Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. 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 former television broadcaster Gina Galaviz will share information to improve your health and well-being. And now here are Gina Galaviz and Dr. Tamika Perry.


GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment today, and I'm so pleased to have you with us. Our program is available on podcasts wherever you get your podcasts. We're also on the radio in several cities in Texas and in Florida. Each week, we talk about a variety of health and wellness issues that impact Medicare eligible seniors and others. Our Docs in a Pod co-host is Dr. Tamika Perry. Hi, Dr. Perry. Before you say anything, I want to toot your horn. You are an associate medical director at WellMed. You oversee several large cities in the Optum Care North Texas region Southern sector. As associate medical director, your goal is to support the providers at these clinics as they deliver quality care and a compassionate patient experience. You also help the organization live out its mission of helping the sick become well and helping patients understand and control their health. That's a lot of work, Dr. Perry, but you do it with a smile on your face all the time. Just so the Prairie View A&M University alums out there hear this, you earned your undergraduate degree there. You went on to graduate from Philadelphia College of Osteopathic Medicine, where she was a National Health Service Corps scholar. Congratulations on that. Then you completed your family medicine residency at Methodist Charlton Medical Center, where you served as the chief resident. You are board certified, and Dr. Perry, how do you have enough time to do all this with your busy schedule? Welcome.


DR. TAMIKA PERRY
Thank you so much. You know, Gina, I was at a resident dinner the other day, and we were telling residents that there is life after residency, and the young lady sitting beside me said, wait, you're Dr. Perry from Doc's in a Pod. I'm like, oh my God, you, my mother and my pug, I have three listeners now. I'm so excited.


GINA GALAVIZ EISENBERG
You're like, Ferris Bueller. I hope I didn't date myself there. Well, you can count all the Eisenberg's as listeners, too. So, you have more than three. Well, we have a fascinating topic today, and one that truly involves all of us. What is the microbiome and why should we care? What should we know about our guts and what can we do to address the issues that may face when the bugs in our guts are out of whack? Dr. Sana Mukhi is our special guest today. Tell us why we need to care about this, and how do we get our guts in check?


DR. SANA MUKHI
Hi everyone. Thank you so much for having me. This topic of the gut microbiome, it's a really exciting one. We're learning so much every year. There are so many studies. There's so much research going on in this field. It's interesting because up until 2017, the Human Microbiome Project, which was an initiative that was launched back in 2007, and completed around 2017, really gave us a lot of information and a lot of insight into this world that we knew not very much about. I remember in my medical school training, even during residency, we didn't really learn much about the bugs in our gut, the gut bacteria and what their role is, how they affect us, what exactly they do. So, really it's a fascinating field of learning and research and as we go on, we're learning more and more about how the gut microbiome affects mental health, autoimmune conditions, metabolic disease, obesity, weight gain. Pretty much all facets of life and chronic conditions. So, the more we learn, we can use that information to be proactive, to indulge more in the preventative side of things when it comes to medicine, as opposed to the reactive approach that we currently have for the most part. So, just to talk definitions, what is a microbiome? The microbiome is basically an ecosystem of bacteria, fungi, and viruses that are present really throughout our body. We have an oral pharyngeal. So, microbiome in the mouth, vaginal microbiome, skin flora, skin microbiome. Then of course, for the purposes of our discussion today, we're going to be talking about the microbiome that resides in the gut. But, the microbiome is the gut microbiome that is made up of trillions and trillions of these bacteria that mainly reside in the distal gut and the colon. In the order of trillions, the digestive tract itself is about nine years long. Just to kind of give you an idea, close to six pounds of that is made of microbiota, which are the actual bacteria both dead and alive. So, when we look at stool, a large portion of it is bacteria that we're looking at. When we talk about what these gut microbiota do, what their purpose is, what their role is, that's something, again, that we're still learning. But what we do know so far is, of course, they help with digestion. They also help break down things like vitamins, macronutrients that we consume. Also they produce substances, mainly short chain fatty acids, which are substances that are produced by the microbiome when they break down fibers that we consume in our diet. That helps maintain the gut lining and prevent inflammation and leakage of a lot of these toxic substances outside of the lumen of the gut, which is thought to contribute to a lot of these autoimmune conditions that we are now seeing and even learning more about.


