Latest / NHA Today Podcast / 153: Thriving Health Starts in the Gut with Dr. Will B. (2025 Replay)

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153: Thriving Health Starts in the Gut with Dr. Will B. (2025 Replay) · NHA Today Podcast

0:00
Welcome to NHA today, where we explore the path to lasting
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health and fulfillment through a whole food plant-based lifestyle.
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Each week we bring you real conversations with doctors, health experts, and everyday
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individuals who have transformed their lives through food, mindset and community.
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This is NHA today powered by the National Health Association.
0:22
Oh no, no.
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Your eyes are not deceiving you.
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Your ears are not deceiving you.
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This, this is not the Exam room podcast.
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This is the NHA today, but I'm still Chuck Carroll here, joined by a very special
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guest, a very special friend of mine.
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You know him as the Gut Health md. I call him the Prince of
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Poop, the Pharaoh of fiber.
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I just think he's the all around one of the greatest gastroenterologists and human
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beings to ever walk the face of the earth.
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Dr. Will Sitz.
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Thanks for being here, my friend.
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Oh, thank you.
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Chuck Carroll.
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Thank you for having me here.
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Here, and thank you to the NHA for hosting this great podcast.
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So cool, man.
0:59
I want to just dive right in today because when I was thinking about what in the
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world do I want to talk about with Dr. B, the Gut Health md, one of the first
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things I thought about was heartburn.
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You know, so many people suffer from heartburn and you go into any pharmacy,
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any grocery store, any seven 11, any convenience store, and you just see like.
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Tums, ANAC, acid, Rolaids, all of that stuff is right there.
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And it makes me think like there's a lot of people walking around suffering.
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And so they're kind of walking out with their chili cheese fries or their, their
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hot dogs and then, you know, they've, they've got the Tums in the other hand.
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So when you were still in practice in South Carolina, how many
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patients walk through your doors?
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Dr. Beam complaining about heartburn.
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I mean a bazillion, just like the rare, bazillion people with
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constipation or a bazillion people with irritable bowel syndrome.
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But you know, to undeniably contextualize this, Chuck, if you were to take a
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look at the top 10 most prescribed medications in America, several of
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those spots among the top 10 are taking up four years, going on decades.
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With medications that are used to treat acid reflux, the proton pump inhibitors.
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So these are some of the most widely prescribed drugs that exist,
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not to mention the people who are buying those over the counter
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solutions that you just described.
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Alright.
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Now, how much of the, or how many of the cases are, you know, something
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that could be really controlled by making diet and lifestyle changes?
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Is this something that we're really doing to ourselves?
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Well, I don't think it's the absence of proton pump inhibitors
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that causes the problem.
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So, yeah, this, there is something that's causing this.
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And it's not to say that if you had the perfect diet, the perfect
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lifestyle and all these different things, that we would totally eliminate
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this diagnosis from the world.
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That's not fair either.
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I mean, there would still be some people who need those medications.
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There would still would be some people with acid reflux.
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But the problem is that.
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We don't currently use strategies to address the root of the problem,
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which we could and we should.
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We should be addressing the root of the problem.
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So I think to me, Chuck, it starts with like understanding what it is,
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where does it come from, and what are the levers that we can pull to improve
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the way in which our body works and potentially reduce our dependence or even
3:19
completely eliminate our dependence on medication, which is absolutely possible.
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Alright, so let's start there.
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Let's unpack that.
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What are the most common causes of acid reflux of GERD that most people
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experience on a day-to-day basis?
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Again, most people.
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Yeah.
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So, you know, let me start by saying this.
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You hear don't eat spicy food.
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Don't eat acidic food.
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Does that mean that spicy food and acidic foods are actually causing
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acid reflux, causing this problem?
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Absolutely not.
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So we need to dive deeper than that, which is where I wanna take you right now.
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There's been this idea that acid is the issue.
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I would argue absolutely not for the vast majority of people.
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It's not that you have too much acid, it's not that you have too little
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acid, it's not an acid issue at all.
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To be totally honest with you.
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It's a motility problem and that's what we've learned through the years.
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So we have to start at the top, which is your throat.
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'cause this is where the digestive system begins.
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I mean, really it starts with your mouth, the digestive system.
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When you consume your food, you chew it, grind it up with your teeth, mix it with
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saliva, and when it's adequately broken down, you get into a position where you
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say, okay, I'm gonna swallow it down.
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What happens?
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You have a whole bunch of muscles right here, the upper esophageal sphincter
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and the pharyngeal muscles that work Chuck in a coordinated fashion to
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clear a path so that food will travel not into your lungs, but instead
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down a tube called your esophagus.
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The esophagus is the, is, you know, after you've entered this trap door,
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the first part of this continuous tube that includes the esophagus, the
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stomach, the small intestine, the colon, the rectum, and then things come at
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the other end of your bottom, okay?
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The esophagus propels things down.
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It is one direction.
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The esophagus is not designed nor capable of propelling things up.
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Things aren't supposed to move that way.
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So when motility, meaning the way in which the muscles move is working the
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way that it's supposed to, things will transfer from your throat down to your
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stomach, and the esophagus is literally just transporting through and they get
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into your stomach and there is a flap, a muscular flap, a valve that closes
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to keep things inside the stomach.
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And we call that the lower esophageal sphincter.
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Lower esophageal sphincter, bottom of the esophagus, top of the
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stomach, and that flap close closes.
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And now whatever it is that has entered your stomach, that's
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where it's going to stay.
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When this process is working the way that it's supposed to chuck,
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things move in a forward direction.
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They go from your throat to your esophagus, to your stomach, to your
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small intestine, to your colon, and that's the end of the road.
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And then any, if there's anything left, it comes out in the toilet.
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Acid reflux by definition is things moving retrograde in a direction that they're
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not supposed to, and there's breakdown of the systems in order for that to happen.
