In this episode, I am speaking with Dr. Grace Liu – who is a functional medicine practitioner who specializes in gut health and the founder of the Gut Institute. She has formulated her own brand of probiotics (which we will discuss today), and host of the Microbiome Medicine Conferences and the Heal SIBO Summit. We will talk about the gut bacteria and viruses and the link between gut health and the immune system.
Table of Contents
In this podcast, Dr. Liu will cover:
- The connection between the gut and immune health
- The uplifting data on survival COVID-19 survival rates in the elderly population
- The critical role of lifestyle and stress in gut health
- The link between testosterone and anabolism and how it relates to gut health
- A practical guide to probiotic supplementation
- The connection between gut health and COVID-19 infection
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Ari: Everyone welcome back to The Energy Blueprint Podcast. I’m your host Ari Whitten. Today I have with me Dr. Grace Liu, who is a Doctor of Pharmacy. She’s an AFMCP which I will let her describe what that is. She is a functional medicine practitioner with an international functional medicine practice that includes nutritional consultations, integrative laboratory analysis, and personalized counseling. She’s a gut expert in particular, and that’s what we’re going to be talking about today. She’s the founder of The Gut Institute. She’s the formulator of probiotics. She’s a host of the Microbiome Medicine Conferences and the Heal SIBO Summit.
I recently connected with her on the topic of coronavirus, of COVID-19 that everybody’s talking about right now. She let me know about some fascinating research about how the gut microbiome ties into immune health. I basically said, “I’d love to have you on the podcast to talk about all this stuff.” In particular, there was some stuff she mentioned about the gut-lung axis. Now, I had heard of the gut-brain axis, the gut-skin axis, the gut-mitochondria axis, in particular, is an area where I know a lot about, but I’d never come across anything about the gut-lung axis. I started to look into that and I just thought it was mind-blowing and fascinating stuff. I’m excited for this conversation. I’m really excited to have you on the show, Dr. Liu.
Dr. Liu: Thank you so much, Ari. I’m so grateful to be here.
The gut-lung axis and the gut-immune axis and why they matter
Ari: Well, let’s get into it. Tell me about the broad landscape of the gut-immune axis, the gut-lung axis. How would you describe what’s going on there to the person who knows nothing about that subject?
Dr. Liu: We know from a lot of research and academic articles, our immunity is 80%, 90%, it’s estimated to be in our gut, particularly the small intestines. There’s a variety of anatomical structures known as Peyer’s Patches, M cells, a whole host of macrophages. These are our sentinels, like our FBI, SWAT team, all that. Our human immune system is so interesting. If you believe in evolution, we have been here for millennia. There was a divergence somewhere along the line when mammals were developed. Mammals happened. They had internal fertilization. Instead of aborting and kicking out a fetus, they identified it as self and the immune system learned and trained itself to not kick it out, whereas it would for a parasite that got stuck in the system or elsewhere.
Instead of laying eggs, humans and mammals had babies that were internal. This changed our immune system at that point. We went from teleost fish and egg-laying and then suddenly we’re mammals. Our immune system really had a big deal about that. There was a lot of other changes along the way. Our brains grew bigger because this is going back kind of a ways. Our food system changed. We can trackback to petrified poop and see these changes actually. Our microbiomes shifted, and with more foods that grew our brain like omega-3s and cooked barbecued starches, barbecued meats, there was an increase in bifido, lacto and butyrate producers and many other species that were seen in these– they’re petrified remains of feces.
We know a lot about the immune system now. They’ve done testing. When they do germ-free they take away our known healthy bacteria, the microbiome, the hundred trillion microbes, and bacteria. These animals end up not being able to socialize, all their organs are tiny, small heart, small everything, and they don’t act very normal. They’re not fearful. They weren’t around. They don’t act normal at all. Not having a commensal or real keystone bacteria that trains our immune system makes a lot of changes and it can add to disease burdens. There was actually a PNAS article in 2011. It was a seminal article. They showed that by altering the microbiome using different antibiotics and testing with different infectious agents like Legionella and other things, these researchers showed that the lung susceptibility to influence a virus was dependent on the microbiome and whether the keystone species are there or not. Even coronavirus, because it’s very common coronavirus is all over our earth, and they infect poultry, pigs, all our domesticated animals could get infected.
Ari: Just for clarity on that point, some people may be under the impression that there is only one coronavirus. It is this coronavirus outbreak, COVID-19. Just for clarity, basically what you’re saying is there are many types of coronaviruses within this family and this-
Dr. Liu: Yes, just Wikipedia.
Ari : -this outbreak is one specific strain of a coronavirus?
Dr. Liu: Right. We had others. 2002 we had pandemics and then SARS 2012 and other years. This has been around. There are coronavirus in our animals and we can learn a lot about the way the clinical course is for animals. We can learn a lot about how animals, using probiotics, it’s so amazing that their health can be protected even symptom-free. There’s a common diarrhea virus that affects pigs. Just using probiotics they can avert nearly all signs and symptoms of diarrhea because diarrhea will kill them. It’s so lethal, that type of coronavirus. Just as COVID-19, it is apparently pretty lethal. Let’s say our flu, normal flu is 0.1%, 0.2% lethal, this is magnitudes above that, 1%, 2%, depending on where the region, the hospitals, whether they have ventilators or not. It can be 2%, 3.5%, 4.7% lethal.
