What We Got Wrong About the Gut Microbiome (And What's Actually Right)

27:49So, I mean, the first is buying into the model, this seven-pillar model. Other people have proposed similar kinds of models as well. We have to get away from one thing that if you meditate five hours a day and do nothing else for your health, it's not going to help you. Monks don't live into their hundreds. I've always looked at this when I was trekking in the Himalayas. You don't see people that live into their hundreds. That's not their goal anyway. But now our goal is healthy longevity. I mean, I think society has finally recognized that this is, for the most important goal, healthy longevity without billions of pharmaceutical products keeping us alive.

28:43And for that, I think you need to have a whole program. I think that functional medicine also proposes that. You don't say to somebody, you just have to take that one supplement and we'll take care of it. So I would say all of these things will be reflected in a change in the microbiome, which is interesting. So you would think why does sleep affect the microbiome or a sense of purpose or sense of community? But studies have shown that it's reflected in a healthier microbiome characterized by generally increased diversity and richness and increased number of anti-inflammatory producing organisms.

29:26Yeah, this is my main insight in the last 10 years, I think coming from the mind-gut connection to this holistic program where the microbiome still plays a central role, but it's sort of a readout, which is a good thing. So when we do stool tests, and I think we are getting better in interpreting these stool tests, I still think we're not there where we want to be ultimately, that we have a readout with a predictive value. Are you at high risk for Alzheimer's or when you do this in your 20s or 30s? But we will get there. I think that technology is advancing and also AI, how to interpret these massive amounts of data you can get out of the microbiome.

30:11So, yeah, I would say the microbiome is an excellent readout, better than most of the other components or organs in our body.

30:20Dr. Mark Hyman:I mean, I think it's quite an interesting model you're talking about because you're saying basically you are understanding now that outside influences are our thoughts, our feelings, experiences. All these things affect the microbiome, exercise, stress, sleep. It's bidirectional, though, because also the microbiome affects all those things. So it's kind of this conversation that's going on all the time between the microbiome and the brain. And, you know, I think, you know, I remember when we were trained in medical school, you're a little bit older than I am, I think. But, you know, we learned that irritable bowel was a functional bowel disease.

30:54Dr. Mark Hyman:And it was, we joked that it was super tentorial, meaning it was all in your head. And that we identified that people were anxious and that was why they had this problem. and we kind of blame them in a way because it's your fault, you're just anxious, that's why you have these digestive symptoms. But I remember a paper, I think it was in JAMA, many years ago where they, I forget the scientists, but he was talking about the other direction, that the enteric nervous system and the leaky gut and the dysbiosis and the inflammation in the gut was sending signals back up to the brain when there's a dysregulated microbiome to cause brain dysfunctions, whether it's mood issues, behavior issues, attention issues, you know, autism spectrum issues, all that is affected.

31:36Dr. Mark Hyman:And so I think, you know, your model is really important because it's sort of both top down and bottom up. And it's, you know, it's sort of, I mean, I would say, I hate to use that expression, trendy, but if you look at science, I mean, it's more and more moving into this direction of, you know, systems biology. And we also do it in our own research. I mean, analyzing these complex data sets with data from brain imaging and behavioral and blood values and the microbiome values and diet. You put all this into a pot, and then you have sophisticated AI techniques work with this data, which you cannot as a human brain comprehend in a similar way.

32:21So this, I think, is happening in many areas, this overabundance of data that we can generate and gather. But we haven't really been able to do the best way in interpreting it and creating action items based on individual patterns. So there could be pattern one in one patient and pattern two in another patient. And there's always attempts to do this in a simplistic way. like many of my colleagues, we strongly believe that I will make the breakthrough in this.

32:53Dr. Mark Hyman:Let's talk about that, because I think what you're speaking is really important, because there's probably 40 trillion cells of bacteria in your gut. There's probably 102 more times as much DNA from bacteria in your gut as your own DNA. It's constantly making proteins and metabolites. There's thousands of metabolites in your blood from the microbiome. It's almost incomprehensible. The average doctor can look at a panel of blood tests. It's 20, 30, 50, 100 maybe. But when you're talking about thousands, it's just hard to process all that. And so you're talking about an era that we're entering where AI is going to help us understand the complexity of human biology.

