The Mel Robbins Podcast

00:00 Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. 00:08 Today, you have an appointment with one of the most trusted gut health doctors in the world, Dr. Rajshree Nambudrapad. Dr. Rajshree is here to give you her comprehensive guide to what truly causes gut health issues and her protocol for healing them for good. 00:28 She's going to begin by explaining that there are four things you must understand about your gut in order to heal it. She will teach you that your gut is connected to your brain, your immune system, your metabolism, your mood, your skin, your energy, basically every single part of your body. So whether you deal with IBS or bloating or cramping or burping or acid reflux or you're tired of feeling backed up for days— or you just have symptoms you can't figure out, you are going to love this episode. 00:59 And she's not just going to teach you from her experience as a medical doctor, she's also going to teach you from her personal experience, because she herself has struggled with debilitating gut issues, and that experience fundamentally changed the way she understands the gut, the way she treats her patients, and it shapes the protocol and the recommendations she is going to share with you today. It's so easy to feel powerless, but today, Dr. Rashri is here to show you how to understand gut health and heal your gut once and for all. 01:41 Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. I'm really excited that you're here because I think you're going to find this conversation today to be such an extraordinary resource. And it's always an honor to be together and to spend this time with you. And if you're a new listener or somebody shared this with you, I just want to take a moment and personally welcome you to the Mel Robbins Podcast family. Today, you're going to learn all about your gut, how to heal it, and you're also going to get a doctor's guide to relieving bloating, IBS, constipation, and so much more. 02:14 Our guest today is Dr. Rajshree Nambudrapad. She's a board-certified physician who has built an audience of millions online because she makes gut health issues so easy to understand. Dr. Rajshree is board-certified in internal medicine and integrative holistic medicine, and she has built a global audience of 3 million-plus subscribers on YouTube because of her simple videos where she explains the root causes, symptoms, and treatment for conditions like bloating, IBS, acid reflux, insulin resistance, skin conditions, and so much more. 02:49 Dr. Rajshree is the founder and medical director of OC Integrative Medicine and a member of the medical staff in the Department of Internal Medicine at St. Jude Medical Center in Fullerton, California. She graduated at the top of her class from Northeastern Ohio Medical University and completed her internal medicine residency at Northwestern University. She trained in gastroenterology at UC Irvine and the Institute of Functional Medicine and in endocrinology at the Mayo Clinic. Please help me welcome Dr. Rajshree to the Mel Robbins podcast. 03:24 Thank you, Mel. It's wonderful to be here. 03:26 And since we all have had the experience of feeling bloated or being uncomfortable, or we know somebody that has a lot of GI issues, I would love to have you start, Dr. Rajshree, by speaking to the person who's with us. 03:42 What could change about their life, their health, how they feel, if they really take to heart everything that you're about to teach us? 03:51 Well, today I'm going to help you better understand what is actually happening in your gut. 03:56 So if you're someone out there who's struggling with bloating every day or chronic constipation or inconsistent bowels, or maybe you have reflux or food sensitivities and you don't even know what to eat anymore, I want you to know that there's hope and there's so much we can do to heal your gut. 04:14 And today I'm going to share a lot of practical tips that you can actually begin using right away to start feeling better. 04:20 And by healing your gut and improving your digestion, you're going to notice so many other aspects of your health improve. From your energy to your mental focus, your mood, your skin, your immune system, your metabolism, and so much more. 04:36 One of the reasons why I wanted to talk to you is because you have such an extraordinary background and you're in a clinical practice, but your approach is grounded in science and deeply personal. Could you just explain a little bit more in depth about your training and your background and how you approach your gut health medical practice? 05:00 So I did my internal medicine training at Northwestern in Chicago. 05:04 And then I did gastroenterology training at UC Irvine. And so during that GI training, I did endoscopies and colonoscopies. I did all the traditional treatments. Like reflux was treated with proton pump inhibitors to just shut off the acid. 05:20 And if someone had constipation, they were given prescription laxatives. So intuitively, I just knew that there was so much more we could do for the gut. I really wanted to help patients heal, not just suppress the symptoms. And then I had my own personal journey with SIBO. And I think that really transformed the way I saw so many things in the gut. And then a lot of things I've actually learned from my patients. 05:45 Why are you smiling so much? Like, what have you discovered in 15 years of practice of not just treating symptoms, but restoring the overall gut health and how a simple protocol that we're going to learn today really is the place to start for absolutely every single thing that you may be experiencing right now related to gut issues? 06:07 So many people I think maybe are stuck and they're just living with these symptoms every single day and they may have nowhere to turn to and they may feel like, is this how my life is gonna be for the rest of my life? I know because I was there and how scary that was. So when I finally figured it out for myself, I thought I have to share this with others. There's so many people suffering. I have to make this standardized and I need to create a protocol, a roadmap for people. Because if it was that difficult for me to figure out, imagine other people that don't have GI training. 06:41 Dr. Ashri, tell me about what happened that makes this deeply personal for you. 06:48 So about seven or eight years ago, I started to notice that at the end of the day, I had so much pain in my abdomen. It was miserable pain, super sharp. And it was so much pressure in my abdomen. I even felt like it was hard to take deep breaths. 07:05 And that pressure would make me feel anxious. It would make me feel agitated. It's hard to focus on other things. 07:12 So I was really trying to figure out what was causing it. So I initially thought maybe it's a sensitivity to gluten and dairy. So I cut those out. But then all of a sudden, I couldn't eat quinoa anymore. I couldn't eat brown rice. Those would make me bloated too. 07:30 And then all of a sudden, I couldn't eat cheese anymore. I had eaten cheese my whole life. Now I couldn't eat that. I couldn't have butter. Yeah. 07:38 So my diet became very restricted in order to control the symptoms. I literally was down to like eggs, salmon, white rice, arugula salad, and chicken soup. 07:50 So I couldn't even go out to restaurants. I was afraid when I got an invitation to someone's house, I would always eat before going out. 07:59 The turning point for me wasn't when I realized I couldn't eat fruit anymore. 08:04 Because fruit is what I consider healthy, and I had always enjoyed eating bananas, but now even a banana was causing bloating. 08:13 So that's when I realized that the problem wasn't the food. The problem was my gut. 08:19 So why is gut health so important, Dr. Rashri, for your overall health? 08:26 The gut is really the foundation of your health. So if you truly want to be healthy, you absolutely have to pay attention to your gut. So your gut is sending signals to every organ in your body. So for example, let's start with your brain. Your gut is constantly talking to the brain through the gut-brain axis. 08:45 So often when I'll see patients who have gut issues, they're also suffering from anxiety and brain fog and often sometimes even insomnia. 08:54 And then our gut strongly influences our immune system. 