many things.

I have written down here three areas, and you can correct me if I’m wrong. The first one is sleep/exercise. How important it is for our general health and our well-being to have high quality and higher quantity sleep, and to also be exercising. Moving our bodies in many different ways from walking to deadlifting and everything in between. What is interesting is this notion that your gut biomes help you with your sleep and exercise. Your sleep and exercise can help you with your gut.

We can’t get into all the best practices around sleep and exercise here, but it is a friendly reminder that those are 2 of 3 legs of a stool on which good health is built on. The second one is nutrition or eating. That’s the third leg. I separated it from sleep and exercise because I think it’s closely connected to the gut. We’ve been dancing around it, talking about dairy and gluten. Let’s talk about eating because we opened this up with people going, “I need to eat more yogurt.” I have a feeling it’s more complex than that.

That’s a great point around the precision approach to what should you eat for optimal microbiome health and optimal health in general. That is a very specific question that will always be different from person to person. Some of it ties to your ancestry and genetics. The most popular food trend now is veganism. It’s something a lot of people are dipping into and cutting out animal proteins.

When I launched my practice a few years ago, I was getting a lot of people with Northern European genetics that were coming to me and saying, “I’m being told that this is the healthiest way to eat, but I feel horrible. I’ve lost muscle mass. I’ve put on fat. Am I doing this the wrong way?” I was like, “No, you have Northern European genetics. You need a lot more fat and protein, which is what your genes have been primed for generations.”

This is an interesting area where even with the ancestral approach, sometimes you have to be appropriate to the individual person. It doesn’t matter what happened in the ancestry. If somebody is sensitive to certain foods that their ancestors ate, they should not be eating those foods. My ancestors ate a lot of grains. In our recent history, we’ve consumed a lot of wheat products. However, I am very gluten sensitive. I have been for most of my life. Even though that may be culturally appropriate, it is not appropriate for my own body.

What you’re suggesting is this is complex because there are individual and ethnic differences. My guess is there are also developmental differences, the difference between a teen, a 50-something and an 80-something. Even in the person, it may change across the lifespan. Are there some general best practices when it comes to eating and learning about yourself that might be low cost? The average person may not be able to afford you. They don’t have that luxury. What are the low-cost easy ways to start to figure out and adjust your diet to try to optimize your gut? What is the more aggressive or luxurious approach?

There’s a concept I like called metabolic typing by William Wolcott. That’s a way to assess your macronutrient needs. With yourself, Peter, and some of the intakes you filled out, I was able to assess what your metabolic type is. That will determine whether should you be eating a balance of carbs, fats and proteins, should you be eating protein and carbs, or should you be eating fat and protein?

What are some of those questions that are part of metabolic typing?

The way that William Wolcott did his research and the way that clinicians have been utilizing metabolic typing is absurd. You wouldn’t think about it so much like, “When do you feel the best, when you eat carbs at night or in the morning? What is your metabolic rate like?” We can determine a lot about dental health. It ties into oftentimes your metabolic type as well. It is like how you would think about a car. Cars use different octanes of fuel. You can have an electric car or a gas-powered car. There are variations. Getting the right type of fuel is important. That can change at different periods in somebody’s life based on how much they’re exercising. The carbohydrate intake definitely changes.

An extremer example of this is a lot of people I’ll find are so well adapted to fat and protein. Their bodies thrive on higher fat and protein or lower carbohydrate. They mentally feel better. Their bodies feel tremendously better. That’s one piece of the macronutrient ratios for your body. The other thing would be figuring out what things you can eliminate that could be beneficial for you. That can become a trickier question. Someone might ask, “What tests should I need? Could I do it without some testing?” If you’re feeling a digestive upset, the biggest food triggers tend to be gluten and dairy.

I’m not an anti-wheat crusader. It’s just that we have modified the wheat plant in the United States. We have a ton of pesticides dropped on greens in the United States. I’m not speaking for the rest of the world, where that can be a very problematic food for gut integrity and the gut microbiome. If you’re feeling imbalanced digestive upset, cutting out gluten can be helpful. Cutting out dairy for a short period of time can be helpful as well, and then focusing on the things that people usually know like healthy proteins, healthy vegetable intake, and the rest.

