Why Gut Heath Is So Important with Christine Lee, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

If you've got a bad feeling in your gut, well, it's best to pay attention to the message that's being delivered. What's happening in your belly has far-reaching implications for your overall health. To use an old analogy, your gut and its complex microbiome serve as the canary in the coal mine for a whole bunch of issues. So how can you keep your gut happy? That's what we're going to find out today from gastroenterologist Christine Lee, who's back for another podcast chat about what's going on downstairs. Dr. Lee is one of the many trusted experts at the Cleveland Clinic who joins us weekly to explain why our bodies work the way they do. So, let's learn what we can do to get our gut in a good place. Dr. Lee, so nice to have you back on the podcast. I always love it when we get a little bit of time together.

Dr. Christine Lee:

Thank you for having me. Our conversations are always enlightening.

John Horton:

Well, and today, now, you've been, I know, a gastroenterologist for a long time, and so you've always been into gut health, but it seems like the rest of the world has, all of a sudden, become fascinated with this because gut health is like the new big thing. I mean, have you found this when people come into the office that they're more and more interested in it?

Dr. Christine Lee:

Absolutely. When we first started - and it's almost like people didn't want to see their GI doctor - but now, it's almost a cool thing to do. So, all of a sudden, I'm so popular now. Everybody wants to have discussions about their gut health. So, it's no longer, you're banned from talking about work on the dinner table. Now, it's the most common dinner topic wherever you go. So, for me, I think it's great.

John Horton:

Well, we always knew you were the cool doc, so now, I guess everybody else knows, too.

Dr. Christine Lee:

I don't know about cool, but people have lots of questions. It's a hot topic.

John Horton:

Well, and we have questions, too, which is why you're here. So, I know most people just think of their gut as a place where the food you eat lands and does its thing, but I know it's far more than that. So, tell us why gut health is so important to overall health.

Dr. Christine Lee:

So, there's an old saying that says, "You are what you eat." So, it is so true. You want to make sure you feed your body well, treat your body well, and your body will treat you well in return. So, what you eat does affect our overall health. If you're putting substandard things in, you're going to produce substandard output. So, it's so important to recognize what good health is and promote that. So, if you can keep your insides healthy, your outside will be healthy as well.

John Horton:

And I thought I read where it says that gut health even affects your immune system, which is just not a connection I would make.

Dr. Christine Lee:

The first line of defense to infections or intrusions is that skin or gut barrier, so what we eat. The intestinal lining is the inside skin as far as protection - so your intestinal health is extremely important. It's your first line of defense to ward off gastroenteritis or bacterial infections or any kind of invasion, whether it's virus or bacteria or even food poison toxins. It is your first line of defense. So, you want to keep that as healthy as possible.

John Horton:

Tell us a little bit about the microbiome, which, just - I think it's a word now that we've all heard and we're familiar with, but we have no idea what it really is.

Dr. Christine Lee:

Sure. So, our intestinal tract on the inside is lined with microorganisms. Those are the healthy gut flora. They are our army of defense to ward off when invasions occur, whether it's viruses or bacteria or even toxins, when they try to invade our intestinal tract. Our first line of defense is our biome, which is gut bacteria. They're healthy bacteria that are actually working and fighting for our health. So, they're on our side. So, they're the good guys. If you're talking in Army terms, that's the good guys warding off the bad guys.

John Horton:

Yeah, because everyone thinks that bacteria are a bad thing, but this is bacteria that's actually, it's working for you.

Dr. Christine Lee:

That's correct, that's correct. So not all bacteria are bad. There are good bacteria and there's bad bacteria, and you want to make sure that the good bacteria outnumber the bad bacteria. So, should there be an attempt of invasion that the good bacteria can ward it off and avoid it at the border before they even enter, that's your first line of defense. So, you want to keep those good guys healthy.

John Horton:

It amazes me how much is going on inside there that you don't even think about, I mean, you eat, and the food goes in and then all of this stuff starts taking place.

