[0:00]Hello, I'm Dr. Steven Gundry and welcome to The Dr. Gundry Podcast. What does your poop say about you? Well, actually, your poop says a lot about you. And it can say a lot about your health. For instance, did you know that what's in your poop has a lot to do with whether you're going to gain weight or lose weight? And in fact, research shows that you can tell if someone's going to gain weight or lose weight based on what's in their poop. So, today we're going to talk all about poop. But before we do that, I want to talk about something really exciting. Because this podcast is sponsored by the Human Biome Project. And that is a research project that my company, Gundry MD, is embarking on to actually uncover some of the secrets of the human microbiome. And we're going to do that by doing some human research. And we're going to collect thousands of stool samples and analyze what's in your gut microbiome, and compare that to your health and how you feel. And so, if you're interested in learning what's in your microbiome and how that compares to other people, please go to humanbiomeproject.com. That's humanbiomeproject.com and sign up for our initial research study. You're going to learn a lot about yourself, and you're going to learn a lot about what's going on with your health. It's a really exciting project, and it's the first time that we've ever done anything like this. And we're going to make some astounding discoveries. So please join us, humanbiomeproject.com. All right, so let's talk about poop. We've got a great interview today with Dr. Aaron Lerner from Israel. And we're going to talk all about leaky gut and how your poop is actually a really good indicator of what's going on in your gut. You know, when I started my work many years ago, I didn't realize how important poop was. But in fact, I wrote a book called Dr. Gundry's Diet Evolution. And I actually had an entire chapter called Know Your Poop. And a lot of what I learned in Know Your Poop was just observing patients. Because frankly, I had nothing else to go on. And one of the interesting things, and this may surprise you, is that what your poop looks like, and how often you poop, has a lot to do with what's going on in your microbiome. So for instance, the Bristol Stool Chart is a really great indicator of what's going on in your health. And if you're not familiar with the Bristol Stool Chart, just Google it. It's a very famous chart, and it's been around for quite a while. And basically, it shows pictures of different types of poop. And each one of them tells you something about your health. So for instance, if you have very small hard pieces of poop, that usually indicates that you're constipated. And that constipation has a lot to do with what's actually going on in your colon. And believe it or not, the bacteria in your colon have a lot to do with how hydrated your poop is, and how much water is actually extracted from your poop. And so, there are certain types of bacteria that are very good at drying out your poop, and other types of bacteria that are very good at actually making your poop too wet. And as we're going to talk about today with Dr. Lerner, your gut bacteria, your gut microbiome, actually has a huge amount to do with how your gut actually works. So for instance, we know that if you have what's called slow transit time, in other words, if your poop just sits in your colon for a long time, that that's a good environment for bacteria to make things like methane gas. And methane gas can actually slow down your gut even more. And it can also make you constipated. And finally, methane gas is actually a signal to store fat. So if you have a lot of methane producing organisms in your gut, the chances are you have slow transit time, you have constipation, and you also are storing fat without even trying. On the other hand, if your poop is always too soft, or even diarrheal, that's also an indication that your gut microbiome is out of whack. And that has a lot to do with what's actually going on with your health. For instance, irritable bowel syndrome often has either diarrhea or constipation as an ongoing symptom. And it's really easy just to observe your poop and say, hey, this is something I need to pay attention to. We're going to talk a lot about leaky gut and how that impacts not only the makeup of your gut microbiome, but also your actual health. And in my new book, Unlocking the Keto Code, which is out now, I talk a lot about what's called postbiotic compounds. And these are compounds that your gut bacteria make from the foods that you eat. And some of them are incredibly beneficial, and some of them are not. And so, your poop also has a lot to say about what kinds of postbiotic compounds you're making. So if you're making a lot of beneficial compounds, you're going to look a certain way, and your poop is going to look a certain way. And if you're making a lot of detrimental compounds, then your poop is going to look a different way, and your health is going to look a different way. And you know, quite frankly, my original research on patients had a lot to do with just watching what happened to their poop as we change their diets. And it was really a very good early indicator of how people were doing on a program. So get ready to talk about poop. Let's bring in Dr. Lerner. Welcome to the Dr. Gundry Podcast, Dr. Lerner. It's so great to have you. Hello, it's my pleasure, Steven. It's wonderful to be here, and thank you for the invitation. You know, you and I have been aware of each other's work for a number of years. And I've always followed your work with great interest, particularly on gluten and leaky gut. So, welcome. So let's just jump into the whole concept of leaky gut, because you've really been one of the pioneers in showing that this is a real phenomenon and not just some woo-woo thing that naturopaths talk about. Absolutely. Absolutely. And this is