Gut Expert Vincent Pedre, MD, on Gluten, Dairy, Pre- and Probiotics, and building a Happy Gut

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Content By: Ari Whitten & Dr. Vincent Pedre

In this episode, I am speaking with Vincent Pedre, MD, who is the medical director of Pedre Integrative Health and founder of Dr. Pedre Wellness. He believes the gut is the gateway to excellent wellness. As the best-selling author of Happy Gut: The Cleansing Program to Help You Lose Weight, Gain Energy, and Eliminate Pain. Through his proprietary blueprint for healing the gut: The Gut Care Program. he has helped thousands around the world resolve their gut health issues. We will talk about the latest research and his extensive clinical experience teaches us about fixing gut health problems.

Table of Contents

In this podcast, Dr. Pedre and I discuss:

  • The most common causes of leaky gut 
  • How a gut imbalance can cause weird symptoms
  • Is gluten or dairy universally bad and to be avoided?
  • Is it fermented foods or dietary fiber that is more important for microbial diversity and lowering inflammation (What does the research say?)
  • Why antibiotics cause gut issues
  • Do we really need specific strains of gut probiotics for optimal gut function? 
  • Are there any real benefits to avoiding eating a high-fiber diet? 
  • What people with SIBO and gut issues can do to optimize their gut health

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Transcript

Ari Whitten: Hey, this is Ari. Welcome back to The Energy Blueprint Podcast. With me today is Dr. Vincent Pedre, who is the medical director of Pedre Integrative Health and founder of Dr. Pedre Wellness, Nutraceutical consultant, and spokesperson for Nature MD, CEO of Happy Gut Life LLC, and a functional medicine certified practitioner with a concierge practice in New York City since 2004.

He believes the gut is the gateway to excellent wellness. As the best-selling author of Happy Gut: The Cleansing Program to Help You Lose Weight, Gain Energy, and Eliminate Pain, featuring his proprietary blueprint for healing the gut: The Gut Care Program. He has helped thousands around the world resolve their gut health issues. On a personal note, I will say that I really enjoyed connecting with Dr. Pedre and getting his insight into a number of controversial gut health-related issues. I found this conversation really fun and insightful. I hope you’ll enjoy it and get a lot of value from it.

Dr. Pedre, thank you so much for coming on the show. It’s a pleasure to have you.

Dr. Pedre: Hey man, I’ve been following you for quite a while on Facebook, love your posts. I’m really excited to be here. Thank you for having me on.

Ari: Thank you so much, my friend. The feeling’s very mutual. I’ve been meaning to have you on for a long time, since your book came out. What, two years ago? Something like that.

Dr. Pedre: Oh, no, it’s been–

Ari: Three?

Dr. Pedre: It’s crazy. No,s ix plus years ago.

Ari: What? Oh my gosh. Time flies. That is crazy.

Dr. Pedre: Six years ago.

Ari: You have another book coming out soon, right?

Dr. Pedre: Next year.

Ari: What’s the title of that one? I know I commented on the cover designs for it.

Dr. Pedre: Yes, thank you. The Gut Smart Protocol.

Ari: The Gut Smart Protocol, I like it. Given that it’s The Gut Smart Protocol, you’re known as America’s gut doctor. How did you get there? How did you develop an interest in gut health and end up specializing in it and become America’s gut doctor?

Dr. Pedre: Interestingly, I was one of those kids that was put on like 20 plus rounds of antibiotics by their pediatrician over the course of my teenage years and I always suffered from gut issues. Being on that many antibiotics you can just calculate, it was probably two to three rounds of antibiotics per year that destroyed my gut microbiome, led to a leaky gut, I developed sensitivities to gluten and dairy specifically, but some other foods.

Even if I look back at my pictures, I always had weight issues, usually being too underweight, which was probably my leaky gut. Then in college, when I went away and I was eating in the dining halls and eating a lot of bread and wheat, you could see my face was puffy. Like I was just retaining water. Honestly, it took me several decades to really figure it out. It was having more systemic effects on me, especially gluten was causing mental fog, making me feel really tired, not being able to get through a 12-hour workday.

Back then I was seeing patients 12 hours a day, or my day started and ended like in 12-hour. I was looking to bio-hack and see, “How can I make myself better because I can’t get through the workday without wishing that I could take a nap at 3:00 PM?” I started looking into the gut when I discovered functional medicine and I realized, “Wait, oh shit. I was on 20-plus rounds of antibiotics. My gut microbiome is destroyed and I’ve never done anything to restore it.” I became my patient number one, thinking that I was just basically doomed to IBS for the rest of my life.

