385 | Health Tips to Maintain a Healthy Gut Microbiome, Prevent Colon Cancer and Reverse Aging with Dr. Roshini Raj

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

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[00:00:53] In this year coming up, I'm ready to give back to my body in a way that I usually don't, which is working on your mobility, working on your breath work, working on your core stability, working on those muscle activations that are going to help you to feel better when you're doing those crazy workouts outside.

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[00:03:12] Up on the podcast next, we have Dr. Rashini Raj, who is an MD, is a graduate from Harvard College and NYU School of Medicine.

[00:03:21] Now, this was probably one of my favorite interviews, especially talking about gut health and so much more.

[00:03:27] So you're going to want to listen to this and then pass it along to other people.

[00:03:30] I'm telling you.

[00:03:31] She's a board certified gastroenterologist with an active practice and holds a faculty position

[00:03:36] as associate professor of medicine at the NYU Grossman School of Medicine.

[00:03:41] She has a successful second career as a television personality and medical journalist.

[00:03:46] In 2015, Dr. Raj founded Tula Skin Care, a probiotic-based skincare line sold through Ultra Beauty,

[00:03:54] Neiman Marcus, Nordstrom, Tula.com, Amazon, and QVC.

[00:03:59] Her most recent venture, Yay Day, is a digestive super supplement formulated with magnesium, fiber, and enzymes

[00:04:07] designed to help those who don't get enough fiber in their diet with better sleep and digestion.

[00:04:14] Dr. Raj appears regularly as a contributor discussing a range of health topics on shows,

[00:04:19] including Today, Inside Edition, Dr. Oz, and Rachel Way, and networks such as CNN and Fox News.

[00:04:26] Dr. Raj has also appeared on many other programs and channels, so many to name,

[00:04:33] and she's the contributing medical editor of Health Magazine and is quoted frequently in national publications.

[00:04:39] And Dr. Raj is the author of What the Yuck, The Freaky and Fabulous Truth About the Body,

[00:04:45] and Gut Renovation Unlocked the Age-Defying Power of the Microbiome to Remodel Your Health from the Inside Out.

[00:04:51] She lives in Manhattan with her two sons, and this is such an incredible conversation.

[00:04:57] So get ready. There's so much to learn.

[00:04:59] And again, pass this along because you're going to want to share this episode.

[00:05:03] Dr. Raj, thanks so much for being with us this morning.

[00:05:06] We're actually really excited because we haven't gotten a chance to interview somebody

[00:05:10] specifically in the field of gastroenterology.

[00:05:12] So I think you're going to bring a new and unique perspective that our audience hasn't quite heard yet.

[00:05:17] I love it. I'm so happy to be here. And because I am, admittedly, I'm a little biased,

[00:05:22] but because I really believe that health affects every aspect of your health,

[00:05:25] I'm really excited for your audience to join this discussion today.

[00:05:29] So I want to know a little bit about your background too, because getting into, you know,

[00:05:34] becoming an MD and getting into gastroenterology, first of all, what made you want to go down that

[00:05:39] particular route? And then how has it expanded to what you're doing now?

[00:05:43] Yeah, it is a bit of a convoluted story, but I'll keep it brief. So I am the, I live in New York,

[00:05:50] born and raised here. So I'm definitely a diehard New Yorker. I am the only child of two doctors.

[00:05:57] So definitely medicine was always in my consciousness and pretty much knew that's what

[00:06:02] I wanted to do since I can remember knowing anything. But I went to med school with an open

[00:06:06] mind in terms of which field of medicine. And, you know, in med school, you do different rotations

[00:06:11] through everything to help you decide. And I loved my surgery rotation. I loved the kind of immediacy

[00:06:17] of being able to see inside someone's body, potentially see a problem and even fix it right

[00:06:22] there. And then I found that very exciting, but I also really loved the part of internal medicine

[00:06:27] where you actually developed, you know, long-term relationships with patients. And I saw that with

[00:06:31] my own parents who my mom was actually a gastroenterologist. My father was a lung specialist,

[00:06:36] but they would have, you know, Christmas cards and they would have patients that, you know,

[00:06:40] for 10, 15 years who were like family at some point. So I wanted to have that as well,

[00:06:44] which I didn't really think surgeons, you know, experienced that. So I felt like gastroenterology

[00:06:48] was a happy medium between the two where we do do these mini surgeries. We call them procedures.

[00:06:55] And I spend a lot of time doing colonoscopies and endoscopies where I can literally look inside

[00:06:59] someone's body and see what's going on. But I also have my chronic patients who, you know, maybe,

[00:07:05] maybe they're coming every five years just for colon cancer screening and they're very healthy,

[00:07:08] but some people have chronic acid reflux or irritable bowel or Crohn's disease. And,

[00:07:13] and so I've never regretted the decision. I found it to be such a rewarding career,

[00:07:18] but I've actually taken some divergent paths away, a little bit away from clinical practice. And

[00:07:25] about 20 years ago, when I first started practicing gastroenterology, very randomly, I happened to

[00:07:31] encounter some TV people who wanted to do a TV segment on colon cancer. And that was one of my

[00:07:37] kind of passions and research interests at the time. I ended up doing a TV spot for them.

[00:07:42] And they really liked it. I really liked the experience. One thing led to another. And I have

[00:07:47] now over the last 20 years had a pretty robust career as a medical journalist and correspondent on

[00:07:53] several TV shows most recently, or most frequently, I should say is the Today Show. So that's been amazing

[00:07:59] and allowed me to also become the editor of a magazine called Health Magazine. And with them,

[00:08:04] I wrote my first book. And then I wrote another book recently called Gut Renovation,

[00:08:09] which is all about how your gut microbiome and your gut health affects every aspect of your health

[00:08:14] from head to toe. And we'll definitely get into that more. And then kind of because of that,

[00:08:20] in a circuitous way, I ended up becoming an entrepreneur and starting a probiotic-based skincare

[00:08:26] company because the microbiome has been a passion of mine for many years. So I started a skincare line

[00:08:31] called Tula, which is now 10 years old and very popular and successful, which has been great,

[00:08:37] great to see. And most recently, kind of going back to my roots a little bit, decided to co-found

[00:08:43] a new digestive super supplement. And what does that mean? Basically, this is, we call it the triple

[00:08:50] threat of prebiotic fiber, digestive enzymes, and magnesium. The magnesium is there for really the gut

[00:08:56] mind component because it helps with sleep and calming, which we know are so important for your gut health,

[00:09:01] as well as your overall health. And so wanted to kind of reinvent a pretty sort of stayed category,

[00:09:10] the fiber category that I think needed some fresh eyes and perspective and better ingredients,

[00:09:15] better taste, just more fun experience overall. So...