08:57 So 70% of our immune cells are in the lining of our gut. So if your gut is inflamed, you might notice that inflammation pop up elsewhere in your body. And then our gut strongly influences our skin through the gut-skin axis. 09:11 Wait, the gut-skin access? What is that? 09:13 So our skin microbiome strongly reflects our gut microbiome. Really? Yeah. So what's fascinating is when I help patients heal their gut, they'll often come back and tell me, well, by the way, my acne cleared up. My eczema cleared up. 09:29 And I treat some very complex cases of psoriasis, which is an autoimmune skin condition, simply by healing the gut. We see the skin improve dramatically. 09:38 You're kidding. Yeah. 09:40 Dr. Rajri, you talk about this concept of the gut garden. What is that? 09:46 So basically, what I want to make clear and share with the audience today is that our gut is not a simple tube where food goes in one end and waste comes out the other end. OK. A lot of time, we're given that impression. Yes. You know, because you might have had an endoscopy or a colonoscopy. And during those procedures, the gut kind of looks like a tube from the inside, you know, with twists and turns. Yeah. But so many of my patients have had those procedures, and they're just told that everything looks normal. but they don't feel normal. 10:16 And they have a lot of symptoms that are affecting their quality of life. 10:20 So what I want to share today is that the gut is actually a complex and delicate ecosystem. And the best way that I like to explain it is that it's a garden. 10:31 So let me show you more about that. 10:32 Oh, I'd love to see this. If you're listening right now, what we have is just a visual prop. We're just kind of a garden that we've put together. You see soil, you see a watering can, you see bees, and you've got all these beautiful flowers and greens that are growing in the garden. And one of the things I just want to say, Dr. Rajshree, is I am one of those people that have always envisioned a long tube when somebody says the gut. Why do you want us to envision a gut garden? 11:05 So what I've observed from 15 years of clinical practice and treating very complex gut disorders is that sometimes you can't explain these conditions if you just look at the structural aspects of our gut. 11:18 Okay. 11:19 So what I've discovered is that there's actually four main systems of our gut garden. And to really have ideal digestion and to feel your best, you have to correct all four aspects of this garden. 11:31 Okay. 11:32 And when we do that, remarkable things happen. 11:35 Patients who have had symptoms for years, sometimes even decades, they get better. Wow. Yes. 11:43 So let me tell you what these four systems are. Great. The first system is the motility in the gut. 11:48 The who? The motility. 11:50 Motility. 11:50 Okay. 11:51 That's like the irrigation system of your garden. 11:53 Okay. 11:54 So we have to have good motility in your gut. Everything's got to be moving through your gut nicely. If anything gets slowed down or backed up, that's a problem. 12:03 What's the second of the four things in the gut garden? 12:06 So the second is the pollinators of your garden. So like the bees and the butterflies. So we have one little bee here. So similarly in our gut, we have to have digestive enzymes. We have to have stomach acid and we have to have bile to break down our food. 12:24 So many patients I see, they're lacking in one of those areas. They don't have enough stomach acid or they don't have enough pancreatic enzymes. 12:33 Or they had their gallbladder removed, so they don't have bile that's stored up. 12:38 And so when they eat food, they just can't break it down. 12:41 So that would be the second system of the garden. 12:44 Okay, pollinators. Yes. What's the third? 12:46 Okay, the third system is the garden bed. So that's like the soil in your garden. And that's similar to the integrity of the gut lining. 12:56 Okay. 12:57 So it's so critical because if you have inflammation in your gut lining... 13:02 That's very close to your immune system. So 70% of your immune cells are sitting there right under the gut lining. So that's like having big cracks in your soil. 13:12 It's kind of like having leaky gut, which we'll talk about today. Yeah. So that's the critical third system of the gut. 13:18 Gotcha. And what's the final one? 13:20 The final one is your microbiome. So the plants and weeds in your garden. Flowers are like the good bacteria in your gut. 13:28 And then these weeds that have popped up here, these are like the bad bacteria, maybe even fungal organisms in yeast. Yeah. So in order to have a healthy gut, you need to have a balance. You need to have a robust and diverse types of plants so that these weeds don't pop up. And when we see weeds growing in your gut garden, we call that dysbiosis. 13:50 Dysbiosis? Uh-huh. Okay. 13:52 Dysbiosis means bacterial imbalance. 13:55 Oh, okay. So... 13:57 If you're having gut issues, do you have to know which one of these four things is out of whack? 14:04 Well, the beautiful thing is if you're not sure what to do, you can just start with step one and step two, which I'm happy to explain today. 14:13 Okay. 14:13 And for more than 50% of people, that's going to help them tremendously. And that's the motility and the pollinators, those first two. 14:23 So what I do with my patients when I see them— Most of the time, I have them work on that irrigation system, the motility, and the pollinators breaking down their food, starting at that initial consult, even while we're waiting for testing to come back. 14:38 So if you have any gut issue and I were to come to your office, Dr. Rajshree, you would tell me, start doing these two things immediately because these two things, no matter what you're dealing with, are going to help your overall gut health. 14:51 Absolutely. What are they? Okay. So to promote motility, usually we want to make sure your bowels are 100% and complete every day. 15:00 What does that mean? 15:01 So, so many of us, we have some form of constipation. So we got to get the bowels emptying perfectly. So I'll put patients on magnesium at bedtime. 15:11 Which kind? Because there's so many different kinds of magnesium. 15:13 Absolutely. Magnesium citrate, glycinate, and malate. Okay. Okay. The citrate part is really the one that works as a natural osmotic laxative. What that means is it pulls water into your colon. 15:27 So you take it at bedtime and you can adjust the dose based on your bowels. But that way, when you wake up, your bowels are like clockwork. So that's the first thing. But we also use something called a prokinetic dose. A who? A prokinetic? Yes. Okay. A prokinetic is not a laxative, but it's something that activates those cleaning waves in the gut. 15:48 Really? Give me an example of what a prokinetic would be. 15:52 So a natural prokinetic is ginger. 15:54 Oh. 15:55 Ginger. So we use a supplement, but it's essentially a patented formula of ginger and artichoke, and you take that along with the And what it's going to do is it's going to clean up your small intestine while you're sleeping and you take that consistently. And that's going to help that first system of the gut garden, that motility, that irrigation system. And that's huge. 16:18 Okay. So that's number one. The second step that you give to people that come to see you, no matter what their complaints may be, is what? 16:25 The second thing is I enhance their pollinators. 16:28 Okay. 16:28 So I give them digestive enzyme support. And what does that mean? So I have them take high-potency digestive enzymes either before or after their meals, and they can try it both ways and see what works for them. Okay. But what that does is it helps break down the food better. Huh, so it breaks down proteins, fats, and carbohydrates. So guess what? You don't get bloated. You might be able to eat foods that normally would upset you. Like, I have some patients who can't eat Brussels sprouts, but if they take their digestive enzymes, they can. 17:00 Because it breaks down the food better. Is there an example of like a food that acts as a digestive enzyme? Absolutely. So if you don't have access to these supplements, you can at least have water with lemon juice. Oh, okay. Or a little bit of apple cider vinegar. Okay. The acidity will help you break down the food better. 