We’re not there yet. At some point in time, there are going to be low-cost options where you can figure this stuff out and get a personalized customized set of algorithm-based set of prescriptions for people. Until then, it sounds to me like there are two things that should be going on in a world without waste. That is, in general, doing best practices with regard to eating well like whole foods, staying away from processed foods, and eating fruits and vegetables. These are the first step. The next one is the idea of paying attention to how your body is reacting, and experimenting with removing, changing things and seeing whether there are some improvements.

I’ll give you a personal example of this. I used to think I was a good eater and that I had good nutrition. I did compare to the average American. I didn’t eat at McDonald’s and I didn’t drink soda. By comparison, I felt like I was good. What I decided to do was to lean into raw fruits and vegetables. One of the big things that are fairly simple but had a radical effect was anytime that I would have normally eaten a sandwich, I replaced it with a salad and some protein. Anytime I would have been tempted to eat cereal, I grew up eating cereal. I love cereal. It tastes good. It’s easy, fast and cheap. For a poor boy from Jersey, eating cereals and putting some fruit on there seemed like a good option. I would replace that with something like eggs and a type of meat, or even a salad for breakfast.

There were two effects of that. One is that my body began to look better. I became leaner and then the other one was I became a lot less gassy. I had less flatulence. That improved in a sense. Some of that probably was removing dairy, gluten, and the processed meats that were on the sandwiches and stuff, and replacing them with healthier stuff. That was reinforcing because when I paid attention to my body, I noticed that my body responded well to that. That seems to be the best low-cost practice in a sense.

All the foods you were saying, I was running the calculations in my head. Those are all great options, all good macronutrient ratios, and solid micronutrient ratios.

I’m not saying that will work for someone else, but that worked for me when I was paying attention to it. One of the members of the community said, “What can you immediately cut out to help heal your gut?” She wrote, “It’s something that Peter avoids.” One of the things that were happening during the time that I was also making all these changes was I never was a big drinker, but I have largely limited alcohol from my diet. I have maybe 1 or 2 drinks a week at most. It’s not uncommon for me to go an entire week or two without having any alcohol. Can you talk about alcohol and its effect?

I’m glad you brought that up because someone like me can get caught up and enjoy talking about the complicated science of the gastrointestinal lymph system and all these other concepts we’re talking about. Something like alcohol is endemic to our culture. It is how we socialize. That’s what you go on a date and drink. That’s how you loosen up. That’s how you’re supposed to feel comfortable. Let’s celebrate or let’s have a drink. It’s utterly endemic.

There are competitors. There are non-alcoholic functional beverages like Kava and other functional ingredients like Ashwagandha. We’re experimenting with different things to put in functional beverages that give you a buzz and a high without destroying your gut. On one level, what alcohol does is it backs the liver up, and then when you drink too much, the liver begins to dump out a lot of toxins. It will skip those detox phases. Why you feel that hangover the next day is a lot of biotoxins are being flooded into your system and now are being absorbed by your brain. That’s one level.

On the other hand, it is damaging your gut ecosystem. It’s killing a lot of good bugs, those aldehydes are produced in the body when you drink. On top of killing the good bugs, some bad bugs release some fungal organisms. It releases this compound that is similar to alcohol. When you drink alcohol, it can fuse with that and make these harsh toxins that not only damage the bugs but can damage the gut wall lining itself and then cause food particles to enter into your bloodstream, creating immune reactions that make you feel funky. More people are becoming sensitive to alcohol, but avoiding that is definitely an important part of healing the gut.

If you’re drinking soda and you’re ordering Pizza Hut all the time, and you’re going to Taco Bell, you have much bigger problems than what we’re talking about here. You’ve taken care of the basics and now you’re trying to fine-tune and make some improvements. Feel free to be controversial. In your opinion, should people not be drinking at all or is this like, “The occasional drink is fine? How radical is your feeling about alcohol, good health, and then optimization?” Can someone be optimizing and drinking a couple of nights a week?

A couple of nights a week would probably be challenging because then your body has to repair with that. A lot of the things that we do, our body is repairing. There are healthy stresses like exercise. The body has to repair after that. The difference with something like a lot of drinking is the body has to then repair those epithelial junctions in the gut lining. Some people are able to do that and drink a lot. To optimize our health, we should take a period of time where we don’t drink for 2 or 3 months. Give yourself that period when you’re doing a gut optimization program to try to limit alcohol intake. If you’re going to do alcohol, do a cleaner spirit. If you feel compelled like if you’re in a social setting, do the cleaner spirit. The beers are pretty bad because there is a lot of sugar.