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So now the flap at the bottom of the esophagus has opened.
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It's no longer competent.
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Things that were in your stomach that are supposed to move in a forward
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direction are now squeezing and moving in a retrograde direction.
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And now things that are never supposed to be in the esophagus
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in the first place, because again, this, the esophagus is meant to
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only send things into the stomach.
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Now we're doing the opposite.
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We're saying things from the stomach into the esophagus.
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Now those tissues that are not designed to deal with those things.
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Are forced to be exposed to stomach acid and enzymes and bile and
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these other things that basically irritate the lining of the esophagus.
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And next thing you know, you the person experience heartburn and discomfort
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that burning sensation in the chest.
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And that is the result of things that were never supposed to be going in that
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direction are now going that direction.
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But the key from my perspective, Chuck.
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The foundation that I want to build upon throughout the course of this episode
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as we discuss options for treatment as we discuss solutions to this problem.
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The foundation that we build upon Chuck is that this is a motility issue
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where things are moving in the opposite direction from what they're supposed to.
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And if we could restore forward, flow, forward, motility, efficiency,
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and competence to this process, you would not have the issue.
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Okay.
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Without being an alarmist.
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And, and absolutely we know that, uh, motility here is gonna be restoring,
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that is gonna be the key for everything.
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But I, I don't wanna be an alarmist here, but at the same time, I
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also don't want people to think like, oh, it's just heartburn.
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It's, it's not that big of a deal.
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Over time, it's my understanding that it can begin to erode somebody's esophagus.
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And in even more extreme cases, I've heard of that stomach acid traveling
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all the way up the esophagus and then going down the windpipe and actually
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going a little bit of it winding up in a person's lungs, which can be
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particularly a dangerous situation.
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Correct?
8:43
Correct.
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So there's the classic symptoms of acid reflux, which I
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mentioned heartburn a moment ago.
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Heartburn occurs as a result of the breakdown of the cellular
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tissues that protect the esophagus.
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So, and we can dive deeper on that in a moment, but I want to
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play off of what you just said.
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If that acid goes beyond the bottom of the esophagus and goes to the upper
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esophagus, it can give you a sour taste in the back of your throat.
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It could potentially go down into your lungs, which it's not supposed
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to be there and cause aspiration.
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It could cause reactive airway disease, which is asthma.
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Um, it could cause you to feel like there's a lump in the back of your throat.
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We call that globus sensation.
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So, and these can all be the consequences of acid reflux.
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Sometimes people go to their dentist, the dentist says, you have
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horrible dentition in the back.
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And I think it's because acid has been in contact with your teeth in the back.
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That's the consequence of acid reflux.
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So there's many different potential consequences.
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And if we start at the bomb of the esophagus, chuck, where I mentioned
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heartburn and there's breakdown of the lining of the esophagus.
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Let's, is it okay if I double click and go to a little deeper on that?
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Oh, 100% man.
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Let's go.
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Okay, cool.
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So first and foremost, before there's any visible damage,
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there will be microscopic damage.
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So the cells that line the esophagus are held together by proteins, tight
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junctions, and if you damage those proteins, they break apart and you create,
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if you're looking at the video right now, you can see I just opened up my hands.
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I had two fists pounded together and I just pulled them apart.
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I just created, imagine a channel between two cells and what passes
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through that channel includes.
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Protons, which is acid.
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So the acid from your stomach, once we have on a microscopic level, broken
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down those proteins, the acid from your stomach comes into contact with
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your esophagus, and now it gets easy access passing between the cells and
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coming into contact with your nerves.
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And that's when you experience heartburn, right?
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And that would be the beginning of this problem.
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Now an upper endoscopy in the beginning will look totally normal.
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You can't see acid damage yet.
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But if we had the ability to look on a microscopic level,
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that's what we would see.
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We would see the breakdown of those proteins and allowing that stomach
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acid to now get access to your nerve, to the, to the nerves that, uh, that,
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uh, have sensitivity in that area.
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As this progresses and you continue to splash acid in this place where
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acid is not supposed to be, you will eventually erode the surface cells
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and you will get an early ulcer.
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And that ulcer can continue to grow and get bigger and bigger and bigger.
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Ulceration is damage that has occurred to the surface cells requiring
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repair, and we call that esophagitis.
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So in the gastroenterology world, we would call that erosive esophagitis.
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You've now progressed, this is even more severe than it was before.
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Before it was only a microscopic issue.
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Now it's a macroscopic issue.
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I can actually see the ulceration that's occurred as
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the result of the chronic damage.
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And Chuck, if you were to take that ulcer and allow it to continue to exist, we have
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an active inflamed area on these cells.
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Inflammation leads to the development of cancer.
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Eventually, what your body would do is create new cells
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to try to protect that area.
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And we have a term for that called Barrett's esophagus.
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And Chuck, I think you know this about me, but many of the
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listeners may not realize this.
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I used to study Barrett's esophagus when I was, when I was at the University of North
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Carolina at the School of Public Health.
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This was my area of research esophageal cancer.
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Why?
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Because esophageal cancer has increased dramatically, 700 to 800% increase
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since the 1970s in esophageal cancer.
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And there's this precursor that exists called Barrett's esophagus that you
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can see during an endoscopy, and it's an opportunity to potentially
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prevent the cancer before it occurs, but you actually wouldn't know.
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There's no way to know from a symptoms perspective that you
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have this Barrett's esophagus.
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You can't feel it.
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In fact, if anything, you feel less.
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Why?
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Because the change that just occurred with the Barrett's esophagus to cover
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up this area that's been injured.
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It actually reduces the amount of acid that gets contacted to your nerves.
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So believe it or not, chuck, these people, they actually have less heartburn.
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So then they think their problem went away.
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But now the problem is still there.
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It's just a precursor to, to cancer, and eventually it can
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turn into esophageal cancer.
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This is, by the way, particularly common among white men with acid reflux.