17:18 Okay. So just those two recommendations. You take your magnesium, right? And like, let's just say you're just going to simplify. You take magnesium before bed and then you try some digestive enzymes with your meals. That's going to help a lot of your patients just out of the gate start to feel a little bit better? 17:37 Yeah. Basically, when I see patients at their second appointment, they've already started this. They've been doing it for maybe a month. We now have all their test results back, but they tell me they're over 50% better. No way. 17:49 Yes. 17:50 Wow. I love this. Okay, great. Let's talk about some of the things that happen that can make the weeds come and kill the flowers and make the dirt turn into cement. What causes bloating? What is it? 18:03 So bloating is that uncomfortable feeling that you get when there's pressure building up in your abdomen and you notice your abdomen get distended. So the classic scenario is when you feel and look like you're six months pregnant by the end of the day. 18:18 So there's many reasons for bloating. 18:21 The first thing I always ask my patients is how are your bowel movements? 18:26 And if they tell me, well, I go to the bathroom every three to four days, well, then that's the problem. Because if you're constipated that severely, that backup of stool in your colon is going to make you feel bloated. So we have to fix that first. 18:40 How often should you go, number two? 18:43 Every day. 18:44 Every day? 18:45 Every day. Mm-hmm. 18:46 So is the protocol that you prescribe to your patients for constipation the same, whether you're going once a day or going once every three days or going once a week? 18:58 So we start with the basics. 19:00 Okay. 19:00 Magnesium's my favorite because of the other benefits on the body. It's safe to take long-term. Okay. 19:07 The second, again, is that prokinetic, that motility activator. That's the ginger pill. That's also safe to take long-term. 19:14 If that's not working, we escalate. We use natural stimulant laxatives like aloe, the plant aloe vera. They come in dried capsules, so it's the leaves of the aloe vera plant. And that's a little bit stronger. That will stimulate the bowels to move. That's not something I encourage people to use daily, but They can for a while, but eventually our goal is to transition back to just magnesium and motility activator. Honestly, those are kind of like game-changing treatments. Again, I'm surprised because they're so simple. They're so accessible to anyone. 19:45 But I don't think they get enough awareness in mainstream medicine. 19:50 So, Dr. Roshri, you said that when somebody comes in and they're complaining about bloating, the first thing you do is you ask, how often are you going to the bathroom? Yes. Because you want to rule out constipation. 19:58 Absolutely. 19:59 If somebody is bloated and they are going to the bathroom regularly, what are the other causes of bloating? 20:06 So usually when we're talking about bloating, we're talking about trapped gas in the intestines. 20:12 OK. 20:13 But I do want to make one thing clear. Gas itself is not the problem. 20:18 Because if you're eating certain foods, like you're eating beans or a salad or broccoli, you're going to have gas. That's normal. But if you pass the gas and it doesn't bother you, that's totally fine. Not a problem. 20:30 It becomes a problem when that gas is trapped inside of you and it's causing you pain. 20:35 And trapped gas can present differently in different people. Some people get sharp stabbing pain. Some people get this intense pressure. Other people get cramping. So it really varies. And the pain can be anywhere in your abdomen. It could be at the top. It could be at the bottom, the sides. 20:54 But usually it comes down to a problem with one of three things in your gut. 20:58 Okay. Okay. 20:59 The first thing is the motility, like we talked about. Maybe things are not moving properly through your intestines, so it's getting backed up. 21:07 The second is maybe you're not breaking things down properly. So again, a problem with your pollinators, you're not digesting properly. 21:15 And the third is maybe you have bacteria in the wrong place. 21:20 Hmm. Yes. Okay. 21:23 So how do you stop bloating fast? 21:26 First thing, take digestive enzymes right away. Okay. Basically what it does, it's going to break down your food. So if you're bloated and you're uncomfortable, go ahead and take one or two of those and see how you feel. What it's going to do is start breaking down the food. And within 30 minutes to an hour, you should feel that bloating go down. Okay. 21:44 Wow. What's another thing you can do? 21:47 The second thing is take that prokinetic, that ginger artichoke pill, take one or two of those, and it's going to start getting those cleaning waves going so that it moves the gas bubbles downward so you can actually pass those bubbles so they're not stuck inside of you. 22:02 So that's the second thing. 22:04 And the third thing is kind of what we touched on, taking that magnesium every night so that you never run into a problem where things are backed up. 22:11 What I love about this advice is you keep coming back to the same recommendations. Oh, yeah. 22:15 It's very simple. Thank you for simplifying it. You can also go for a little walk. Okay. How does a walk help? So walk naturally activates the motility in the gut. So the worst thing you can do if you're bloated is to just sit there at your desk. So even if you can just get around, walk around the office, go up a flight of stairs, that gets that motility going. 22:36 So that's an easy thing that anyone can try. I love that. Yeah. 22:40 Dr. Rajri, I am already learning so much from you, and I hate to do this, but I got to hit the pause button real quick because I want to give our sponsors a chance to share a few words, but don't go anywhere. There is a ridiculous amount that we are going to unpack here, and we are just laying the foundation with the garden. Coming up, Dr. Rajshri is going to show you how to start building a healthier gut, including the best diet for gut health and the five most important daily habits that will really help you start feeling better right away. 23:19 Have you ever found a protein drink that you actually like? A protein drink that when you drink it, you don't feel bloated. It doesn't have that weird chalky aftertaste. I've never found anything like that. And then a friend showed me something that changed everything. They pulled out this little shot from their pocket and I couldn't believe it. They said, Mel, there's 23 grams of protein in this thing. I took a sip. Holy cow. It was the best protein I'd ever had. No bloat. Delicious. No artificial flavor. Sugar-free. Fat-free. Are you sure this is 23 grams of high-quality protein? 23:50 You better believe I'm sure because I'm a co-founder. I have one first thing in the morning before I work out. Boom. 23 grams of high-quality protein. Handled. Use code MELTEN at Pure Genius Protein for 10% off your first order. 23 grams of protein in three seconds for under $3 a shot. 24:12 Welcome back. It's your friend Mel Robbins, and today we have Dr. Roshri teaching you all about gut health, how to heal your gut, how to relieve bloating, IBS constipation, and more. Here's my next question. Dr. Roshri, what is IBS? 24:28 So IBS, it's irritable bowel syndrome, and it actually affects 10 to 15 percent of the population. It's that common. 24:37 Wow. What is it? What are the symptoms? 24:40 So to have IBS, you just basically need three things. 24:44 You need to have abdominal pain or discomfort. 