The Power of Your Gut
Did you know that our guts hold the power to our overall well-being? The gut is connected to our skin, brain, and holds the majority of our immune systems. I figured, since the holidays are coming, it would be the perfect segue to go deeper into our guts. Plus, when we start looking good from the inside out, we're always winning. We all want to live our best and healthiest lives. So, let's do it!
It is my honor to introduce Doron David Kahana, M.D. He’s a first-rate physician in gastroenterology and medical nutrition. He is the President of the National Board of Physician Nutrition Specialists. As of June 19, 2019, Dr. Kahana took a full-time position at the Department of Health Services, Los Angeles County. He leads the Medical Nutrition Clinic for the Martin Luther King Outpatient Center.
Seriously. Dr. Kahana is the first person anyone would want to talk with about our guts and nutrition!
Already having tremendous knowledge of health, especially gut health, he continues to expand and learn. But what makes him truly great, is his humbleness and sincerity as a doctor. It is such a gem to speak with him and share his insight.
We chatted about our careers, and shared that I was an on-air personality at, I’d say, the most diverse station there was in LA. We may have drastically different career paths, but our passion for health and people connects us. Our microbiome is becoming a popular topic, more than ever now. It’s where microbes: bacteria, parasites, viruses, and fungi co-exist harmoniously. At least, that’s the goal. So, let’s talk about all things gut health with Dr. Kahana!
DK: “I’m intrigued that you pointed out to diversity as being one the most important things at that radio station because it’s also one of the most important things for the gut in the microbiome. It’s also one of the reasons that I really like working for the Department of Health Services. I see a lot of value in diversity. The importance of diversity to the microbiome, to the micro-ecology in our gut, is probably the strongest sign of health. When you translate that to society, as a greater whole, it really makes sense. It’s something that really powers my passion for medicine. So, diversity is key.”
It really is fascinating how everything works together to keep us thriving. You are thriving in the medical world by being super involved in various scopes. Please tell us to what other areas you are connected.
“I do a lot of colorectal cancer screening at the H. Claude Hudson Comprehensive Health Center, part of the Ambulatory Care Network. So, I’m not just a full-time county employee. Still really focused on medical nutrition. I’m also currently serving as the President of the National Board of Physician Nutrition Specialists, which is a volunteer position. We certify physicians across the world in medical nutrition. There isn’t an official fellowship in medical nutrition; we’re trying to establish one. But right now, people go through other fellowships — we’re not recognized by the American Board of Medical Specialities. We are affiliated with the American Society of Nutrition. That’s something dear to my heart.”
What are prebiotics and probiotics? What do they do for our GI (gastrointestinal) health?
DK: “Prebiotics are food substances that are beneficial for the microbiome. And the more specific definition is fiber that increases the count of bifidobacteria. So, it’s specifically defined by its ability to create bifidobacterium diversity in the microbiome. Then, even more so defined, as the ability to increase the production of butyric acid. Prebiotics are all those things.
I told you what prebiotics are. Let me tell you about probiotics. They are defined as live microorganisms that confer a health benefit. So, they are mostly bacteria. There are some yeast probiotics like the Saccharomyces boulardii. By far most probiotics are bacteria; mostly bifidobacteria and lactobacillus. They stimulate digestion. The idea is to increase digestive capacity for those who are finding it a real challenge to change their diets.”You also work with an amazing supplement company that uses clean ingredients; free of preservatives, gluten, soy, and sugar. On top of that, it’s vegan.
DK: “I consult for 1MD, which is one of the brands that belongs to Scale Media, Incorporated. It’s a brand we have for physician consultants in different fields. rheumatologists, immunologists, urologists, and, myself, a gastroenterologist. Everyone is responsible for their own area. We have a whole suite of GI supplements from probiotics to digestive enzymes to, our most popular and most successful product, LiverMD. Probably just our strongest supplement to date.”
Why do you think LiverMD is so much more popular?
DK: “Being at the county, I’m seeing a lot of cirrhotic patients. A lot of patients who have cirrhosis. And not necessarily just from Hepatitis C or B, or alcohol; although, that’s probably still the majority that I see. But also, largely because of NASH (Non-Alcoholic Steatohepatitis) or just fatty liver disease for short. And the supplement really addresses that.”
Do you think that the increase in cirrhosis of the liver is caused by our eating habits, especially the regular consumption of fast food?
He did! His doctors were not happy with him. Aside from caring for our key organs like the heart, and the basic necessities, we tend to neglect our guts. We just say, “Oh, I ate too much or I shouldn’t have eaten that.” On a scale of 1 to 100 how important is gastrointestinal health to our overall wellbeing?
DK: “It’s 100% important. I would say the gastrointestinal tract exposes us to our external environment to a greater extent than any other organ, not even our skin, which has a very strong barrier, which really exposes us to our external environment. We constantly sense and taste our environment through our gastrointestinal tract. Therefore, the majority of the immune system resides in the gut. So that’s something else that a lot of people don’t realize—is that most of our immunity is in the gut.”