Ari: Got it.
Dr. Liu: The good news is there’s a lot of people surviving. Even for age 85, 90% survive.
Dr. Liu: Yes. It may kill 10% of 85-year-olds and up. The good news is 90% of over 85 super survive COVID-19.
Ari: That’s great. That’s great news. I hadn’t seen that data point yet. Having said that there is this interaction between the gut and the immune system, what specifically are the mechanisms by which these gut microbes are affecting, let’s say, our risk for a respiratory infection? How could they be modulating that?
Dr. Liu: One thing we know about the human coronavirus, SARS-CoV-2, version 2, COVID-19 is that it binds our human ACE2 receptor system, receptors. It lines our lung and then guts. There’s receptors in the mouth, and it’s very abundant in the small intestine. There are a lot of reports the [unintelligible 00:08:08] constipation. It’s affected by this receptor system because of the local effects there. There are a lot of natural things that actually dock the same receptor system. We don’t know if they’re super antiviral, but some are. One is citrus, like zest. If you look at hesperidin, yes, that comes from lemon, lime, and other citrus, the zest part. There are other things as well too. Some are anti coronavirus. They’re also antiviral so we have a lot of natural products that can come against this.
We probably have been eating them all along and we see a big diversion. Not everyone gets the cold and flu during flu season, they don’t get the vaccine and they’re totally completely fine. We’re seeing the same with the coronavirus COVID-2 as well. Half of the people are completely asymptomatic, but then they still shed. Like enteroviruses, polio, other viruses, there’s a shedding that may occur in the biological fluids and even in stools. It’s detected even five weeks out. Recovery or asymptomatic stage, it’s found in the stools.
Our whole body is in parallel. We know that breast milk isn’t sterile. We are feeding our next generation bacteria for mom’s poop. They travel up through the lymph, from the gut, through the limb into the mastoid tissues, and they get secreted in breast milk. This is how we protect our babies that have zero immune system. They have no antibodies.
Ari: It travels from the gut through the lymph to the breast? Really?
Dr. Liu: Yes. Many years ago, we’ve discovered that. That’s why breast milk is awesome. There’s a lot of carbs in it. It’s a low carb food but these carbs are indigestible by human pancreatic enzymes and our gastric acid. They’re for the flora. They’re fertilizer for the flora because the baby has no immune system. Only mom’s immunoglobulins and the baby’s born leaky. This is a good thing so mom’s immunoglobulins can IV through the gut, intravenous because there’s only one layer that separates baby, the guts, small intestines, and the bloodstream.
Mom’s IgG’s go in, protect the baby and then the moms building its wealth. I call it the gut profile. If the baby doesn’t have Bifido because babies are supposed to be full of Bifido, if the baby doesn’t have butyrate producers and other protective flora, guess what happens? Baby dies. In spite all of the efforts, conception, nine months carrying this baby and mom’s loaded, she’s got iron and all the nutrients to also breastfeed the baby for the next three years after that. Its brain will continue to double. It’s born with a soft brain and it will continue to double. How do we nourish all that and keep the immune system strong so it doesn’t die from all the microbes that live on her?
A lot of things hardwired for us and they’re all in parallel. It’s when we disrupt this, then we get huge deaths, pandemics, and problems and we’ve done that to ourselves. Antibiotics, hyper hygiene, super sanitation, and Clorox everything, never go outside. Don’t go into the forest, don’t touch the soil, don’t eat tongue [unintelligible] fork to farm, farm to fork, don’t support the local farmers.
The role of the ACE2 receptor in the development of COVID-19
Ari: Maybe we can come back to that point about excessive hygiene, I think that’s an important topic we could delve into. You mentioned the ACE2, and specifically, how this COVID-19 is binding to ACE2. Not all infectious microbes work through that receptor, right? Do all flu and cold viruses work through the ACE2 receptor or [inaudible]?
Dr. Liu: I don’t think any do, but I’m not an expert on the flu viruses and other viruses like RSV or metapneumonia or the other common viral viruses that cause cold and flu. It’s very unique.
Ari: I have seen some other research showing that, for example, probiotic supplementation can decrease the risk of respiratory infections that are non-COVID-19 respiratory infections as well. Do you know what mechanisms that, that might work by, aside from how they may interact with the ACE2 receptor?
Dr. Liu: I work with a lot of athletes. We work with executives and a lot of really smart moms and we reduce brain fog, body fat, and fatigue in six months or less. With a lot of athletes, they get sick prior to they’ve been training or they’re in camp and then they do their event. Sometimes it’s an endurance event, they get really ill. There’s a lot of probiotics that show protection against flu, upper respiratory infections, asthma, even diarrhea because they’re turning all their adrenaline system, everything gets loosey-goosey. Probiotics help a lot.