24:47 You need to have an alteration in your bowel habits. So either constipation or diarrhea or a combination of both. 24:54 And you need to notice that when you have a bowel movement, your symptoms and your pain improves. Okay. So, so many people fit the criteria for IBS. How would you like us to think about IBS? 25:09 IBS is just a label for your symptoms. Okay. But it's not what's really causing the symptoms. And so if you've been told you have IBS... 25:18 There's so much more investigation that can be done. Okay. What we now know is that 70% of IBS is actually caused by SIBO. Wow. Yeah. 25:28 But if it's IBS, what do you do about it? 25:33 So if a person is coming to see me, I have the luxury of doing all that further investigation. So we always test for SIBO. We test for food allergies. And most of the time, the SIBO test will be positive. If for some reason it's negative, then we move on to a gut microbiome test. 25:51 So again, it's always about figuring out what that root cause is and fixing it. 25:56 Now, if you're just someone with IBS and you don't know where to start, You can start with the first two systems of the gut garden, which is promoting motility, making sure your bowels are 100% and complete with the help of magnesium and motility activator at night, and improving your digestion of food. Try some digestive enzymes. It's a low-cost intervention. It might help you tremendously. And see where that takes you. What is SIBO? Small intestine bacterial overgrowth. So SIBO is basically when bacteria back up. 26:30 So now they're in the wrong place. So normally our small intestine does not have much bacteria. The job of the small intestine is to absorb nutrients from your food. 26:40 The trillions of bacteria, they're located in the colon. That's where your primary microbiome is. 26:47 But if something causes those bacteria to back up into your small intestine where they're not supposed to be, they start fermenting your food too early. So every time you eat, you get this miserable gas and bloating and it can alter your bowel habits. Hence, now it resembles IBS and maybe you've been labeled with IBS. 27:07 It can also cause acid reflux and nausea. It gives you that feeling of what we call early satiety, where you can't really eat that much because you've got all this pressure in your abdomen. 27:18 Yeah. 27:19 And it can even interfere with your nutrient absorption. So then you get deficiencies in B12 and vitamin D and iron. 27:28 And SIBO can even have effects outside the GI tract. 27:33 So people with SIBO get really anxious, they get brain fog, fatigue, joint pain, and so much more. Wow. 27:41 Yeah. I see that you have a model next to you of a human being and it's all the insides. It's like something you would see in a medical school, I think. 27:52 And this human model is these little stickers are the bacteria in your colon. 27:55 Okay. If you're listening, she's got these like splashy stickers around the colon. That's it. Just representing that's the bacteria. Okay. Okay. 28:03 Imagine what would happen if we take these bacteria and we move them to your small intestine where they're not supposed to be. Oh, my goodness. This is going to cause so much havoc to your digestion. 28:15 It looks like she's putting little like explosions all over your small intestines. Yes. I'm just looking at this model and it feels like I'm getting bloated. 28:25 That's exactly what it does. Those bacteria, they start fermenting your food in the wrong place. 28:31 And they interfere with your digestion of food. 28:35 How do you diagnose SIBO? So it's a simple breath test. 28:40 And it's a test where you drink the solution of lactulose. What is lactulose? It's a type of sugar that your body cannot absorb. So it stays in your intestines. And if you have SIBO, the bacteria, they're going to ferment it into gas. 28:56 And then you actually blow and collect your breath at 20 to 30-minute intervals for a full three hours. Okay. And you mail back the tubes. And they're going to graph out what's being produced in your breath. 29:10 No way. Yes. That's insane. So how did you treat SIBO? Like, what was the first thing that you did to either confirm that this was what this was or to just go, you know what? I have a feeling this is what this is. And so what do you do to treat this? 29:30 So the conventional treatment for SIBO is to take an antibiotic. What? Yes. Well... 29:37 The conventional treatment, unfortunately, doesn't work well. It has a very high failure rate and a very high relapse rate. So when I treat SIBO, I look at this as a full garden ecosystem problem. We have to fix the motility in the gut. We have to fix your breakdown of food. 29:55 The foundational steps is where we get everything ready to kill the bacteria. We don't kill the bacteria until the fourth and final phase of treatment. 30:04 Oh. 30:05 So phase one is promoting motility. That's the magnesium and the motility activator. We got to get that all going first. Phase two is the digestive enzymes. 30:15 Some people need that extra betaine and pepsin. Not everybody, but some people have low stomach acid and that can be a game changer. 30:22 So that's the pollinators. We're getting that going. Phase three is there's probably inflammation in the gut from all these bacteria. So I start patients on a spore probiotic. that has immunoglobulins to heal the inflammation in their gut. So that's phase three. So those are the foundational steps to get everything in order before we can actually kill the bacteria in phase four with the herbal antimicrobials. The ones we use are called berberine. 30:53 It comes from the root of a berberine plant. Oregano oil. You're probably familiar with oregano. And the third one is allicidin. It comes from garlic. 31:02 Now, what have you seen in your clinical practice and in yourself, Dr. Rajshree, when you follow this protocol with your patients and with yourself when somebody comes in and has a positive SIBO test? 31:16 So this protocol, I would say, is incredibly successful. It was for me and for hundreds of my patients. 31:23 But we see incredible results because, again, I think that my protocol really addresses the four systems of restoring the gut ecosystem. So at the end of it, not only have you cleared SIBO, you have a healthier gut microbiome. 31:38 And then we have this whole strategy for prevention of relapse that is so critical in SIBO. 31:44 Because 50% of patients will relapse in nine months if you don't have a strategy. 31:50 Incredible. I just want to remind you as you're listening that we have a... comprehensive guide to every episode with show notes, with links that we prepare for every episode. So if you're like me and as Dr. Rajshree is talking, you're trying to take mental notes. Okay, what did she just say? Because I got to send this. You can go to the show notes and it's all going to be right there for you. So you can just lean in and listen and we got you. 32:17 Let's talk about leaky gut. What is leaky gut? 32:20 So the medical term for leaky gut is increased intestinal permeability. 32:26 So it's basically a problem with that third system of the gut garden, the garden soil. Imagine your garden soil having big cracks in it. 32:37 So normally our small intestine is made up of tiny little cells, which I have a little example here. 32:44 She's got yellow yoga box. I'm going to narrate this for you if you're listening. 32:48 And these tiny little cells are what we call enterocytes, the little tiny cells on the lining of your small intestine. 32:55 Okay. So these are the things that line the wall. 32:58 Mm-hmm. Okay. Now, these tiny cells, they're bound together by tight junctions that hold them together. Okay. And the job of these cells is to just absorb nutrients from your food. Okay. Okay. 33:11 But if something disrupts these tiny junctions between these cells and pops them open, now it could be a variety of things. It could be the standard American diet, which is full of preservatives and emulsifiers and additives. 33:26 It could be antibiotics. It could be NSAIDs, like if you're taking a lot of ibuprofen on an empty stomach. 33:34 It could be if you're a heavy drinker. So all of these are insults to the gut. 33:38 Can the bacteria we talked about also be? Okay, great. 33:42 Absolutely. So SIBO is a big root cause of leaky gut because of the bacteria, again, interfering with the enzymes, creating inflammation in the gut. 33:52 So this is what leaky gut looks like. Now you've got openings between these tiny cells in your small intestine. Oh. 33:59 So instead of having a tube, you have mesh. 34:02 Exactly. You have little holes in your gut now. This is a problem because bacteria and food that are normally on the inside of your gut... Instead of getting properly absorbed through these cells, they now have an open window to enter your bloodstream. 