[00:09:19] Did I mention that it's almost baby number two time? Is that not just the craziest thing to think

[00:09:26] about right now? And I'm just, I'm so grateful for this pregnancy. It's been a very different journey

[00:09:32] from my first pregnancy, but I'm grateful for the support that I've had and the prenatals that I've

[00:09:39] been taking. That's been a huge part of feeling okay enough to work every day and to chase after a

[00:09:47] toddler during this pregnancy, even despite all, you know, the different body stuff that I've experienced

[00:09:53] is pregnancy. This is where Needed has been such a huge, crucial role from the time that we were trying

[00:09:58] to conceive to during pregnancy. And I know that they're going to be a part of my postpartum journey as well.

[00:10:03] And again, I just want to reiterate that Needed is a company that I sought out based on...

[00:10:08] I saw other people talking about them and I looked into what they had and I really loved the support

[00:10:14] that they have when trying to conceive and during pregnancy and postpartum. And I just realized,

[00:10:20] you know, this is a company that I want to use within my own body. And I would never talk about

[00:10:26] something that I don't use myself. I've used it entirely throughout the entire pregnancy and

[00:10:31] my trying to conceive journey. And I just have truly felt so supported in my body. I have not felt

[00:10:37] depleted when things have come up in blood work. I've been able to add one of their supplements in

[00:10:42] and it's been really cool to see the physical changes by adding something in that's been beneficial.

[00:10:49] So this is where I'm going to tell you, if you have not checked out Needed, no matter if you're in the

[00:10:54] pregnancy or postpartum journey, or you are just in a space where you're feeling like you're not

[00:10:59] getting the nutrients you need and you need a little extra support, Needed is good for the entire family.

[00:11:06] And Dom also takes their men's multivitamin because he realizes that it is hard to get all the nutrients

[00:11:12] that we need. And going with a company that doesn't just do baseline, but goes above and beyond and is

[00:11:19] really based on clinical research is everything, especially to us as doctors of physical therapy.

[00:11:26] So I'd highly recommend head over to thisisneeded.com. Use code OPTIMAL. You get 20% off of your

[00:11:33] first order. That is T-H-I-S-I-S-N-E-E-D-E-D.com and use code OPTIMAL. You get 20% off your first order.

[00:11:43] I think I've covered it all in a short time, but that's basically me in a nutshell.

[00:11:48] Yeah. And that's quite the journey. And all that it tells me is that you clearly have developed a

[00:11:54] reputation as a very trusted resource in this space of gut health with all of your connections with

[00:12:00] media and becoming the editor of a magazine. It sounds like people want to hear and appreciate

[00:12:07] the information that you have. And like you said, gut health, I think in general is becoming this

[00:12:13] more popular topic, but it also gets really convoluted as you know, with the immediate

[00:12:20] access people have to information. Not all of it is good information. And I'm sure that's something

[00:12:28] that you combat with people coming in asking you questions about what they hear online,

[00:12:33] what they see on the most recent TikTok or Instagram reel. So what is gut health? What should

[00:12:41] people be thinking of when they hear gut health or microbiome? And I guess after you answer that,

[00:12:48] what are just some of like the blanket things that you tell people can be really beneficial for

[00:12:53] general gut health? Absolutely. So you're right. Gut health has become the hot topic,

[00:12:58] I think of the last few years. It's only growing in popularity, both in terms of people wanting to

[00:13:04] learn about it and people creating products that are purported to be great for your gut health. So

[00:13:09] really important to understand what we're talking about here. I think when most people these days

[00:13:14] talk about your gut health and why it's so important, they really are referring in the most part

[00:13:18] to your gut microbiome. And so what is that? So first of all, what is your gut? When we talk about

[00:13:24] your gut, we're really talking about your intestine. So we have a whole digestive tract,

[00:13:30] which starts with our mouth and ends with our atus and everything in between is part of our digestive

[00:13:34] tract. But when we say your gut, really what that means is your small and large intestine.

[00:13:40] Your large intestine is also known as your colon. And so when we talk about your gut microbiome,

[00:13:44] that's referring to this community of trillions of bacteria and other organisms, like including

[00:13:50] viruses and things like that, that live inside you and you're born with some and you definitely

[00:13:56] accumulate a lot more as you age. And those bacteria, how do they exert their influence throughout your

[00:14:02] body? And you have good bacteria there and bad bacteria. And hopefully you have more of the good

[00:14:08] bacteria and you're in a nice balance there. Because when that's the case, your microbiome actually

[00:14:13] exerts very protective effects for your gut and for your body in general. So starting with what is it

[00:14:19] doing to your intestine? Basically, you have a lining of your intestine. And it's important because you

[00:14:24] know your intestine is a tube and it's holding food and bacteria and potentially harmful toxins, which

[00:14:30] are fine if they're inside, inside the lining of that tube. But if they can leak through and break

[00:14:36] through into your bloodstream, that can trigger inflammation throughout your body. And what your gut

[00:14:41] microbiome, one of its jobs is to really make sure that lining is intact and strong and healthy

[00:14:47] and not leaky and allowing things to leak through. And that's really the most sort of direct way your

[00:14:53] gut microbiome or your gut health can affect your overall health. Because we know once you start

[00:14:58] triggering inflammation, that can cause arthritis, that can cause wrinkles, that can cause heart disease,

[00:15:04] dementia. There's so many diseases that we know in all different parts of our body that start with

[00:15:10] too much inflammation in our body. And so that's one of the ways. But the other thing that also lives

[00:15:16] within your gut, in your intestine, as well as your microbiome, are things like neurotransmitters and

[00:15:23] hormones and immune cells. And so a lot of our immune cells in our body are actually located in our gut.

[00:15:28] And so we know the health of your gut microbiome and your gut overall can affect your immunity,

[00:15:34] it can affect nerves, it can affect mental health because of some of those neurotransmitters and

[00:15:39] hormones. There's also nerves that travel directly from your brain to your gut and vice versa. And so

[00:15:45] that can definitely cause this, you know, two way conversation that's constantly going on.

