Podcast transcript

INTRO
Welcome to Docs in a Pod presented by whelmed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron, and Dr. Tamika Perry.

RON AARON
Well, hello, everybody, and welcome to the award winning Docs in a Pod. I'm Ron Aaron and delighted to be with you. Docs in a Pod comes to you every week on radio stations in Texas and Florida. Our podcast is available at any place you get your podcast. We welcome you to sample Docs in a Pod. Tell a friend, tell a neighbor. We invite you to join us for great conversations about a variety of health and wellness and medical issues. Our co-host, Dr. Tamika Perry is here as well. Dr. Perry is an associate medical director at WellMed. She oversees several large clinics in the Optum care in the North Texas region Southern sector. As a medical director, Dr. PerryÕs goal is to support the providers at these clinics as they deliver quality care compassionate patient experience. She earned her undergraduate degree from Prairie View A&M University, then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was a National Health Service Core Scholar. Next, she completed her family medicine residency at Methodist and Methodist Charleston Medical Center, where she served as Chief Resident. She's board certified by the American Osteopathic Board of Family Physicians and went on to earn a master's in public health with an emphasis in health management. She's also a diplomat of the American Board of Obesity Medicine. Obviously, Dr. Perry, you are an overachiever.

DR. TAMIKA PERRY
Ron, thank you. Your payment will be in the mail for that introduction. I appreciate that.

RON AARON
So, we're going to take up a really interesting topic today. It's one that has been debated and continues to be debated. When we talk about gut health and the microbiome, what works? What doesn't? Probiotics. No probiotics. Why don't we welcome our special guest today? We're delighted to have him with us, Dr. Benjamin Mendez. Dr. Mendez is a board certified family medicine physician at WellMed at Lake June near Mesquite and Dallas. He provides comprehensive, patient centered care and earned his medical degree from the University of Texas Medical Branch in Galveston. He completed his residency at Lone Star Family Health Center in Conroe, Texas. Dr. Mendez is passionate about preventive care, chronic disease management, and a whole lot more. Dr. Mendez, thanks for joining us.

DR. BENJAMIN MENDEZ
Thank you very much for having me.

RON AARON
I read from time to time, yes, you should take a probiotic. No, you shouldn't take a probiotic. Yes. You take a pre pro whatever. What's the skinny today?

DR. BENJAMIN MENDEZ
Interestingly enough, the prebiotic probiotics all depends on the life cycle of bacteria in your gut. So, when you think of a microbiome, it really is an ecosystem that lives in your small and large intestine and in your stomach. it is called the GI system. There are trillions of bacteria in there, and they span your entire intestine, and they work and provide you with metabolism of your food. So, when we talk about prebiotics, I like to think of it kind of like fertilizer for your lawn. It's all the nutrients that the gut bacteria needs to thrive and survive inside a very harsh environment that is your intestines and your stomach. Probiotics are just samples of bacteria that people sell over the counter. You can buy them at almost any Walmart, CVS, Walgreens. They are all different and in different quality levels. But they are just samples of bacteria that are considered beneficial for your intestines.

RON AARON
How are we to know what we need, what we don't need, and what bacteria we should try?

DR. BENJAMIN MENDEZ
How should we know which we do and do not need? It's very, very highly debated because your gut bacteria is different from person to person. It's different from region to region, country to country, and even within your own family. It all gets altered as you live and breathe and grow. By the food you eat, your stress levels, different diets that people have. Some people are on a carnivore diet. People that are on a Mediterranean diet, people that eat fast food for 60 to 80% of their meals like most Americans do, that alters your gut bacteria and your gut flora. So, to answer that, there is not one answer that this specific gut bacteria is specific. What works for one person might not work for everybody.

DR. TAMIK APERRY
Dr. Mendez, how would we know? What signs or symptoms may tell us? We may need to work on our gut flora?

RON AARON
Gut flora, meaning the bacteria?

DR. BENJAMIN MENDEZ
Yes.

DR. TAMIKA PERRY
The smorgasbord of bacteria that's in your gut. How do I how do I know if mine is right?

DR. BENJAMIN MENDEZ
The most common symptoms are going to be bloating. There's also going to be symptoms of reflux. Gut bacteria, if altered, and even people that have diabetes metabolic syndrome tend to have alterations in how they processed foods. Interestingly enough, while I was reading more about this for today, there is something called the gut brain axis. We have people that have issues with anxiety and depression and insomnia. Your gut will actually help metabolize a lot of the hormones. Those hormones that interact with your sleep wake cycles, the way that you process foods for your endocrine system, it's been linked to metabolic problems. People that have prediabetes, diabetes and obesity, all of that interact well with how well you take care of your gut bacteria right now.