34:20 Uh-oh, uh-oh. Like this. This little ball. She's got a ping pong ball and she just shoved it through the wall. Yeah. So now it's floating around in my body? 34:28 It's entered your bloodstream. And guess what's over on this side? The rest of me. 34:33 Yeah. And 70% of your immune cells, they're sitting right there on the other side of these tiny cells in your gut. 34:39 Oh, so on the inside, you've got this lining that's absorbing nutrients. And that's also, when working correctly, is supposed to keep all the food, bacteria, and crap on the tube. Exactly. But if you're eating a bunch of unhealthy ultra-processed crap or- doing too much ibuprofen or taking antibiotics or you got bacterial or SIBO or other stuff, it starts to stretch the lining. And now all the stuff on the inside is scooting through and now it's in your bloodstream. But the first thing in your bloodstream on the outside of your intestinal walls is the immune cells. 35:16 Exactly. 35:16 So what happens? So it confuses your immune system and it creates this whole entire inflammatory cascade. 35:25 And so now what's happening in your gut affects the rest of your body. 35:31 And it can present in different ways in different people. So how do you heal a leaky gut? So we heal leaky gut. First, we've got to clean up the diet. So we've got to get rid of those inflammatory triggers. We have to remove alcohol, gluten and dairy. 35:47 Because those are potentially inflammatory triggers, at least while we're treating leaky gut. We may be able to reintroduce those later. 35:55 We also cut out processed foods to get rid of all those additives and emulsifiers. 36:00 And then the two treatments we use for leaky gut, the first is L-glutamine powder. 36:06 So it's just an amino acid, and it happens to be food for these little enterocytes. Okay. So it feeds these cells, and it nourishes these cells and seals up these tight junctions between the cells. It does take time. It's not an overnight process. 36:21 How long do you need to dedicate to do this? 36:24 Three months for sure, sometimes up to six months. 36:26 Okay. Okay. 36:27 So that's the first treatment we use. The second treatment we use is immunoglobulins, also known as IgG antibodies. 36:36 They're kind of similar to colostrum. Are you familiar with colostrum? That's from milk, isn't it? 36:41 Yes. 36:41 It's like the mother's first milk, you know, that has all the antibodies to nourish the infant's gut and immune system. So the issue with colostrum is it has dairy proteins. So immunoglobulins are completely dairy-free. 36:55 So there's no dairy proteins and they're derived from bovine serum and they just come in capsules. 37:02 And so these two are the primary treatments that we have for leaky gut. But leaky gut does not usually happen in isolation. So we're back to that garden metaphor. 37:13 And now there's this new bacteria that I'm noticing that's missing in a lot of people's gut and it's called Ackermansia. 37:20 Ackermansia, the full name is Ackermansia mucinfilia, but it lives in the mucus layer of the gut. So it lives right here next to these enterocytes, and it creates that protective mucus that, you know, prevents leaky gut. 37:34 But if you're missing this critical bacteria that's making the mucus, well, you're definitely higher risk of leaky gut. So if you're missing that, we will also replenish that Ackermansia. 37:45 And then the final thing is if you've got a bunch of weeds on this side, the bacteria like we talked about, SIBO or dysbiosis or candida, we've got to clean that up as well. And that's where the herbal antimicrobials come in. 37:57 Dr. Rajshree, what is the best diet for gut health? 38:00 So everyone has a different gut garden. 38:03 So the interesting thing is that the same diet might not work for everyone. 38:08 Oh, see, I wanted a simple answer. 38:10 Well, let me give you an example. 38:13 I have some friends who are vegan and they eat a vegan diet incredibly high in fiber and they're thriving on that, which is wonderful. But if that same diet was given to someone else, they'd probably get bloated and miserable. 38:26 So some people do good on a Mediterranean diet. Some people do good on a paleo diet. But there are some key principles that I recommend across the board. 38:36 The first is that you want to eat whole foods. So you want to avoid processed foods as much as you can. Absolutely. 38:44 The second is that you want to have as many colors on your plate as possible. 38:50 So that means, you know, having some berries or colorful purple potatoes or purple cabbage, carrots, because colors is when you're going to get the antioxidants and the phytonutrients. So try your best to eat a diverse array of colors. 39:05 The third thing is to listen to your gut and figure out which fibers agree with you. Now, how do you know? 39:13 So it's a little bit of trial and error. OK. But let's say you eat arugula. 39:19 Arugula is usually well tolerated because it doesn't have any fermentable carbohydrate. So if you eat arugula with lemon juice and olive oil and you feel good eating that, that's a great fiber to keep in your diet. 39:31 Versus if you eat beans and you get bloated, maybe that doesn't agree with you. So fiber is good, but you may have to do trial and error to figure out what fibers agree with your gut and keep those in your diet. 39:44 And the fourth and final thing is to try to diversify your diet as much as possible. 39:49 So what that means is that instead of just having like broccoli every night, maybe try green beans or asparagus or better yet, stir fry a bunch of vegetables together. Because the more diverse your diet, the more robust and resilient your gut microbiome. So you're going to get more plants growing in your gut garden. And that's going to make it more strong so that the weeds don't come back. 40:13 What does fiber do for your gut? 40:15 So when we think about fiber, usually we think of it as bulking up your stool, keeping your bowels flowing regularly. But it does so much more for your gut. So fiber is actually food for the good bacteria in your gut. 40:29 So when you're eating fiber, it's like putting fertilizer into your gut garden. So you're gonna have more flowers popping up. And the good bacteria use the fiber to then produce critical postbiotics that are critical for your health. I mean, these postbiotics influence your immune system, your metabolism, your skin, and so much more. 40:50 How much fiber do you recommend to your patients that they try to get every day? And do you have your favorite forms of it? 40:58 So that's a great question. Fiber for a lot of my gut patients can be like a double-edged sword. 41:06 A lot of my gut patients are what I call fiber sensitive. 41:11 So... 41:12 Even though fiber, in theory, is so good for your gut, I can't just tell patients to take the recommended 25 grams for a woman or 38 grams for a man. That'll probably cause them a lot of problems. Okay. Usually what I recommend is start with the leafy greens. That's like the arugula, the spinach, the chard. 41:33 And start with the cooked form if you prefer. Cooked vegetables are always easier to tolerate than the raw. 41:40 But the nice thing about these leafy greens is they don't have any fermentable carbohydrate, so they usually don't cause bloating. 41:46 So if you're someone who's fiber sensitive, try sautéing a bunch of spinach first. Make sure it's well cooked. 41:53 So usually it's about taking baby steps, starting with really well cooked, figuring out what agrees with you, and then trying new things in your diet. 42:03 And then whatever does work for you, keep that in your diet and try to diversify. So everyone is kind of unique. You have to do a lot of trial and error and listening to your gut. 42:13 Dr. Rajshree, thank you so much for explaining it that way. Let's take a quick pause so we can hear a word from our sponsors. When we come back, she's going to break down one of her most popular topics online, which is histamine intolerance. You may have never heard of it, but when you hear her discuss this, you're going to go, oh, wait a minute. I think that's me or maybe somebody I know, and she's going to tell you exactly what to do about it. Stay with me. We'll be right back. 42:48 Welcome back. It's your friend Mel, and today you and I are here with Dr. Rajshree, and she is teaching us all about gut health and her simple protocol for healing your gut. So Dr. Rajshree, here's the next question I've got. What are the five most important daily habits for having a healthy gut? 43:07 I love this question because I think we pay so much attention to what we eat, but how we eat and when we eat are so important. So the first thing I recommend to all my patients is to practice meal spacing. 