33:26Dr. Mark Hyman:And I would really love to hear you kind of talk a little bit more about how this is going to affect our thinking about the microbiome and how it's going to affect the clinical practice of medicine around chronic illness and how chronic illness and the microbiome are so connected. I think it will dramatically change the way we look at the microbiome, I still, even though, you know, the stool tests have gotten a lot better and some of these, some companies use AI to interpret them or put them into context of published data. But I think ultimately we will come up with conclusions that are way beyond what we're talking about now.

34:06You know, it's, you know, this whole still, I mean, the current approach that look at these microbiome tests and look at which ones are outliers from a normal pattern, and then you focus on these three or four organisms and you create a probiotic or a prebiotic cocktail that will strengthen those. I personally think that that will kind of disappear, really. I think we will have footprints. We'll get footprints of people and then we compare this with tens of thousands of people, and we see that these footprints are recurring in different populations, and we can connect them to, you know, dietary lifestyle patterns.

34:57I mean, this is, I think, is going to happen in the next five years. You know, we're sort of confronted with this ourselves. We have these massive data sets, and, you know, collecting the data is one thing, but then really grinding them through this analytical mill is still an unresolved issue. So that's definitely going to happen. I think guidelines will follow from that. The current guidelines, they often focus just on diet. If you look at what happened in IBD first, there was a recommendation of a fiber-poor diet being beneficial for patients with Crohn's disease. now we have pretty good evidence that a Mediterranean-style diet is the best anti-inflammatory intervention you can do if you don't have strictures and stenosis.

35:53So I think we will get much more rational recommendations. And also what I see, like at UCLA, if somebody comes, a complex patient with IBS disease, they're not just going to get a dietary recommendation or a probiotic recommendation. They also get a behavioral assessment. And then if, like many people that make it to a university clinic, you know, they have the strong brain component being early life trauma, anxiety disorder, depression. It depends on the population, but in the most severe patient populations in IBS, you can't deal with the issue just with a dietary change or with an antibiotic.

36:45You have to embed this in a holistic approach, and you need to experience practitioners in these areas, gut-focused psychologists, gut CBT, gut hypnosis, kind of specialized people. So I think it's already changing the system when I look at what happened at UCLA since when I started there, we first started a clinic like this, a holistic clinic, but it took a long time. It took like almost 40 years before this is now becoming an official program of our GI division. And it's happening at other universities as well, in other settings as well. So I think we're moving for some, and I shouldn't just say it's important for IBS.

37:31I mean, same situation in inflammatory bowel diseases, where we get quite a few people that do not respond satisfactorily to biologics. Where increasing the dose of the medication is not going to do it, but you have to identify mechanisms in which the brain basically drives the inflammatory condition in the gut, in addition to what goes on in the gut.

38:02Dr. Mark Hyman:So it's quite an exciting time for the microbiome, I would say. I think we're learning so much. I want to kind of dive into another part of the conversation, which is about longevity and aging and what happens to our microbiome as we get older. And there seems to be some interesting literature around, and you've discussed this around the microbiome in Parkinson's and Alzheimer's. And the question is, how do we think about the aging microbiome? is in hallmarks of aging now, which is the features of aging, it seems to be one of the things that goes bad. And it seems like it's a modifiable risk factor.

38:39Dr. Mark Hyman:We've looked at really exceptionally healthy older adults and centenarians, and their microbiomes, I wonder if they're different. So maybe you can talk about some of the aspects of longevity and the aging microbiome and how we need to think about that. Yeah, so the initial studies were done on selected populations, like in homes for older people. And there was a confusion of how much the change in the microbiome, the decrease in diversity and richness, was actually a consequence of this dramatically changed lifestyle in these retirement homes or nursing homes, both in terms of diet, particularly in terms of diet, but also in terms of loss of purpose and loss of social interactions.