[00:15:50] We know that gut and mind is a very strong connection and each can influence the other.

[00:15:54] So yeah, I would say that's sort of the basic explanation of how your gut affects your body.

[00:15:59] Um, and you know, I've been looking at this for, like I said, I first learned about the microbiome

[00:16:04] about 20 years ago when I was just finishing up my training. So a little more than 20 years ago,

[00:16:09] it was a totally new concept before then we were like all bacteria or bad bacteria. You find a

[00:16:14] bacteria, I just get rid of it. And then we started learning. Well, no, actually there's some

[00:16:18] bacteria that you need. And if you don't have them in balance, other bad things can happen.

[00:16:23] But we were really still just thinking about it as digestion. Like, okay, if you don't have enough

[00:16:27] good bacteria, you might get diarrhea or you might get this certain type of colitis that we see.

[00:16:32] Uh, but over the last 20 years up to now, there's been such a huge explosion of research and evolution

[00:16:39] in our understanding of how the microbiome affects not just digestion, but like I said, everything from

[00:16:46] dementia risk to heart disease to cancer, you know, autism. There was a really interesting study

[00:16:51] that just came out looking at that. And so I think it's just, you know, we're just seeing the tip of

[00:16:56] the iceberg. And literally every day I see a new study showing a connection between your gut microbiome

[00:17:02] and some other aspect of your health.

[00:17:04] Which makes it so incredibly vital, but also really confusing out there to understand what to do to

[00:17:10] start taking care of our gut health. And I think you explained it so beautifully in terms of what

[00:17:17] the function is and what it does to help people like actually visualize that leaky gut, you know,

[00:17:23] that people talk about. Unfortunately, the way you explained, it doesn't fit well in a 15 second

[00:17:28] tick tock. So you're going to have to work. You're going to have to work on that.

[00:17:31] I know, I know, I need a good animator or something.

[00:17:36] No, but that was great. And so I want to like, what are some key takeaways that we can,

[00:17:42] how do we start reducing that inflammation that gets out into the body? Like, how do we make sure

[00:17:47] that that lining stays intact and, you know, the good and bad bacteria is staying balanced? I know

[00:17:54] that's probably not an easy question, but like, where do we start?

[00:17:58] It's actually not as complicated as you may think. Because, okay, so the goal is, like you said,

[00:18:03] you want to keep that lining intact. And as I was saying, the way to keep that intact is to keep

[00:18:08] your microbiome healthy and balanced, because that's their job. When they're healthy and balanced,

[00:18:12] they do what they need to do to keep the lining intact. So how do you make your good bacteria,

[00:18:17] happy? And it's, it's actually somewhat simple. I wouldn't say simple, but there are a few things

[00:18:23] that we can do very directly. One is you want to feed your microbiome, the things that they like,

[00:18:28] you want to feed the good bacteria, the things that they like, what they like more than anything

[00:18:32] is prebiotic fiber. And so what is a prebiotic? Well, first, what's a probiotic? A probiotic is a

[00:18:38] good, healthy bacteria. We have our own natural probiotics. And then there are supplements

[00:18:42] with probiotics. There are foods that contain probiotics. But a prebiotic is actually something

[00:18:47] that feeds a probiotic. So anything that fuels the growth of your probiotics, that would be

[00:18:53] considered a prebiotic. And prebiotics are always made up of fiber. So not all types of fiber are

[00:19:01] prebiotics, but all types of prebiotics are fiber. And this is part of what inspired me to start EA Day,

[00:19:07] that I really wanted to give people the best prebiotic fibers to feed their microbiome. So

[00:19:11] that's number one, you want to be feeding it the good stuff. And that means having a diet that is

[00:19:17] very plentiful, plentiful in fiber, which of course is mostly plant based. And then there are other

[00:19:23] things than fruits and vegetables that are actually great for your microbiome that are not necessarily

[00:19:27] prebiotics, but are antioxidants or polyphenols. And basically, if you're getting a healthy mix of

[00:19:33] different fruits and vegetables, you will be getting those those antioxidants as well.

[00:19:38] And then you can actually get probiotics themselves in your diet. So you can eat fermented foods,

[00:19:46] things like yogurt with active cultures, kimchi, sauerkraut, miso, you know, these are foods that

[00:19:53] actually kefir is a drink, you know, these are foods that actually contain a mixture of good healthy

[00:19:59] bacteria. So that's a way to kind of replenish and keep things in balance.

[00:20:03] Of course, you can take probiotic supplements as well. And that's something that if you're not

[00:20:07] someone who's good about keeping up with fermented foods could be an option. And then, you know, I like

[00:20:13] to start with the positive of what you should be doing. But there are also things that you shouldn't

[00:20:17] be doing to maintain a healthy microbiome. And so we know that ultra processed foods, for example,

[00:20:24] which is unfortunately, a large part of the average American diet, that's really directly toxic to

[00:20:30] your microbiome. And so people who have more of those, that kind of diet, really, when they examine

[00:20:36] their stool and examine their microbiome, it's a much unhealthier pattern of bad versus good bacteria.

[00:20:42] Alcohol is another thing that is really detrimental to your microbiome. And, you know, the big bad guy,

[00:20:50] of course, is antibiotics, which we know can really deplete your microbiome. And sometimes short term,

[00:20:57] but sometimes it can take a long time to recover and multiple courses, sometimes it's very, very

[00:21:02] difficult to recover. So while antibiotics do have their place and can be used appropriately,

[00:21:07] they should definitely be used sparingly when it comes to taking care of your microbiome.

