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Cheryl Martin (Host): Gut health affects far more than digestion. It influences mood, immunity, energy, and everyday wellbeing. On this episode, FirstHealth functional medicine physician, Dr. Scott Jamison, breaks down what gut health really means, the subtle symptoms people should not ignore, and the simple steps anyone can take to feel better from the inside out.

 This is FirstHealth and Wellness Podcast from FirstHealth of the Carolinas, connecting you to the people in medical services that make your life healthier. I'm Cheryl Martin. Dr. Jamison, thanks for coming on

Dr. Scott Jamison: Thanks, Cheryl. It's great to be here.

Host: First, when we talk about gut health, what does that really mean and why is it important for the average person?

Dr. Scott Jamison: Yeah. So, gut health has really become a broad term. It probably has a lot of meaning to different people. For me, gut health is sort of the center of the universe. In functional medicine, we really focus pretty much on gut health as really that first step often in approaching a wide variety of medical issues and conditions.

The gut is the center of the universe when it comes to the immune system with approximately 70% of your immune system located within the gut. There's connection between the gut and the immune system, the gut and the brain, gut and inflammation. And so, really, the health of the gut, good or bad, has a broad range of implications for overall wellbeing and health.

Host: I'm glad you're saying that because many people don't realize that gut health affects more than digestion. So, talk about how it influences things like mood, immunity, or energy.

Dr. Scott Jamison: Yeah. It's really fascinating, and it's been a multi-decade evolution that is still ongoing. There are really a couple of excellent books out by one of the thought leaders, Emeran Mayer, who is out in California, and it really has brought up this really elaborately worked out and ongoing elaboration of the connection of the gut to the brain. It turns out that there's bidirectional information flow from the gut through the vagus nerve to the brain and reverse from the brain to the gut. So, the old saying of, you know, "I have a gut feeling about this" is really quite true. And we're learning more and more that healthy gut can reduce anxiety, can help control depression and mood. There's new data coming out that abnormalities in the gut wellbeing can lead to more increased risk of Parkinson's disease, Alzheimer's disease. So, the brain-gut connection is really quite profound. Stress can have a major effect on the gut and reverse. And again, a healthy gut really does a lot to transform this process into setting a stage for inflammation, mood, anxiety, to be better.

In terms of the immune system, again, approximately 70% of the immune system is located within the gut. So, what's happening in the gut can positively or negatively affect inflammation in the body. There's new data that abnormal gut health may be tied in with certain conditions such as fibromyalgia, such as certain cancers, heart disease. It's, again, just a tremendously exploding, area of research on the connection of the gut to the immune system and the brain.

Host: So, what everyday symptoms, even subtle ones, might signal that your gut is out of balance?

Dr. Scott Jamison: So, the common things that we think about, I mean, obviously, the patient who has alternating stool effects, you know, constipated, then they have diarrhea, bloating, abdominal discomfort are things that can be pretty obvious signs of something going on with gut health.

Unfortunately, a lot of times in my patients, you have to be highly suspicious of the gut. They may not have overt symptoms of what we would consider classic GI symptoms, but just somebody who comes in with joint pain or muscle pain or inflammation or brain fog. These are sort of things that I look at. And again, the gut in functional medicine really becomes one of our main focal points for pretty much a wide variety of our workups that we kind of dive into and often start with looking at the gut first.

Host: I'd love for you to delve more into this, because i'm not sure if functional medicine is something new, but how does a functional medicine approach? Talk more about how it helps uncover the root causes of chronic gut issues.

Dr. Scott Jamison: So, functional medicine in its basic approach is always looking at a matrix, if you will, of all of the variety of influences that can affect an individual system. This is a big part of why I love functional medicine and its alternative approach to taking care of patients. In specific relationship to the gut, we're looking at multi-variate matrix of how things affect the gut, And that can be diet, exercise, stress, sleep, alcohol, chemicals in the environment, obviously antibiotics and certain drugs. So when we approach a patient that we are interested in their gut health or planning to evaluate symptoms that may be related to gut health, we really spend time in that basic foundational approach to really understand the whole matrix of the patient's world. You know, what's going on in their work world and their home world and change in their diet and medications and various things that then help us set the stage for understanding what tests we need to do and how we need to begin to move that patient forward to better gut health.

Host: Please share with us some realistic, simple changes that people can do to improve their gut health right away. You know, we like quick solutions.

Dr. Scott Jamison: And some are quick and some are slower. But I think you know, some really good basic, really across a broad spectrum of people that there are acceptable and easy recommendations are, first, your diet. I think eating less processed food, even eating less meat. There's clear cut data that populations of people who eat more plant-based, that fiber, which is really the critical thing in a plant-based diet, the fiber is what really drives the positive changes for the gut microbiome. So going to a healthier, less processed food, less sugar, more fiber, doesn't have to be vegetarian, but more fiber in your diet can have really a profound and actually very quick impact on gut health.