The studies aren’t perfect, some don’t show any benefit. I think it has to do with the dose a little bit because again, if our immune system is 80%, 90% in our gut, just like a poison is dose-related, a lot of benefit we’re seeing is also just really good probiotics. That’s what you see with an FMT– I don’t know if your audience is aware of what FMT is, fecal microbiota transplant. Poop pills or infusing poop pill, it literally saves lives for those who are susceptible to certain infections like Clostridium difficile from a hospital of [unintelligible]. It literally will save lives but it has to do with the dose probably and the species there.
Ari: You mentioned, I think, in passing there, there is some specific research around the use of probiotics or certain bacterial strains in the context of specifically COVID-19 or coronaviruses in general?
Dr. Liu: There’s a number of lactobacilli that was shown for pig coronavirus protection. Many are just common lactobacilli you find in a lot of different probiotics. We have also probiotics and some strains are found in here. Also, L. Plantarum is seen to be really helpful. Lactobacillus Plantarum is found in sauerkraut, fermented vegetables, fermented carrots, onions, garlic, kimchi, things like that.
They’re all around us, we just may not be able to anchor a lot of it. Studies show engraftment of good probiotics happens, it has to do with the host. What I see for our clients– because we do gut testing. I really believe in testing not guessing. A lot of people think they’re healthy but then we pull organic acid test or a stool kit and I’m like, “Wow, I don’t even know how you walk around.” There’s a bankruptcy of good gut flora, can’t count any Bifido in there, no Akkermansia, I call them ABCs, Akkermansia and then Bifidobacteria longum, and then butyric producing Clostridiales. Literally, every centenarian that has a microbiome study, they have it as well.
Ari: What specific gut test do you like because I know, there’s a variety of them out there? I’ve heard many mixed opinions, let’s say, from functional medicine practitioner friends of mine, who say, “This test is not valid. That test is not valid. The Viome stuff is nonsense. The uBiome stuff is this,’ or, “This test from this company is not valid,” or, “There’s different– You can’t really gauge it because the amount that’s being shed in the feces is not necessarily a great reflection of what’s actually going on inside of the gut.” There’s various takes on the situation like that. I’m just curious what specific test you prefer and do you think it’s really an accurate reflection of the microbiome? Are there any caveats in how you interpret that finding?
Dr. Liu: Yes, actually, I trained coaches and clinicians on how to read and interpret and the protocols that go with it, so I totally agree. We’re in the sort of dark ages of gut testing. We really want to look at the small intestines which is, when you look at surface area that’s more than our skin, even it’s as large as a tennis court. It’s hard to assess that. The way I love to assess that is looking at urine because what gets shed from the small intestines goes into blood and then we screen it through your kidneys so it goes into urine. Also, it’s non-invasive, we can do it on children, and in the opposite spectrum in any time. Just take the first-morning urine [unintelligible 00:16:23] ship it in.
It’s an amazing organic acid test. I read it with a little more comprehensiveness than even the lab company, Great Plains. When we see even one marker above the one-fifth range for a fungal output– They have nine markers for fungal output and then three markers for oxalates. Oxalates are very important. Oxalates come from our diet like green leafy kale and smoothies like that. They also come from mold and fungal overgrowths, which everyone has.
That’s a problem with COVID-19 and the progression to ARDS, respiratory problems and pneumonia and death because there’s bacterial overgrowth and fungal overgrowth. That’s what kills people and then the cytokine storm. We can see that actually on an OAT. Actually, on my first conference for microbial medicine, I had 50 practitioners, everyone got a free OAT kit and we got most of the results back. Everyone had a fucked up OAT. I’m sorry, I don’t know if I could talk like this, but– [crosstalk] Then the history–
Ari: Everyone had a messed up OAT.
Dr. Liu: Very much. The ones that had overcome cancer or two or three autoimmune problems, they still had a messed up OAT.
Ari: Got it. You mentioned something in passing there, you said everyone has fungal or mold overgrowth. I guess I have two questions there. If everyone has it, how can it be viewed as abnormal? Is it truly–?
Dr. Liu: It’s our norm. I think it’s more our norm now because we’re in the Western world. Europeans, to me, don’t seem to have as many issues as we do, but we’ve had antibiotics here 50 years before Europe. We had herbicides, pesticides, and glyphosate 50 to 100 years before other countries have. We have so much deep damage, just like hyper hygiene and other issues, C-sections, Pitocin. Every Pitocin dose comes with usually an IV antibiotic dose as well. We have had generations of damage before others and it shows up.
When I used to be a pharmacist, we used to counsel women on their little antibiotic, whatever it was for like “Hey, if you get a yeast infection–” We had to literally warn every woman that got an antibiotic, “Go talk to your doctor about getting an antifungal or antifungal care. It’s so inherent and common. When we look at the right studies, it shows the same thing as well. It’s [unintelligible 00:18:44] that component. It makes it hard to address because fungal cells are eukaryotic-like ours. We used to joke around some of the best or antifungals are also really toxic. Amphotericin is one drug that we used to call it Amphoterrible. Literally, every drug class that’s antifungal is also super toxic as well, causing widespread liver problems, liver failure, and multi-organ problems and other problems.