GINA GALAVIZ EISENBERG
I'm going to stop you just really quickly. I know we have a lot of follow up questions, but I just want to say hi to folks just joining us right now, and if you're listening to the award winning Docs in a Pod with our co-host, Dr. Tamika Perry, I'm Gina Galaviz Eisenberg, and our podcast is available wherever you get your podcasts. Dr. Sana Mukhi is our guest, and we're talking about the microbiome in our gut. Dr. Perry, how do you know when your patients' gut is out of whack?


DR. TAMIKA PERRY
That's a great question. They may have symptoms of digestive system problems such as bloating, acid reflux, weight problems. And like Dr. Mukhi alluded to, there may even be emotional problems, and that's on the other end of the spectrum. But what Dr. Mukhi was basically telling us in a nutshell is that, yes, we need bacteria inside of us. It's actually a good thing in certain instances. So, when we take medicines like antibiotics and it generally wipes away that gut flora, we can have a lot of issues from that. I mean, do you see that in your practice, Dr. Mukhi?


DR. SANA MUKHI
Yeah. Since we know so much about the importance of having a healthy gut microbiome, when it comes to bacteria in our gut, we want diversity, not just having bacteria present there, but different types, different phyla, different species of bacteria. In order to optimize health overall and antibiotics, we historically haven't been very judicious with the use of them. Now, the more we learn about this, the more it helps us to look at the effects downstream of giving these antibiotics. Giving antibiotics to the right patient in the right instance is important, but be judicious with the use of that, because they do wipe out a lot of the good gut bacteria that we do need for optimal, not only, again, gut function, but, mental health, autoimmune conditions, and just overall digestion of food.


DR. TAMIKA PERRY
Dr. Mukhi was being nice when she said we weren't being judicious. We're being irresponsible as clinicians with our overuse of antibiotics. I mean, truth be told. And not to say that I'm not guilty of it because I am. Sometimes patients pressure you and they will say, I have a cold. I need that infamous one letter pack. But that is not a cure all, and they do have side effects. One of the side effects is if you have a viral illness that doesn't require an antibiotic because it's for bacteria, and we give this to you, we could wipe out your gut flora. We could cause a vaginal yeast infection. I mean, it can go on and on and on about inappropriate prescribing of antibiotics affecting our gut biome. So, we're trying to fix one problem and in essence, we have caused another problem. So, the gut microbiome, and I didn't mean to interrupt you, Dr. Mukhi, because I was listening intently, like, what's she going to say next? What were you going to say next?


DR. SANA MUKHI
Going back to prescription use, KPIs, which are for tonics, we give out for acid reflux. What I've seen in practice is these medicines tend to just kind of stay on once started. It’s just added on to the medicine list and the patients are on them long term. But they can have significant impacts in the long term, not only when we talk about bone health, kidney dysfunction, potentially side effects of PPIs, but also having issues with malabsorption or decreasing the acid production when it's not indicated in most patients that I'm seeing. It's really for symptom management that they're given this. They can lower stomach acid, which we need to digest the foods and that can affect digestion downstream. So, yes, to your point about antibiotics as well as other classes of medicine, it's really important to look at the patient, and really get to the root cause of what's going on as opposed to just prescribing medications solely for supportive management and not really looking back and reevaluating and revisiting those.


DR. TAMIKA PERRY
As a clinician, every time we prescribe medicine, we have to look at the risk-benefit ratio. What is the risk versus the benefit of this drug, and how long potentially is the patient going to be on this drug? Because just like Dr. Mukhi said, not only is your gut biome affected, so many other systems in your body are affected. So, we really have to look at every single time whether that medicine is an antibiotic or whether it is protonics. It doesn't matter what it is. Every single time we have to look at what is the risk versus the benefit for this particular patient?


DR. SANA MUKHI
Absolutely.


GINA GALAVIZ EISENBERG
What about probiotics? Is that something that can put us back in check?


DR. SANA MUKHI
It's a good question. The answer is a little bit nuanced. Not very clear cut. In the context of let's say, after an illness, after you have taken antibiotics to restore that gut flora that is lost because of antibiotic use, probiotics are great. I actually tell my patients to take probiotics while they're on antibiotics as well as a while after they're done with their antibiotic course in order to replenish that gut flora. So, probiotics in that context will help. However, studies have shown that we can overdo probiotics. There was a study. I can't remember the name of it, but it talked about overproduction of lactate as a result of doing too much probiotics. And that actually can result in brain fog in a lot of these patients. There is such a thing as too much probiotics. Again, it really depends on the patient, the context of why it's being prescribed, what symptoms are you really looking to help the patient get relief from, as well as their existing chronic conditions, what medicines they're on, what kind of foods they're eating. So, it really depends.