43:23 Meal spacing? Yep. So meal spacing essentially means no snacking between meals. 43:30 So that's having four to five hours between your meals. And what that does is it activates the cleaning waves in your gut. So it really reduces bloating. So that really, really is helpful. 43:42 The second thing I recommend is to practice mindful eating. 43:47 So I think so many of us are eating under very stressful circumstances. We've got stress from work. We may be eating on the go or while doing work or scrolling through stressful emails or news. And that stress puts us into a state of fight or flight. 44:05 So when you're eating, you want to activate the parasympathetic nervous system, which helps you rest and digest. So one of the easiest things you can do is is put away all your devices. 44:18 Take a few moments for yourself. Take a few deep breaths. And that's going to activate that vagus nerve. 44:24 And that vagus nerve is what tells your stomach to make stomach acid, your pancreas to make pancreatic enzymes. And it gets that motility going. So your digestion will be so much better. And when you eat, you really want to enjoy every bite. You know, take the time to chew your food, taste your food. The third thing would be to only eat when you are truly hungry. 44:48 So when you are truly hungry, that's when your stomach acid is going to be strongest, your pancreatic enzymes are going to be strongest, your motility is going to be activating, and your digestion is just going to be so much better. 45:01 So the fourth thing is to stay active throughout the day. 45:06 So after eating, if you can go for a little walk, again, you're going to naturally activate the motility in the gut. 45:12 So if you can work in a little bit of movement throughout the day, that's going to help your digestion so much more. Again, being stagnant and just sitting at your desk is probably the worst thing you can do for your digestion. 45:23 And the fifth thing is to try not to drink too much water with your meals. 45:28 Really? 45:29 Yeah. Why? 45:31 So water obviously is important for hydration, but when you drink a ton of it with your meals, you're actually diluting your stomach acid and your pancreatic enzymes. 45:42 So what I've observed with my patients and with myself is when I eat my meal, I'll take a few sips of water if needed, but I'll save the bulk of my water for like 45 minutes later and And by doing that, I need far less digestive support. Like I don't need to take as much digestive enzymes because my natural acid and enzymes are concentrated. 46:03 So I'd love to switch gears. What is histamine intolerance? 46:08 So histamine intolerance is another extreme form of food sensitivity. 46:15 And basically, a person with histamine intolerance suddenly feels like they're allergic to everything. 46:23 And the unfortunate part is a lot of really healthy foods that we think are good for our gut are loaded in histamines. So that's the fermented foods like the kimchi, sauerkraut, kombucha, and the bone broth. What is a histamine? So histamine is a compound that's made by our immune system, and it's naturally released when we're having an allergic reaction. So if you're having a sneezing attack or environmental allergies, your immune cells are releasing that histamine, and that's causing the nasal congestion. 46:57 But histamines can affect multiple organs in your body. 47:02 So in your brain, it can create anxiety, insomnia, headaches. 47:07 In your skin, it can cause rashes and hives. 47:11 In your heart, it can cause palpitations. 47:14 And in your stomach, it can cause acid reflux. And in your gut, it can cause bloating and diarrhea. 47:22 So it can really affect your whole body. 47:25 And histamines are found, like I said, in those fermented foods. It's also found in aged foods. So it's found in soy sauce and aged vinegars, aged cheeses, and alcohol. 47:37 Can you show me how histamine builds up in the body? 47:41 Absolutely. So let me get an example over here. 47:43 Okay. She's got a glass-like vase that has ping pong balls in it, white and blue. And there's a red line halfway up to mark halfway up. And then you've got some more ping pong balls here. 47:55 Yeah. 47:55 Okay. Okay. 47:56 So these balls represent the histamines. Okay. So I'm going to give you a story of one of my patients and describe his day and what happens with his histamine levels. Okay. So one of my patients, let's just call him John. He's a 45-year-old man and he comes to see me and he's basically reacting to everything. Okay. 48:18 Everything he eats is making him feel sick. He's bloated all the time. He's got diarrhea. He's got headaches now. He's super anxious and he can't sleep at night. And his skin is breaking out. 48:30 That's a lot. 48:30 So let me describe what's happening to John. John. 48:34 So let's say he wakes up in the morning and he's trying to be healthy. So he has his sourdough toast with avocado, a slice of tomato and an egg. That sounds healthy. It sounds healthy. But little does he realize that avocado and the tomato have histamines. 48:51 So now his body's got more histamines. 48:55 And then for dinner, he goes out to dinner with his wife to his favorite Japanese restaurant. 49:01 And he has a couple glasses of wine, which again have histamines. Oops. 49:06 And then he has his favorite sushi with a bunch of soy sauce. Soy sauce is loaded in histamines. 49:13 So guess what happens to John that night? 49:16 He comes home. He has a horrible headache. He's super anxious. He can't sleep the whole night. His skin is breaking out. It's itching. He's absolutely miserable. So he basically crossed the threshold of his histamine bucket. It's overflowing in his system. 49:34 So why did this happen? Because literally six months ago, he could have eaten the exact same foods and been fine. 49:40 Yes. 49:41 Well, it comes down to what's happened in his microbiome. There's been a shift. 49:45 And there's an overgrowth of weeds. 49:49 in his garden. 49:50 These bacteria are now producing more histamines, and they're eating up a critical enzyme that normally breaks down histamines. And that enzyme is called DAO, diamine oxidase. 50:04 So what I did for John is I had him do the SIBO breath test and the stool microbiome test. And we found that he had very significant SIBO, both types. 50:16 And he had leaky gut. 50:17 So he had the perfect storm. He had a bunch of weeds in the wrong place in his gut. And because of the leaky gut, his immune system was now confused, overreacting. 50:28 So I basically treated him by putting him on a protocol to heal the SIBO and the leaky gut. So it was a three-month protocol, doing everything we talked about today. 50:40 And to help with his symptoms during that time, I put him on a low histamine diet. 50:46 Now, this is where a lot of people get confused, and they think that the treatment for histamine intolerance is a low histamine diet. 50:54 What's the treatment for histamine intolerance then? 50:56 The treatment is really getting to that root cause, cleaning up those weeds. 51:01 So it's like the same protocol we've been talking about over and over to get the gut environment healthy again. And in order to help it, you're just lowering your own histamine intake to give your gut a chance to get healthy again. Because one of the things that I think is important to say is you're not saying these foods are unhealthy. 51:22 You're saying that based on your gut system and what's off- 51:29 in those four ways your gut can be off, foods that are really healthy can wreak havoc because your gut environment's bad. And so when you recommend a low histamine diet, it's not because the other stuff was unhealthy. It's because his gut couldn't tolerate it because the gut was unhealthy. 51:45 Exactly. 51:46 Got it. Okay. Dr. Rajshree, how are your thyroid and gut connected? 51:51 So our thyroid is that butterfly-shaped organ in our neck and And it's basically connected to your gut through the gut-thyroid axis. 52:01 So your thyroid can affect your gut and your gut can affect your thyroid. So let's talk about the ways that the thyroid can affect the gut. 52:10 So first is your thyroid strongly influences that motility in the gut. 52:16 So anytime I see a patient who's constipated, we need to check the thyroid labs to make sure that's not a root cause. 