Our cells are so similar. It’s hard to have a good approach, that’s why botanicals are helpful and good. It’s really great because a lot of antivirals are also antifungal. When a plant which cannot move around is trying to defend itself from marauders and pathogens, guess what? A lot of the secondary compounds or I don’t know if you’ve heard of endophyte fungi that live inside stem and cells and plant cells. They’re like microbiomes, but these are like super guardian angels. They also secrete secondary chemical compounds that protect the plant as good as its own cells but they’re awesome. The compounds are antiviral, antifungal, antibacterial at low, low levels. You don’t need a lot. They’re very targeted. Low dose goes a long way.
How lifestyle and stress plays a role in gut-health
Ari: Got it. Is there any other aspect of this gut immune relationship that is worth talking about? One thing is actually–
Dr. Liu: Absolutely. Yes. Lifestyle changes and stress levels. Like when we’re stressed, we don’t make oxytocin. Guess what? Our gut and our lung epithelium is going to start getting leakier faster. They just like play on periphery.
Ari: Interesting. You mentioned also something in passing earlier that these bacteria can train our immune system.
Dr. Liu: Yes.
Ari: I’ve also heard there’s some interesting data I think that’s come out on even dead bacteria. Like it may not even be that important whether the bacteria you’re consuming, for example, as probiotics are even alive or not and whether they colonize the gut for example, but even dead bacteria that’s consumed can create some effects locally in the gut or in training the immune system. Can you talk about that a bit as well?
Dr. Liu: Absolutely. Absolutely. There’s a Russian strain of Lactobacillus rhamnosus, which we’re practically 50% Lactobacillus rhamnosus is in our different [unintelligible]. I tried to emulate a lot of really great formulas out there and studies show even when it was dead, it had the little like cell membrane parts or who knows? Like other cellular parts inside it, it would stimulate the immune system to improve health to be resistant against infections and every manner of health. I prefer alive, and that’s what some of the studies are when they have a [unintelligible]. These are like live bacteria, they’re secreting a bunch of– a chemical known as antimicrobial peptides, AMPs. These are powerful.
But studies are showing even when bacteria are dead, like the lactobacillus rhamnosus strain I was talking about, some part of the cell wall or other parts of it literally bind to certain parts of our immune system and turn them on in a good way. In a very good way. We’re hard-wired to have good bacteria, whether they’re dead or alive, to work synchronously with our bodies. We’ve been like this for millennia, like since the first cell. Our bacteria can do a lot. I don’t think it’s everything. We have a toxic burden now. People even have metal toxicity or other toxicity. Those all eke away our resources–
I did a keynote for the American Academy of Environmental Medicine. It turns out our cell wall of a strong probiotic, like our Bifido [unintelligible] a lot of the strains in here were studied. They literally are like resin binders. We have mold issues, people use all these resin binders, charcoal clay things. Literally the cell walls of Bifido and lactobacilli strains, like the ones in here are ionic resins that combine heavy metals. The study show even they bind glyphosine herbicides and they literally will take them out of the system. They bind mycotoxins as well too. A lot of people would take probiotics. They tell me, “Wow.” Especially ours at a high dose, they feel calm for the first time. If they had mold, they’re starting to actually change things because Bifido literally will bind mycotoxins in vitro, in a petri dish and neutralize them. Now it’s so toxic.
Ari: I’ve had many conversations on the microbiome and on probiotics and I have never heard that before. Very interesting.
Dr. Liu: I’ll send you my slides. Yes, they’re fascinating. Our little babies, when we don’t have them it’s literally like a bankrupt wealth portfolio. How is someone going to retire and live and not be homeless? You’re pretty fucked. That’s like our gut to our health and our immune system. We can do everything we want, take lots of fiber as well. You can’t resurrect what’s not there. That’s why some people’s guts are like. they’re bankrupt. They may look super healthy on the outside, but if you drill down, they’re anxious, they’re paranoid something’s off. They’ve got three autoimmune problems, still can’t eat whatever, whatever foods. I mean, people should be able to eat gluten and dairy. Literally, in two or four weeks [unintelligible], they’ve reversed half the food allergies.
That’s how powerful our immune system is. We’re not supposed to have reactions to whatever we eat or put it on our mouth. Only happens when there’s hyperpermeability and the depletion of the good flora that regulate immune responses. They shouldn’t be going, “What the–?” Ask everybody about the food. They should be calm and happy and digest the food. When we are depleted of those good flora, there’s a lot of problems that happen through hyperimmune responses to gluten, dairy or even like flax or egg whites, egg yellows. These are unnatural. We can normalize these reactions. It’s not that hard at all.
The difference between live and dead bacteria
Ari: Very, very interesting. You mentioned something there in passing that I think is worth digging into. You made a distinction between alive bacteria and dead, and I think in the context of even your probiotics, please correct me if my interpretation is wrong, but I think you mentioned that in some of your probiotics you have some species which are dead and some which are alive. Is that–?