Then all of those other symptoms, the brain fog, all that, the achy joints, skin rashes, and I was able to reverse these things with probiotics, prebiotics, shifted our diet, started eating organic, like really getting into where food was being sourced. I just became fascinated with it because in our medical training, basically, for any gut diagnosis, there’s only about three different medications that you can give. You give an antispasmodic, you give an antiacid or you give an antidepressant.

I thought to myself, “This is wrong. This has to be more complicated than what we’ve been taught. How can it be this simple that all these people who have kind of similar symptoms, but they’re slightly different–” The gut patients always were super confusing to me, but I love figuring out puzzles. When I got into functional medicine, I was like, “Wow, these gut patients, actually, what I thought was just two shades of gray is multiple shades of grays and different colors.

There’s actually more stuff going on underneath the surface than I ever thought because we couldn’t test for it because we don’t know what to test for. When you send a stool test to Quest or Labcorp for ova and parasite, 99.99% of the time you get a negative and that gives you no information. Over the years, I’ve seen– I got really fascinated because of myself and then working with gut patients and seeing them get better and realizing, “Wow, this is fun.” I wasn’t even trying to be a gut expert.

I’m like, “This is just kind of fun.” I like working with people’s guts. It’s happy. It’s easy. You change people’s diets, you fix their microbiome, and suddenly they come in and they tell you their asthma’s disappeared or that this is the first year they don’t have spring allergies. You were like, “What? All of this because of the gut?” I learned it in theory, but when you start seeing it in practice, then it’s really remarkable. It got me deeper and deeper into the gut and I just kept getting referrals.

Patients referred their friends, their family and it was endless. I thought, “Why are these people? They don’t know the solution? It’s just so simple.” I’m like, “Change your diet, fix your microbiome, heal your leaky gut, and then you’re good.” Life is good. Obviously, it’s not that simple. I thought, “I want to write a book about this.” I had wanted to write a book for six years, but it really wasn’t about just being a scientist, writing a book about anything, I wanted to write a book that was authentic and real for me. This was the topic.

This was it. I was very lucky that I kind of was at the very beginning of the wave with the microbiome when my book came out. I knew that I wanted to have a voice, I wanted to help as many people as possible, but I wasn’t going to do that trying to be the doctor of everything. The best way for me to do that was to be the doctor of the one thing, that niche that I love, that spoke to me, that was the way that I could communicate with people. That became the gut.

How gut dysfunction cause fatigue and brain related fatigue

Ari: Beautiful. I have a long list of questions for you. Actually, I’m very up-to-date on my gut health-related knowledge. I just took a course with one of the world’s leading researchers in gut health. I learned a ton and I had to take a test. I’m well-studied on all these topics. I’m also very interested in the fact that some of the other gut health experts that I’ve interviewed have differing opinions from one another. I’m curious to get your take on some of these more controversial topics.

First of all, as an entry point, let’s talk about the connection of gut health to some of those symptoms that you were talking about, particularly energy. You mentioned that you personally were falling asleep at 3:00 PM in the afternoon, brain fog, obviously GI symptoms, but some of these more systemic symptoms related to mood and energy and things of that nature. What’s going on mechanistically that links the gut with those symptoms?

Dr. Pedre: I’ll go from, from macro, which is the bigger picture. Anybody who’s got gut issues, anybody who’s been on antibiotics, anybody who’s stressed, anybody who’s taking over-the-counter ibuprofen, women on birth control pill, they’re all going to have leaky gut or they’ll be on the spectrum of gut leakiness. When you’ve got a leaky gut, they’ve actually shown in studies that bacteria and bacterial DNA gets into your bloodstream.

When that gets into your bloodstream, especially when you’re exposed to certain bacterial proteins and lipo-polysaccharides, the biggest one being endotoxin, that activates your immune system. It’s almost like having the mild flu. If you don’t feel sick, you’re not sick enough to feel like you’ve got a cold but you’re activating the immune system enough that it’s going to cause your brain to shut down. When your gut becomes leaky, then your blood-brain barrier becomes leaky so that protective circulation the brain is not there. Things can get through lip polysaccharide is fat-soluble, so it can get through that blood-brain barrier anyway.

They’re binding receptors in the hypothalamus for endotoxin and it activates a very specific pathway. It’s called the NF-kappaB pathway. It’s an inflammatory cascade. It causes inflammation in the brain. That leads to brain fog now for me. On those days specifically, the worst days for me were when I went and had a sandwich or I went and had a slice of pizza as my lunch. A couple of hours later I could barely keep my eyes open.