[00:21:13] And then, you know, the reason I wrote a book called Gut Renovation is there are actually,

[00:21:18] the way the book works, it's a sort of a metaphor on renovating a house, you know, and each chapter is

[00:21:23] named after a room. So the bedroom is the sleep chapter, the kitchen is the diet chapter, home gym

[00:21:28] is the exercise chapter. And what I mean by that is, all of those things I just mentioned, sleep,

[00:21:34] for example, has a very direct effect on your gut microbiome. So if people ask me, what should I do to

[00:21:40] take care of my microbiome? Yes, we'll talk about diet, but you need to get a good night's sleep,

[00:21:45] because there are studies showing that sleep deprived, they did it on med students, which are,

[00:21:49] you know, notoriously sleep deprived people. And if they did a night shift, for example,

[00:21:54] for a few weeks, and really were not getting a lot of sleep, they noticed an unhealthy shift in

[00:21:59] the pattern of their microbiome. So these things have an effect. Stress is another big one where

[00:22:05] they look at people who are under chronic stress, or if they're depressed, and they can see changes

[00:22:10] occurring in their microbiome. And then there's also that bit of a chicken and the egg, because

[00:22:15] sometimes an unhealthy microbiome, they think sort of precedes a depressive episode. So,

[00:22:20] you know, these things are very interrelated. And I think to only focus on diet, if you really want

[00:22:25] to optimize your gut health is a mistake, because it's really pretty much everything you're doing

[00:22:29] can affect one way or another, what's going on in terms.

[00:22:32] I mean, I think there's so much there that, you know, we can go even to the next level on.

[00:22:37] And you kind of mentioned, towards the end of your answer, something that I was thinking of that

[00:22:41] how it's like, the chicken or the egg. And these things are kind of, these things are kind of feedback

[00:22:46] loops on themselves, even what you said about sleep, or diet, or mental health, like, they both affect

[00:22:54] each other. If we have poor mental health, if we have poor sleep, if we have poor diet, it might

[00:22:59] affect your microbiome. On the flip side, if we have a poor microbiome, or if we're already developing

[00:23:04] something like SIBO, like a small intestine bacterial overgrowth, it might affect your sleep, it might

[00:23:11] affect your mental state, it might affect what foods feel good to eat. And that's what I kind of want

[00:23:17] to ask about. Yeah. Because a lot of times, if people are having gut issues, they'll say it's

[00:23:23] really difficult to eat foods that are, you know, high in fiber. And they'll say, like, I can't eat

[00:23:29] the fibrous foods. They're telling me I need to eat more fiber. Every time I eat fiber, I end up on

[00:23:33] the toilet or with stomach pains or things like that. So what if somebody is already in a

[00:23:38] dysfunctional state with their, their gut health and their microbiome? How can they kind of work

[00:23:44] in the direction that you're talking about with the foods to eat?

[00:23:47] Yeah, well, I think, you know, that's a great question. And fiber, you know, one of the sort

[00:23:52] of downsides or the thing, the reason why people don't eat fiber or take fiber supplements, one of

[00:23:57] the big barriers is the bloating or discomfort issue. And that's extremely common. And, you know,

[00:24:02] I write, I end up recommending fiber to like 70% of my patients just because it's, it's sort of so good

[00:24:07] for so many different ailments in my world. But I will admit that a lot of them don't adhere to it

[00:24:13] because they develop discomfort. And so that's part of the reason why we felt it was so important

[00:24:17] to put the digestive enzymes into EA day, because that's really there to address that issue. And so

[00:24:23] I think choosing the right fibers is one part of it, or using digestive enzymes when appropriate.

[00:24:28] But I think the other thing is, you know, like I said, like if you're someone who's having a lot

[00:24:34] of gut issues, and you feel like all the foods that people are saying are good for you or not

[00:24:38] agreeing with you, it is actually also important to then look at every other aspect of your life.

[00:24:43] And so when I have patients who are in that exact situation, we start to talk about, well,

[00:24:48] how are you exercising? Like, what is your sleep routine? And what is the stress that's going on?

[00:24:53] And what are ways that we can help you manage that more? And once they start to kind of figure out

[00:24:59] those aspects, they actually find that they are able to process certain foods better than they

[00:25:04] were in the past. And so, like you said, it's all part of the equation, and you kind of have to work

[00:25:09] on all of those things. But it certainly can be challenging. And we do things like keep food diaries

[00:25:14] and eliminate certain things and slowly reintroduce those foods that they may find problematic one by

[00:25:20] one to see like, which is really the culprit or which one can you tolerate more? But you know,

[00:25:25] it definitely doesn't happen overnight. And it can be difficult, for sure. But you know,

[00:25:30] like when you were saying about the which comes first, it's so fascinating, because even the sleep

[00:25:34] one where, like I said, they look at people that are sleep deprived, and they say, okay,

[00:25:38] that's messing up your microbiome. But the reverse is so true. And there was a study that I saw that I

[00:25:44] found so fascinating, because they actually identified certain types of bacteria that were associated with

[00:25:50] insomnia, like certain strains, and other strains that were associated with good sleep. And so you

[00:25:56] really feel like in that case, it's more the bacteria that's dictating how you're sleeping,

[00:26:00] rather than reverse. And then I think it was really interesting what you said about kind of

[00:26:04] what foods you choose or what appetite, because there's also really interesting, you know, research

[00:26:10] on obesity and microbiome, and whether certain microbiome profiles make people more likely to binge,

[00:26:18] or more likely to be sort of, you know, having addictive eating patterns, or even just more

[00:26:23] likely to crave unhealthy foods as opposed to healthy foods. So, you know, certainly weight loss

[00:26:29] with all these weight loss drugs is such a topical, you know, situation right now. And I think learning

[00:26:34] more about how the microbiome is playing a role there, I think will be really important.

[00:26:38] Actually, something I wanted to tap into as well. But I want to go back a little bit too. I mean,

[00:26:44] understanding the balance in life is hard, because we're going to have instances where we're having

[00:26:51] the processed foods, or we're going out and enjoying different things, or we just had a week

[00:26:56] vacation with family who brings a ton of crap. Which is funny, because I notice when I eat that

[00:27:03] way, even for a week with the family, and it's a lot. It's a lot more than my typical dose of

[00:27:09] ultra processed foods. I start to notice things. My family has history of a lot of skin issues. I start

[00:27:14] to notice skin patches pop up, dry patches, psoriatic type, you know, skin issues that as

[00:27:21] soon as I get back home and get into my routine, they all go away.

[00:27:24] Right. And how long does that take? Like, how do we live that balanced lifestyle? Like,

[00:27:29] is it okay that I go out and I go through the drive-through? Or like, how often? I guess that's

[00:27:38] a hard question to ask. But just understanding in the typical world where people are busy and going

[00:27:43] about life and just trying to eat.

[00:27:46] What's the allowed dose of junk food? Because I need to have an In-N-Out burger every once in a while.

[00:27:51] I'm sorry.

[00:27:52] No, listen, I do as well. And I certainly don't claim to be like, perfect or, you know.