How does our gut do this?
“We’re constantly exposed to the outside world and we have to fine-tune our inflammatory response. If you don’t turn on inflammatory pathways to combat exogenous stimuli—viruses, bacteria, microbes, or toxins, then you’re not going to clear them out of your system quickly enough. And, you’ll get sick. You need some level of low-grade inflammation in the body—that comes from the gut. The gut fine-tunes that low-level inflammation. When you have too much — when it’s turned on too much, it can cause auto-immune disease, immune-mediated problems like asthma, rheumatoid arthritis, lupus, multiple sclerosis, autoimmune hepatitis. All of those come from the gut. So, gastrointestinal health is extremely important to overall health because that’s where the immune system sits.”
So, what is a healthy gut? You mentioned that you have to have a little bit of inflammation.
DK: “Inflammatory response. You can’t have the soldiers go to sleep. Some of them can rest or sit down, but you have to have someone watching guard. The generals have to be aware. There has to be communication between the T-cells and the B-cells. The natural killer cells, macrophages, neutrophils, and monocytes. There are so many different arms in the immune system. You have to activate a part of them. It’s the gut where the army lies and gets mobilized from the gut to other places in the body.”
If I eat healthily every day. Then, one day, I eat, say, Popeye’s. Is that going to affect me badly because I ate it once in like a year?
DK: “So, in medicine, we always like to talk about risk. What is the risk of eating unhealthily once in a while versus eating unhealthily all the time? There are good studies that show there’s a core microbiome and a variable microbiome. It’s very hard to change the core microbiome. It’s established very early on in life; maybe by 5 [years old]. Most of your core microbiome is actually established in the first year of life which is really a boon to breastfeeding. It has been shown to be extremely important for establishing a healthy core microbiome. So, about 80% of your microbiome is a core; hard to modify, even if you change the way you eat. It may take years; you may eventually be able to change some of the core, but it will take a conscientious effort for years to do so.
And the 20% that’s variable, those are [made up of] a lot of transients that go in and out of our bodies. There’s a constant war on the mucosal surface between the good bugs and the bad bugs. We can eradicate bad bugs. And how we process foods. You asked me what constitutes a healthy gastrointestinal tract. I would say very simply, it’s our ability to break down, i.e. digest, food matter which also includes microbes — Our ability to digest, absorb, and assimilate nutrients. If you can break down food well, you’ll have a healthy gut. But if you don’t break down food very well, if you overeat, you overwhelm the digestive system. You don’t produce enough digestive enzymes to break them down, or enough stomach acidity. If you exposed your body to large molecules of food particles, then it’s either going to get fermented by bacteria, it’s going to get absorbed or leaked into the body through a leaky gut-type of a mechanism. And going to turn on inflammatory pathways and you’re going to be sick.”
So, this is why how much and how fast we eat plays a part in digestion. Got it. Some people tend to take a couple of bites, then, swallow.
DK: You want to digest. You want to break down everything you eat as completely and fully as possible. Your body doesn’t like to absorb large molecules. It needs to recognize everything you put into your body as food. That’s something that Popeye’s may not pass because of some of the stuff in it. Your body will just not recognize it as food. It is clearly adulterated to increase the smoke point, to improve the flavor. Don’t make me hungry. I haven’t had lunch yet. I mean, who doesn’t like fried chicken. It’s kind of like how I tell my kids about donuts. What’s better than fried sugar? But is it good for you? Your body is not going to recognize it as food.”
What about people who’ve completely cut out sugar? Is that a good thing?
DK: “I’ve heard many smart people call sugar poison. Sugar is definitely addictive. The only reason to eat sugar is if you want to be happy. If you don’t want to be happy, don’t eat sugar. It’s not good for anything. It really drives cancer; probably nothing drives cancer more than sugar. And heart disease, liver disease. Yeah, sugar is terrible for you. But getting sick and dying a miserable death, that’s not going to make you happy either.”
Cutting out sugar is one way to keep a healthy gut. But how can we reach our optimal GI health?
DK: “I’m a food first kind of guy. Louis Pasteur, the father of microbiology, who invented the germ theory of disease, on his death bed said, ‘The germ is nothing, the soil—everything.’ It’s about the soil that you ingest into your digestive tract. And that means fiber, it means you’re providing sustenance and nutrients to the microbes in your gut, and to your microbiome, to enhance a diverse and stable microbiome. Those are the two qualities that confer the most health benefits — Diversity and stability. You don’t want too much variability. Too much migration and species going in and out of extinction. You want a stable microbiome and diversity. And for that, you need veggie soil.”
To get that, what foods do you recommend?
DK: “Fiber is something that we have in vegetable matter. So, it’s fruits, vegetables, legumes, lentils. It’s a plant-based diet. A plant-based diet will definitely provide you with the most fibrous sustenance for your microbiome.”