Well, we know that gluten metabolizes into whole series of metabolites and some of them actually become morphine-like substances called gluteomorphins. There’s also glutenins and those are neurotoxic. They’re having an effect on your brain as well. It’s making you feel like you’ve got to go to sleep. From the perspective of leaky gut and also the metabolites coming from these either gluten dairy, also you get casomorphins as well, so morphine-like chemicals from dairy that just basically dumb down your brain. They make you feel like it’s shutting down.

Is gluten really harmful to your gut?

Ari: Got it. Since you brought up gluten and dairy, let’s go deeper into gluten especially. This is one of those controversial topics, that there’s pretty wide variety of opinions among experts. Are you of the opinion that everyone universally should avoid gluten or how would you distinguish between overt celiac disease versus gluten intolerance versus non-celiac, gluten sensitivity? Do you think any of those distinctions matter or gluten is just bad, everybody should get rid of gluten?

Dr. Pedre: That’s really great question. I know a very controversial question. You distinguish it first by the testing. Celiac, you can check genetics, HLA DQ2, DQ8, and you can also distinguish it by looking at antibodies to tissue transglutaminase. There’s a very specific definition for celiac. Of course, the gold standard endoscopy that shows the blunting of the villi.

You see that the gut barrier has been compromised. Non-celiac gluten sensitivity is a bit more controversial because there’s not a perfect test for it. You can look at deaminated gliadin peptide and see if there are IGG antibodies to that. That might be or IgA or IgG antibodies. That might be a sign that the person is gluten sensitive and that’s where I fell. What took for me to give up gluten, because I was like, this is a really big sacrifice, even though I was starting to tell my patients to go gluten-free.

I was like, “How in the world am I going to do this?” I needed blood test verification and I tested positive via food sensitivity test. It was an IgG with complement activation and gluten lit up really high for me. Really, in the end, the gold standard I think because there’s no perfect test, especially when it comes to these IgG food sensitivities, there’s no standardization.

You could send the same blood sample to the same lab and get slightly different results. Whereas if you’re doing IgE testing, which most people know like peanut allergy, pine nut allergies. Those are standardized across every single lab. If you send it to one lab, you’re going to get the same result as another lab. What I tell people is when you’re looking at, especially when you’re getting into the sensitivity category, this is a Monet painting. It’s blurry. You might know you’re looking at Big Ben but you can’t see it in full detail.

Same thing, this is giving you a ballpark assessment of where you’re at. That the interesting study that I saw was a study that looked at the effect on gut permeability of gluten on different types of people. They had a normal group, a non-celiac gluten-sensitive group, and a celiac disease group. What they found was that as expected in the celiac disease group, gluten increased gut permeability the most. In the non-celiac gluten-sensitive group, it increased gut permeability but not as much as in the celiac group.

What was surprising is that in the normal group it also increased gut permeability, not as much as the non-celiac, not as much as the celiac. It was like celiac was worse, non-celiac second worse, and normal was not zero. It was somewhere in between. The question then becomes, I think a bigger macro-question of how wheat has been hybridized and transformed and whether our genetics have evolved fast enough to deal with the change in the gluten concentration in this hybridized dwarf wheat compared to some of the more ancient wheat.

When you say, am I a proponent for everybody to be gluten-free, usually I start with, “What are your symptoms? What are you experiencing?” If you feel great and you’re having wheat from time to time and it’s not causing any brain fog, any sinus issues, any immune issues, nothing that you’re feeling, no joint inflammation, no joint aches, which are the types of symptoms you might see with someone who’s gluten-sensitive, then your gut is probably fine. You don’t need to make a change.

If you are experiencing these things you can go the route of doing testing or you can go on a gluten-free diet and test it out yourself and see the before and after. I really do think that experiential test of seeing how your body reacts to not being on gluten, I think is really important. What I’ve noticed and what I’ve seen with patients is when you are gluten sensitive, within two to three weeks you feel a shift. The biggest shift I felt was suddenly, I didn’t need a nap at 3:00 PM.

My energy level shot up. I could get through a 12-hour day and still be as mentally sharp at the end of the day as I was at the beginning of the day. I knew that gluten taking gluten out had made a difference. The interesting thing is they say that it takes 6 to 12 months to basically metabolize all the gluten metabolites that are actually still in your system. When I did this back in 2007, I kept testing. I tested at the three-month mark and I got some weird itchy rash on the inside of my wrist.

I tested again at sixth-month mark, same thing happened. I tested again at the year mark same thing happened. During that time, the longer I was off of gluten, the better I felt. I think that’s something that a lot of people may miss when they do an elimination of whether it’s gluten dairy, that you might get to a certain level at four weeks where you’re not going to feel the full benefits, probably a couple of months in as the inflammation in your body starts to resolve. I’m a big believer in self-observation and intuitive eating.