[00:27:58] I would say, you know, I think it's important to enjoy your life. And we know mental health affects

[00:28:03] gut health. So you don't want to be like bored and, you know, depressed because you never have

[00:28:07] anything fun. But I would say to me, what's worked and what I recommend is you want to keep your daily

[00:28:14] routine as healthy as possible. So you're kind of regular at home. You really want to keep it clean

[00:28:21] and, you know, really reduce ultra processed foods, mostly plants and vegetables, limit the alcohol.

[00:28:26] And then if it's, I mean, it's hard to say a number, but let's say if it's twice a week,

[00:28:31] you are out socializing. You know, it's okay to indulge in those things because you know that

[00:28:38] 80, 90% of your meals for that week have been healthy. And so I always advise, and I know I'm,

[00:28:44] I need to do this because I don't want anything unhealthy in my house. Because if it's there,

[00:28:48] I will crave it and I will seek it out and I will eat it.

[00:28:51] Um, and so, but when I go out, I'm not like, oh, I can only have the salad and the cooked

[00:28:57] vegetables. You know, yes, I will have what I feel like. Now, if I find that there's a week that

[00:29:01] I have a lot of social occasions, I probably will on, even if I'm out trying to make healthier choices

[00:29:06] for at least some of those. And I, you know, red meat is something I have pretty infrequently. So,

[00:29:12] you know, that I try to do not more than like twice a month, for example. But in general,

[00:29:17] I think what's most important is to have your regular daily routine as healthy as you can.

[00:29:22] And then when you depart from that routine here and there, it's not the end of the world. I mean,

[00:29:27] traveling is an interesting one because, you know, sometimes you're traveling for two weeks,

[00:29:32] three weeks. And I definitely find a lot of my patients or even friends or even myself,

[00:29:37] often our digestive routine or our bowel routine really goes haywire when we travel.

[00:29:43] And so that's a time where as much as you want to still have fun and indulge,

[00:29:47] it is important to try to keep up with fiber and everything because travel for many reasons

[00:29:52] can upset your routine, your bowel routine. You may be dehydrated from a long plane ride.

[00:29:58] You're less, during the travel itself, the car ride or the train ride or the plane,

[00:30:03] you're stationary for a long period of time. And that can actually cause your colon to just kind

[00:30:06] of go into shock a little bit. And then again, you have this jet lag and your gut also has a

[00:30:12] circadian rhythm. So that's thrown off. So I do recommend trying to keep up with the fiber and

[00:30:18] water and exercise while you're traveling. And exercise could just be walking around,

[00:30:23] seeing the sights so that that's fine. But yeah, the bottom line is you don't have to be perfect,

[00:30:28] but if you're aiming for about 80% to do these things that I'm talking about,

[00:30:33] then you're probably going to be in pretty good shape. I love that 80-20 rule of what you just

[00:30:37] said 80%. It makes me think of the 80-20 rule. That applies to many things in life. And we find

[00:30:44] that travel just takes a bit more planning. You just have to be a little more forethinking about

[00:30:51] what's the plan to get that movement in. I mean, we were in the car for seven plus hours and I love

[00:30:57] how you keep kind of bringing back movement and how that can help with gut motility and how that can

[00:31:01] help keep everything a little bit more active. You've mentioned a few times this gut-brain access

[00:31:08] or the gut-brain. And that's something that I think it's brought up a lot. And I'm fascinated about that.

[00:31:14] Us being physical therapists, we learn a ton about the nervous system. And so many of our foundational

[00:31:23] ganglion and nervous system foundation is housed right behind our gut. And any chance I have to

[00:31:31] learn more about this gut-brain access, what it means, I want to jump on. So can you talk a little

[00:31:36] bit about what is the gut-brain? How is it connected to our real brain? And when our gut starts to get

[00:31:43] dysfunction, why is that so impactful? Yeah, absolutely. And I'm also fascinated by the topic,

[00:31:50] so I love to talk about it. So sometimes your gut is actually referred to as your second brain or your

[00:31:57] little brain because it is so replete with nerves and neurotransmitters and hormones that can affect

[00:32:04] mental and physical well-being. And there's also something called the enteric nervous system. And

[00:32:10] what that means is the lining of your entire digestive tract from mouth to below is lined with

[00:32:16] nerves, nerve cells. And that's because you can imagine as you are digesting food and all of these

[00:32:22] things, you're not consciously telling your esophagus, move the food along. That's what

[00:32:28] these nerves are doing. And they are doing that because the brain is sending them signals that you're

[00:32:33] not aware of. So there are constantly signals going on from your actual brain to your gut. And the

[00:32:39] reverse is true as well. And so, for example, if you're having severe distension in your bowel because

[00:32:47] you're sick or you're bloated, that can actually, first of all, of course, send a signal to your brain

[00:32:52] that you're in pain. But it can also, if it's happening chronically, cause mood changes as well.

[00:32:57] And we know that people with irritable bowel have a higher propensity for anxiety and depression. And

[00:33:03] that's, again, a sort of two-way reaction. Probably the most simple example of the gut-brain connection

[00:33:09] is when you get butterflies in your stomach. So you're excited about something or you're a little

[00:33:14] nervous and all of a sudden your stomach starts doing little somersaults. Or you might have something

[00:33:19] a little bit more dramatic, which is you have a big presentation you're about to get on stage for

[00:33:23] and you need to run to the bathroom and have a little loose bowel movement. And I think we've all

[00:33:29] experienced that at one time or another in our lives. And that is literally showing how your brain

[00:33:34] is sending signals to your gut saying like, I'm anxious, I'm nervous. And then those same

[00:33:39] neurotransmitters and hormones cause your gut to kind of do this and contract and cause you to feel

[00:33:44] uncomfortable. So we know that this is a very clear connection and so much so that there's now a field

[00:33:50] called nutritional psychiatry, where we know that what you're eating and thereby how you're feeding your

[00:33:58] gut can affect dramatically things like depression and anxiety. And I really am hopeful that not in

[00:34:05] the too distant future, we will see people being treated for those conditions with dietary changes,

[00:34:12] maybe probiotics or prebiotics, which are really side effect free, which is amazing compared to

[00:34:18] antidepressants. And so yes, it's a very robust, interesting conversation between the two.