Exercise, regular exercise, not too much exercise can help the gut. Good sleep can make a big difference. Less alcohol, being careful of taking antibiotics and addressing that when you have to; being aware of what medications you're taking and the impact they can have. But I think on a simple basis, diet, good sleep, and exercise are really those everyday things that all of us can do to really work to keeping our gut in a healthier ecosystem function.

Host: You mentioned probiotics. What about probiotics and gut health supplements? They're everywhere. So, what should people know before buying them?

Dr. Scott Jamison: Yeah. Oh boy. Tough question but an important one. You're right, you go to the store and there's 30 or 40 in the refrigerated part of your health food store, and it's an outrageous amount of money. There is a great deal of research going on now, looking at very specific forms of probiotics, such as Akkermansia, which can help with metabolic control and weight loss. There's others that are being explored in Europe that may be helpful in people with even psychiatric illnesses. But in the general population, in my practice, I'm always happier to support people's gut with things we just mentioned, the diet, more fiber. There's actually data that just giving people fiber improves their brain function without even having to take extensive amounts of probiotics.

In addition to that, I think eating fermented foods is critical. The history of the world, most populations have always had fermented food as part of their diet. If you look in the current state of things, populations that eat more fermented foods tend to have healthier guts, have signature changes in their gut microbiome. So while I certainly encourage the use of probiotics in times, like after antibiotics or after surgery, then I think that's very reasonable. But in general, I tend to shy away from probiotics, and I'm happier with fiber and with fermented foods.

Host: Give us an example of some of the best foods for fiber and also fermented foods.

Dr. Scott Jamison: Yeah. So, the fermented foods, the classic ones are kimchi, sauerkraut, miso. Kombucha has some, the population of bacteria are a little less. Yogurt has some, kefir has some. For patient and personal use, I tend to stick more with kimchi and sauerkraut. A somewhat acquired taste, but two to three tablespoons a day is pretty dramatic. And the spectrum of bacteria you get, it's hard to match in any sort of commercial probiotic. In terms of diet, I think the higher fiber foods, so root vegetables, rutabaga, turnips, parsnips, beans. Things that are higher in fiber content are the ones that are going to help, support the gut the most.

Host: So when is it time to see a specialist instead of trying to self-manage gut symptoms at home?

Dr. Scott Jamison: Well, I think one of the really important caveats to that question is that when do we need to be careful, even from a functional medicine point of view, that we're not missing a more important pathology? And I've certainly seen cases where people were being treated for gut issues, and it turned out they had a more serious diagnosis.

So in my sort of approach to history, somebody has a lot of mucus or blood in their stool, if somebody's lost a significant amount of weight with the onset of their gut symptoms, if the gut symptoms have been very abrupt in their onset, those are things that I think really often need a more classical gastroenterology workup, or at least a GI testing to make sure that you don't have Crohn's disease or you don't have colon cancer, or you don't have diverticulitis.

Once you've sort of excluded that, then that's where the functional medicine approach comes in. And there's a number of ways to do that. There are testing that actually has exploded with microbiome testing, which can at times be helpful. But sometimes, it's just taking people, putting them on that good diet, adding a little fiber.

Because I see people who have more serious gut problems, I tend to do stool testing, which the advantage is you can actually look at somebody's microbiome. You can see if they have parasites, if they have abnormal bacteria, do they have leaky gut, do they have inflammation, do they have low butyrate. And those sets of data points really help us set up a very well-defined set of supplements and interventions that can really be quite remarkable in what it does for a person's overall wellbeing and health.

Host: Anything else you'd like to add on this topic?

Dr. Scott Jamison: I think it's a very amazing growing area. I think it's going to be expanding month to month. I think one of the big areas that's coming up for therapeutic manipulation of the microbiome is looking at targeted fecal transplants for neurodegenerative disorders such as Parkinson's and Alzheimer's. There's some fascinating work being done with the gut microbiome cancer therapy. So, I think that's the wave of what's coming from a technical point of view.

But I think the big thing is back to basics. And it's eating that healthy diet, more plant-based, plenty of fiber, avoiding processed foods, avoiding excess of probably meat or animal products. Remember that alcohol gives you leaky guts, so you want to moderate that. Good exercise, good sleep, work on stress, stress management. Those are sort of the everyday things. And don't spend a lot of money on probiotics. Work on the healthy diet, work on fermented food.

Host: Dr. Scott Jamison, thank you for educating us on the importance of gut health. Extremely informative. Thank you.

Dr. Scott Jamison: Thank you, Cheryl.

Host: To learn more about functional medicine at FirstHealth, visit firsthealth.org/gut. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics of interest to you. This is FirstHealth and Wellness Podcast brought to you by FirstHealth of the Carolinas. Thanks for listening.