one of the important parts of the lecture today. As you said, for a long time, the academic community of physicians and gastroenterologists have disregarded this phenomenon, although it was there. But you know, it takes time until we are acknowledged and accepted. So, intestinal permeability, or leaky gut, is not a concept. It is a phenomenon, it is a biological event that exists in our body in many conditions, in many diseases. And definitely, its detection, its diagnosis, is also something that can be measurable and should be measurable. And we are going to talk about it today. Absolutely. Now, you have a particular interest in gluten, and how gluten impacts leaky gut. And I do as well. Can you explain how gluten works to make a gut leaky? Sure. First, we have to talk about what is gluten. Because the modern gluten is not the gluten our ancestors ate. So gluten is a big family of proteins found in wheat, barley and rye. It's composed mainly from two big parts. One is the glutenins and the other one are the gliadins. And each one of them is composed of several small groups of proteins. But the gliadin is the bad boy. The gliadin is the part of gluten that is toxic, that is inflammatory, that is immunogenic. And it is the culprit for the celiac disease for the gluten sensitivity and many other related diseases, autoimmune diseases and beyond. And what happens is that gliadin, when it encounters the intestinal wall, it opens the gates between the cells that create the intestinal wall. And these gates are called tight junctions. And there is a special protein in our body that opens these gates called zonulin. And gliadin upregulates the secretion of zonulin, and therefore, it opens the gates and creates intestinal permeability. So this is basically the mechanism of gliadin that increases intestinal permeability. And as a result of that, now things from the gut lumen can literally leak through the opened gates into the bloodstream and create havoc. And that can create autoimmune diseases, that can create many other conditions like chronic fatigue, fibromyalgia, arthritis, multiple sclerosis, you name it. So it's basically the beginning, it's the gate that is opened and allows the toxins to enter the body. So you brought up a really important point that the modern gluten is not the gluten of our ancestors. And in my new book, Unlocking the Keto Code, I go into a fairly intense discussion on the differences between ancient wheats and modern wheats. And the gliadins in ancient wheats, for instance, there was a double strand gliadin. And in modern wheats, because of the hybridization of wheat, there are now up to five strands of gliadin. So you literally have more gliadin in modern wheat than you did in ancient wheat. But also, as you pointed out, these are more potent, more toxic gliadins. And so, in essence, we have a bigger gun pointed at our gut every time we eat modern wheat. Is that a fair assessment? Absolutely. Absolutely, this is the most accurate assessment of the difference between ancient and modern wheat. And you know, even the way it is grown now, it's grown with pesticides, herbicides, Roundup, which itself is a very well-known cause of intestinal permeability. So we have to take all these into consideration as well. So you're also implying that there's more than one way to get a leaky gut. And that gluten isn't the only way to get a leaky gut. What are some of the other ways that we get leaky guts? Oh, many. Oh, many. The causes for intestinal permeability are divided into three major groups. The first one is the environmental factors that we've been talking about, the gluten, the Roundup, the pesticides. We have to add to it, bacterial toxins, for example, from the intestinal microbiome, we have infections, viruses and bacteria. The second group are the food factors, which are gluten and beyond gluten. We are talking about food additives, emulsifiers, nanoparticles, all kind of things that are inserted now in our food. And then we have the human factors. And the human factors are stress, obesity, metabolic syndrome, fatty liver, diabetes, chronic inflammation, exercise. So there are many, many factors, but they all converge into one common pathway. And the common pathway is the leaky gut. And the leaky gut is a gateway for diseases. So, my new book, Unlocking the Keto Code, actually shows that all these factors that you just mentioned impact the mitochondria in the cells that line our gut. And that these mitochondria will actually shrink their numbers of what are called tight junctions, these rivets that hold cells together, in a protective mechanism. But in fact, that protective mechanism is designed to allow things to come into the cell to be fixed, but then they're supposed to reform these tight junctions. But it appears that modern life is constantly attacking these tight junctions and keeps these gates open. So, it's not a woo-woo phenomenon. It's a very well-orchestrated mitochondrial defense mechanism that when it gets out of control, creates havoc. And I love that you are doing this research and showing that it's a real thing. Now, why is it so hard to detect that somebody has a leaky gut? Because if it's so fundamental to health, why don't we have simple blood tests for it? That's a very good question. And definitely, what we are doing in our lab, and what other labs around the world are doing, is to find the suitable and perfect biomarkers for its detection. So if we are talking about zonulin, zonulin is still the best biomarker for intestinal permeability. But it has to be measured accurately in serum. Because the previous kits for its detection were not accurate enough. And in some of them, there was more than 100% false positive. So people were talking about zonulin being a non-reliable marker for detection of intestinal permeability. But in recent years, a new generation of kits for its detection have entered the