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So if you're a white guy like me, like you Chuck, who has chronic acid reflux,
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we need to be more conscious of this.
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That is a huge number since the seventies.
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So over the last half century or so, you're talking about a seven
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to 800% increase in the number of esophageal cancer cases.
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What is the prevailing theory as to why that's occurring?
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Well, let's let, let's get back to this foundation.
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Like you don't have the Barrett's esophagus and you don't have the
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development of esophageal cancer without actually first having the
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injury that occurs to the esophageal tissues, which is the result of
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the reflux of stomach contents that include acid and bile and enzymes.
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Onto those tissues.
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So this is, this is the reason why, like on a, on a very basic
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level, like why is that happening?
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Well, we have more acid reflux.
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It's proof of the rise of, of severe acid reflux in America.
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Why do we have severe acid reflux in America?
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Why do we have a motility disturbance in America that's so pervasive?
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That's the million dollar question, and I'm happy to dig into those
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answers as we move through.
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Oh yeah.
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I mean, I would, I would love to get your, your theories there.
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Um, but just outta curiosity, you've, you've launched something new called
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The Gut Health Collective, where it's a, it's a community of people who are really
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trying to take charge of their gut health.
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Since the launch, how many people in there have also talked about
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suffering from these same types of symptoms You and I are discussing.
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Well, so the beauty of the Gut Health Collective, Chuck, is that I wanted
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to create a space for people that have gut health issues where you could be
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in this space and it's a safe place where you're like amongst friends
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who understand the way that you feel.
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And we can lift each each other up together.
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And of course, I'm personally there myself.
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I'm answering questions literally every single day.
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I did today, I did yesterday and every single day in the last week.
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I've been in there basically interacting with people, answering
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questions and providing education.
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But the point from my perspective is that the gut health collective was
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built to be this, this space where if for people that want to improve their
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gut health, this is where you go.
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And we have tons of people who have, for example, acid reflux.
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There's a place where you post, um, where it's called gut chat.
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You go to the gut chat and like, Chuck, if you wanted to talk about this, you go
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in the gut chat, you put a post down, you say, Hey, here's what I wanna discuss.
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Does anyone have any thoughts?
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And you come back tomorrow and you're gonna have probably 12 comments from
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people who are basically trying to provide you with support and, and
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share with you the things that have worked for them, because there's tons
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of those people in this community.
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So it's basically a network of people who are looking to improve their gut health.
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That's awesome though, that they get the chance to, to interact with you
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and you can throw in, you know, your thoughts on, on everything as well.
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I think that there's a huge upside to that, um, not to give a hard sell
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or anything like that, but I mean, you know how many episodes we've
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done together and how often people come up and they're like, oh my gosh,
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you know, is he still practicing?
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How can I get 'em, you know, I want to ask 'em about, you know, my own
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specific case, what I'm going through.
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This just seems like a really cool opportunity for you to
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reach the people that way.
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I can't, I can't give direct medical advice within this context, right?
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This is an educational platform, but what I am there to do is to properly
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educate you with high quality information that you have great confidence in,
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because you know me and you know where I come from, which is I'm evidence-based
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and I'm looking to try to help people through the power of a plant-based diet.
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And so, and, and we have, you know, as a quick example, Chuck, we have
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live events, so like later today.
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I have a live q and a where basically I'm gonna like open up a window just like you
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and I have right now, and there's a chat room and people can drop their questions
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in there and I answer your questions.
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And so we're doing stuff like that now.
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I am going to open a clinic in the future, Chuck, that's not like some
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big wild announcement right now.
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This is something I've been meaning to do.
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So I am going to be opening a clinic in the future, but people need to
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also know that there's complexity to all that because I'm a South
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Carolina licensed medical doctor.
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You can't just open up a clinic and have anyone that wants
18:07
to come see you come do that.
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It's just not possible.
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So, but the beauty of the collective is it's very inexpensive and it's a
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place where you can go and basically get with other people and create
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solutions together, including me trying to contribute to those solutions.
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Alright, well, let's see if we can contribute to some blue, uh, some
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solutions here on the NHA today as well.
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Um, so much of what the NHA talks about are diet and lifestyle changes.
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So I'm curious, like in terms of everything that you've written about,
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uh, in your books, fiber fueled and of course plant power plus,
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which is, uh, coming out as well.
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You know, what are the strategies, the dietary strategies that have been
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proven to really help out with a lot of these GERD and acid reflux symptoms?
18:52
Okay, so I'm gonna, I'm gonna get you to the evidence that exists from
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a diet and lifestyle perspective.
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In fact, I gave a very prestigious keynote lecture on this topic at an ENT
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conference, I think it was two years ago.
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So I got invited and flown, uh, up to Boston to give this talk.
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But before we talk about specific dietary stuff, let me start with
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the stuff that you're gonna hear.
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Or if you Google this, I'm gonna tell you the stuff that you're gonna hear,
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which is to avoid spicy and acidic and peppermint and chocolate, and
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caffeine, and alcohol and smoking.
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I think that probably covers most of it.
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They're also probably gonna say to avoid fri fried foods, fast foods.
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Okay.
19:43
So if I could, I wanna go through some of those just to
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explain what's going on there.
19:47
Absolutely.
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Let's start with the, with the big ones that everybody's heard.
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Uh, which would be, to me, the spicy foods, the caffeine, and the alcohol
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that's like the holy Trinity of reflux.
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Uh, that's been really hammered home time and time and time again.
20:00
Yeah.
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Yeah.
20:01
So, okay.
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So the, the spicy food that, or like orange juice, right?
20:07
Just orange juice.
20:08
People say Don't, don't drink orange juice.
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It's just the acid.
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So let's go back to this image that I've, uh, that I've laid down.
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The reason why I got into such detail is I wanted you understand
20:19
really what's happening.
20:20
So imagine again that those cells are broken up, they're
20:23
damaged on a microscopic level.