Dr. Liu: No, no. I love our probiotic. We actually stuffed it four to eightfold higher on a lot of the strains. At the time of shipping, it’s four to eightfold higher than what’s stated on the label. There’s natural degradation. Most companies, others [unintelligible], in our industry, usually it’s like 0.5 or 1X more a doubling. Rarely do people go 4X, 8X, to stuff on because there is loss with travel and shipping and storage. But these are all–
Ari: You’re talking about the viability of the bacteria that they’re alive, but over time they will die just if they’re sitting on a shelf. Right?
Dr. Liu: Right. Right.
Ari: Okay. But you mentioned something in passing that was a distinguish between alive and dead bacteria. Are you saying that there’s some probiotics on the market that are dead bacteria?
Dr. Liu: Our spore-based are not alive. If you’ve heard of microbiome labs, they’re MegaSpore, or Enviromedica, their Terraflora. I mean, there’s so many fantastic spore-based probiotics. Clostridium butyricum. It’s a good clostridium. They’re spore-based, so they live forever. UV light, heat and cold won’t destroy them. Literally we find them in the bellies of bees through their [unintelligible 00:26:16]. You can open them up, open their bellies, they’ve got spore-based probiotics in there. You can literally bloom them. They can come back to life. Spores are amazing, but they’re not alive. We can regenerate them. In our guts they make spores and then they bloom, so that goes on throughout the whole GI tract.
Ari: For people who may not understand this, what is a spore? It’s not alive, but it colonizes us and then does it become alive at that point?
Dr. Liu: They’re like seeds. There are certain kind of bacteria that can lay an egg. It’s called a spore and it’s very resistant to everything.
Ari: What does it do? Does that spore do–?
Dr. Liu: These are called probiotics. Spores don’t do much as far as I can tell. I think I saw one or two studies spores might do something as they’re on the way out, but they bloom at some point and then they become real viable bacteria like a live probiotic. They’re great because you can ship them room temperature and can store them forever on a shelf for literally decades and decades and decades with no loss on viability.
Ari: Got it. I was talking to a friend of mine yesterday on probiotics, Dr. Michael Ruscio. He breaks things down into three different categories. Category one is lactobacillus and Bifido probiotics. Category two is Saccharomyces boulardii, and category three is the spore-based probiotics. He talks about it from the frame of each of those categories has distinct and different benefits, and recommends– He’s not saying one is better than the other. He’s saying they’re all good. They’re all useful. I’m just–
Dr. Liu: There’s many categories. There’s more than that, and probably I would say seven. Here’s one called Equilibrium. It’s 115 strains. It actually has the butyrate producing new bacteria. It’s part of the bigger part of the clostridiales that I talked about. A lot of people with gut issues, they don’t butyrate. You can eat kilos [unintelligible] you won’t get the butyrate. That’s a myth. I love also coffee but you won’t get enough butyrate. You have to get it from your bacteria and by giving them fertilizer then they produce it for you.
Dr. Liu’s practical guide to probiotic supplementation
Ari: Okay. In terms of a practical guide to probiotic supplementation, what do you think are the big principles of how to do that?
Dr. Liu: Okay, there’s three I’d go over. One is this [unintelligible]. Not every probiotic is good for human, meaning they don’t produce benefits. What I’ve seen is because we do massive testing. We do do IgG panels and panels on people to see really what’s going on. We have different levels of detection compared to the parent labs actually. What I see across the board is everyone’s got deep dysbiosis. Even every one of my colleagues that I look at their gut problems. I mean that is why they usually go into functional medicine coaching. They started off with the problems and they wanted to get better.
But what I see is, there is a lot of strep in people’s guts. When strep is present at toxic pathogenic levels, that means they are depleted for the good stuff. The butyrate producers, Bifido and lacto. There’s actually good Bifido and good lacto. Study show in [unintelligible] you got the bad lacto and Bifido in abundance and they’re in the wrong place and too high of an abundance. They’re usually the sugar and starch-eating ones. We don’t need a massive amount of those. We want actually the mucus-eating bifido and lacto, the ones that are right up against our mucosa lining and they eat [unintelligible] and they eat really gooey, cook-resistant starches and eat mucin and mucus.
It’s a whole different category. It’s whole grains, just the oligosaccharides and whole grains. Raffinose oligosaccharides and beans and lentils. I studied for two years as an undergrad. [laughs] We were trying to GMO it out but they’re actually really important. These oligosaccharides in plants actually end up as being anti-freeze. It keeps the plants from freezing during all the Ice Ages but they’re good for our gut. They’re gooey. They’re like our mucus. They [unintelligible] good Bifido and lacto. When you’ve got an overabundance of Bifido adolescentis and Bifido animalis and starch-eating ones, you know the gut’s messed up.
You can look at a profile. It’s just like stock. You want to get Walmart’s stock and you like it, it’s doing well [inaudible]. Okay, you know it’s good. But if it’s not dividend-producing, you’re bankrupt. You’ve got not-so-great stock that’s actually stealing your money and lowering your overall portfolio. You can look at the gut. There’s ways to actually look at that. That’s what we do for clients. We’re so grateful we have all these tools available for us. The first thing is it’s a lot of strep. Cheap probiotics like VSL#3, they’re full of strep. We see problems with them all the time. Everyone has strep antibodies at some point or they have high strep.
