Dr. Robynne Chutkan Landscape

My guest today is integrative gastroenterologist Dr. Robynne Chutkan. Studying at Yale University and then Columbia medical school, Dr. Chutkan took a job with Georgetown University Hospital. Then in 2004, she created the digestive center for wellness. Dr. Chutkan continues to help patients heal various health issues with proper nutrition and lifestyle choices from autoimmune disease, skin disease, eczema, asthma and so much more. She even noticed that some underdeveloped countries have far fewer autoimmune diseases than our developed country. What was this based on? Early in her practice, Dr. Chutkan saw patients improving their health drastically and finally asked them, “what are you doing differently?” Inspired by their improved results through healthy eating she started to explore this path. She is not opposed to medication, but she says there are quite a few options to getting better besides using medication as a first and only solution. Her latest book, ‘The Anti-Viral Gut,’ is out now. Enjoy!

Listen to the episode here:

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Key Topics:

  • Opening Up Digestive Center for Wellness [00:05:56]
  • The Mechanical Aspect of the Digestive System [00:09:32]
  • The Knowledge and the Practical Side of Medicine [00:13:43]
  • Low Carbohydrate Diet [00:19:15]
  • Balancing Gastroenterology Practice and Business [00:22:52]
  • The Influence of Microbiome [00:29:43]
  • The Hygiene Hypothesis [00:32:39]
  • Stomach Acid: The Foundation to Gut Health [00:35:42]
  • On Fermented Foods [00:41:01]
  • Changing Behavior in Food [00:45:35]
  • Aging and Staying Healthy [00:51:17]
  • Prebiotics and Probiotics [00:57:50]
  • The Role of Stress and Sleep in Gut Health [00:59:36]
  • On Medicines and Antibiotics [01:03:39]

A Practical Plan for Strengthening Your Gut | Integrative Gastroenterologist Dr. Robynne Chutkan & Her New Book ‘The Anti-Viral Gut’

“I was shocked by the idea that diet could heal, not just make you feel better in terms of the number of bowel movements or how you felt but the gold standard, which is what we call mucosal healing. Her colon could go from severe Crohn’s to normal with diet. It was magic to me and I was like, “I have to learn more about what she’s doing.” This is crazy.”

“I’m not here to sell you any supplement. I want to give you good advice. I want to teach you how to be a better advocate with your doctor. Let me give you a little script almost. Don’t go in there saying, “I don’t want to be on any drugs.” Go in there saying, “I appreciate this well-thought-out plan you have for me. However, I want to try a dietary approach. I want you to be my partner and I want you to be with me through this.”

My guest is Integrative Gastroenterologist Robynne Chutkan. She is working at The Digestive Center for Wellness that she created in 2004 where she worked after Georgetown University Hospital. She was educated at Columbia Medical. She went to Yale. You get the point. She has a book that I am excited to share with you called The Anti-Viral Gut. There is so much information in this book. There’s even an extensive way to communicate with your doctor.

She’s a doctor. She was sensitive, when she worked at the hospital, that your doctor has seven full minutes with you and we want to get you in there for a colonoscopy because that’s how our business works. She’s saying, “If you’re on medication, which can be hard on the thing that they’re trying to heal, these are the questions that you can ask.” If you’re on medication, ask these questions. If you’re trying to maybe lower your dosage, ask these questions. If you go off your medicine and you have a negative reaction, these are the things to ask.

She thought about everything. She’s written other books like Gutbliss and The Microbiome Solution. She is hands-on with patients. What I love is she had a traditional education and then she gets into practice. Let’s say she had patients that, for example, she would do a colonoscopy on and they come back and she’d do another one and there was some huge improvement. She would say, “What are you guys doing?” What she found is patients won’t tell you but if they asked, they might share that they were using food, a big shocker, to help heal their guts.

It’s confusing. We all hear about the microbiome and how much it impacts us, our personalities, our moods, and our health. Even in our wealthier countries, all the new autoimmune diseases showing up. If you go to some of the Third World countries, they don’t even have it because they’re not eating all the unusually processed foods that we’re eating. Also, they don’t take as many medications as we take and such.