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So any acid, no matter what direction it comes from, no matter what
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the source is, any acid is given instant access to your nerves.
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It's not necessarily that the acid is causing reflux.
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That the acid that you swallowed in your orange juice is going to
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go and pass through this area.
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And because it's so quick and easy for it to get access to your nerves and cause
20:48
heartburn, it will and you will feel it.
20:52
So we tell people, avoid acid, avoid spicy foods.
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Avoid, avoid citrus and orange juice.
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That's the reason why it's not causing reflux.
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It's just coming into contact with this area of vulnerability that you have.
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Caffeine.
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Alcohol.
21:07
What's happening there?
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We believe there's a couple things.
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First of all, caffeine, it's related to stomach acid production.
21:13
It's not to say that stomach acid is the cause of acid reflux.
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It is to say though, that when reflux occurs, stomach acid is
21:23
part of what splashes up there.
21:25
And once again, once you have reflux on a microscopic level, any
21:29
acid that comes into contact with this area will cause heartburn.
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The idea of proton pump inhibitors doesn't actually stop most reflux from occurring.
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What's happening is you've reduced the ity of the reflux.
21:43
It's not as caustic as it used to be 'cause you cut the stomach acid.
21:46
So, and that's the idea with caffeine.
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Um, with the alcohol, it's a combination of stomach acid and
21:55
also the, the key here with the alcohol is that it relaxes muscles.
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Including the lower esophageal sphincter muscle, and because it relaxes that
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lower esophageal sphincter muscle.
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And also specifically, a lot of people when they drink,
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it's not early in the day.
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They're drinking in the evening when it's dark out and then they go to bed.
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You've just disrupted your sleep.
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That's number one.
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But number two, you're now laying flat.
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Your lower esophagal sphincter got disrupted by the alcohol too.
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You just set yourself up for reflux.
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When you're laying flat in a bed with a disrupted lower esophagal sphincter,
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you're set up for the problem.
22:35
Yep.
22:36
You're absolutely right.
22:37
Most people do have that, that night cap.
22:39
And you know, like alcohol I think in a lot of cases gives people a
22:43
false sense of security because it kinda lulls them to sleep initially.
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But as you said, it really disrupts.
22:50
The, your circadian rhythm or, or your ability to just get
22:53
that quality night's sleep?
22:55
Man, it, it really is, man.
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It's a double-edged sword for a lot of people I think.
23:00
Yeah, it is.
23:00
Because what you really want is you want the deeper m sleep.
23:03
It's the deep rem sleep that is high quality sleep.
23:05
So, you know, imagine that you just, like, you went out, uh, you had a
23:08
college reunion, you went a little too hard 'cause you were pretending
23:11
that you're still in college.
23:12
You're not.
23:12
I'm not,
23:16
yeah.
23:17
I'm not calling you out.
23:17
I'm not calling you out.
23:18
Chuck, I'm, I'm speaking to the NHA audience here, right?
23:21
Oh, oh, I thought you were talking about Well, 'cause I do have a
23:23
25th reunion coming up next month.
23:25
I was like, oh, oh, oh.
23:27
Yeah, those reunions, they just sweep and warm.
23:28
They just keep coming.
23:29
They just keep coming.
23:30
But anyway, yeah.
23:31
High school reunion, college reunion, medical school reunion.
23:35
We got lots of reunions.
23:36
Yeah.
23:36
All right.
23:37
Yeah.
23:38
I'm not in college anymore.
23:39
And so the problem is you go and you go a little too hard.
23:44
What do you notice the next day?
23:46
You're like insanely fatigued.
23:48
You're hungover, by the way, that a big part of that is microbiome
23:53
and the, the following night.
23:55
You went out on Friday night.
23:57
Let's pretend that Saturday night you don't drink and you tuck in
24:00
for a nice good night's rest.
24:02
You're gonna have really, really vivid dreams.
24:05
What is that?
24:06
Those vivid dreams that you have on night two the next night.
24:11
That's REM rebounds.
24:12
So REM sleep is where we have those vivid dreams.
24:15
You suppressed your REM sleep with alcohol on Friday night.
24:20
So now on Saturday night, your body.
24:22
Compensates with excess REM sleep.
24:26
And that's not, that doesn't, that doesn't get you to net neutral though.
24:29
That's the problem.
24:30
You've, you've already disrupted your sleep.
24:33
Oh, boo.
24:34
Yeah.
24:35
Sorry buddy.
24:35
We could, no, well look man, in all honesty, it's, it's okay.
24:38
I mean, I know darn good and well, I'm not in my twenties anymore, you know,
24:42
and I, I have no delusions of grandeur of trying to be a frank the tank out
24:46
there or anything like that, you know?
24:48
Um, so I, I don't really have to worry about that.
24:52
I just thought that that would be a, a, a nice little.
24:54
PSA, so to speak, for the, for the good people.
24:57
Um, you mentioned PPIs.
24:58
Before we get back to diets in particular, one of the things that
25:01
really kind of struck me is that for a very long time we thought that just
25:07
suppressing the stomach acid really didn't have any kind of long-term effects.
25:11
But it comes, come to find out, as we've been learning over the last
25:15
few years, long-term use of PPIs may not necessarily be such a great idea.
25:20
What do we know there?
25:21
Uh.
25:22
Yeah, the, the issue is that we have stomach acid for a reason.
25:28
So our body is like, I, I would argue quite perfectly designed with
25:35
specific things and with purpose.
25:39
And we as humans aren't always capable of understanding that complexity.
25:44
There's, there's tremendous complexity to it.
25:47
And so we do simple things like, Hey, acid is the problem.
25:52
Cut stomach acid and then you expect that, that's perfectly fine.
25:56
And then people are on these medications because we don't address
25:59
the root of the issue, Chuck.
26:00
We don't give them lifestyle choices.