Ari: Explain what that means for people who– [crosstalk]
Dr. Liu: We can do a Neural Zoomer. We can see how suboptimal people’s antibodies are to bad flora in the gut. At one point, I actually had chronic fatigue. When you dig into the chronic fatigue literature, people with chronic fatigue have very bad guts. Then, they also have antibodies to flora in their gut, even the good flora. Antibodies means they hang around. They’re not necessarily bad but what studies for chronic fatigue show that, if they lured these antibodies with gut-healing modalities like fiber, probiotics, some zinc, quercetin, things like that, NAC, just like our antiviral protocols, they would lure these antibodies. The degree of luring these [unintelligible] antibodies was to the same degree as the improvements in chronic fatigue syndrome symptoms. We see this across every condition, whether it’s inflammatory bowel disease, or Hashimoto’s, or cancer.
We can check anti-strep antibodies. Cyrex Labs offers it, Neural Zoomer offers it. But I have a different– A lot of people don’t check the total IgGs either. If someone’s immunocompromised, like a lot of our gut dysbiosis people, even the hemoglobins are lower. You have to calibrate it. Some labs will do it for you like Neural Zoomer will do it for you for free if you ask for it. A lot of people have these low levels that shouldn’t even be there of anti-strep antibodies. They also have– We do a cheap panel called IgG for Great Plains. Everyone has saccharomyces antibodies. Either low levels, which is suboptimal, or really high levels.
Ari: Is that saccharomyces cerevisiae?
Dr. Liu: Cerevisiae, but there’s cross [inaudible] reactivity. Just like if Sue was allergic to gluten, do you go feeding all day or even bourladii, which has some gluten in it. No. Right? No one should be taking S. boulardii. I don’t care what the fucking studies say. In our patient population, you have this elevation which is nearly everyone now. It’s literally everyone. Unless you test, you don’t know. I know there’s good studies with S. boulardii, it’s even anti-fungal. I think it’s BS. They’re not the patient population that we currently see in functional medicine that are pretty ill at many, many levels. We’ll eventually see triggering for people who are on these products. I had one IBD client. [crosstalk] Now, he was taking it [inaudible].
Ari: It’s typically Saccharomyces boulardii.
Dr. Liu: I feel like it. Yes. It depends on the dose. Same with strep too. There’s a lot of strep lozenges. There’s strep. Really high doses. It’s the number-one ingredient in VSL#3. You’d see a lot of people trigger for eczema and other skin disorders, and other things. Initially, they felt better because, for once, they finally got good Bifido and lacto at a high enough dose. Clearly, we’ll do a trillion of this a day and we see amazing shifts if they can tolerate it, but not everyone can tolerate it. Sometimes, when they have anti-strep antibodies, they may even have anti-lactobacilli antibodies. That’s a small percentage of our practice because people are really ill.
Ari: It’s strep what? What species?
Dr. Liu: Salivarius is a probiotic. Thermophilus is the most common one. It’s a super cheap dietary probiotic found in yogurts and probiotics that are probably a little substandard. In theory, in my opinion.
Ari: It’s a common species that is found in the oral microbiome. Isn’t that correct?
Dr. Liu: Yes. You don’t need a lot. If you have an immune reaction to it, you just don’t want a lot of it to get triggered, until your body’s healed and the immune system is calmed down. We can check IgGs to look at what the immune system is– What’s going on. We can also check a CytoDx test now. It looks at cytokines, like IL-1, IL-2, IL-10, IL-6, and TNF alpha. It’s really great to check all these if people are interested in doing it.
Ari: Now, are there any safe strategies as far as probiotic use that are pretty much, with few exceptions, safe across the board for most people?
Dr. Liu: Everyone’s really different and their immune tolerance is different. I’d say it’s really hard. You want to try a low dose of something, and then, gradually up it if there’s no problems. You don’t have to test everything. Sometimes, if the IgGs are low, total IgGs are low, it’s hard to see, really, what’s going on unless you to just test it out. The second thing–
Ari: The lactobacillus and Bifido species, for example, are– A probiotic based on those species is not going to be, let’s say, almost universally beneficial. You’re going to see 50-50.
Dr. Liu: They should be.
Ari: 50% of people are going to [crosstalk] or something?
Dr. Liu: No. 80%, 90% tolerate really well but there’s a lot of keto leaders, I’ve looked at their guts. Some can’t tolerate a probiotic. They can’t tolerate any probiotic. They may poop blood or green mucus. They’re triggered. They have to look at more what’s going on with their immune system and co-infections.
Ari: Do you find that keto diets are reliably messing up people’s gut microbiome?
Dr. Liu: If they’re not messing up the gut microbiome, they’re definitely messing up adrenals without carb cycling.
Ari: Got it.
Dr. Liu: Doing cross-fit with fasting is one of the worst ways to ruin the adrenals and lower total testosterone. Once you lower total testosterone, you’re fucking your gut. You cannot be anabolic enough to regrow your gut. We regrow our gut every 72 hours.