GINA GALAVIZ EISENBERG
All right. Dr. Mukhi, Dr. Perry, I tell you, we will continue our discussion on the gut microbiome in just a moment. I'm Gina Galaviz Eisenberg along with Dr. Tamika Perry. We're going to take just a short break.


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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. I'm Gina Galaviz Eisenberg. Back to our guts and the bugs that live within us.


DR. TAMIKA PERRY
Dr. Mukhi did such an excellent job of explaining to us what a probiotic was. It's a supplement we can take that's actually a live bacteria that kind of replenishes that gut flora. Patients may see terms on bottles that say pre or probiotics. Just for clarity, prebiotics are a substance like a fiber that really encourages the growth of the bacteria that's already there. Probiotics are actually live cultures that you would take to replenish that. If you deplete that live culture with certain antibiotics, you can get a plethora of gut disorders. Dr. Mukhi, what is one that you see quite often?


DR. SANA MUKHI
I'm sorry. Your audio went out there. Can you repeat that last part?


DR. TAMIKA PERRY
Oh, yeah. We were talking about if you deplete your gut flora, you may see things like C diff. Can you tell us a little bit about C. difficile?


DR. SANA MUKHI
Yeah, sure. C. diff is an infection. It is Clostridium difficile, and it is an overgrowth. It's typically seen in patients who have recently been hospitalized or have been on multiple rounds of antibiotics. There are some very common antibiotics, such as clindamycin that have been associated with C. diff. What that is, it's a bacterial infection which can lead to complications such as a toxic megacolon. If left untreated, it can lead to kidney dysfunction as well as blood count abnormalities. Going back to what we were talking about earlier, this is one of the things we also have to think about when it comes to antibiotic prescription in patients, because there isn't always a risk of this particular C. diff infection potentially occurring in patients. Interestingly enough, it's treated with different types of antibiotics, this particular infection. Because again, it is an overgrowth. What is interesting is that, in patients who have recurrent C. diff, meaning that they are kind of resistant to the current antibiotic treatment regimens, another therapy that has also been shown to provide relief is what we call fecal transplantation. So, it's basically taking stool and transplanting that stool into the patient with C diff. That's been shown to provide relief as well as treat the C. diff the patient does have. So, it's essential transplanting more gut microbiomes, which are destroyed because patients have had this infection, and transplanting a new gut microbiome via stool transplantation into the patient's gut. That actually helps provide relief and is a modality of treatment. So again, with C. diff and antibiotics, that is also definitely one of the big things we need to think about when prescribing antibiotics.


DR. TAMIKA PERRY
I know what some of the listeners are thinking, where do you get the stool from? So, just like you can donate blood, there are donation centers. Am I allowed to say doo doo on the air?


GINA GALAVIZ EISENBERG
Yes.


DR. TAMIKA PERRY
You can actually donate your stool also. So, there are donation centers for stool donations.


DR. SANA MUKHI
People get paid for this. People can make a living from donating their stool.


GINA GALAVIZ EISENBERG
Please don’t tell my kids.


DR. TAMIKA PERRY
I've actually had a patient in my very, very past who had a donation because she had a myriad of autoimmune disorders, but she could not keep weight on, and it was like a last ditch effort. And it actually worked for a minute. I mean, she still had some other issues going on, but we did a fecal transplant, and she was able to start to gain weight and felt a little bit better.


DR. SANA MUKHI
Did her autoimmune conditions also improve a little bit?


DR. TAMIKA PERRY
A little bit.


DR. SANA MUKHI
It's really interesting because 70% of our immune system is in the gut. So, that's why the thought now is the immune system and imbalances or autoimmune conditions. The focus probably needs to be shifted into gut health and looking at the gut a little bit more closely into patients diet, what they're eating, how stressed they are in order to provide this other layer of why is this going on with this particular patient? And can we provide other potential treatment modalities to help their particular autoimmune condition? So, it's very interesting.


GINA GALAVIZ EISENBERG
How do you know if your gut is out of whack? I mean, you go for your checkup, but you don't tell the doctor you're bloated or not feeling good, but you're just still feeling bad. Does it really have to get bad before you start investigating?