52:23 The thyroid can also influence your production of stomach acid. So a lot of my patients with hypothyroidism, they have low stomach acid and they may benefit again from the digestive enzymes. Sometimes even that detain and pepsin, those acid pills that I talked about. 52:39 Now, people with hypothyroidism, because of that slow motility, they're also higher risk of getting SIBO. 52:46 So if they're struggling with bloating or food sensitivities or bowel issues, we always test for SIBO. 52:53 So now let me explain how the gut can affect the thyroid. 52:57 So again, because the immune cells are in the gut, a lot of people with autoimmune thyroid disease, whether it's Hashimoto's or Graves' disease, Hashimoto's is the one that's associated with low thyroid, and Graves' disease is the one that's associated with high thyroid. 53:15 A lot of that can be linked to what's happening in the gut. So if their disease is flaring, again, it could be because of leaky gut or inflammation in the gut. So when we pay attention to the gut and treat whatever we find there, we often see antibody levels go down. 53:32 That's super helpful. What actually is Hashimoto's and what are the symptoms? 53:37 So Hashimoto's is an autoimmune disease of the thyroid. Your body is producing an antibody. It's called the thyroid peroxidase antibody or TPO antibody. And that's attacking your thyroid. 53:50 Now, there's many stages to Hashimoto's. Like a lot of times we can catch Hashimoto's early before it actually makes you hypothyroid. So the symptoms of Hashimoto's are kind of general. It depends on how active the disease is. Some people with mild disease may not have any symptoms. Maybe they're having fatigue, brain fog. Maybe they're having slow gut motility and bloating and constipation, sometimes joint pain. 54:15 So it really varies. 54:17 How do you heal your thyroid? 54:20 Our thyroid is dependent on critical nutrients. 54:24 So an easy thing that I do for patients is I check their nutrient levels and we try to optimize that. 54:30 You can easily do that by taking a high quality multivitamin that has all of these things in there. 54:36 But if someone's really deficient in iron or vitamin D, I might have them work on that specifically. 54:43 And then again, if we're talking about Hashimoto's, because of the autoimmune process, we really need to target gut inflammation, the health of the microbiome, and seeing what we can do there to improve the immune regulation. 54:58 Let's talk about insulin. What is insulin? 55:01 So insulin is a hormone that's been made by our pancreas. And the job of insulin is to tell our cells to take up blood sugar. 55:11 So let's say you have a piece of cake. 55:13 Okay. 55:14 Your blood sugar goes up. And the way your body controls that is by releasing insulin from the pancreas. 55:23 Now, the key thing is whether or not your insulin receptors are listening. So let me show you an example. Oh, I'd love to see an example. 55:31 Okay. She's got a glass jar of sugar cubes. Perfect. Oh, and she's got a Tupperware, round Tupperware thing with a lid on it. 55:40 So this Tupperware container is like the cells in our body. 55:44 And then these sugar cubes represent glucose in your bloodstream. 55:49 So you had your piece of cake and your blood sugar is just going up. 55:53 So your body is going to release insulin from your pancreas. And insulin is like the key. 56:00 Now in order for insulin to work and tell your cells to take up the blood sugar, The cell's insulin receptors have to be unlocked. 56:09 Got it. 56:10 So let's say this is a receptive cell. It's unlocked. So it opens up, it listens to insulin, and it takes up the blood sugar. And interestingly, you can actually naturally open up your receptors. 56:22 You can? How? By exercising. Really? When you exercise, your muscles will naturally open up their insulin receptors and take up glucose. 56:32 That's why you can see a drop in your glucose levels when you exercise. Okay, I get this. I love the visuals. So all she's doing, if you're listening, is when you eat cake, you got sugar cubes on the left. And in order to process the sugar, your insulin receptors have to open up in the cells so that we can lower glucose instead of having a spike. And insulin, she's holding this big, bright, it almost looks like a Dr. Seuss key that says insulin on it. Insulin unlocks the receptors. 57:00 But the problem... 57:02 is a lot of people have cells where the insulin receptors are locked. So that's like having a tightly closed Tupperware container that's not responding to this insulin key. Got it. 57:13 Okay. 57:14 So when this happens, your pancreas responds by increasing the production of insulin. This is a problematic scenario because high insulin levels is inflammatory on the body. 57:29 High insulin levels tells your cells to store fat and lock it away. 57:34 And high insulin levels makes you very hungry. So guess what? 57:38 Two hours later, you're ready for your cookie. 57:43 Even though you just had cake. 57:45 So it drives this vicious cycle of hunger and weight gain. 57:51 So... 57:52 People who have high insulin levels, they often struggle to lose weight. It's very difficult to fast because of the hunger that's controlling everything. Insulin resistance can happen far before you're diagnosed with prediabetes or diabetes. 58:10 And we now know that about half the population here in America are insulin resistant. 58:16 The good news, though, there's so much we can do to reverse insulin resistance. So that's kind of a window of opportunity where we can intervene and reverse this whole process. 58:25 Dr. Rajshree, what can you do to reverse insulin resistance? 58:30 So usually it's a combination of three things. 58:33 The first thing is the diet. 58:36 So we take away the things that spike the insulin because that's feeding into this whole vicious cycle. 58:42 So obviously we want to avoid simple sugars and carbohydrates as well as alcohol because alcohol turns into sugar. 58:51 So we really want to put you on a diet that's going to stabilize your blood sugar. So when we do that and you focus more on eating proteins and vegetables and healthy fats like avocados and nuts, that totally reduces your blood glucose level. So you're not having these spikes up and down all day. Your blood sugar is kind of stable meal to meal. 59:12 So guess what happens? Your pancreas doesn't have to produce as much insulin. 59:18 So your hunger goes down. I mean, you can still have some carbs like from berries and yams. 59:24 So the insulin goes down and then all of a sudden, because the cells are not over flooded with the insulin, they start opening up. 59:33 What's the second? 59:34 The second thing we can do is exercise. Like I mentioned, exercise is going to naturally open up those insulin receptors. So I'd recommend 30 to 45 minutes of cardio every day. You can split it up into two sessions if you want. And strength training two to three times a week because the more muscle mass you have, the more insulin sensitive you are. 59:55 So that's the second thing. And the third thing you can do is to take some natural supplements. And so the two that I use in my practice are berberine and cinnamon and chromium. 60:05 You're smiling as you say this. 60:08 Well, I think because I've seen such radical transformation in patients. OK, I'll share one of the most fascinating stories of my career. 60:16 I met a lady. She was vegetarian. 60:19 And her hemoglobin A1C, when I first met her, was 13. 60:24 Which, in other words, her fasting glucose was over 300. She was a very poorly controlled diabetic. 60:31 But she followed everything I asked her to do. 60:34 The diet, the exercise, and these supplements. Yes. 60:37 But by six months, she had lost over 30 pounds. And her hemoglobin A1c was 5.7, which is like normal. And her insulin was 8, which is also pretty close to normal. 60:50 That's incredible. 60:51 Dr. Rajshree, what is the difference between acid reflux and GERD, and how do you treat them? 60:59 So GERD is gastroesophageal reflux disease. 