26:02
We just cover it up with a bandaid, which is the proton pump inhibitor, and
26:07
they're on it for 10, 15, 20, 30 years.
26:10
And these medications were created in the nineties.
26:12
We have people who have been on 'em for 30 years now.
26:16
And by cutting the stomach acid, it disrupts the microbiome.
26:20
So that stomach acid is actually part of the balance that exists
26:24
throughout the entire intestinal system, all the way down to the bottom.
26:28
And when you remove that acid entirely, we can't pretend
26:31
that there aren't consequences.
26:33
It clearly affects the microbiome.
26:34
It's been associated with small intestine, bacterial overgrowth,
26:37
and other forms of dysbiosis.
26:39
So I'm not a, I'm not a fan of chronic long-term use of those
26:42
medications whenever, whenever we can possibly avoid them.
26:46
Could it also be, and, and this is just a a lay question here, is there also
26:50
a risk because you're not producing the same amount of stomach acid, that
26:54
you're not breaking down the food as well as you would have, and so perhaps
26:58
you can even run into, I don't wanna call it malabsorption, but you're not
27:02
absorbing all the nutrients that you would ordinarily because the food isn't.
27:07
Being digested the way that it is or, yeah.
27:10
Or you're making it more difficult to digest and, and the result of
27:13
more difficult digestion is, is that you put more pressure on your
27:16
microbiome to be able to step up.
27:18
Yeah.
27:18
So, and it's a two hit, right?
27:20
Because you now didn't digest it fully in the stomach.
27:23
So now you expect the microbiome to step up and do it for you, but
27:26
you've just induced dysbiosis in the microbiome with that medication and,
27:31
and then people have digestive symptoms.
27:33
So we've talked about some of the foods that may, you know, not necessarily cause
27:38
the reflux, but certainly can agitate, you know, the nerves down there when
27:42
everything's already kind of stimulated.
27:45
But what are some of the more soothing foods that you would prescribe, so to
27:48
speak, to people who are suffering?
27:50
Well, we wanna restore motility to the system.
27:54
And the interesting part is that the microbes are a really
27:59
relevant part of this story, jock.
28:02
There's been quite fascinating evidence that, so number one,
28:06
there's an esophageal microbiome.
28:09
You know, you hear me out there.
28:10
I'm talking 38 trillion microbes in your colon, blah, blah, blah, blah, blah.
28:15
Okay?
28:16
We're on the opposite end of the intestines right now.
28:19
This is as far as just about as far as you can get away from the colon.
28:24
There's microbes there, and actually the esophageal microbiome they've shown.
28:29
There's a difference in the microbes that are there in health.
28:33
There's a difference in terms of the microbes that are there
28:35
in non erosive reflux disease where you can't see any ulcers.
28:41
There's a difference in the microbes that are there for erosive reflux
28:44
disease, and there's a difference in the microbes that are there.
28:47
When a person gets the precancerous esophagus.
28:51
There's a progression that occurs in disruption of the microbiome in the
28:55
esophagus as we move from health.
28:58
Towards non erosive.
29:00
Towards erosive.
29:01
Towards precancerous.
29:03
So the esophageal microbiome is part of the story.
29:06
And so to answer your question, there's fiber, right?
29:10
Because when we want to restore health to a microbial ecosystem, what do we do?
29:16
We feed the good guys.
29:18
And the fascinating thing is that they have several examples of
29:23
prebiotics, chuck, which help reflux.
29:28
Why would a prebiotic help reflux?
29:33
Because it might be helping to address the esophageal microbiome,
29:39
which may have an impact on motility in this part of the body.
29:44
There's also evidence with cilium husk.
29:47
Why would cilium husk a fiber supplement provide benefits?
29:53
Two acid reflux.
29:54
It's not neutralizing stomach acid.
29:56
That's not what it's doing.
29:59
So what is it doing?
30:01
It's enhancing motility throughout the entire intestinal system, Chuck from
30:06
the top all the way down to the bottom.
30:08
So yeah, you have better bowel movements and you address
30:11
constipation because you're moving your bowels through down and below.
30:15
But what you don't realize is you're also stimulating and enhancing motility in
30:18
the esophagus and enhancing the strength.
30:22
Of the lower esophageal sphincter, the flap to keep it closed and
30:26
enhancing the stomach to propel things forward and into the small intestine.
30:32
So the first answer to your question of like, what are the things that we
30:35
can do, the first lever that you can pull is to increase your fiber intake.
30:40
And thus, this is why you're the fiber guy.
30:43
This is why you're the pharaoh of fiber, my friend.
30:46
Um, the, specifically the high fiber foods, obviously
30:50
coming from a plant-based diet.
30:51
Have there been any like full-blown studies that look at the prevalence of
30:57
reflux of gerd, Barrett's esophagus based on a person's dietary pattern such as.
31:03
Is a plant-based high fiber diet really gonna be the one where you see the lowest
31:08
prevalence versus something like the ketogenic diet, which is very low in fiber
31:14
and very high in inflammatory properties.
31:17
Is that the one or have there been studies that actually look
31:20
at those two things head to head?
31:23
Well, what I can say to you, Chuck, is there is a study that was done
31:26
by a, um, uh, progressive New York based ear, nose, and throat doctor.
31:34
Many years ago, and they assigned their patients to a plant
31:38
forward Mediterranean diet.
31:41
So it wasn't a vegan diet, but it was like a diet that was
31:45
built on a foundation of plants.
31:47
And that's what they pushed is like eat as many plants, different colors, different
31:51
varieties as possible, and by following this plant forward, Mediterranean diet.
31:57
They actually found that people had as much benefit to their acid reflux symptoms
32:01
as they would've had from medication.
32:03
So that was quite powerful.
32:05
That is pretty good.
32:06
I like that.
32:07
Um, we haven't yet touched on, uh, uh, stress here.