RON AARON
Hold that thought. I'll come right back to you. I want to let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and we're talking with Dr. Benjamin Mendez. You find him at WellMed at Lake June outside of Dallas, and we're talking about gut health and microbiome. Dr. Mendez, when the microbiota about gut health, as Dr. Perry was saying, how do we really know, other than the symptoms that you had listed, that we need to do something about our gut?

DR. BENJAMIN MENDEZ
There is no one symptom that says you have a bad gut microbiome. But the most likely candidates for people are going to be people that have issues with vitamin deficiency. Some people that you happen to be low on certain vitamins. Like when you go get your checkup and they say, you are low on your B vitamins. If people that are associated with anemia, people that have clotting deficiencies, tend to have people that have bad gut microbiome. As most always linked to symptoms that are going to be people that have like we're talking about bloating, people that have insomnia, people that have metabolic syndrome. There isn't a blood test that you go to the doctor and tell you that you have a bad gut microbiome. The way I've always attributed it to is people that have a front yard or they have a lawn. People that have a very nice, pristine, well-kept lawn tend to be people that take care of their lawn. People that don't take care of their lawn, it's obviously that you can see it, but you can't see your gut microbiome. This is something that you got to take care of and work on daily to eating the right foods, exercising, monitoring weight. That is going to be the best way to take care of your microbiome.

RON AARON
Is there a screening test that you can run patients through checking out have you got the good bacteria? The bad bacteria? Here's what you need.

DR. BENJAMIN MENDEZ
There are stool cultures. The most common bacteria that people will take off the probiotic is going to be like lactobacillus. it is going to be a very common one that when I really look at the ingredients of your probiotics, it'll say they're lactobacillus. But there are thousands and thousands of bacteria that form these colonies that is your biome. And thatÕs not even just bacteria. There are fungi, there are viruses that all coat your entire intestine. So, there is no one species of bacteria that's favored over the other, but they all work symbiotically. If we think of an ecosystem, where there's like cross pollination of some plants that help other plants. If you ever go to a greenhouse, and I remember when I spoke to the person that told me about my plants that sometimes you have one plant and you have it next door to one, and they start to die, but you move in next door to another and they start to thrive. The same with our biome. The bacteria almost talk to each other and live in harmony and all work together to give you the optimal nutrient that you can extract out of the food that you eat.

RONA ARON
So, you've got an entire city living inside of you and living inside of you?

DR. BENJAMIN MENDEZ
Yeah. It's interesting enough, your gut microbiome, if we go cell per cell, there are more than a trillion different bacteria and viruses that live in your microbiome. So, there's more cells and bacteria living inside you than actual cells that encompass your human organism. So, in a human there are more bacteria than actual human cells.

RON AARON
How do they get there in the first place?

DR. BENJAMIN MENDEZ
They get there from the moment that you are born. The moment that you were born, if you happened to be born the traditional vaginal way, your mother will pass on her microbiome to you. Then, as the baby starts breastfeeding, you start ingesting food and breast milk, and you'll actually start ingesting bacteria as well. So, if you have a good biome, I guess you can say start as a good, healthy mother.

DR. TAMIKA PERRY
There's a good catch phrase from a famous rapper from New Orleans, and he says, you get it from your mama. So, in essence, it starts with your mama. During delivery. it starts with your mama, and then it kind of just build from there.

DR. BENJAMIN MENDEZ
Yep. And it's very, very interesting because as you have a growing adult, and you start making the proper food choices. I'll get to the food choices that help feed your bacteria in a little bit here, but as soon as you're weaned off to eat your own meals, the right food will then help protect your microbiome. As you protect it, the better you protect it, the better your biome will protect you. It'll help protect you from an infection. It will protect you from metabolic diseases that help promote good immunity. So, it goes on and on.

RON AARON
We're going to come back to you in just a minute. I want to find out when you say the right foods. Many of us here have no idea what that means, so we're going to find out in just a minute. I'm Ron Aaron and along with our co-host, Dr. Tamika Perry. We're talking on our Docs in a Pod hotline with Dr. Benjamin Mendez. We're talking about gut health and what that means. We enjoy listening and enjoy you listening to the award winning Docs in a Pod.