39:23But we know in the meantime, that's one factor, and many aging microbiome studies have been affected by this. They've not been controlled for factors other than age. So we know that, you know, I mean, the microbiome diversity is fairly well maintained through age, from midlife to age. There are changes. If you compare microbiomes from different people, they become more different. so some more individualized pattern evolves. There's a decrease in certain microbes that play a role, for example, in bile acid metabolism in the gut. So I think we're slowly getting a fairly good picture in somebody that is a healthy centenarian.

40:14It's not the simple explanation that we gave like 10 years ago. It's just a decrease in diversity, and that's why they're more prone to develop diseases. It's a much more nuanced... What's happening then? I think there's dramatic changes in these factors that we talked about earlier, these petals that influence the microbiome. The exercise obviously goes down pretty dramatically in the majority of people. Food, unless you can afford to have your 30 different plants and vegetables a week delivered to you will decrease in the variety. So this decrease in diversity and this decreased prevalence of the beneficial microbes is definitely a risk factor for the manifestation of many of these diseases that come with older age.

41:06But we have to realize these diseases like Alzheimer's and Parkinson's, they start at the microbiome level in our 40s. There's more and more studies that are showing that you can actually predict changes based on microbiome, negative changes much earlier in life. But then when the microbiome goes down in its main functions, the disease actually then becomes apparent. You could probably, it's sort of a good way of identifying where we can intervene. So we can intervene at midlife, in patients at high risk that have absolutely no symptoms. But we can see some signs on the microbiome level that indicate, don't guarantee, but indicate that this person is at high risk.

41:57But we can certainly, once the first signs and symptoms of the neurological disease, and I've talked particularly about Parkinson's and Alzheimer's, to really aggressively reverse the changes that are going on within the gut microbiome. I would say at that age, probably diet is more successful, more practical than some of the other changes. But also just connectivity, purpose, I mean, all these things. I think that so many elderly people, you know, we have this epidemic of loneliness, which is definitely, it's reflected at the gut microbiome level as well. You know, that's kind of the intriguing thing.

42:42It's like you have this mirror inside of you. The better we get in identifying the subtle changes that reflect environmental influences, the better we'll be in preventing them and treating them aggressively. If you have the full-blown disease, I don't think you need to do a microbiome test. It's not going to change somebody who has full-blown Parkinson's disease with all the neurological symptoms. It's not going to make a difference. same with Alzheimer's in Alzheimer's it's almost like the opposite you know you want there's evidence that a keto diet is actually beneficial because it has anti-inflammatory effects on the brain in somebody with you know

43:31Dr. Mark Hyman:I've treated patients with Alzheimer's and they use keto diets and it has been remarkable to see the way it impacts them and I think the question I would have for you is now we think about taking care of a microbiome and the aging microbiome is a thing in terms of contributing to acceleration of aging through increasing more of a sterile inflammation in the body and affecting every other system. Let's kind of walk through practical steps because you mentioned the 30 plants. I think that's important. I want to talk about the specifics with you of what you actually recommend to people so that they can keep their microbiomes healthy as they age.

44:06Yeah, it's actually not too different from what I would recommend to all my patients. And I mean, sometimes it's kind of embarrassing to say that, you know, so with all this fancy science that we have and all these subtypes and personalized diet, that the approach is fairly standard, you know, the overall approach. It has to be sort of standard concept of like the 30 or 35 plants and vegetables has to be adapted to the taste preferences because food has to be enjoyable. A major function of food on our health is the enjoyment and the pleasure. It's closely linked to the centers within the brain.

44:50So I would say, you know, start with a breakfast bowl. that has many of the ingredients, seeds and oats and chia seeds, fruits, fermented fruits in it. So you can easily come up with five to ten ingredients that you add a spoonful to that morning bowl that you have rather than just have your yogurt with blueberries. I think more than ever, you want to avoid the ultra-processed foods, you know, eliminate them from your diet.