Really one of the things that I teach my patients is to listen to their bodies and be your own doctor like be your own health guru, because you’re the one who knows your body better than anybody else.

Dairy and gut health

Ari: Well said. I like that answer, very nuanced. Okay. Do you think it’s worth going into dairy as well? Do you recommend dairy avoidance pretty much across the board? Do you feel it’s universally damaging to gut health or not so much?

Dr. Pedre: That is a very nuanced answer. As part of my program in Happy Gut, I take dairy out. That’s because for people who have gut issues, anywhere between 70%- 90% of people across the world have lactose intolerance. Part of that is probably due to dysbiosis, so derangements, imbalances in their gut microbiome so they can’t digest lactose as well. Now, the caveats to that are also knowing food sourcing because when we’re talking about dairy are we talking about factory dairy or organic dairy? Are we talking about pasture raises dairy that– it’s not the same thing, you can’t compare them. Butter that comes from factory-raised cows is probably one of the most toxic things you could eat, but butter from pasteurized cows can be great for you or ghee, which is devoid of the dairy protein so if you absolutely have issues with dairy proteins, food sensitivities, because a lot of people get confused.

Lactose intolerant is not a sensitivity to dairy. They’re not the same thing. One is an enzyme deficiency so you can’t break down the sugar and you get a lot of gas loading and maybe diarrhea. The other one leads to systemic effects because you’re getting an IgG response. You’re getting the blood antibody response to the dairy proteins, whether it’s casein or whey. It gets more complicated than this because the majority of the cows in the US are what we call A1 cows.

It has to do where there’s one amino acid mutation on that casein protein that makes it very difficult for our enzymes to cleave the protein. If you go to New Zealand, the majority of the cows are A2 cows and that one or two, all it means is that there is a difference in one amino acid. That one amino acid difference means that A2 milk is much easier to cleave that casein protein into smaller amino acid chains that do not cause an immune reaction, whereas A1 milk does.

There’s so many levels and we can get to raw versus non-raw milk. I’m a big fan of raw cheeses because it’s still full of all the enzymes. I think that as part of a program of rebuilding the gut, even though you might take dairy out, eventually there is a role for introducing fermented dairy in the form of kefir, maybe homemade kefir from organic milk or maybe organic goat milk, less antigen than dairy and/or yogurt. I think being black and white about this is wrong because there’s a lot of nuances depending on the person.

I’ll give you an example again, from my own experience I went to Guatemala in January of 2021, got Giardia probably from being in Lake Atitlan.

Ari: Maybe worse you could have been in Lake Titicaca, which is obviously the best name for a lake ever created.

Dr. Pedre: Yes. Right.

Ari: Sorry. I digress

Dr. Pedre: While I was treating myself for it, I actually avoid dairy in the winter months because it creates more mucus and it’ll make it easier for me to get sick. For some reason, intuitively my body was asking for kefir. As I was healing my gut from the Giardia with bone broth, probiotics all the things that I know to do, I started having a shot of kefir every day and that made a huge difference.

Ari: Interesting. I had dairy as a big part of my diet for many, many years, and both consuming yogurt and raw– I was generally consuming good quality raw milk and lots of whey protein, tons of whey protein supplements, and even casein protein supplements. At a certain point, I started to develop this weird symptom that took me months to figure out what was causing it. It felt like that feeling you have on the first day you’re catching a cold where you have this irritation in the back of the throat, something in your nose, and a little congestion. I felt like that every day for months and [unintelligible 00:24:28] have a chronic sinus infection or something.

Dr. Pedre: That’s a typical symptom of dairy sensitivity.

Ari: Yes. Then I removed dairy and it went away within a couple of days. After that point, I thought, “Oh, I guess my body’s reactive to dairy now.” I removed dairy from my diet completely for two or three years. I just recently reintroduced it without any symptoms. I’m curious if the mechanisms behind what could explain that because I certainly don’t.

Dr. Pedre: One can be overexposure. When it comes to food sensitivities, there’s threshold issues. It could be that you passed your threshold that then activated your immune system. There could have been other shifts going on in your gut microbiome at the time. Maybe your gut permeability was a little bit higher and then it was just smoldering the fire. You kept exposing yourself to whey, which also can be hard for the digestive system to break down. Again, without all those enzymes, because raw milk has all the enzymes.

The other thing I wanted to mention is I think a really important study that came out last year, Stanford University where they looked at a group of mostly women. I will paraphrase by saying this was not a large study and it certainly wasn’t a diverse group. It was mostly White women. It was divided into 18 and 18, 18 people did a high-fermented food, diet, and 18 people did a high-fiber-rich diet. They wanted to look at different parameters. They looked at 19 different inflammatory markers.