61:03 So that's basically the medical term for acid reflux. It's the same thing? Pretty much. But what I've observed in my practice is that out of 10 people who tell me they have reflux, they call it reflux, Seven of those 10 people actually have the opposite problem. 61:22 They have non-acid reflux. What is that? So non-acid reflux is where they're not digesting their food properly because of low stomach acid. And that undigested food fragments kind of trickle up their esophagus. It causes all this phlegm in their throat. They're constantly clearing their throat after meals. 61:45 And in the SIBO IBS population, this non-acid reflux is very, very common. 61:52 And so it's an important distinction. So when we're dealing with true acid reflux, the patient will often describe burning in their stomach, burning in their chest. 62:03 So they kind of hold it in between their breasts or right above it, saying it's kind of right here. Exactly. 62:09 Exactly. 62:10 When they're talking about non-acid reflux, they don't describe any burning. They're talking about phlegm and throat clearing. 62:18 And so I have to ask these questions to really tease it out because otherwise patients just think they all have acid reflux. But this distinction is so important because the treatments are opposite. 62:29 How do you treat acid reflux and GERD versus non-acid reflux? 62:34 I'll start with the non-acid reflux because that's the easy one. 62:36 Okay. 62:37 Non-acid reflux, the treatment is to provide the acid. So we use those capsules of betaine and pepsin. Betaine is hydrochloric acid, and pepsin is an enzyme to digest proteins. So a patient will try that. They'll take it after a meal. And if they notice all these symptoms reduce, their phlegm is gone, throat clearing is gone. And if they take it and they don't feel any burning, that means they need it. It's actually helping them. But if they were to get burning, then we know that they don't need it. 63:07 They have enough acid. 63:09 So that's the treatment of non-acid reflux. 63:11 You just add acid. 63:12 Yeah. Very simple. Very simple. 63:15 Now, when we're dealing with acid reflux, There are natural treatments, but we also need to do more investigation. 63:23 Or we use DGL capsules, which are a type of licorice. And they're convenient because they're in capsules that they can take with them anywhere. And it's very soothing to the stomach and the esophagus. So SIBO, interestingly, is a big root cause of acid reflux. 63:39 And part of that is because if you have a lot of pressure under the diaphragm from the SIBO, that gas pressure is going to push the acid upward. 63:47 So we have to take a full picture at their gut ecosystem. 63:51 And once we fix that, usually we see acid reflux go away. 63:55 How do you suggest or recommend that I or the person listening... 64:03 Go about finding the right doctor when you have unexplained gut issues. Because I think as I listen to you and as the person who's watching and listening is like, I want you to be my doctor. But what questions would you ask or how do you find somebody that takes such a holistic approach to gut issues? 64:21 So you probably need to do a little bit of research. I think your gastroenterologist is a great starting point as far as ruling out all the structural issues. For doing all the standard tests to make sure nothing really serious is going on, like ruling out colon cancer, ruling out inflammatory bowel disease, celiac disease, they can help with all of that. A lot of times, well, you could ask your GI doctor for the SIBO test. A lot of them are familiar with it. You always want to know what you're treating. Then you might want to research someone who has knowledge in integrative and functional medicine, someone who's familiar with SIBO, familiar with the microbiome, someone who's going to pay attention to your diet, the food allergies, the food sensitivities. 65:05 So it may take a little bit of research. 65:07 What are for you kind of top red flag symptoms that you would recommend that I or the person listening go talk to a doctor about? 65:18 So if you have blood in the stools, that's usually a red flag. I mean, it can be hemorrhoids. And so I try to understand the patient's history. Like if it was after a significant straining and it was a one-time thing, one wiping. But if it's a consistent blood in the stools, that is definitely a red flag. 65:36 If you're vomiting a lot, that's a red flag because SIBO can cause nausea, but it shouldn't cause persistent vomiting. 65:44 If you're losing a substantial amount of weight, more than 10 pounds, and you can't seem to stabilize that weight, it's just coming off, that's another red flag. 65:54 Dr. Rajshree, what are your parting words? 65:56 So if you're someone out there who's struggling with gut issues, whether it's bloating every day or constipation or reflux, or you're reacting to foods, I just want to bring you hope that healing is possible, that you don't have to live like this for the rest of your life. There's so much we can do. It's just a matter of figuring out what part of your gut garden needs support. So hopefully with all of these tools and tips that we've talked about today, you can see improvement in your gut health and in your overall health. 66:28 Well, I just want to say thank you. 66:30 Thank you for getting on a plane and flying across country and taking time out of your extraordinarily busy clinical practice to share all this. This is a comprehensive guide that not only left us with specific things to do that you're seeing work for yourself, for your clinical practice over and over again, but that also was easy to understand. And I really appreciated that and I feel way more hopeful. 67:01 And what I also appreciate that you brought to this is that there is the emotional side. It impacts your quality of life. And so I loved that your approach kept coming back to the baseline understanding of these four factors of how you create this healthy garden in your gut system so that your overall life becomes healthier. So thank you, thank you, thank you. 67:26 Thank you, Mel. It was such an honor and a privilege to be here today to have this amazing conversation. And I really hope it reaches a lot of people and helps so many people. 67:35 I know it will. And I also want to thank you. Thank you for taking the time to listen to this, to better understand your gut, and to learn how to create a healthier gut. There's no doubt in my mind, based on the way that she explained this all to us, that you can feel better in your life. And I really hope that you not only take the recommendations and try it, but you also share this free resource with people in your life who deserve to feel better too. And in case no one else tells you, I want to be sure as your friend to tell you that I love you and I believe in you and I believe in your ability to create a better life. 68:12 And boy, wouldn't your life feel better if your gut felt better? Of course it would. I will welcome you in to the next episode the moment you hit play. I'll see you there. 68:24 She's built a global audience of 3 million plus subscribers. 68:31 And then he's got it. Now I'm sharing poor Chris's details. This is probably a HIPAA violation, if not a violation of our marital contract. 68:39 So motility, is that what it is? Mobility? What would you call it? Motility. 68:42 Motility, yes. Because if your bowels are regular, you're less likely to be bloated. Sorry, let me do that again. 68:49 Shout out to the team on the props. Killing it. Love the props. Love the props. Okay. 68:54 The fourth thing. 68:55 It's question Q18. 68:59 Sorry, guys. 69:00 Oh, you're perfect. Don't worry about it. 69:01 Now, do you think it's okay if we take a little break? 69:04 Yeah. 69:05 I want to deliver the whole thing. No, I agree. 69:07 Fantastic. 69:09 I want quality to the end, you know? We've got a ball that can just squeeze right through. 69:14 Let me try that again because I didn't make enough space for the ball. 69:18 Okay. 69:19 I'll let you get your water. I'm going to take a sip of my coffee. This is probably not good for my gut, by the way. 69:24 No. 69:29 Oh, and one more thing. 69:30 And no, this is not a blooper. This is the legal language. You know, what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend, I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode. 70:03 Sirius XM Podcasts.