32:12
I know that a lot of people, we live high stress lives and that's definitely
32:15
one of the pillars of lifestyle medicine is really getting that stress out of
32:20
your life to the degree that you can.
32:22
Um.
32:24
Can stress on its own cause reflux here, even if a person's eating a healthy
32:29
diet, how much of a role does that play?
32:31
A hundred percent.
32:31
It plays a role and the, and the reason why has to do with the gut-brain axis.
32:38
So the gut brain axis is basically the communication system that exists
32:42
where things that are happening in the gut can be communicated to
32:44
the brain and, and in doing that actually influence what the brain.
32:50
Basically how the brain reacts and, and responds.
32:53
And the flip side of that is that things from the brain can be communicated and
32:58
disseminated down through the gut brain access to influence things within the gut.
33:04
Now, within this particular setting, what we're talking about is activation
33:08
of the sympathetic nervous system.
33:11
So we have, we have two parts to our, what we call our autonomic
33:15
nervous system sympathetic.
33:18
Which is basically get up and go right, and it's what we
33:22
do, like moments of stress.
33:24
It's actually designed to like, make us focused, make make us
33:27
more capable of doing something.
33:28
In the moment, if I get attacked by a saber-tooth tiger, it's my sympathetic
33:33
nervous system that increases my heart rate, shunts the blood to my
33:36
muscles, and allows me to climb a tree real quick to protect myself.
33:41
But.
33:42
The opposite of that is the parasympathetic nervous system, which is
33:46
what you do after you just had a big meal.
33:49
And if I were a cave person laying down and relaxing and allowing my
33:55
body to digest that food, right?
33:57
And, and basically activating the rest and digest aspect of our body.
34:04
And so, and these are opposite and competing ideas.
34:07
You can't be both at the same time.
34:09
You're gonna be one or the other.
34:10
So you can think of it like.
34:12
The speedometer of a car where like basically when the speedometer is
34:16
high and it's going fast, that's the sympathetic nervous system.
34:19
It's all gas.
34:21
And when it starts to slow down, that's the parasympathetic nervous system.
34:25
That's break.
34:27
And so stress activates the sympathetic nervous system, the modern world we has
34:31
put us on sympathetic overdrive, and that can be a lot of different things.
34:37
You know, it's not just like, Hey, this stressful thing happened to me.
34:40
It could be so simple as opening up Twitter and seeing
34:45
things that tick you off.
34:47
And trigger you or the commercial On, on Red Zone.
34:51
Chuck that Oh no.
34:53
Tick you off.
34:54
Oh bro.
34:54
You try to watch Don't me started.
34:56
No, you try to watch.
34:57
Watch the football.
34:57
It's Sunday.
34:58
CO's the first commercial free football, it used to be commercial
35:01
free football and after 15 years.
35:03
You're paying 15 bucks a month and they're feeding you with commercials
35:06
in addition to the 15 bucks a month.
35:08
That's not the way it used to be.
35:09
Chuck, in the good old days, careful, you're gonna give yourself reflux will,
35:12
you're gonna give yourself reflux.
35:14
I'm, I'm on sympathetic overdrive.
35:16
As we sit here, I have trouble controlling the volume of my voice.
35:21
Okay.
35:22
We all have our stress saying, I will say this.
35:25
If that is the biggest problem that you are facing, my friend,
35:29
I think you're winning at life.
35:31
I'm not digesting anything right now.
35:33
I'm yelling at you.
35:35
Okay.
35:36
All right.
35:37
But if you want me to drop down and give you 30 pushups, I could
35:39
do it because I activated the muss.
35:41
Go climb that tree man.
35:43
Go climb that tree.
35:43
Climb tree.
35:44
Yeah.
35:44
I gotta watch out for those tigers.
35:46
Here in my beautiful Air Condit, home of Charleston, South Carolina.
35:50
Alright.
35:51
So, but the point though is that, okay, so let's, let's, let's like
35:54
zoom in a little bit on sympathetic, because what I'm saying to you is that
35:58
the world is unsympathetic overdrive.
36:01
Like we don't, our culture doesn't allow us to slow down and like take a break.
36:08
And so by being on sympathetic overdrive, what happens is that your brain.
36:13
Activates these signals and it releases a hormone called
36:16
corticotropin releasing hormone.
36:18
And this corticotropin releasing hormone has systemic effects
36:22
throughout your entire body.
36:24
But what it does in the gut is it disrupts gut motility.
36:30
So what I'm saying to you, Chuck, is that sympathetic
36:33
overdrive promotes acid reflux.
36:37
All right.
36:38
And let's, let's wind up, uh, or end with this.
36:41
Let's talk about the benefits of exercise here in treating some of these symptoms.
36:47
Um, I would imagine exercise actually helps with the motility a lot.
36:51
Um, what do we know there?
36:54
What's the connection between people who are sedentary and the likelihood
36:57
that they're suffering from reflux versus those who are pretty active?
37:01
There's no doubt.
37:02
I mean, look, these things tend to travel together, right?
37:04
So people who, um, adhere to a healthy lifestyle, they many times will improve
37:10
their dietary pattern, add more fiber rich foods simultaneously get more
37:14
involved with some form of exercise.
37:16
There's many different forms.
37:18
There's, there's yoga, there's um, obviously taking a walk or doing a run.
37:23
There's also strength-based training.
37:25
They all have beneficial effects on our microbes.
37:28
When you support and nurture your gut microbiome, you are, you are, you are
37:33
working on the intermediary towards better gut motility because it's the
37:37
microbes that are pulling those strings.
37:40
So whether it's the data that exists for yoga, where yoga has been shown to
37:45
improve gut microbiome health and reduce IBS symptoms, or whether it's taking
37:49
a walk after a meal, which has been shown to stimulate gastric emptying,
37:54
stomach emptying, which by the way.