They looked at the immune system and how the immune system was behaving and they also looked at microbial diversity. I don’t know if you saw this study, but I’m going to ask you which group do you think was able to attain the greatest gut microbiome diversity, the fiber-rich diet group or the high fermented foods group?

Ari: Maybe I’d go with fiber if it had a diversity of fiber.

Dr. Pedre: That’s what I would’ve said. The surprising result was– and that’s what they teach in functional medicine. They’re like eat the rainbow, eat a bunch of fiber, that creates diversity in the gut microbiome. Yet it was the fermented foods group that was able to reach the highest diversity.

Ari: Interesting. Well, with some fermented foods, there’s quite an amazing diversity of microorganisms in that.

Dr. Pedre: You can’t think of it as just the reason that I was thinking that fiber was better is because fiber’s a prebiotic and it’s going to feed exactly a wide variety. What I realized is that our thinking of fermented foods is a little bit limited because we’re thinking if you’re drinking kefir, you’re getting a lactobacillus, whatever it is and that’s what you’re adding to your gut. No, you’re adding– you’re seeding a bacteria that’s going to create post-biotic metabolites that then feeds other groups of bacteria and it’s going to support the growth of this whole complex group of bacteria.

It’s actually increasing microbial diversity and the other thing that the fermented foods diet did was lower 19 markers of inflammation.

Ari: Nice.

Dr. Pedre: Whereas the fiber-rich diet, what it did was it helped with immunomodulation. It benefited people who were healthier more than people who started with an unhealthy diet.

The primary causes of gut permeability/leaky gut

Ari: Very, very interesting. Okay. Let’s zoom out for a second. You’ve mentioned gut permeability, leaky gut several times thus far. What’s the big-picture list of factors that are causing this? Why do so many people have leaky gut? I assume a hundred years ago, this wasn’t the case. We didn’t have an epidemic of leaky gut.

What’s going on in the modern world? I think you have some personal experience with one of those factors that’s contributing to it.

Dr. Pedre: I think one of the biggest factors, antibiotics. There was a study that, that came out recently that looked at antibiotic prescribing and it was interesting because they were looking at different ethnic groups and they found that in the Black community and Hispanic community antibiotics were more likely to be prescribed from a doctor’s appointment than other groups or White Caucasians. Overall, antibiotics are overprescribed.

If you look at the rest of the world, you can just walk up to the pharmacy and get an antibiotic without a doctor’s prescription. Outside of the US, I think we can also say that antibiotics are being overused and oversimplified because people can just have a cold and say, “I’m going to go get an antibiotic to knock this out.”

Ari: Two weeks ago our nanny in Costa Rica had a boil on her butt, on the back of her leg. The best way I can describe is like a big blister.

Dr. Pedre: Yes, it’s like an infected blister underneath the skin.

Ari: She went to the doctor and they prescribed systemic oral antibiotics for a single blister on the back of her leg. She told me the doctor said something like, “If I don’t give you the antibiotics, you’re going to have this all over your body in two weeks.” I was like, “That sounds like total BS to me.” Maybe you could justify a local antibiotic ointment or injection or something but to give somebody oral antibiotics for a blister on the back of their leg is insane.

In the time that I’ve known her, she’s been prescribed three courses of antibiotics for random little issues like that. She goes to the doctor and, “Oh, antibiotics for this, antibiotics for that.” I cannot believe [unintelligible 00:31:01]

Dr. Pedre: I’m a medical doctor. I was trained in this country. I know how they think because I was trained to think that way at one point, and I had to rewire the way that I thought about things because you start realizing we’re using too many antibiotics.

Ari: I just got reminded of a study. I must have seen this 10 or 15 years ago, and I won’t remember the specifics but it was talking about the incidence of doctors prescribing antibiotics for viral respiratory infections knowingly. They’re not even concerned that it’s a bacterial infection but prescribing it basically knowingly as a placebo, because they know that patients will walk out of the doctor’s office more content, feeling more satisfied with that doctor’s visit if they were prescribed something that they now at least have the placebo effect from versus a doctor said, “Well, it’s a viral infection, we don’t have anything to treat the viral infection so just go home and rest and eat chicken soup and drink lots of water.”

Dr. Pedre: Having been there, can I just insert a bit of a dystopian tone to this?

Ari: Yes, please.

Dr. Pedre: As a doctor, within the insurance space medical system, you have 15 minutes to see a patient and get them out of that room. You want to do whatever is not just going to make them happy, it’s going to move them out. I was that doctor at one point, and they’ve looked at this. They’ve done studies within the first minute, first minute of the visit, patients telling you what they’re there for, the doctor is already thinking, “What medication can I prescribe to this patient to get them out the door?”