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47:09Dr. Mark Hyman:And then the reason is that the science is there that it damages your microbiome. So if you, you know, 60 % of our diet is ultra processed food, that is directly damaging our microbiome. And it's increasing what we call leaky gut because of some of the emulsifiers and other additives. So it, you know, it's not in artificial sweeteners affect the microbiome. So people think, oh, it doesn't matter, but like, it's such a big deal then I think if one people could do one thing is swap out all your processed food for real food and eat a lot of plants, right? Yeah, and then, I mean, just to make it practical, you can create salads, not the typical lettuce salads, and now, you know, get a bad rap because of these infectious diseases.

47:52Plyclospora, yeah. So we've experimented this at home. You can easily add 10 different vegetables to a salad, to a complex salad. So if you start your morning like this and end your day with a salad like this, you actually already fulfill these criteria. And you avoid the ultra-processed foods, particularly sugary stuff. I mean, we still don't know exactly what the ultra-processed foods. I mean, there is this controversy about this concept that it's too loose and some people say it's all the sugar, but that's definitely not all of it. No, no. Like all the chemicals, I don't even know what they are printed on the label.

48:37It's kind of amazing. Like on an airline, you look at this thing with your so-called pretzels. The pretzels are the minor part of this.

48:47Dr. Mark Hyman:And if it's a minute package, unless it's got simple ingredients that you recognize, it's definitely not good for you. Do you focus a lot on prebiotic foods for people? Because I think, you know, I think there's more and more data on prebiotics and polyphenols rather than probiotics as a benefit, because that really changes over time the composition of your microbiome, whereas probiotics just sort of just gives you something additional, but it doesn't really sort of shape the bugs that are growing in there. Yeah, and coming back to this, I mean, these 30 fruits and vegetables. So from most vegetables and, I mean, also for some of the fruits, fiber is obviously a very important component, a health-promoting component, because microbes are masters.

49:30I mean, they love the fiber because they break it down to their own food, main food source, but they also convert it into like these short-chain fatty acids again. from a lot of the fruits. You get the polyphenols, and that's a group that's sort of been, I would say, mislabeled or misrepresented in terms of calling them antioxidants because it's a very interesting part of our diet, just like fiber. It's not absorbed in our small intestine. The molecules are too big, so it has to be broken down. The same about the polyphenols, they're broken down by the gut microbiome into smaller molecules, which are then both, again, food for the microbes and are absorbed as health-promoting phenols and phenolic compounds that circulate in the body.

50:20And there's some very good studies. People always forget that. With some polyphenols like flavanols, for example, the studies reach all the way from molecular studies showing that they foster vasodilatation of small blood vessels, both in the heart and in the brain, increase nitric oxygen production with the vasodilator. And so we know the mechanism, how they actually protect these organs, both the brain and the health. And we have clinical outcome data from pretty well-designed clinical trials. when this is an exception, you know. So I think this is often, it's often swept under the carpet that people say, yeah, the antioxidants, yeah, it's good to have antioxidants.

51:13It's something much bigger than that, you know.

51:17Dr. Mark Hyman:Yeah, they're kind of, I call them biological response modifiers. They basically are signals or chemical signals that regulate all sorts of systems in your body. And I think we co-evolve with all these plants to do all these things for us, particularly a microbiome. And, you know, we have to feed ourselves, but we also have to feed the microbiome. And I think the focus on more prebiotic foods, more fermented foods, more polyphenols, these are things that are different than just like taking a probiotic that I think people really could learn about. And I think you could probably cover this in your book, right, The Mayer Model, and talk about these various aspects of how to optimize your diet for your microbiome.

51:56Yeah, and I always emphasize this point. And it's actually quite easy to find the right diet. If you identify a diet that's beneficial for your microbes, for the diversity and the health and the richness of your microbes, that's the best diet for you as well. Because we have lived with these organisms for millions of years. Our ancestors, pre-human ancestors, done that as well. So I always say the general advice is eat what's best for your microbes. and the two main categories that pop up are definitely fiber, prebiotics, and polyphenols. I mean, there's obviously many of these other vitamins and micronutrients that you can add in, but the main workhorse are really these three groups of ingredients.