DR. TAMIKA PERRY
Correct me if I’m wrong, Dr. Mukhi, because you're by far the expert on this, but there’s not a screening test for it like we do for diabetes or certain chest X-rays for cancer or a pap smear for cervical cancer. So, it's not like it's a screening test. It's really symptoms. You're disclosing symptoms to your doctor. That's why it's very important, and I know I sound like a broken record, for you to have that relationship with your PCP and to be able to disclose to them maybe some uncomfortable topics like my doo doo ain't right.


DR. SANA MUKHI
That's very true.


DR. TAMIKA PERRY
I have patient’s say, I feel crampy all the time. I'm nauseous. At this point, this is where your doctor is supposed to start to investigate these things. Is there something going on with their biome in their gut?


GINA GALAVIZ EISENBERG
How does alcohol affect our microbiome? You drink some wine and you don't feel so good. Or if you abstain, you feel great.


DR. TAMIKA PERRY
Caveat: I like wine. That's just a caveat. However, does it have any therapeutic effects? can't cosign that whatsoever. Dr. Mukhi, what are your thoughts?


DR. SANA MUKHI
Alcohol is a depressant. As you know, we have neurotransmitters in our microbiome as well. We have gaba, we have serotonin, we have dopamine. When we're ingesting anything, whether it be food, whether it be something like alcohol or drugs, there is a very intricate interplay between communication that is between the gut neurons and whatever is being adjusted in it. That gets communicated via the vagus nerve, to the brain and to different parts of the brain. That can actually lead to excitatory or inhibitory actions. For example, if you ingest a donut, for example, it's digested and then there are certain bacteria that pay very close attention to and then transmit those signals to certain parts of the brain about, is it sugar that's digested? Is it protein? Is it amino acids? They are sensing these things and transmitting those signals to the brain. That leads to one person craving something like sugar versus more craving for another type of food. This, again, can lead to addiction when it comes to things like alcohol or any kind of drugs. So, it's a very complex interface and interplay between the gut and the gut brain axis, which is, again, very interesting.


GINA GALAVIZ EISENBERG
So, when people say, listen to your gut, it takes on a new meaning, really.


DR. SANA MUKHI
Oh, yes. Not only that, a lot of patients do have symptoms. Most of us are on the SAD diet, the Standard American diet. We tend to think that having a bowel movement once a week is normal. That's not normal. You can have bloating, constipation, brain fog, all of those things, and it can be traced back to the gut. But not only that, when we do blood work, insulin resistance, obesity, it's been found that patients who are obese, they have a higher ratio of bacteria compared to bacteroides. That ratio being elevated specifically is found in patients with obesity. Similarly, certain colonies of bacteria help the GLP-1 agonists that are pretty popular on the market these days. There is interplay between the bacteria and their assistance in secreting more of those substances, such as GLP-1 to help with satiety, to help with feeling full, to help decrease cravings. So, their end product, the enzymes that they're producing, the effect that they have on the neuron system, they can really affect metabolic health, even outside of the digestive issues.
It's interesting you say that. About 7 or 8 years ago, I was taking some classes back at Harvard, and I just like saying I was taking classes at Harvard.


GINA GALAVIZ EISENBERG
Fancy.


DR. TAMIKA PERRY
We were talking about it in class. There were obesity classes by their gastroenterology department, and saying that one of the viable treatments they were studying there was a fecal transplant for people who were morbidly obese to change their biome. Exactly what you said, to change that ratio of the fermenting bacteria.


DR. SANA MUKHI
I can't speak to the fecal transplant. If that's been done in patients with obesity specifically looking at that, I'm not I'm not too aware of any studies of that nature. But I will say that the microbiomes can be changed with diet. There's a lot we don't know, but we do know that having a diverse microbiome with different types of bacteria is actually a good thing. So, incorporating more fiber into our diets. The average American gets about 10 to 15 grams of fiber. That's not nearly enough. Having more plant-based fiber, having more fermented foods, having things like avocados or things that are naturally high in GLP-1. Those are all things that can affect the diversity of our microbiome.


GINA GALAVIZ EISENBERG
I really hate to interrupt. We will have to continue this on a different segment because we're now out of time.


DR. SANA MUKHI
I didn't even realize it.


GINA GALAVIZ EISENBERG
I know. We'd like to thank everyone for joining us today on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg, along with Dr. Tamika Perry and our special guest, Dr. Sana Mukhi. Look for her at WellMed at Huffmeister in Houston. In the words of the late Charles Osgood, I'll see you on the radio.


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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