Dr. Christine Lee:

Sure. So, it's more so now than ever. A long, long time ago, when antibiotics were not as freely available, we had those good guys in our intestinal tract that fought off bacterial invasion or attempts or even viral attempts. That being said, as you know, antibiotics are so readily available now. People, they don't even need to be seen in their pediatrician's office. They just tell them they have an earache and you're getting an antibiotic for otitis media or bronchitis or sinusitis, and antibiotics are just everywhere, and antibiotics are a good thing when used appropriately. So, it does ward off, though, it kills the bacteria infection. However, it does come with a cost, and the cost is, it's not a smart bomb. It doesn't just go to the sinus and kills the bad bacteria that's causing sinusitis. It does do that but at a cost, and the cost would be, it also kills quite a bit of your natural healthy biome, meaning the good bacteria that we need in our intestinal tract.

And that might be why more and more we're seeing an increase in the prevalence of gut motility pains and disorders. And a lot of this talk comes up because people are losing a lot of their healthy biomes. And that's why now you go to the market, and you see probiotics and kefir and all these health supplements for your gut health, trying to restore the losses that might've occurred from frequenting doctors and getting IV antibiotics for a procedure or hip replacement. You get really powerful antibiotics IV or just oral because you had an ear infection or a sinusitis or a UTI.

John Horton:

So, Dr. Lee, it sounds like what you're saying is everything that we take in, whether it's medications or food or what you drink, it all has an effect on your gut health.

Dr. Christine Lee:

Absolutely. So, everything you just said, very important.

What you drink, hydration is important, so you don't want to go through these prolonged periods, where you're not drinking anything, and you get dehydrated because then, you're swinging back and forth from dehydration to overhydration. So, you want to make sure you're hydrated throughout the day, so you avoid periods of dehydration states.

As far as medications are concerned, only take the medications that you absolutely need because every medicine has the good and the bad, so nothing comes with the side effects. So, blood pressure medicine, high cholesterol medicine or antibiotics, they're all good medicine with good intent, but be aware of the side effects and make sure you accommodate for the side effects that it brings.

As far as food, you want to make sure you eat a wide variety of foods, lots of colors. Don't stand with one color. You want to do greens, reds, oranges, lots of fruit colors, different variety of colors. It has beta-carotene; a colorful diet will provide the widest variety of vitamins and nutrients that your body needs.

John Horton:

So, if you have good gut health, I take it, that's one you eat and everything moves through the way it should, and the process just goes, you have a good balance. What are signs that your gut health isn't what it should be? And then, when should you talk to your doctor about that?

Dr. Christine Lee:

So, you'll start noticing some slowness in the digestive system, meaning you ate, it's been four to six hours, but you still feel full, and it's likely because you are still full. Things are slowing down as we get older. So, when you notice, “Hey, I ate something six hours ago and I'm still burping it up,” that's an indication that you might have something called gastroparesis, or your bowel habits changes.

You don't go every day; you go once every three days or twice a week. That's a sign of things slowing down, and you might need some help.

Another thing's fatigue, you ate but you're tired all the time. So, you might need some vitamins and be mineral deficient. So, you want to make sure your energy level is not going down. Those are all indications of something that might be going on with your digestive tract.

The other thing would be skin rashes even. Some vitamin deficiencies can present with rashes or ketosis, or ulcers in your tongue and mouth. Those are all indications of gut health as well.

John Horton: 

And I think when we were talking about just things slowing down, one of our favorite subjects, and it seems like we always go here, is just pooping. And that's just if you're not pooping regularly, and there's not getting constipated, that's a sign that maybe your gut health isn't where it should be.

Dr. Christine Lee:

That's exactly right. And the word constipation — I can't foot stomp this enough — a lot of people, just because they go, feel that they're not constipated, but that's really not true. It's really about how much is left in your colon despite the fact you had a bowel movement, can be an indication of constipation. So, a lot of times, we'll see patients who said, “Oh, they have had gastroenteritis and they've had such a terrible bout of diarrhea,” but when you do an X-ray, the X-ray's full of stool. So that's an indication that perhaps they actually had constipation with overflow. And even though they've had a bout of terrible diarrhea, on X-ray, they still have a visible amount of stool in their colon.

John Horton:

That does not sound comfortable, which gets to, I know you always talk about — you got to make sure you clear out everything that's in there, which is why it's important to be regular and make sure you're eating a healthy diet and all of that stuff.