52:47Dr. Mark Hyman:So there's the fiber, the polyphenols, and the prebiotics. I'm not clear on the third thing. It was prebiotics and polyphenols, and then the third part? Yeah, I mean, the third thing that I recommend for the diet is naturally fermented foods. And the reason I'm saying this is because people always talk about, you know, yeah, I mean, when did people start eating yogurts? But there's thousands of years' history of our ancestors fermenting food products in order to preserve them, not for their own health. So our immune system and our gut had enough time to adapt genetically to these fermented foods.

53:33Again, the larger the variety of these fermented foods components is, the better we think. I mean, variety is always sort of a key component in the recommendations. It's not just what you eat, it's what variety you eat and how often do you eat it.

53:51Dr. Mark Hyman:Yeah, and I think you're saying more specific. There's a lot of specific foods that you can eat that are helpful. And I try to cook these and eat them regularly. One is like garlic, onions, shallots, leeks. They're great probiotic foods. Asparagus, dandelion greens, beans, lentils, chickpeas, oats, barley, cooked potatoes that are cooled, rice or pasta that's cooled, makes it more resistant starch, green bananas. There's a whole bunch of these that are really great. I think there's also polyphenols. Like I know, for example, cranberry, pomegranate, green tea, and a lot of the colorful compounds really help a lot.

54:25Dr. Mark Hyman:And those I've used myself personally to help my own microbiome, and I see a change from it. Have you ever had a microbiome? I'm sure you had multiple stool microbiome tests done. Yeah, yeah. Oh, yeah, I've had them, and they definitely change, and they shift in response to what I'm eating and my overall health. So I think, you know, the bottom line is it's hard to change your microbiome through probiotics, but if you use the fermented foods, the prebiotics, and the polyphenols, you're naturally going to be growing a better garden, essentially inside your gut. And I think it's a really empowering thing to sort of start to think about when you're eating, to actually use the science around what your microbiome likes to eat to feed them as well as yourself.

55:08And it's not rocket science. It's actually fairly straight. Once you accept that concept, it's not rocket science. And it needs to be pleasurable. I always emphasize this. If you go to Mediterranean countries, they love their food. They don't eat it because it's healthy. Yeah, they eat it because it's good.

55:31Dr. Mark Hyman:It tastes good, right? That's right. And if you eat this way, you can make delicious food. I think about just being more deliberate. And also just being aware of all the things that harm your microbiome. And I think it's important to be aware that eating ultra-processed food, a lot of different medications,

55:53Dr. Mark Hyman:exposures to environmental toxins, all these things will affect your microbiome, stress, your relationships, your connections, the amount of exercise, all the things you talked about in the Mayer model are all things that modify the microbiome in one way or the other. And the levers are there. I think, you know, I'd just like to close by asking you, you know, this is sort of a general conversation about creating a healthy microbiome. But, you know, I find it as a target and very specific target in order to treat a lot of conditions that are medical conditions using the microbiome as a direct kind of doorway to many, many health conditions, whether it's autoimmunity or allergy or asthma or fibromyalgia or even things like migraines or you talk about the strobilome, which is basically the estrogen metabolism and the microbiome.

56:40Dr. Mark Hyman:We didn't get into that too much, but that affects women's hormones. So treating the gut can often be a doorway to many, many different problems across many, many different specialties. And I wonder sort of how you think about that and where the sort of evidence is on that right now. It is amazing. I'm still amazed about that. You know, and as a sort of a, you know, physician and scientist, it's kind of against my nature to say there's this string theory of health and diet that explains everything. But I think the The microbiome has that quality that you could use it as a—and I keep emphasizing its connections to the brain and the gut.

57:29I mean, the gut is an amazing organ. It has all these components in it, immune component, hormone component, the nervous system component, and the microbes know exactly how to communicate with these systems within our gut. So I would say it doesn't surprise me once you understand that it has so many influences on particularly the immune system. When you think about almost all the immune cells travel through the gut and reach distant destinations like what happened during COVID. You know, COVID doesn't start in the gut, but the immune cells that are in your lungs have a connection to their past when they, you know, did their migration through the gut-based immune system.