37:56
Is exactly what you want to prevent acid reflux, taking a walk
38:01
after a meal to stimulate stomach emptying, which also improves
38:06
bowel regularity and constipation.
38:10
In all cases, exercise can contribute to better, uh, better health.
38:16
Hey, Chuck, real quick.
38:17
Yes, sir. One thing that we haven't touched on that I feel compelled
38:20
to say if we're, if we're getting close to the close here Yes, sir.
38:23
Is there are.
38:25
Some things that are not related to the food that you eat and exercise and stress.
38:32
There's also the anatomy, which is the possibility of a hial hernia, and
38:38
those are things that are anatomical that you may not have total control
38:41
over, and what is happening there?
38:44
A hial hernia is that your diaphragm sits at the bottom of your chest and your
38:49
diaphragm has a hole in it, and that hole.
38:53
Supposed to mine up with the lower esophageal sphincter.
38:57
So the flap muscle is supposed to sit in like right next to the diaphragm so
39:03
that when you breathe, the diaphragm actually is pinching that area.
39:06
So when things are lined up properly, you have both the diaphragm and
39:10
the lower esophageal sphincter protecting you from reflux, and
39:13
that's actually your reflux barrier.
39:15
And what, what happens when you have a hial hernia?
39:18
Is that the hole?
39:20
Now the stomach has pushed up into the chest, so the stomach, which is supposed
39:24
to be in your abdomen is actually moved upwards up into your chest.
39:29
There's a number of reasons why this can happen, but the point is now your
39:33
stomach is pushing up into your chest and the lower esophageal sphincter is
39:36
way up and removed from the diaphragm.
39:39
And so now your barrier is not only incompetent, but the pinching that the
39:44
diaphragm does every time you breathe can actually create a pouch with the stomach.
39:49
That actually promotes reflux.
39:51
So I, I, the reason I mentioned this is like, you could do everything right, but
39:55
if you have a large hial hernia, you might need to have that surgically repaired.
39:59
And it's just something to be aware of because that's an anatomical issue.
40:02
That's not, that's not a diet and lifestyle problem.
40:05
That's your anatomy.
40:06
So, and sometimes we have anatomical issues that need to be dealt with.
40:10
How large is a large, this is something that I, I know very well, uh, what
40:15
it is that you're talking about.
40:16
Um, I have one that, uh, they discovered it's about three centimeters, which it's
40:22
my understanding that that's borderline in the medium size on the high end of small.
40:27
But you know, if somebody.
40:29
Were to have a lot of these reflux symptoms and they were
40:33
attributable to a hiatal hernia.
40:35
How large of a hernia are we talking about most often?
40:38
Well, you have to understand that there hidal hernias come in many
40:41
varieties because you could start with a sliding hidal hernia, where
40:45
sliding basically means that it might look normal one minute and be very
40:50
abnormal a different minute because the stomach is sliding through that hole.
40:54
So, but in terms of these measurements that, that we make, it's based upon an
40:58
endoscopy typically where the doctor, such as myself, you take a look and
41:02
you say, okay, where's the diaphragm?
41:05
'cause I can see it pinching when you breathe.
41:07
And where is the bottom of the esophagus?
41:09
'cause I can see that too.
41:10
And how many, how many centimeters separate them.
41:13
One or two centimeters is small.
41:15
Three or four centimeters is medium, and five centimeters or
41:18
larger is a large hidal hernia.
41:20
But just be aware that like that's not the only thing that matters
41:23
when it comes to these hernias.
41:24
Like there's other aspects that we would be looking at.
41:27
All right, and let's end on this.
41:29
I wanna circle back to exercise then.
41:31
I'll ask you about plant powered plus.
41:33
Um, we didn't talk about like how much exercise and, and the intensity of it.
41:40
Is a higher intensity exercise going to do you more benefit?
41:43
Or really is it as simple as just making sure you're out
41:46
there walking 30 to 60 minutes?
41:48
What's the sweet spot here?
41:49
Well, okay, so think about it this way.
41:51
I've already shared with you that during moments of stress that actually that's
41:55
disruptive to your motility, right?
41:58
What is exercise that's not rest and digest?
42:02
You actually are activating your sympathetic nervous system in a good way.
42:05
In a good way because ultimately that's an example of where, you know, like
42:10
something that's stressful and hard actually makes you stronger on the
42:13
other side when you recover from it.
42:15
But if you were to eat a meal with Chuck and then go straight to exercise,
42:19
you're setting yourself up for reflux.
42:21
So the idea would be that you probably shouldn't be going
42:24
and doing aggressive exercise.
42:27
I'm talking about like, you know, high intensity interval training or um.
42:33
That kind of stuff where you're like getting crazy in the gym,
42:35
getting your heart rate way up.
42:37
Okay.
42:38
That, that probably will make your reflux worse within that context, what
42:42
the exact amount is that's good for you.
42:45
It's hard to like put an exact number to that because this, these are not
42:48
thresholds, these are shades of gray.
42:51
So the thing that I would say is like more is better stick getting,
42:55
particularly considering most of us live a very sedentary lifestyle.
42:58
Getting up, moving around, taking walks, spending time outside.
43:02
You know, uh, doing strength-based training, resistance type
43:05
training, I would support all of that, all of the above.
43:10
How much of this is covered in Plant Powered Plus, which is coming out in
43:13
January, I believe, early January?
43:16
Well, so Plant Powered Plus is the story.
43:18
It's coming out January 13th.
43:19
It's available for pre-order now, everywhere that books are sold.
43:22
Plant Power Plus is about inflammation.
43:25
So to me, Chuck, inflammation is the health story of our time.
43:30
Like if, if we go and we take a look at all of the health related issues
43:35
that exist, and you ask the question, is there inflammation present?
43:39
You're gonna find that inflammation is in fact present for over 130
43:44
different health conditions,
43:47
including the common stuff.
43:49
And that's because ultimately.