Ari: Wow, yes.

Dr. Pedre: I ran into problems because I was the doctor that butted heads with patients telling them, “You have a viral infection, I’m not going to prescribe an antibiotic.” It takes a little more time because now I need to educate the person on, “You’ve got a viral infection. These are the things we can do. This is what you can do to optimize your immune system so your body can fight this off better.” Now, the caveat is something interesting that I discovered and I know we’re in good health but we’re just on this tangent.

I discovered during COVID because I was researching why Zithromax might be beneficial, and I found a study that showed that Zithromax turned on antiviral genes in the lung cells that produce interferon. That’s interesting because that’s the one antibiotic, antibacterial, that I’ve read actually has some antiviral properties that I didn’t realize. Just digging through the research I found that but by and far, I was working for one of the busiest practices in the Upper East Side and already my philosophy was changing.

I couldn’t with good conscience give an antibiotic. This is before I really understood the full depth of everything that it causes in the gut and the downstream problems. I refused to give an antibiotic to a patient. She walked out, checked back in, got in to see a PA in the same practice that she knew would just give her the antibiotic, and got her antibiotic and left happy.

Ari: Oh my gosh, that’s nuts.

Dr. Pedre: Then of course she gave me a really bad review.

Ari: For not giving her antibiotic.

Dr. Pedre: For not giving her the antibiotic, yes.

Ari: I think it’s worth stating this directly. We’re both implied it, but just consider given what you’ve said about antibiotics and gut health. Now, what kind of collateral damage is being done from just that one practice of prescribing antibiotics in this inappropriate context that’s happening, what? Hundreds of thousands of times every day in doctors’ offices.

Dr. Pedre: Cipro, so one course of Cipro the most commonly prescribed antibiotic for UTIs. Five-day course will cause a derangement in the gut microbiomes when imbalanced that without any other correction will take 12 months to recover.

Ari: Wow.

Dr. Pedre: When you do repeated courses of antibiotics, the belief is that over time, say you’re growing up, you’re toddler, you’re being exposed to breast milk, your gut microbiome is getting expanded and educated. By the age of six, it’s almost become like the adult gut microbiome. Say the diversity is here, every time you have an antibiotic course as you recover, you never hit the same diversity, it keeps dropping. You can never get back to where you were supposed to be.

Five-day course of Zithromax, the most commonly prescribed antibiotic for upper respiratory infections, six months to recover. Now, the scary thing is that I was at the microbiome congress, I don’t know, I think it was 2018, 2019, heard a lecture from a researcher that was looking at what happens to the gut microbiome of people who live together when one of them is prescribed an antibiotic.

Ari: Oh, interesting.

Dr. Pedre: I think they were looking at Zithromax, so the Z-Pak. They did different groups, so they did husband and wife, they did roommates that were not romantically involved and the scary thing was that if one took the antibiotic, the other one who wasn’t taking the antibiotic showed a change, a shift in their gut microbiome.

Ari: Wow.

Dr. Pedre: It wasn’t dependent on whether they were sleeping together, exchanging fluids or not. It happened across the board.

Ari: Crazy.

Dr. Pedre: Yes. I don’t know if that has been published. I know that was research that was being presented and they were just sharing that but I thought, “Wow, that’s a whole other level that I’m not even ready to deal with.” You’re prescribing to you, you’re a father, you’ve got a wife, imagine now to think like, if you take it, you’re affecting your whole family.

Ari: Yes, absolutely.

Dr. Pedre: Wild.

Ari: What if my nanny takes it, how is she affecting my kids?

Dr. Pedre: For something like that, I think that I would want to see the research and just verify that it’s true. The big picture is antibiotics cause a loss in microbial diversity. If you lose microbial diversity that causes an increase in gut permeability. Add to that the standard American diet, the lack of fiber in the diet. I still think even though I just presented this whole juxtaposition between fiber-rich and fermented foods, I’m not saying don’t eat fiber and just eat fermented foods. That could be really bad for some people. Fiber is still good, we need fiber.

Ari: Fiber is in some ferment– I don’t know if it was in that particular study but let’s say you eat sauerkraut or kimchi or something like that, you’re getting plenty of fiber.

Dr. Pedre: Right, you are getting some fiber there. The thing is that the average American only gets 10 to 15 grams of fiber a day and we’re supposed to be getting anywhere between 25 and 35 grams of fiber even just for what it does to the gut microbiome and the immune system. That in itself, antibiotics, poor diet, add stress, catecholamines. Catecholamines are an attack on the gut, they increase gut permeability.