[00:34:24] And to me, you can't really ignore that gut mind if you're talking about gut health, because it plays such

[00:34:30] a significant role. And I mean, I have so many patients who maybe their issue is constipation, and they

[00:34:37] will very clearly tell me, well, when I'm stressed, or this thing happened at work, and everything just shut

[00:34:42] down for a week or 10, you know, like they see a very clear correlation, which is why we talk about what are some

[00:34:48] ways we can reduce the stress. And that could be exercise is a huge one. It'd be yoga, deep breathing,

[00:34:55] meditation, you know, there are a lot of different ways to address it, but it's definitely real. And

[00:35:00] it's very important to be aware of.

[00:35:02] And I love that medicine as well as taking a look at like, how are you doing? And how are you feeling?

[00:35:08] You know, it's not just what's happening internally, but it's what's happening with the person what's

[00:35:13] happening with you as a whole, and how it's all connected. It's a breath of fresh air to hear a

[00:35:18] gastroenterologist say that she will prescribe breath work or stress relief techniques or meditation to

[00:35:25] somebody because I think that that just has been so foreign for so long in the traditional medical world.

[00:35:30] Right, I agree, it has been. And you know, I think it's like, at this point, impossible to ignore that there is

[00:35:36] such a strong connection. Like we used to think, oh, stress doesn't really matter that much. It's all about

[00:35:42] internal physiology. But now we realize the internal physiology is very real. And by the way, as I'm

[00:35:48] sure you know, I mean, there are studies looking at meditation showing MRI changes in the brain. So

[00:35:53] it's not like you're just sort of, you know, giving someone fairy dust, like this is actually something

[00:35:58] that has real science based effects on your body. And so I think it's a very legitimate thing to try.

[00:36:06] A hundred percent. And I love that. You kind of mentioned how you studied a lot with colon cancer and

[00:36:11] it's just, it's so prevalent and cancer in general, unfortunately, but, but especially, you know, cancers

[00:36:20] that affect anything along the digestive tract. So what can we do to start trying to be preventative? And, and is

[00:36:29] that the goal? Because I know some family members will be like, well, I'll just get tested, you know, and once I know,

[00:36:34] then I'll do something about it. And it's like, is it too late by that point? What can we do? Can,

[00:36:41] is there something we can do proactively to try to combat cancer?

[00:36:47] Yeah, no, absolutely. I think colon cancer is something I love to talk about. And it's a really

[00:36:51] important topic. As you said, it is very prevalent. So among cancers and I'll leave skin cancer out,

[00:36:58] because that's usually not deadly. It's very common, but not deadly among real cancers. Um,

[00:37:04] colon cancer is the second leading cause of cancer death for both men and women. And in some age

[00:37:09] groups for men, it's the first. So that's pretty amazing because the only thing more, you know,

[00:37:14] that's causing more deaths is breast cancer for women and prostate cancer for men. So we know that

[00:37:18] this is really an important topic. I definitely think screening and getting checked. You were saying

[00:37:22] that's what your family, that is very important. So I would never say like, don't do that.

[00:37:26] Of course you need to do that because colon cancer most of the time doesn't cause symptoms.

[00:37:31] Um, and so you might feel totally fine, but if it's the right age, you know, and that's 45 for

[00:37:37] everyone, but earlier, if you have certain family history and certainly earlier, if you have symptoms,

[00:37:42] um, you should get screened and checked. Now the question of like, well, is it too late once they

[00:37:46] find a cancer? Actually the good thing, if I can say there is a good thing about colon cancer is

[00:37:51] when it's found early, which is often with screening, you know, people who don't have symptoms,

[00:37:56] if they find it, it is usually early. It's extremely treatable. So for example,

[00:38:01] if you find a colon cancer and you're in its early stage and you remove it with surgery,

[00:38:06] which you have to do, the person basically has almost a completely normal lifespan.

[00:38:10] So probably like a 95% survival compared to a hundred percent if you didn't have colon cancer.

[00:38:15] So, um, very treatable. It's definitely not, you know, they're, they're kind of some old school

[00:38:21] people who'll say, well, if it's there, I'd rather not know. And what's the point? It's too late. And

[00:38:26] that's not true when it comes to colon cancer. There's definitely a point in learning early

[00:38:30] about it because later stages, it's a very different story. Um, but in terms of, can you prevent it?

[00:38:37] I mean, there are definitely ways that you can work on preventing it. Um, one is the fact that

[00:38:42] colon cancer in the vast majority of cases starts first as a polyp before it grows into cancer. So

[00:38:48] a polyp is a little growth, looks like a pea, it grows out of the lining of your colon and they're

[00:38:53] very common. Um, and most of them are benign, but some of them can grow bigger and bigger and grow into

[00:38:59] a cancer. And so that's one of the main reasons where we're doing colonoscopies. We're not just looking

[00:39:04] for cancers. We're looking for these pre-cancerous polyps, because if we find them, we can remove

[00:39:09] them, take them out. They have no chance to stay inside your body and grow into cancer. So that's

[00:39:13] a very clear way to prevent colon cancer, which is nice. You don't have that opportunity with most

[00:39:17] other cancers. They just, either they're there or they're not. You don't have this precursor that you

[00:39:21] can find. But then in terms of even before polyp formation, what can you do? We know that limiting

[00:39:27] alcohol is good for preventing colon cancer. So the more alcohol you have, the higher risk of

[00:39:32] colon cancer. Smoking as well, the more sedentary you are, the higher your risk. So exercise is

[00:39:37] important as well. Um, in terms of diet, generally for cancers in general, we know that, we know that,

[00:39:43] um, antioxidants in your diet are good. You know, the less processed foods as opposed to

[00:39:48] ultra processed foods, fiber as well has been shown to help decrease colon cancer risk. And I think the,

[00:39:54] one of the, probably the most important thing I would say is that talking about bowel movements still

[00:39:59] remains an uncomfortable and embarrassing topic for a lot of people. And I think the most important

[00:40:04] thing you can do for your gut health is pay attention to it and talk about it if there's a

[00:40:09] problem. Don't feel shy or embarrassed. Certainly your doctor has heard it all before. Um, and just

[00:40:14] make sure that you're very proactive because yeah, there are definitely signs that shouldn't be ignored

[00:40:20] when it comes to colon cancer. Yeah. Definitely need to talk more about poop and be more aware of

[00:40:26] what is coming out of us because a lot of people, it's like, sit down, go to the bathroom, flush it

[00:40:31] down. I don't want to don't think about it. Don't think about it. Don't look. Yeah. Every time. And it

[00:40:36] might sound weird to people listening, but every time I go, I take a look. How, how's it looking? What,

[00:40:41] what is the product like today? And that tells me a little bit about it. Just that little bit of

[00:40:46] feedback that I can get right away because we've talked to a lot of people like you and we know what

[00:40:50] our stools should look like. And we know that if they shift in one direction or another,

[00:40:54] it might mean something about what my body's asking me for. And I think that that's so important for

[00:41:00] people to be aware of. I totally agree. And it's funny because hundreds of years ago,

[00:41:05] you know, the doctors sort of in the dark, you know, would look at stool and draw all these conclusions.