A huge problem with alcohol is also the regulations. I was never a drinker. When I started going out with people and looking at it, I was like, “It doesn’t tell you how much sugar is in that beverage.” It’s a way where people get in 80, 100 or 120 grams of sugar in casual drinking, mixing a shot of tequila with this juice and that juice, this or that flavored syrup. We can literally look at the data and somebody’s microbiome. My thing is to optimize your gut. Make a resilient gut, and then you can handle the occasional drink, especially if that’s something you enjoy. One is ought to be able to have that resilience.

If you can’t go two months without drinking, you need to take a hard look at your drinking at the people around you, whether they’re supporting your good health, and what type of situations you put yourself in. I was reflecting on my mid-30s around the time that I was telling you about my anxiety level kicking up and it’s affecting my sleep. I remember looking in the mirror and noticing I was aging. I’m shrugging my shoulders like, “I’m getting older.” My skin is better now than it was 15, 17 or 18 years ago. I think some of it is because there’s little alcohol in my life and I’m eating better.

Take a before and after photo of giving up alcohol for 2 or 3 months, I think you might be surprised. Like many things, your energy level and skin are leading indicators of your health more generally. Let’s talk about specific interventions. That might be particular types of food and supplements. There’s a lot of like, “If you go to Whole Foods, there are lots of probiotics, pills, tinctures and things. They have to be in the refrigerator or keep them in the dark.” Let’s keep these two low-cost levels. Let’s finish by talking about the more luxurious level that’s there.

On the basic level, there are even tests that you can order that you don’t need a doctor or practitioner for. That gives you good run-of-the-mill data on what’s happening in your gut microbiome and what foods might be beneficial for you. Viome is the most popular test without getting into the specifics of that. That’s not something I personally use in my practice. I have other lab tests that I use. For somebody that’s like, “Look at my microbiome and I don’t want to spend a lot of money. I want to spend $200 or $300 on a test,” check the Viome now. It will tell you some of that. It will give you that data.

Is that a urine test or a blood test?

It’s a stool test.

You do this at home. You mail it in and then you get a report that says, “You’re good here. You’re bad here. Here are some things that you want to do.”

It will tell you that. It will tell you foods that they believe you should avoid and foods that you should consume. For someone who is cost-conscious, that can be a good approach. From there, that gives you a little bit of diagnostics. From there, you can figure out your metabolic type, and macronutrient ratio, then figure out what micronutrients your body likes and are good for you. Microgreens are usually helpful because it’s dense. Each microgreen of broccoli has the nutrient density of the whole flora of broccoli. That can be helpful.

It’s easier to eat too.

You have nutritional yeast, then you have probiotic foods. You have to troubleshoot yourself if you’re doing that. You can see what probiotics your body likes. If sauerkraut, kimchi or beef kebabs works for you. You feel great with those foods. Your gut feels like it’s digesting food better, that’s amazing to utilize all of them. If you feel that you have a bit of a histamine sensitivity like you’ve dealt with histamine allergies.

What does that mean?

People who get sniffly. They take an antihistamine like Claritin. They have seasonal allergies or other histamine responses. You can get a sore throat from being around a certain type of allergen or something like that. If you are like that, then histamine-rich probiotics like Sauerkraut may not be the best for you. You may want to stick to low histamine probiotics like coconut yogurt or something like that. The probiotics like coconut yogurt or maybe low fermented sauerkraut would be good for you. Figure out what probiotics you can and will eat. Figure out your macronutrient and micronutrient ratio. Avoid the bad stuff. You’ll be eating pretty good. You’ll feel stronger and better. That would be the first year.

One of the things that were nice about getting to know you and working with you is you said to me, “Peter, you should add some avocado to your salad so your body is going to respond well to having a little more fat.” That was helpful for me because I grew up in a time when sugar was good and fat was bad. There are habits and legacy beliefs. You might not say that to someone else. You might end up saying, “Limit your carbs.” You even said to me, “It’s okay to eat white rice.” I was like, “What? I can eat white rice. I thought that was bad now.” If you can hone this in and figure this out, whether it be through trial or error or through some outsourcing, this can be liberating, as well as also helping you live healthier.