The link between testosterone and anabolism and how it relates to gut health
Ari: Explain that. Explain the link between testosterone and anabolism and how that relates to gut health.
Dr. Liu: There’s an Australian study that came out a few years ago. They were looking at testosterone. They took really healthy, young German dudes. They were aged 18 to 40 or something. They injected them with a bunch of really [unintelligible] 0.8 nanograms of LPS. LPS is a polysaccharide, a cell wall of really nasty gram-negative bacteria that tend to overgrow when we have a depletion of good stuff. They instantly saw, within six hours, a really big drop in their testosterone. But the really healthy dudes, within a few hours, everything normalized again.
What I see in men, a lot of them report to me they look really healthy on the outside but no morning wood. Some of my friends, my guy friends, have said like, “Oh my God, none of the guy friends they know under age 40 have morning wood every day.” Persistently everyday like a healthy dude. When we heal the gut, we do– Even the anti-virals because a lot of them are anti-fungal. They’re good gut protocols. Then, we do really good probiotics and some anti-inflammatories. Within a week, everyone’s morning wood is back again.
We also do a little bit of estrogen blockers. When there’s a lot of stress in the system, in the gut, it causes [unintelligible] to go nuts. People also are converting that, for men, the tea into a lot of estrogens that they don’t want. Some of these estrogens are carcinogenic. You can check it on a [unintelligible]. We see all of these cut in half or completely normalized with gut protocols.
How to heal your gut
Ari: Interesting. Take me through– Having said this is personalized based on a person’s testing, what does this approach look like to gut healing if you could map out the general framework of how you do this?
Dr. Liu: We teach the three R’s at The Gut Institute. One is you have to look at root issues. Everyone’s root issues are different. Some people worked at the dry-cleaners. They got tons of chemicals onboard. Or they work on a golf course so they got tons of [unintelligible]. Everyone’s toxic burden is a bit less. One, other people have gotten the flu shot every freaking year. They’re just full of heavy metals and maybe they have one or two fillings as well. Everyone’s root issue’s different. Some people have just genetic [unintelligible]. They’ve had a perfect diet but they have every genetic variant for the gut and for calcification of oxalates so they’re pretty congested and all their [unintelligible] and terrain is all calcified.
Everyone’s root issue is different. We look at that. The genetic blueprint. I know you like blueprints. I’ll look at the mitochondria because a microbiome literally is our mitochondria. Mitochondria used to be a bacteria, gut bacteria, [unintelligible]. Second is to recolonize the terrain. Nobody has good terrain. Not even me. I still slip when I’m [unintelligible]. Too much not-great food and not working out. Recolonizing. That’s a constant thing. If you have slips and then it’s something you have to work on, or if you had a lot of antibodies. My dad’s a surgeon. We got every antibiotic [unintelligible]. 20 million. I’ve had problems for a while. That recolonization–
Ari: Because your dad’s a surgeon, he was just throwing out antibiotics everywhere.
Dr. Liu: Every fever, every sniffle, every cold. He thought he was doing the best but my parents are super healthy. He’s on the front-line. Still working. He’s 80. No COVID-19 for him. My siblings and I, we all developed an auto-immune problem. All four of us at a very young age. Yet my parents are super healthy. They grew up dirt-poor. Licking dirt off of every surface and no running water, no toilets. Recolonizing is really important. You have to look at some medicines and diets, prebiotics, probiotics.
The third is resetting the rhythms. So many people I talked to them, their body temps are like 95.0. There’s no way you’re going to eradicate a virus at a body temp of 95.0. We are mammals and 98.6 Fahrenheit or even higher, like Dawson dogs I know are even higher because that’s where we shed the great majority of pathogenic microbes. Our bodies kept that, not just metabolism, that energy blueprint, but it’s also to keep the microbes away and to keep our fetuses strong. That rhythm is really important. Looking at the Dutch, looking at [inaudible] cortisol, looking at metabolized cortisol, looking at testosterone for men and for women, we look at progesterone.
Ari: Got it. Are there any probiotics? For example, any probiotics that you sell under your brand that you would recommend to people listening to this without hesitation even if they haven’t been tested for anything or does everything revolve around the testing?
Dr. Liu: No. I’m pretty agnostic to probiotics. I think they’re all fantastic. Unless you’re healed stay away from S. boulardii and strep containing probiotics. But Bifido Maximus is a really great value. It has millions of doses that look like if you’re only interested in 20 billion a day, it’s got millions of doses in here and it lasts forever. For those who need more, it’s almost like an FMT when they can do five scoops a day like really healing. I had to do a higher dose. But it’s good to get variety. I call it the probiotic grade, we put all our clients on it. It’s rotating out different probiotics. Once you’ve gotten in a probiotic daily for about a week or two, you can start rotating it once or twice a week. Studies appear to show they’ll stay anchored if there’s regular normal diets.
Ari: What does dosing look like because there are probiotics on the market that are everything from 100 million CFUs colony forming units to 40 or 100 billion CS?