[00:41:10] And then we as modern doctors thought that that was kind of crazy. And I think now we're going

[00:41:14] back to the fact that actually they may have been really onto something because you're right.

[00:41:19] It is a reflection of what's going on internally. And it's really important. And that's one of the

[00:41:24] missions we have at EA Day is really trying to get this conversation out in the open. This is

[00:41:29] something we're all doing and it doesn't have to be certainly not embarrassing, but it also shouldn't

[00:41:34] be uncomfortable or unpleasant. Like let's make this a beautiful experience that hopefully sets you up for

[00:41:40] a great day. And then we obviously want to give you the ingredients and the tools to do that.

[00:41:44] But it's also about just the conversation. Like we want, we want to hear about like couples. Do you

[00:41:49] feel comfortable talking about it with your partner? You know, do you feel like you need to go to another

[00:41:54] part of the house? Like I find all of that really satisfying. You know, like I had a boyfriend in

[00:41:59] med school who was like, oh, I don't even want to think about you doing that. And I feel like that was a red flag.

[00:42:03] And I was like, we're clearly not together anymore. But I was like, I'm a human being. We're both in

[00:42:10] medical school. Like obviously this is a normal, you know, so it's, it's, it's just interesting and

[00:42:15] something that we want people to feel more and more, not just comfortable, but actually like excited

[00:42:20] to talk about. Yeah. Well, let's talk about it for a second since we're on the topic, because

[00:42:25] people are probably like, well, how should it look and what should be happening? How many times a day?

[00:42:31] Or, you know, is it just once a day? Is it multiple times a day? How many times is too bad? And then,

[00:42:37] and then what should it ideally look like? Yes. So number one, I just want to put out there that

[00:42:43] the most important thing to me as a doctor is how you're feeling. So I don't want to say like,

[00:42:48] it has to be exactly this formula. And even if you feel great, like if it's not this, there's a major

[00:42:53] problem. So if you feel fine, you're not feeling pain, bloating, you're not struggling to move your

[00:42:58] bowels. Chances are whatever your frequency is, you're good, but we do have some general

[00:43:04] guidelines and I think they are helpful. So you want to be going at least three times a week.

[00:43:09] So if you're going less frequently than that, it's probably something to talk to your doctor about.

[00:43:14] And certainly no matter how often you're going, if you're not feeling well, have a discussion.

[00:43:18] And then in terms of how much is too much, if it's more than twice or three times a day,

[00:43:23] I would say three times a day is probably getting excessive. That's another reason to discuss with your

[00:43:28] doctor. But there are people who just the way their body works, when they eat, they go to the bathroom

[00:43:33] and that's okay if they feel fine. Now in terms of how it looks, generally you want it to be a formed

[00:43:41] stool, meaning it's not all liquid, it's not in pieces. It doesn't look like as soon as it hits

[00:43:46] the toilet water, it's breaking apart. But you also don't want it to be super hard. So it shouldn't

[00:43:52] feel hard when it's coming out or painful, almost like it's tearing or having some sharp edges to it.

[00:43:59] You would like it to be a healthy diameter. So we talk about a sausage-like appearance,

[00:44:05] as opposed to tiny little pellets. And you want it to be a regular brown color. So if it's very light,

[00:44:12] sometimes that can be a sign of sometimes gallbladder issues or obstruction there.

[00:44:18] If it's floating or you see oil droplets, that could be an issue with your digestive enzymes from

[00:44:22] your pancreas. Certainly if you see blood and blood can be bright red or actually black because

[00:44:29] digested blood can turn black, that's something to be alarmed about it and to talk to your doctor

[00:44:35] about. But I will also say that sometimes things you eat temporarily, like beets can turn your stool

[00:44:41] red. If you have a very fatty meal, you might see it floating a little bit one day. I wouldn't be

[00:44:48] alarmed by almost anything if it's just one day. If it's consistent though, that is definitely a

[00:44:53] reason to talk to your doctor.

[00:44:55] Great. That's helpful.

[00:44:57] So I think that we need to be a part of shifting the conversation to the point where everyone just

[00:45:01] has like a stool chart that's taped underneath the lid of their toilet that they just get up and

[00:45:07] take a look and compare and say, oh, that's what it's like today.

[00:45:11] I think so. And, and, you know, I mean, it's, it's sad, but we really are seeing younger people,

[00:45:17] you know, like you read the headlines about colon cancer and younger people, but then you actually,

[00:45:21] of course I see it as a doctor, but I think just as a human, you hear about like, oh, my friend,

[00:45:26] I had a patient today who said her friend died of colon cancer at age 40. I mean, we didn't really

[00:45:30] hear stories like that 20 years ago. So there's something going on. And I mean, not to bring a

[00:45:36] somber note into it, but it's what you're saying is right. Like that's the reason why people should be

[00:45:40] looking and paying attention and knowledgeable about what's going on in the toilet.

[00:45:45] Oh yeah.

[00:45:46] Yeah. So on the, on the topic of colon cancer, Jen, actually before the interview was saying,

[00:45:52] Hey, I saw something, was it from the Today Show where they were talking about some of these weight

[00:45:57] loss drugs, like you, like Ozempic or things like that and how they have actually seen a reduction in

[00:46:06] risk of colon cancers and stuff like that. Can you talk a little bit about that?

[00:46:11] Absolutely. I was, I don't know if Jen saw me, but I was on the Today Show talking about that as

[00:46:15] well.

[00:46:16] Yes, it was.

[00:46:17] Because it's really, it's amazing. I mean, these weight loss drugs are such a fascinating phenomenon.