High cortisol causes changes in the gut microbiome, eating too much sugar, artificial sweeteners, all these things cause shifts in the gut microbiome and whenever you cause a shift, where our gut barrier is dependent on a healthy gut microbiome so it’s not just on our side, it’s on the other side as well and maintaining that mucus layer. All these things lead to increase intestinal permeability. I mentioned ibuprofen, birth control pill, there’s a lot of different medications that can increase gut permeability as well. Even acetaminophen, they showed in a study that it will lead to imbalances in the gut microbiome. Anything that even if it’s not directly increasing gut permeability, indirectly, it will if it’s causing a shift in the gut microbiome to something that’s not as favorable. I think an important thing to mention is all of the symptoms that leaky gut can lead to that aren’t just localized to your gut because leaky gut is the common denominator that connects a lot of chronic health issues.

Leaky gut is behind allergies, asthma, airway issues, headaches, migraines specifically, any skin rashes, hives, any other systemic conditions can be tied to the gut, joint inflammation. Even things that we call autoimmune disease because we can measure autoimmune markers for it in the blood could still be tied to leaky gut and to [unintelligible 00:41:18] imbalance in the gut microbiome and maybe yeast overgrowth, things like that.

Probiotics

Ari: Excellent. I have a probiotic question and a prebiotic question for you. Probiotics, I interviewed two gut health experts recently. I won’t mention names, but I guess people will find out if they listen to my podcast because I’ll release both of them. One is with a world-renowned gut health researcher and clinician, and then the other one is with a clinician who specializes in gut health, who’s also very smart and I have a lot of respect for, they have very different opinions on probiotics on a very critical issue.

The researcher is very strongly of the opinion that strains matter tremendously, and that even within a given species of bacteria, the specific strain determines whether or not you’ll get an effective outcome. The other gut health expert was arguing the opposite, that all this talk of strains is greatly overblown and is largely marketing hype to drive profits by the creators of these strains. What’s your take on that?

Dr. Pedre: I disagree. I want to clarify because I think there’s a lot of– Well, I disagree with the second is what I’m going to say and I’ll tell you why. If you pick up a lot of probiotics on the market, it might say lactobacillus acidophilus, Bifidobacterium breve, it’ll have the genesis and the species name, nothing else. What that tells you is they’re using a generic line of bacteria that has never been tested, has never been studied.

We don’t know if there’s any clinical effect from these. We just know based on extrapolation, but we don’t know for sure. When you’re looking at a probiotic and it’s got the first name, last name, so [unintelligible 00:43:25] species, and then it’s got a code after that name, that’s the substrain. Anything with a code, the only way it can have that code is because it’s a strain that has been clinically studied in a research study, and it’s been shown to have some effect.

Maybe it’s immunomodulate, maybe it stimulates, peristalsis. Maybe it helps with constipation. Maybe it helps lower inflammatory markers. Personally, I think it’s very important to look at that and especially, I think this is one of the biggest areas where consumers are completely misinformed. You don’t know if you’re picking up a probiotic by any– I was just showing a patient that who was taking a probiotic and I had her, “Let’s look at the label, let’s look at it together. Let’s see what’s on this label.” It just had generic strains.

I don’t know if any of these strains have been proven to do anything. I think it’s really important if you care about what you’re putting into your body and especially when it comes to probiotic strains. I think eventually probiotics are going to be very specific. We have companies that are studying probiotics that can help with anxiety, that can reverse eczema, that can help with depression. You can’t say that every lactobacillus acidophilus going to do that when it wasn’t that strain that wasn’t studied. I think that’s really important.

I think the other piece of confusion on probiotics is what the expiration date on the bottle means. It can mean different things depending on different companies. I think people don’t understand this. If you’re picking up a bottle of a probiotic and it says 100 billion on it, or 30 billion, whatever it is. If the company really values what it’s doing, there’s something called overage. What that means is that when that probiotic is manufactured and usually at the point of manufacturing, it has two years to expiration 18 months to 24 months.

In order to get to that, they have to put overage in the capsule. If it’s 100 billion, they might put 130, 150 billion because it’s going to slowly degrade over time. That expiration date doesn’t mean the probiotic has expired. It just means that on the date of that expiration, we can still guarantee that there are 100 billion CFUs in one capsule. That’s what it means. I think a lot of people get confused about this because they think that expiration dates are the same. They’re not the same for everything.

When probiotics it’s really more guaranteed till date and depending on the manufacturer, they’re doing third-party testing to see if they’re still viable probiotics. There should still be 100 billion or 30 billion, whatever the bottle is saying, there should be that much or more on the expiration date.