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RON AARON
We are so pleased you are sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. You can also hear us on the radio in a number of cities in Texas and Florida as well. Dr. Tamika Perry is with us, and our guest is Dr. Benjamin Mendez. We're talking about gut health and the microbiome. Dr. Mendez, on a couple of occasions, you said eating the right foods is beneficial, but what does that mean? Are there right and wrong foods?

DR. BENJAMIN MENDEZ
Yes, there is. Your microbiome, it's a living, breathing creature that, like we said, encompasses all your intestinal lining to your stomach, your large intestine, your small intestine. And like any living, breathing part of your body, it needs to be fed correctly. The foods that they thrive in are going to be foods that they are able to metabolize and create the nutrition that it needs. That tends to be foods that are very high in fiber. The fiber gets metabolized into something called short chain fatty acids. And that is the bread and butter, for lack of a better term, for these bacteria that they love to thrive on. These short chain fatty acids in turn actually decreases what's called the pH of your abdomen and your intestine there.

RON AARON
And what does that mean?

DR. BENJAMIN MENDEZ
That's how acidic. You know how they say that your stomach has a very high acid level? The high after it a lower pH. That is used to help metabolize the food. So, those short chain fatty acids is what these bacteria thrive on, and that is what helps them grow. It is the flavor of the day for these bacteria, and they love it. So, foods that are high in short chain fatty acids are fibers. So, it's going to be very much for your fruits and vegetables. Fruits and vegetables are what's going to make your gut bacteria very happy. People like lists, so I put here the most common foods that are going to be great for your gut health. Garlic, onions, asparagus, banana, barley, apples, avocados and artichokes. Foods that are high in fiber are going to be very, very good for your gut health. People actually like lists of foods that are going to be bad for your bacteria. So, it is mostly foods that are high in saturated fats and high in carbs. The things that we love to eat are not good for your gut bacteria.

DR. TAMIKA PERRY
I should not have finished my enchiladas for lunch.

DR. BENJAMIN MENDEZ
I mean, you can have it, but maybe you can have a healthier dinner.

DR. TAMIKA PERRY
I'm going to work on that. You talked about what goes in one direction. So, let me pivot for a minute and talk about what comes out in the other direction very tactfully. There is a such thing as, believe it or not, fecal transfers or fecal, I don't want to say implants.

DR. BENJAMIN MENDEZ
Transplants.

DR. TAMIKA PERRY
There you go. Fecal transplants. And because they are trying to get the good microbiome from one individual and put it in another one, maybe an individual is a high enchilada eater and their gut flora isn't that great, and they have some issues. To your point earlier, the microbiome is important for your immune system, and obviously important for your digestive health. Is important for many aspects in you, including metabolism. So, believe it or not, if people have issues with weight loss or weight gain, some individuals, I learned this when I was becoming a diplomat of the American Board of Obesity medicine when I was taking classes at Harvard. And I just like saying I took classes at Harvard. When I was there, they will do these fecal transplants for individuals who are either morbidly obese, and I've actually seen it done in Dallas on the other end of the spectrum for people who had trouble keeping on weight. We change our biome all the time. We take antibiotics. So, sometimes we inadvertently kill the good bacteria that's supposed to be there. Then we get issues like C difficile, like C difficile colitis. Which we have to do things to promote this good biome to come back.

DR. BENJAMIN MENDEZ
Yes. I'm happy you did that pivot because that was one of the last things on my to do list to talk about today. Those fecal oral transplants, there are two ways of doing it. There's a pill version that people will take. Then, think of it like a colonoscopy when they will put the camera through the bottom, they'll go in there and they'll spray the fecal or transplant in the gut lining, and it'll help pretty much give you a whole new microbiome. So, things that people take a lifetime building, you'll get it in one afternoon. Sticking to the lawn metaphor that I put, instead of just working hard to put your lawn up, you went down to Home Depot and you buy yourself a whole new lawn and put it in there. So, what this does, it's quite amazing. It really is amazing. And interestingly enough, how you brought up Harvard, over there they actually have a fecal oral bank. So, people that are going to be donors, you have to qualify to be a donor. Literally we drop off a sample and they keep it in a catalog in a little bank, and when someone needs a sample of it, they will get it and ship it and you get a brand-new biome.

RON AARON
So, you're donating your poop to Harvard?

DR. BENJAMIN MENDEZ
Not necessarily to Harvard, but they have it up in the northeast, and that's one of the banks that they have it at. You will get a brand new one. But one of the things to qualify to be a donor is a BMI. I should have written down the actual BMI number, but I believe it's under 30. They ask a lot of questions about when was the last time you took an antibiotic? What is your metabolic health? What is your weight? What is your diet? And to be qualified for that pretty much means you have a very healthy biome, and that goes a long way and people lose a tremendous amount of weight. It's really quite amazing the technology in that.