A lot of people eat with a giant question mark, “I don’t know if this is good or bad for me.” The vegan plant-based people are still telling a lot of people, “Fat is bad. Don’t consume too much fat. This is why a vegan diet is better.” Some people are in the other extreme camp, which is the camp ketogenic diet, which is carbohydrates. Sugar is bad. You get these influencers that are like, “I used to be 400 pounds. Now I have 3% body fat. Look at me. Look at how strong I am. I am keto and 1 gram of sugar is bad for you. Be keto 100%.” People are truly confused. I sympathize with that. There is an answer. In your case, consuming a lot more healthy fats, because you have such a fast metabolic rate, is going to be good for your mental function and performance. That may be slightly different for a different metabolic type.

Going back to these individual differences, whether it be ethnic, just individual or in the lifespan, or what your particular habits are. The other thing that you have done with me, I assume you do this with lots of your clients, is you prescribe supplements for particular types of the day to be either taken on an empty stomach or to be taken with food. This is the leading edge stuff. They’re designed to either enhance, introduce or facilitate good biomes.

I’ll just say I recommend supplements. I’m not a prescribing doctor so I don’t prescribe. Nothing here is intended as medical advice. Speak to your doctor. In a nutshell, what would microbiome supplementation or what might microbiome protocol look like? I’ll break this on basic and then a little bit higher tier. On one level, you should always start with weeding the gut. Our gut has a lot of gardens where the weeds are regrown.

There are a lot of pathogens that are overgrown just because of our ecosystem. Our ecology is slightly off because of antibiotic and toxin use. A lot of the bugs that are not helpful like these harmful toxins, heavy metals, and things like that are in our human ecology. That means that our ecology is off balance. Weeding first is important. After we weed, we then recondition with probiotics and some prebiotic fibers. The probiotics recondition and reinoculate the gut.

A third phase that I usually like to do is what I call fertilization. We’re sticking to that example of that garden. We’ve pulled the weeds out. We’ve planted the seeds for good and beautiful flowers, fruits and vegetables that we’re going to consume. At the end of it, we want to keep fertilizing that good soil. The fertilization is going to look like those prebiotic fibers. Some of those are supplemental. Some of those are food-based. Doing it in that sequence is important because if you start with the prebiotic fibers, the “fertilizers” in the beginning, you will have gas and bloating. You’ll be confused.

You’ll be thinking, “This was supposed to be good for me. What’s going on?” It’s because those prebiotic fibers are being used by those bad bugs. Those bad bugs are pooping out these gases that are making you bloated and filling you up like a balloon. It’s making you feel funky and brain foggy. Once we are appropriately at that third phase, Jerusalem artichoke, fennel, flax, oat bran, and some healthy starch fibers like sweet potato, and plantain, some of these are done in a strategic way. Some antioxidants like pomegranate seeds or seed powders to get a larger volume of them are super incredible prebiotic fertilizers. That garden is going to thrive. It’s going to look and feel beautiful.

I’ve recognized that for the average person, this is a little difluent. It’s a little bit abstract or theoretical. I do think that one of the things that I have noticed for myself, without being delicate, is a change in my bowel movements. What ends up happening a lot of times is human beings are incredibly adaptable. You can adapt and start to feel normal when something is not quite normal. Not until it changes do you notice the improvement.

I’m going to finish with this question if there’s nothing for you to add to it. This was a question from the solo community, which people can sign up for PeterMcgraw.org/solo. I usually post when I’m preparing an episode and say, “Do you have any questions?” You actually have answered many of the questions that were already posed. One of the questions is, “How do I find the right practitioner or tests that can help determine what foods are good or bad for your gut and body?” You already mentioned this one particular test.

Someone like you is another resource. Those are two very different price points. What are some of the other resources?” How do you find the right person because this is so leading edge? My guess is there’s a lot of snake oil out there, and there are a lot of people who seem like experts but aren’t. They’re well-meaning, but they might not be doing the best things. What advice would you give this person?

It’s definitely a tricky terrain because a lot of people don’t have the appropriate training in botanical herbal medicine or they don’t have the training in pharmaceuticals. A little bit of training in pharmaceuticals can be helpful.