Fiber and prebiotics

Ari: Got it. Excellent answer. This will be a challenging one to answer in a few minutes. Fiber prebiotics and gut health issues, SIBO, IBS. Many people react negatively to certain kinds of fiber, and then they extrapolate from this that, “Oh, fiber is bad for me. I need to avoid all these plant foods. They’re all bad for me.” We have the rise, the trending of some of these extreme low fiber or no fiber, carnivore diets, and things like that. What’s your commentary on that landscape?

Dr. Pedre: I’m actually just writing a blog post on this. Where I want to start is we need to expand our definition of what a prebiotic is. Prebiotic is a nutrient that is used by the microbes in our gut to produce postbiotic nutrients that are beneficial to our well-being. Now most people, when you say prebiotic, they’re thinking fiber resistance starch, indigestible fiber that’s going to stay in the gut. If you have SIBO, that is your fricking enemy because it’s going to produce gas, bloating, abdominal pain, can give you diarrhea.

It’s going to make you feel horrible. The true fact is that there’s another type of prebiotic that does not cause that. It’s not a fiber, it’s a polyphenol. Two of the biggest research ones are pomegranate extract and citrus flavonoids. These polyphenols what they do, they do several things. One, they are prebiotic, but when they get metabolized, they don’t produce gas like fiber does. For those SIBO patients, you can give them a polyphenol prebiotic and they’re going to do okay with it.

They’re actually going to thrive with it. the interesting thing that these polyphenols do is that they also link together so they interlace. In a patient with SIBO, inevitably has leaky gut. Now the polyphenols come in, they interlink and they help the gut bacteria then recreate the mucin layer on the inside of the gut lining. They help repair the mucin layer, the mucus layer. By doing that, then they help repair the integrity of the gut lining.

They’re actually helping to reverse leaky gut while not causing excess gas and bloating, all those uncomfortable feelings. I think polyphenols are going to be the new hero prebiotic that nobody is paying attention to. Quercetin is in there. I found a study while back when I was looking at ways to increase Akkermansia because Akkermansia is a type of bacteria that feeds on– It’s called Akkermansia muciniphila and Philia we know from Latin is love so it loves mucin. It eats the mucin. If there isn’t a lot of mucin, then you’re going to lose your Akkermansia. I was looking at ways like how can you increase Akkermansia and I found a study that showed that quercetin helps increase Akkermansia. That was the first time I realized that, “Wait a second. You’re telling me that a bioflavonoid is actually a prebiotic, so it’s an antioxidant prebiotic?” Now I’m not telling listeners to go out and drink a bunch of wine, which is full of resveratrol or which is another polyphenol, but you can get these in supplements, these pomegranate extracts.

The studies have been compelling and how they help actually increased microbial diversity and improve the gut barrier. I managed to answer that in about three and a half minutes.

Ari: Well done. I liked that you mentioned pomegranate extract in particular. It’s one of the ingredients in my mitochondrial formula [unintelligible 00:51:02] The ellagic acid in pomegranate is converted by specific microbes in the gut to [unintelligible 00:51:10] A, which then is one of the most powerful promoters of mitophagy to improve mitochondrial health.

Dr. Pedre: Also blood sugar balancing and it’s a really important post-biotic. The ellagic acid is a prebiotic also.

Ari: Wonderful. Okay, so Dr. Pedre, I’ve really enjoyed this. This was actually a lot of fun, having this conversation with you and picking your brain. Particularly as all these different gut health controversies are fresh in my brain, it was great to get your insight into those issues. Where can people follow your work, get in touch with you, and work with you?

Dr. Pedre: Several places. The easiest place to find me is on Instagram at Dr. Pedre. I’m also on Facebook, Dr. Vincent Pedre, or my website pedremd.com and my book website, which is happygutlife.com. So lots of different places to find out about me and resources to improve your gut health.

Ari: Beautiful. Thank you so much my friend for coming on the show. This was a lot of fun. I look forward to future conversations.

Dr. Pedre: Thank you for having me.

Ari: Hey, there this is Ari again. Thank you so much for listening to this episode. I hope you enjoyed it. If you did, if you found it valuable, please share it with your friends, share it with your family. Help me get the word out there. Also, if you’re on YouTube, make sure to hit the subscribe button and hit that little bell to get notifications every time we release a new video or new episode of the podcast. If you’re listening to this, make sure to subscribe to this podcast on iTunes or on your favorite podcast app. Thanks so much for supporting my work.

Show Notes

How gut dysfunction cause fatigue and brain related fatigue (08:04)
Is gluten really harmful to your gut? (11:30)
Dairy and gut health (19:21)
The primary causes of gut permeability/leaky gut (28:34)
Probiotics (41:29)
Fiber and prebiotics (46:50)

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