RON AARON
That's better than GLP one.

DR. BENJAMIN MENDEZ
Arguably. I haven't seen that study, but it might.

DR. TAMIKA PERRY
I haven't seen a head-to-head between GLP one and poop.

DR. BENJAMIN MENDEZ
Never.

RON AARON
We need a double-blind study.

DR. TAMIKA PERRY
IÕm not sure which end I want to be on.

RON AARON
Let's come back, Dr. Mendez, our biome, as you were suggesting, can change dramatically from day to day, week to week, month to month if we don't eat a consistent diet that feeds those little bacteria.

DR. BENJAMIN MENDEZ
It won't change dramatically day to day. But things that can impact your gut biome can be, for instance, things that Dr. Perry was mentioning like antibiotic use. This is where being good stewards of providers is realizing when the patient calls saying that they had a runny nose, or they had stomach pains for one afternoon and they think they have a stomach infection. These antibiotics, if you give them for a short amount of time, will have a minor impact, but it it'll rebound. But if you give it a very long-term antibiotic use, for instance, some people who use it for antibiotics from the hospital for weeks on a time when they're hospitalized. A lot of times, some GI doctors prescribe a probiotic for a few weeks to kind of help replenish that. After long-term antibiotic use and you just scorched the earth of your biome, that's where you start getting opportunistic infections like Dr. Perry was saying. People that get C. diff and end up in the hospital.

RON AARON
C. diff is not fun. I actually had it and as a result of Z pack, I ended up killing the good bacteria. The bad bacteria apparently are tougher than the good ones. I ended up with C. diff, which clearly was not fun.

DR. TAMIKA PERRY
Yeah, and a lot of patients want antibiotics for, like, I have a cold or, like, Dr. Mendez said, I have a runny nose, or my throat is a little scratchy. All antibiotics are not good antibiotics. They're not good for you at all times. That's maybe what I need to say. C. diff is not fun. It could be life threatening. And it's quite aromatic and not in a good way.

DR. BENJAMIN MENDEZ
Yeah.

RON AARON
Why are the bad bacteria so much tougher than the good ones?

DR. BENJAMIN MENDEZ
ItÕs not that they're bad, it'll just cover your entire intestinal lining. You have other options. Some people have C. diff as a normal part of their flora but it's a very small and controlled environment. It's kind of like if you have your yard and you have one weed on the yard. But if it's here in Texas and it's August and it hasn't rained in two months and your lawn is dying, all of a sudden, your yard will be covered in weeds.

DR. TAMIKA PERRY
Dr. Mendez makes it a great point. Think of your biome, whether it's in your gut, in your mouth, in your back cavity, anywhere there's a biome there's always a checks and balances systems. ItÕs kind of like Congress. Allegedly one is supposed to check the other. So, if you take an antibiotic and it just wipes out the executive branch, the judicial and the Congress can go crazy. They can do whatever they want to do, and that's what happens with C. diff. You were taking the Z pack for whatever reason, your sinusitis, your streptococcal pharyngitis or whatever you were being treated for. But it also killed the bacteria that would normally check the C. diff in your gut. Then the C. diff had a party, and your gut lining says we do not like that much C. diff down here.

DR. BENJAMIN MENDEZ
Yes.

RON AARON
We're almost out of time. But before we go, Dr. Mendez, where do you recommend people look to get more information on this whole topic of gut health?

DR. BENJAMIN MENDEZ
The first person you should always talk to is going to be your primary care doctor. There are some conditions that people are just going to be prone to having bad gut health. It can be people that have inflammatory bowel disease, people that have Crohn's disease, ulcerative colitis. Their intestines are just in a chronic inflammatory state. Those people tend to always have a GI doctor on board as well. So, your primary might refer you to a GI doctor who helps keep track of that for you. So, your GI doctor and your primary care are going to be great people to keep in mind. For myself, I like to really involve nutritionists for my patients. I have metabolic diseases such as diabetes and obesity. So, talk to your nutritionist about a good gut health diet.

RON AARON
I have to stop you right there. Thank you so much. Appreciate you being here, Dr. Benjamin Mendez. You find him at WellMed at Lake June outside of Dallas. Our co-host is Dr. Tamika Perry. I'm Ron Aaron. We'll talk with you soon on the award winning Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton, thank you for listening to Docs in a Pod presented by. WellMed, be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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