[00:46:22] I would say the last few years, so many people are taking them, some appropriately, some not

[00:46:27] appropriately, but we still are seeing millions of people on these drugs. And of course, as a doctor,

[00:46:34] you're always a little bit wary in the beginning. Like, are they too good to be true?

[00:46:38] And what we don't know about the long-term effects. And, but actually most of the news we're finding is,

[00:46:43] is pretty positive about the long-term effects of these drugs. And, you know, there've been

[00:46:49] interesting studies showing that it can help with sleep apnea. It can help potentially with heart

[00:46:54] disease, so much so that they got an FDA approval to, to put that on the label to prevent heart disease.

[00:47:00] Wow.

[00:47:00] And now the latest is this cancer story. So they looked at, I think it was 16 cancers

[00:47:05] that we know are associated with being overweight or obese. And so not every cancer is associated

[00:47:12] with that, but many are, and many of the common ones are, including colon. Breast is another one. And

[00:47:18] when they looked at the data, and it was a retrospective study, I should point out. So,

[00:47:22] you know, it's not our gold standard perspective, double line, all that, but it still was a huge amount

[00:47:27] of data. It was 1.6 million people were studied their charts and reviewed. And they found that

[00:47:33] except for two cancers, all of the cancers were decreased in those who were taking the weight loss

[00:47:39] drugs, as opposed to those who weren't. All these people had diabetes. So it's not just a regular

[00:47:44] population. I should say that as well, but still it was a pretty, and these were in many of the cancers,

[00:47:49] including colon, I think it was like a 30 or 40% reduction. So it was significant.

[00:47:55] Wow. And it's so fascinating. We don't really know why. You know, was it just that they lost

[00:48:01] weight? It seems to be more than that. But it was there. Unfortunately, looking at breast cancer,

[00:48:09] it did not show a reduction. And of course, that is the number one killer of women. And so we would

[00:48:14] have loved to see that. We didn't in that. And there are different theories of why it didn't work

[00:48:18] there. But for many, many other cancers, it did. And so, yeah, it's not exactly sure, clear why,

[00:48:25] but it did have a benefit. And so maybe a lot of these people who are taking it for weight loss will

[00:48:30] have that added benefit as well. That's so interesting. And you kind of mentioned as well

[00:48:34] that there are people who are taking it inappropriately. When are these being used inappropriately?

[00:48:41] Well, I mean, if you look at what they're approved for and what the studies have been shown,

[00:48:46] you know, that they're helpful for is for people that are either obese or overweight with a associated

[00:48:53] medical condition. I'm saying like there are all these positive benefits, but there are side effects

[00:48:57] and they're sometimes significant. And so I don't think it really should be used for anyone who's not

[00:49:02] under those two categories. Now, in the future, will that change? Maybe. Like maybe it's such a great

[00:49:08] heart protective one that cardiologists will prescribe it to other people. I'm not sure. But as it stands

[00:49:13] right now, I really think, you know, it should be reserved for people who are in those categories

[00:49:18] because we just really don't know how it works in other people. And we don't know, we still don't

[00:49:23] know all the long-term effects or even short-term, you know, in a large group. And then, you know,

[00:49:28] I think it's, there's also the reality that there's a shortage of the medications. And so you want the

[00:49:33] people who actually desperately need it to be able to access it. I mean, I have seen people both in

[00:49:38] my practice, you know, referred, you know, from, they got it from someone else, but I've seen people

[00:49:42] that are not even overweight by any stretch of the imagination who are on these drugs. And it just

[00:49:48] shocks me that they were even able to find a doctor who could prescribe it because it's,

[00:49:52] in my mind, completely inappropriate. Yeah. I appreciate that perspective and that with many

[00:49:57] things in the medical industry that become popularized, we need to have that focus on making

[00:50:03] sure those medications are getting to the people that actually need them, that they're approved for.

[00:50:08] Right.

[00:50:08] And that it could be life-changing for. And so I definitely appreciate that perspective.

[00:50:13] I'm always bummed because I feel like the time flies by so fast and there's so much more we could

[00:50:18] dive in on. But I think we covered some really heavy hitting topics and appreciate all the expertise

[00:50:24] that you bring to these topics. And the product that you have out now, Yada, it's the triple threat,

[00:50:30] the trifecta for your gut health. And I think you explained throughout, you know, where that can be so

[00:50:36] beneficial for many of the aspects of gut health and topics that we talked about. You mentioned your

[00:50:42] book also. Where else can people go to, one, get the supplement, but also continue to learn more from

[00:50:49] you? Yeah. Thank you so much. So Yada is at myyaday.com. And my book is called Gut Renovation,

[00:50:57] and it's on Amazon. And I, my website for myself personally is also called Gut Renovation,

[00:51:04] but it's gutrenovation.net. Great. Amazing. We're going to have all that linked up,

[00:51:08] including your social and you guys could just watch the Today Show and catch it on there.

[00:51:14] Absolutely.

[00:51:15] Thank you so much for taking the time. I know you're extremely busy and we just appreciate your

[00:51:20] expertise and what you're providing for the world.

[00:51:22] Thank you. Really great chatting with you both. Have a great day.

[00:51:27] Such a fantastic chat with Dr. Raj on gut health, really kind of demystifying what it is and the

[00:51:34] most important ways we can be proactive about our health. And something that she talked about a lot

[00:51:38] was movement. And that is great because we have our Cyber Monday, Black Friday deal. It's the lowest

[00:51:45] price that our GenHealth annual membership ever is at. It's over a 50% discount on the annual

[00:51:52] subscription. So if you want to get into our community and get moving, there are 12 plans

[00:51:57] that you can move into. It's more than a year of content. If you did every single plan back to back

[00:52:02] to back, there's stuff for shoulder pain, back pain. There's stuff that if you just want to work on your

[00:52:07] core stability, full body mobility, or even get some strength and HIIT workouts in, we have it all.

[00:52:13] And we have an incredible community that moves together. So check out the link down in the show

[00:52:17] notes. You just need to go to Gen.Health backslash free trial. There's no need for any discount code.

[00:52:23] It will already be discounted. So go check that out. If you've been enjoying our podcast, please also

[00:52:28] consider leaving a rating and review on your favorite podcasting platform. And of course,

[00:52:32] we'll see you next time on the Optimal Body Podcast.