43:52
It's our gut microbes and the gut barrier that are contributing to
43:55
the development of this problem.
43:57
When we have a broken down gut microbiome, it leads to disruption of the gut barrier.
44:01
When I say disruption of the gut barrier, I've already described this
44:04
during the episode, which was the proteins holding the cells together.
44:10
When we disrupt that.
44:11
We have problems as a result, and that can include inflammation.
44:15
So plant power plus is the story of that.
44:18
It gives you the dietary strategies.
44:19
It tells you what are the four main nutrients that you need to focus on if you
44:23
wanna reduce inflammation in your body.
44:25
I think that's very relevant to all of us, including people
44:27
following a plant-based diet.
44:28
You should know what are the main levers that you can pull, but I also want
44:31
you to know what are the non dietary strategies that are really important.
44:35
And so we dig into topics like circadian rhythm.
44:38
Fasting sleep morning light exposure, but we also talk about the
44:41
gut-brain access in great detail.
44:43
Chapter eight, which is all about the gut-brain access, is perhaps
44:48
my favorite chapter and I can't wait to share it with people.
44:50
So if you have enjoyed this conversation about sympathetic overdrive, that's,
44:54
you're gonna dive way deeper when you get into plant power plus.
44:58
There it is.
44:58
And listen, without the hard sell, I'm just telling you guys, you're
45:02
gonna wanna pick up your copy.
45:03
You can do that at the gut health md.com.
45:05
That's also where you can sign up to become a member
45:07
of the Gut Health Collective.
45:08
And I, honest to goodness.
45:11
Believe in my heart of hearts, just having that sense of community.
45:14
If you're suffering while you're suffering, to know that you're
45:17
not going through it alone.
45:18
Because if you've been going through something chronically, a lot of
45:22
times you feel like this is happening to you and you alone, and you
45:26
just want to throw in that towel.
45:28
It's really cool to have a community of supporters around you, uh,
45:33
who are also going through it.
45:34
And I think that that helps people rise above.
45:36
So get your education, get your community on, man.
45:39
Well, and the other thing too, Chuck, is it's not just the community.
45:42
Uh, actually the part that I think is the coolest part, this is just, this is
45:45
just my favorite part of the whole thing.
45:46
I think for everyone, it's their own.
45:48
They find their own little home here.
45:50
But my favorite part is we do a monthly challenge.
45:54
So like right now we're doing a circadian rhythm challenge.
45:58
So if a person signs up, you will get immediate access to the 20 page workbook
46:02
that I wrote myself that explains to you what this is about and how to do.
46:07
It gives you all the information that you need in order to do that.
46:10
There's journaling exercises, there's a worksheet so you can track how you
46:14
feel during the course of the week, and basically like see for yourself
46:19
the improvements that occur when you start to address this specific issue.
46:22
There's a video lesson to teach you all about it.
46:24
And all month we have activities related to this.
46:27
We also have other stuff, like for example, on Monday the 15th, we're
46:32
gonna be joined by Dan Butner.
46:34
Dan's coming in, we're gonna talk about his brand new book.
46:37
It's an opportunity for people to be there and ask questions.
46:40
So that's a unique and special opportunity to have Dan Butner there with you.
46:44
Or like later this month, we have other sessions that are taking place.
46:47
For example, we are gonna have a stress reduction session.
46:49
So we talked about sympathetic overdrive.
46:51
You should be there for the session where we're gonna talk about how to get the
46:54
parasympathetic into overdrive so we can really chill and relax and, and restore
46:59
balance and confidence to our body.
47:01
So the point, the point being, Chuck, that this is like a dynamic space
47:05
and the only way to really understand and appreciate it is to check it out.
47:09
And if you check it out and you don't like it, then you just stop doing it.
47:11
But if you find something that's really special, which is what I think the people
47:14
have found, then it's something that I think you're gonna wanna be a part of.
47:18
Uh, that was the softest of soft cells.
47:20
Hey, if you check it out and you find out that you don't like
47:23
it, just don't do it anymore.
47:24
Like, it doesn't get any more honest than that.
47:27
I don't wanna, I don't wanna twist your arm.
47:28
Right, but, but, but like, but like, here's the thing.
47:31
Like, you know this about me, Chuck.
47:32
I'm about delivering value.
47:34
Yeah.
47:34
So you come and you join this community, and then you discover,
47:37
holy moly, I can't believe this.
47:39
This is an awesome thing and I want my friends to be a part of it too.
47:43
That's the way that it works for me.
47:45
Is like when you start inviting your friends, then it gets,
47:48
then it's a wonderful thing.
47:50
And so that's, I think, part of what makes this community cool.
47:53
So we have the circadian challenge that's happening in September.
47:56
I can't tell you what the October challenge is until the last week
47:58
of September, but we're gonna be announcing it then there's gonna
48:01
be an October challenge, a November challenge, a December challenge.
48:04
It's be awesome.
48:05
I would like to throw out a challenge for the month of October.
48:08
That would be to bring back seven hours of commercial free football.
48:13
Now, can you make that happen in the collective Will?
48:15
Can you please, please?
48:18
I can't make it.
48:19
I can't.
48:20
I can't make that happen, Chuck, but what I can do is give you the
48:25
tools and strategies that you need to offset the stress of the blood
48:28
pressure and heart rate rise that you just had in the last 30 seconds.
48:31
That's all I can ask for, and I do appreciate it.
48:34
Dr. Will Sitz, you are the best my friend.
48:37
Appreciate you taking some time to hang out with us here on the NHA today.
48:41
Thank you, Chuck.
48:42
And thank you to all the NHA members and also, uh, to the NHA as an organization.
48:47
Thank you for joining us on the NHA Today Podcast.
48:50
Subscribe and follow the National Health Association on YouTube and social
48:54
media for the latest in plant-based science and healthy lifestyle support.
48:59
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49:02
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49:06
Until next time, here's to your plant powered health.