Dr. Liu: Spore-based probiotics tend to be like that. They’re more like 400, 500 million, not even close to a billion right or if they’re like 1 billion. When you look at the profile, we don’t have a lot of Bacilli spore-based Clostridium in our gut. They’re all under 0.5% 0.1%. When we talk about Akkermansia, when we talk about Bifido and lacto, we’re looking at– and the eubacterium that’s in here. Eubacterium and other butyrate producers, they’re up to 50% of our guts. Then for Bifido and lacto they’re more like 1% or less and then we look at Akkermensia, it really for a healthy person and for longevity people, centenarians who are chronic disease-free and cancer-free, they’ll see numbers of 1% to 5% of the whole profile. We don’t have a probiotic yet but you can do inulin and a lot of fiber and prebiotics and can grow Akkermensia pretty easily.
Ari: Very nice. Again, so which specific supplements under your brand-
Dr. Liu: We have something called Bifido Maximus and then we have a couple bundles so people can do upgrade. Studies with all the probiotics that are in the gut. Another one is known as Bacteroides. We don’t have probiotic with that right now. But Bifido and Bacteroides, they are an ecosystem. They self-feed each other when there’s not enough mucus around or maybe between meals. They even secrete something known as EPS, Exopolysaccharides on the outside of their cell membranes, so they can literally feed other bacteria in the gut even if we’re not eating all the time to feed them.
Ari: Very, very nice.
Dr. Liu: Yes. It’s amazing to look at the ecosystem of the gut because that’s how it can give us the best resilience I feel during this COVID-19 time.
Ari: On that note, could you wrap up maybe with three big key takeaways of everything that you’ve covered? The three things you want to leave people with as far as gut health and immune health and especially in the context of this COVID-19 stuff.
Dr. Liu: Absolutely. First is keep your hormones strong. Do the proper adrenal things, laugh with your friends, even see them on Zoom. I think our mental health is so important. Not being hard on ourselves, loving ourselves, even our shadows because any negative thoughts– even about what’s going on will impact our gut, the microbiome won’t like it. Second is movement. We’re not totally stuck in our houses yet. Get out, breathe in the air forest because you’ll get great antidepressants but you also get soil bacteria. You don’t need a probiotic. Literally, you’ll save hundreds of dollars. Just go breathe in some forests and green areas. Then third, just look at the gut. There are a lot of– I did a series on Facebook, so I’ll send you the link. There’s so much more we can do to have great regulation of our antiviral defenses during this time. We might need it all.
Half of the people are asymptomatic with exposure. It’s a super contagious virus. Not very lethal compared to other pandemics, but super infectious and half the people are super asymptomatic, no signs or symptoms at all, but they’re shedding. Social isolation, that distancing is important.
The other half get symptoms and they may be hacking their lungs out, they may be progressing to respiratory failure and just having even permanent lung damage with no prior lung issues. This is something that’s going to stay with some people just like we have other viruses that stay in our systems that wax and wane like Epstein-Barr. Really important gut and viral defense is really important. That’s what we do. We do a lot of that to lower chronic activation of many viruses, CMV, HHV-6, Parvo, even HSV 1 and 2. Every virus out there starts to become a problem when we lose our firewall. People have had antibiotics and hyper hygiene. If you’ve lost your firewall, you need to consider these things. You’re not going to probably die from COVID-19 but it’s those other things.
There are different things people can do. That one thing is SPM resolvins. These are lipid mediators. They come in a supplement form. A lot of NFL and other athletes have been using it for a while because they help recovery of all injuries, really quick. They also help for asthma and pulmonary disease and also viral and secondary bacterial infections and other things. We use it in all our colitis clients– all our clients actually.
When we’re in a parasympathetic nervous [unintelligible], we make a lot of resolvins. When we’re stressed or worried we don’t. Meditation prayer and all that are awesome because they will increase that [unintelligible]. People who are in pain have very low levels of resolvins in their body. You could take all Omega-3 you want ,you won’t make. It’s supposed to convert from EPA-DHA the Omega-3 but people aren’t going to convert when they’re in a stress situation. You can also be in a stress situation when your guts are messed up. That’s when I think testing and not guessing is super helpful or take one of our classes now to get the gut a little healthier. But resolvins are really helpful. They’re shown to really abort a lot of this progression to cytokine storm or respiratory [unintelligible] and a really safe very [inaudible]. Almost no contraindications I can find and that will be really awesome. You can check it out.
Ari: Wonderful. Dr. Liu, thank you so much for coming on the podcast and sharing your knowledge with my audience. If somebody wants to work with you or follow your work, where’s the best place to reach out to you?
Dr. Liu: Thank you so much for having me. I’m at thegutinstitute.com Just reach out to me there. Thank you.
Ari: Beautiful. Thanks so much, Doctor Liu.
Dr. Liu: Thanks, Ari.
The gut-lung axis and the gut-immune axis and why they matter (1:43)
The role of the ACE2 receptor in the development of COVID-19 (11:33)
How lifestyle and stress plays a role in gut-health (19:49)
The difference between live and dead bacteria (24:30)
The link between testosterone and anabolism and how it relates to gut health (36:46)
How to heal your gut (37:51)