Dr. Christine Lee:

Yes, and a lot of patients, they're very keen and attuned to their symptoms. They just haven't made that connection. So, they're very much aware that they feel full, they feel they haven't eaten, and they should be hungry but they're not hungry, or when they do eat, they're full, even though they haven't even finished their meal, they feel bloated all the time. They report they feel gassy, and they feel just fatigued. Those are all possible indications that they're having constipation or motility disorders. So, you want to make sure that you're in tune to those symptoms and then make sure that you connect that with possible retention of stool in your colon and that reticular disease and whatnot. So, you want to make sure that you stay ahead of that or address that and try to prevent those scenarios as much as possible.

John Horton:

Well, since nobody wants bad gut health and everything that comes with it, that you just described, what can we do to improve our gut health? And I know there's some simple things that you can do at home and in your life to help your gut along. It always seems like the first rule is, it's not just one food that's good for you. It's your whole diet.

Dr. Christine Lee:

Right. So, you want to have a wide variety in your diet. So don't always eat the same food, try to mix it up. A colorful diet is always very helpful, with the rich and wide variety of vitamins and nutrients and minerals. And then, also, just to make sure that you're exercising regularly or hydrating regularly. And then, prevention means don't take anything if you don't have to take it. So, if it's viral bronchitis that would've gotten better on its own, try not to take that antibiotic if you didn't need it because, again, antibiotics aren't smart bombs. They don't just kill the bad bacteria; it kills some of the good bacteria with it as well. So, you want to make sure that if you have had to take a course of antibiotics, that, make sure you try to replete it as much as possible by eating foods that are rich in probiotics. And you can take a probiotic supplement, but you can also do it naturally through diet. So, foods that are rich in probiotics would be anything that's fermented, like sauerkraut, cabbages, garlic.

John Horton:

Well, let's keep going around the store because those are all great tips, as far as the fermented foods, the stuff to buy. I know some of the other things that are usually recommended are naturally high-fiber foods. What would fall in that category?

Dr. Christine Lee:

So high-fiber foods would be whole grains, barley, millet, quinoa, brown rice, red rice, bran, germ — those kinds of foods are all very rich with high fibers and rich in probiotics.

John Horton:

Just really quick here, in case people haven't tuned into our other podcast and they should go back and look, what does high-fiber food do? How does it help the process?

Dr. Christine Lee:

High-fiber foods have natural fiber that's not digestible. So, it actually creates an osmotic gradient. It pulls water into the intraluminal space of your intestines. So, it prevents it from becoming too hard, and so it makes it easier for you to pass through your intestines. So high-fiber food — additional examples would be avocados, figs, prunes, dates, almonds, beans, those kinds of foods. So, the fermented foods we talked about were kefir, sauerkraut, pickles, apple cider vinegar, those kinds of foods.

John Horton:

You also mentioned prebiotic foods, and I feel like that's another one of those things where we've all heard it, but we really don't know exactly what it is. So, what the heck is it and what is it doing for us?

Dr. Christine Lee:

Probiotic foods are foods that are rich in those bacteria, those lactobacilli, and those healthy gut biome bacteria.

Prebiotic foods are foods that are rich in the nutrients that the probiotic organisms need to survive. So, for example, if you took a probiotic pill that's loaded with healthy bacteria, well, that would be wasted if you didn't feed it because then it would die off. It's like if you had flowers, you forgot to water them. Won't do you any good to just get flowers and then just dry them out, they just die in a day or two. So, you want to make sure your diet is rich with, not just probiotics, but also prebiotic foods, so that you can maintain that probiotic biome that's in your intestines.

John Horton:

What are some examples of prebiotic foods, the ones that, then, are helping the bacteria along.

Dr. Christine Lee:

So, the prebiotic foods are whole grains, bananas, greens, onions, garlic, soybeans, artichokes, sourdough — those kinds of foods are very rich with lots of prebiotics that the probiotics need to survive.

John Horton:

And then I saw there's also plant-based foods. The polyphenols are good to get in there, too?

Dr. Christine Lee:

Yeah, so the polyphenols are the berries, any kind of berries, blackberries, blueberries, raspberries; the cocoa, whether it's in dark chocolate or cocoa coffee beans; certain spices like cumin, curry; olives, red wine, soy — those are high polyphenol foods that we should all try to incorporate into our diet. More reasons to have coffee and dark chocolates.

John Horton:

I need more doctors to recommend things like that. That is what we love hearing. What are some foods that you should look to avoid if you want to make sure to keep your gut healthy and happy?