Is there a question you ask of the person that you’re talking to in order to figure this out?

In an interesting way, I sympathize with people because I have a practice. I’m a practitioner myself, but I also refer people out as they have. Let’s say a woman comes to me and she says, “I have this microbiome imbalance. I also have these two thyroid diseases.” Now I have to find her somebody who is a little bit more of a specialist in these thyroid issues than myself to make sure that they’re doing the right work. The most important thing is what kind of data they have in terms of people they’ve worked with.

I will ask other practitioners if I’m working with somebody or if I’m referring somebody out, “How much better do people get? What does optimal look like for your clients??” That is usually an important question, which will tell you a lot. The test that I use for the microbiome is called the GI-MAP. That is a pretty cutting-edge test. It is not self-administered. You need a practitioner to order that test for you. That tells you the imbalance that’s going on in the gut. A lot of good practitioners are using The GI-MAP.

If you’ve been all the way through this episode, you learn about some of the phases of the gut and how we do a protocol. Ask the practitioner when you have a discovery call with them like, “What is your approach looking like? Can you just guide me through how you test, where you start, and how you optimize function? That will tell you a lot.

Let’s finish with the following. For the person whose head is sort of spinning and they’ve got some butterflies in their gut right now, and they want to take some positive steps. We’ve convinced them that the gut matters to their physical health and mental health. They want to live a remarkable life, but they’re a little bit overwhelmed right now. What would be the first 1 to 2 steps that will get them on the right path?

Makes sure you have a good routine with your food. We’ve talked about what you can eat, and some ways that you can find the best foods for you, but figure out your routine with some consistency.

I like to say, “Have a plan.” People are like, “I’m hungry. What’s in the refrigerator?” They have no plan when it comes to their eating and yet it’s such an important element of thriving in that sense. Starting to create a plan and then paying attention, even going as far as journaling. How you feel when you do these certain things may help you stick to it, and help find your way in terms of creating a better plan.

To add one thing to that. Have your plan, start journaling, and note down how you feel after eating certain foods. They call it a food diary. It is a super simple technique. What you can add to that is to just experiment. Look at how your body feels. If you are curious about keto, give the keto diet a run. Play around with plant-based eating. If you feel called to incorporate more plants into your diet, just play around with different things. Don’t hold judgments in your head about, “This is the carnivore diet. This is the plant-based diet.” Play around with different ratios of macronutrients and micronutrient types of foods, and see how you feel. That will give you a ton of data about yourself.

I talk about how there’s not one way to live. Marriage is not the right relationship for everybody. In the same way veganism, ketoism or whatever is not the right way for everybody. One of the valuable things about this conversation is what works well for your gut might not work well for mine, and vice versa. Find some better practices that optimize for your own body. In the same way that some people are good golfers, some people are good long-distance runners, and some people are good power-lifters, I don’t try to convince golfers to power lift and vice versa. That’s good advice.

There are a lot of people out there who want to make money off of you. They have a hammer so everything looks like a nail. I appreciate that nuanced approach and your takeaways. This has been fascinating. I knew it would be. These are the kind of complex topics that I’m eager to explore on this show. I appreciate your grace and generosity in sharing your knowledge with us.

Thank you. This was wonderful. It was a great dialogue. I hope people gained something from it. People can reach out to me anytime if they have questions or if they’re eager to learn something or have a question about a specific area. I’m very accessible. They can feel free to reach out to me.

I appreciate that offer. Cheers.


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About Awais Spall

SOLO 137 | Gut HealthAwais Spall is a Functional Medicine Practitioner that combines the ancestral wisdom of Ayurveda with cutting edge regenerative medicine to help people optimize their microbiome. In his practice he believes that a diverse and flourishing microbiome is the cornerstone of a joyful optimized life. Prior to becoming a health practitioner, Awais worked as a formulation chemist for various cannabis companies.

As a product formulator, Awais combined his knowledge of formulation chemistry with his background in Ayurvedic Herbalism. Awais has inherited much of his knowledge around Ayurveda from his grandfather, who was a renowned herbalist in Pakistan. Awais eventually left the formulation world to pursue his deeper calling in life as an alchemist of the healing arts.