market. And we are using them, and they are detecting accurately the level of zonulin in serum. And by that, we are able to tell if a patient has an increased intestinal permeability or not. And as I will show later, we can also use zonulin as a marker for improvement and treatment. So, we have a blood test now for zonulin. Absolutely. The new generation kits are able to detect it precisely, specifically and accurately. Okay, so there's not just one form of zonulin, right? There are actually multiple forms of zonulin. And some of the old kits were not looking at all forms of zonulin. Is that a correct assessment? No. Zonulin is actually one protein, but there are multiple cleavage products of zonulin that are also circulating in serum. And the new generation kits are detecting the intact zonulin, and also the pre-haplin, which is another name for zonulin. And these are the two forms that are reliable for the detection of intestinal permeability. So a physician could literally order a zonulin test, and it would come back as a good indicator of what's going on with their gut integrity. Yes, they can order it and they should order it. Because many times the patients come to the clinic, and they tell them, I have leaky gut, I have leaky gut, and I don't know what to do. So if you measure the zonulin and it is high, so you can tell them, yes, you have leaky gut, and now let's treat it. And if it is low, you can say, no, you don't have leaky gut, and let's find another cause for your symptoms. So it is a very useful tool, and as I said, we are using it for diagnosis, for management and for follow-up. So you brought up something very important there that I use in my practice. And that is, if a patient comes in, and they've heard about leaky gut, and they've heard about all these diseases that can be caused by leaky gut. And the question is, well, do I have leaky gut? And in the past, without a quantifiable number, it was very hard to know. But now, with a quantifiable number, you can actually say, yes, you do, or no, you don't. And you know, there are a lot of people who think they have leaky gut, but in fact, they don't, or they have other issues. So this is a really important advance, I think. Absolutely. Because it will save time, it will save energy and money from the patients. And for the physicians, it will make them more confident in telling the patients, yes, this is the cause or this is not the cause. And as you know, in medicine, we like to quantify things. And this is a biomarker, and a biomarker is a measurable outcome, and this is what we are looking for. Now, you also mentioned that the microbiome is involved in leaky gut. And I spend a lot of time talking about that. How does the microbiome relate to leaky gut? Is it a cause or is it a symptom of a leaky gut? It's both. First of all, the bacteria in the microbiome, especially the Gram-negative bacteria, when they die, they release a toxin, an endotoxin, called lipopolysaccharides, LPS. And this lipopolysaccharide, when it enters the circulation, it can also cause zonulin secretion and increase intestinal permeability. So bacterial toxins are one of the most important causes for intestinal permeability. On the other hand, intestinal permeability, the leaky gut itself, will cause the microbiome to be dysbiotic, to be deranged. Because when the gates are open, these bacteria will sense it, and they will try to change and adapt themselves to the new condition. So it's a vicious circle. Leaky gut will change the microbiome, and the microbiome will contribute to the leaky gut. So, which came first, the chicken or the egg? It's a two-way street then. It's a two-way street. Absolutely. And that's actually some of the work that I've been doing with the Human Biome Project that I mentioned at the beginning of this podcast, is we're literally going to be looking at what's in your poop and what's in your gut microbiome, and how that relates to your overall health and how you feel. And it is a circular effect, there's no doubt about it. But if we can get a handle on what's going on with your microbiome, it's a very easy way to turn things around. And that gets to the final point I want to make with you. And that is, how do we fix leaky gut? If we've diagnosed it, and we know that it's going on, what are the best ways to fix leaky gut? So the most important thing is to remove the factors that increase the intestinal permeability. So if you are sensitive to gluten, so you have to remove the gluten from your diet. If you are eating too much food additives and emulsifiers, so you have to remove these from your diet. And then after that, to supplement your body with some special ingredients that will help to close the leaky gut and to heal the intestinal wall. And for example, we are using glutamine. We are using some probiotics, and some prebiotics. We are using some specific plant extracts that will help to heal the intestinal wall. And for example, we're doing a lot of research with quercetin, with curcumin, with ginger. And all these have been shown to repair the intestinal wall and to close the leaky gut. So removing the bad guys, and bringing in the good guys. Yes, exactly, exactly. And then, as a physician, you have to follow up the patient by measuring their zonulin level. And if it goes down, so this is a very good indicator that you are on the right track. And that's why this is such an important advance, because you can actually show measurable results. Exactly. Exactly. Excellent. Well, Dr. Lerner, thanks so much for joining me on the Dr. Gundry Podcast. It's always a pleasure to talk to you. It's always a pleasure to hear your insights. And I look forward to working with you more in the future. Thank you, Steven, for the invitation. It was a great pleasure for me as well. And I'm always happy to collaborate and to work with you. And that's it for the Dr. Gundry Podcast. We'll see you next week.