Dr. Christine Lee:

So, the foods to avoid would be foods that are very, very high in salt content. So, anything, that's potato chips, french fries with lots of salt in it. Any canned vegetables or TV dinners loaded with sodium. You want to try to avoid any processed foods. When you look at it, the expiration date is like three years from now — those are just loaded with preservatives. So, all of those things are very difficult to digest and not healthy in any way in our biome, and it really slows down the motility and allows opportunities for other bacteria to build up. So, you want to avoid traditionally processed foods, canned foods, salty foods.

John Horton:

Luncheon meat, I think it would be a big thing to try to avoid. We eat so much of it but yet, it's also something that's just not good for your system.

Dr. Christine Lee:

Right. So, it's a lot of things that have nitrates and have high salt content. Foods that's all sugar also, those are very hard for our intestinal health. So, we should all be eating less salt, less sugar and less processed foods. So, the best foods are the ones when, generally, you go into a grocery store, they're in the perimeter, so the leafy green vegetables that have dirt on them, that just came from the ground couple of days ago. The vegetables even, that's not the little carrots that are all prepackaged in a nice container, but the ones that have that roughage and dirt on the bottom, so you have to actually wash it and peel it. Simple foods are actually the best for our body, so it's less processed, simpler, right off the ground.

John Horton:

And I feel like your body tells you what's good and what's not because when you eat those, the foods that you were just describing, you usually feel a little icky as opposed to when you eat the healthy foods, and your body usually takes that in pretty well.

Dr. Christine Lee:

That's exactly right. So, healthier foods tend to have a high vitamin mineral count. So, you replenish your vitamin A, vitamin D, vitamin E, and those vitamins can help energize your body and keep things in better circulation and in better operational mode. Processed foods really are high in salt and fat and very low in vitamins and nutrients. So inevitably, if you just eat those kinds of foods, you will become vitamin deficient. You may become B12 deficient, you may develop iron deficiency because there's no iron in it. And so all of those things can contribute to your bone marrow activity. Your metabolism can actually slow down your metabolic rate and process.

John Horton:

So, Dr. Lee, we have covered a lot of ground, as far as how to keep your gut healthy, is there anything that we missed that you'd like to add?

Dr. Christine Lee:

So even healthy foods, you want to make sure everything is in moderation — too much of anything, even a good thing can become bad things. So, you want to balance everything out. So, everything in moderation is key. None of us are perfect, so we can't always avoid the icky foods. So, every once in a while, we have a cheat date. But even the cheat date, you want to make sure you keep it in small moderation and rare in between.

John Horton:

One more thing that just came to mind, what about supplements because I know there's so many of those out there? Like take this and it'll help your gut. Are those beneficial?

Dr. Christine Lee:

Oh, I'm so glad you brought that up. That is so important. So even those supplements, you want to take those in moderation because a good example is zinc and copper. So, zinc became very popular over the COVID times and winter times because it stimulates your immune system. It's supposed to ward off colds and flu. So, people were taking these zinc supplements to a very, very high level. So, unfortunately, your body has a counter mechanism, so if you have too much zinc, you become, you make yourself copper deficient because they work in concert. So, you want to make sure even the good things like vitamin C even, you really don't want to exceed the therapeutic level because you can put yourself at risk for, with vitamin C, you can put yourself at risk for kidney stones. So, you want to be careful. And even vitamin D, it's a fat-soluble vitamin, so too much of that, you can develop rickets.

So even good things must be in moderation. So, you have got to be wise, make sure that you don't exceed a self-safe limit on any of those things as well. And as far as probiotics are concerned, you have got to do some research. You need to make sure that the company that you're buying it from is legitimate. Generally, over-the-counter supplements are not FDA regulated. So as far as quality control is concerned, meaning, what it contains is actually, what the label reports is what's actually contained. Dead good bacteria are never going to be helpful for you, but even worse, contaminated probiotics with a bad agent can be actually very harmful. So, you have to be wise in what you're buying, who you're buying it from and how much of it you're taking.

John Horton:

Great advice as always, Dr. Lee. I appreciate you taking the time with us today. And thanks again.

Dr. Christine Lee:

Thank you for having me.

John Horton:

Keeping your gut happy and healthy comes down to filling it with the right food. Eating a variety of fresh whole foods, fruit, veggies, whole grains and more can build the diverse microbiome you need in your belly. Try it. Odds are, you'll feel better if you do. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.