58:22And so even in the same with the brain, so many cells that end up in the brain have a history of encounters with the microbiome. So I think, you know, we have to be careful not to come up with simplistic conclusions. You know, now we know everything, you know. But I think we have to acknowledge that we have discovered unexpectedly a system in our bodies that is doing, is almost like rivaling the brain, you know, in terms of its complexity and its influences on.

59:04Dr. Mark Hyman:It is. I mean, I think we're kind of in the, you know, it's a new sort of era in medicine, I think, where I think the microbiome has kind of shaken some of the foundational principles of traditional medicine, which is specialty and organ focused and sort of understands how now the gut is related to every system in the body and the body's a network and the microbiome is part of the network. And we really have to think more about network and systems approaches to treating disease rather than this reductionist model. And I think, you know, what I've found over the years, being a doctor, seeing patients, is that when I focus on gut health with people across the spectrum of diseases, whether it's some with Parkinson's or allergies or migraines or PMS or you name it, autoimmune disease, that people will get better, that people really do improve.

59:54Dr. Mark Hyman:And, you know, I, I've seen over and over in a way that's pretty striking. Um, and I think, you know, the methods are still being worked out and we're still at the beginning of this era, but it doesn't mean that we can't apply these principles clinically, practically, because they're very low risk generally. They're very, they're very effective often. And, you know, there's, there's not a lot of downside to eating healthier and managing some of those things, taking some prebiotics and probiotics. It's kind of low risk and the yield is quite high. So I think it's kind of an exciting moment. So how do you see this field going over the next 10 years?

1:00:31Dr. Mark Hyman:And just to wrap up. I think there's going to be bigger breakthroughs in terms of practical applications than have happened during the last 10 years. I think the science is still accelerating. I think the acceptance by practitioners, I mean, you see the increased popularity of functional medicine, even for traditionally trained physicians, it keeps increasing for that very reason. And so I think there's going to be, I mean, there's very strong headwinds ahead. You know, we're going to be facing, I mean, the next 10 years, it's hard to imagine actually what this world is going to look like from all these multi-crisis we're experiencing, which also will affect food production and, you know, environmental exposure, heat and all kinds of things.

1:01:27but I think there will be I think there will be a new era of holistic you know I hate to use this old fashioned term but holistic medicine medical practice that takes into account now all these insights that we get from digesting and integrating all these different pieces of information I think people hopefully you know we see some efforts that was the mayhem movement. I mean, that's something that you couldn't expect 10 years ago. You know, something like this would happen. Sorry, which movement is that? The Maha. Oh, Maha. Yeah,

1:02:09Dr. Mark Hyman:yeah. Make America healthy again. Okay. In my opinion, this doesn't go far enough. You know, there's still a lot of loopholes in it that will not do it. But it's definitely something like this could happen. Imagine what will happen in the next 10 years. you know it's yeah it's true it's it's an exciting moment with the convergence of systems medicine with ai with changes in health policy people waking up to the fact that we're we're in a different era i think it's quite exciting and i think your work is such a key part of it and you really contribute so much to the field i definitely encourage everybody listening to get your first book which is an updated edition the mind gut connection and also the new book which is the Mayer Model, available everywhere you can get your books.

1:02:53Dr. Mark Hyman:And Mayer Model is really about practical applications. It's a beautiful book. It's well-designed and it's easy to use. And I think that it covers seven pillars, really helping your microbiome, food, exercise, mindfulness, resilience, community purpose, sleep, and talks about how you can focus on the right diet, very specific things we talked about in even more detail. And I think it'll help everybody listening to develop a healthier microbiome, which is really the key to good health. And I think many ancient healing systems have figured this out a long time ago, but we're finally figuring that out in the West.

1:03:26Dr. Mark Hyman:So thank you so much for your work and your contribution and your new book. And I can't wait to see what's going to happen in the next 10 years. Thanks for having me on your show. Greatly appreciate it, Mark. If you loved that last video, you're going to love the next one. Check it out here.