Then, is meat bad for you? Or, in moderation, is it ok?
DK: “I would say a little bit less than moderation. Right below sugar — is animal products. You really need to be on a whole food plant-based diet in the words of Michael Pollan and put food first. Plants, legumes, lentils, nuts, seeds, vegetables, fruits, whole grains, as much as you’re able to digest these foods because everybody has a little bit of variability of how they digest certain things. Above that, some of the fish and seafood that has been shown to help. There’s no fiber in animal products. Besides being very nutrient-dense and rich in things like zinc, for example, which is very important for the immune system, they’re also very rich in saturated fat and xenobiotics, including antibiotics that animals and animal feed contain. So, that’s not going to be good for your microbiome. The animals are not necessarily kept in a humane manner or killed very humanely. They live miserable lives. They’re not very healthy. We eat a lot of sick animals in this country.”
That sounds disgusting when you put it like that.
DK: “It’s true. Show me a healthy cow, and I’ll probably get hungry. We went to Hawaii and I remember looking at the cows and thinking, ‘Gosh, a steak sure sounds good right now.’ But yeah, some of the stuff we put on our plates on the mainland, certainly, I don’t think are very appetizing.”
No, they're not. I agree. I might not even eat any meat today because I have to rethink my diet.
DK: “Especially the processed meat—I still cannot believe how much bacon we eat in this country. It’s just unfathomable. We love bacon on everything. I would really limit certain foods, including deli meats which everyone seems to think are healthy — which are cured with lots of nitrates, salts, and solutes. Then, we get kidney disease because the kidneys are supposed to filtrate all those solutes out of our bodies. Look. Lots of reasons why we should really maintain a plant-based diet. The health of the microbiome is one of the most important reasons.”
Can taking a supplement help with maintaining a healthy microbiome because I don’t think I’ll be cutting out everything that, maybe, I should, at least not anytime soon.
DK: “PreBioMD is a very good prebiotic. It has several prebiotics, as well as a bacteriophage component which is a new way of modifying the microflora. It more specifically targets E.coli and gram-negative rods which are believed to be part of the dysbiosis in the gut. So, PrebioMd addresses this dysbiosis which is an aberration in your microbiome.
You want to be in eubiosis. Eubiosis is a true or healthy microbiome. And dysbiosis is what a lot of us I think have in the Western world and Western disease. We have an aberrant microecology in the gut, due to our diets, our exposure to antibiotics from animal products, stress and dysmotility, and poor sleep. There’s little doubt in my mind that eubiosis can lead not just to better overall health and reduction in heart disease, cancer, stroke, and cardiovascular disease, but also, skin health, certainly acne benefits from a eubiosis. A dysbiosis can manifest very quickly in acne.”
I also read that some of your patients came to you with eczema and were so happy.
DK: “Eczema and milk especially. It’s amazing how many patients are just allergic to cow’s milk protein, especially earlier on in life. But not just eczema, I’ve seen everything from psoriasis, guttate psoriasis. We had a clear case of guttate psoriasis that resolved completely. At first, we were just kind of holding our breath, but now it has been about five or six years since her last breakout and all she did was eliminate dairy.”
My husband developed psoriasis about five years ago during a stressful time. Someone suggested that he try cutting out gluten to see if anything changes. Being from Italy, he responded that there’s no way that he would cut out pasta.
DK: “People are very stubborn in general about their diets. That’s one of the things that drove me out of private practice is talking to people who kept coming to me with conditions that I knew I could help by modifying their diets. It was like pulling teeth. They’re not going to change their diets. They just want a pill. And that’s what drove us to make these supplements. When Scale [1MD] approached me in 2015, this was a main impetus for me to say this is a great way to help people who don’t want to change their diets because PrebioMD would be perfect for your husband, I think. Also, the Medizyme EnzymeMD has 18 highly potent, plant-based digestive enzymes, and Saccharomyces boulardii, a probiotic that has been shown to help reduce inflammation and conditions like Clostridium difficile (C. diff). So, if you don’t want to take something out of your diet that you know you’re not digesting well, the other approach is to try to increase digestive capacity through the use of prebiotics, probiotics, and digestive enzymes.”
I would also like to ask about GI health affecting the aging process and even your skin. Is that true?
It's not only about looking good. It's about feeling good. Taking care of our skin (especially with Rescue Skin serum) and our health make for a great combo!
Please stay tuned for more on how much gut health affects everything from our skin, aging, mental wellness, and the brain-gut connection. It is truly insane how our gut centers us. What is your gut telling you?
*Note: If you have any questions for Dr. Kahana, please email us so that we can get them into our next conversation! In the meantime, you can view any of the digestive supplements and others mentioned by Dr. Kahana at 1MD.org. If you are a physician, The National Board of Physicians Specialists Nutrition Board is always looking for more doctors to take interest in medical nutrition.
Make sure to send any comments, ideas or questions to email@example.com.