Rather than saying, “This is how I was trained and this is how we’re going to deal with it.” She started experimenting with using food as part of the cure for taking care of things that would maybe be less obvious to you and me. She drills down on, “We’ve got to think about three things. We have to think about our stomach acid. We have to think about our stomach liner, which is about a cell thick. We’ve got to think about our microbiome.” Also, how do we undo dysbiosis or manage autoimmune diseases? Many different things that people will end up dealing with if some of this has arrived or have got punctured perforated holes in their stomach lining and things like that.

The other thing she talks about is we’ve gotten too unwild. We’ve got to get out in nature. We’ve got to be barefoot. We have to commune with dirt. We have so much more power to support our health than we forget. We sign it over. We get lazy. It feels overwhelming. It’s people like Dr. Chutkan that are here to help us and go, “This is what I’m seeing. I work with people every day, all day. This is my business. I’m going to give you some secrets.” Her book is called The Anti-Viral Gut. I hope you enjoy the show.

Dr. Chutkan, there’s so much I want to cover. When I was doing my research, I was like, “I want to give her a hug for this work.” It’s important for people to come with science. You have all this formal education, Yale, and all these things. I have an extra appreciation when people can say, “I’m going along on this path and I’m doing it in this way that’s traditionally done in a grown-up way. Also, I’m seeing some things and I’m willing to take a look at that.”

You’re on the staff of Georgetown University Hospital. In 2004, you started The Digestive Center for Wellness. For me, in 2004, for you to say, “I’m going to open up The Digestive Center for Wellness,” how did you get to the place where you were doing it, I would imagine pretty traditionally, and you go, wait, “There’s more here.”

It’s intuitive that you honed in on that year. 2004 was a significant year because I was pregnant with my first and only child, my beloved Sydney. My husband and I were gutting a house down to the studs. I can’t even see the foundation. We had to pour a new slab. We were gutting a house and I was like, “By the way, I’m leaving Georgetown and starting a practice.” There was so much going on.

I had been at Georgetown for, at that point, almost a decade. While Georgetown is a fantastic institution, I didn’t feel like I had room to take care of patients the way I wanted to take care of them. First of all, to spend the amount of time sitting and talking to somebody, rolling up our sleeves, and saying, “We’re going to figure this out.” Providing other services like a nutritionist and biofeedback practitioner focusing on diet and lifestyle.

While I enjoyed doing colonoscopy as much as anyone else, having done 16,000 or whatever it was at that point, I was like, “I know how to do this and this serves an important purpose but there’s all this other stuff beyond the scope that is important.” I didn’t have room within the confines of academic practice with a lot of endoscopies and colonoscopies and short office visits. Sometimes I look back and I’m like, “What was I thinking? We’re pregnant and gutting a house. I’m starting this fancy practice on my own.”

I remember the first day being there with my wonderful assistant, Betty Greenhouse, who had come with me from Georgetown. We’re hooking up the fax machine. I’m quite big pregnant at this point. She’s like, “Don’t worry. It’s going to be fine. You have a tax ID number. That’s all you need. You’ll be fine.” I remember the first patient who came was a nun and she had been my patient at Georgetown. I was excited she came. I wanted to not charge her and Betty was like, “We’re charging. You have to make a living. You don’t have a salary anymore.”

[bctt tweet=”We have a medical culture that prioritizes pills over diet and lifestyle.”]

It was this adventure of being able to create the practice and take care of people the way I wanted to take care of them. If you are a patient having a digestive health problem and I don’t have the space to talk to you about what you eat and the stress in your life and how you live, how am I going to solve your problem? I can’t solve your problem with my colonoscope and a prescription pad. That is not enough. You’re right, that was the beginning of the journey.

The opportunity to write the first book, Gutbliss, and to put my nickel down and say, “This is what I think. This is my belief system. This is what I see that’s going on.” For all the people out there, especially the women who are struggling with this and being gaslighted in some way, let me give you some information and a roadmap so you can start to try and figure this out. That was an incredible opportunity.

Whether it’s working with patients and helping them improve through their lifestyle and maybe healing their gut and doing some other things, what were the patterns that you were seeing that you thought, “I’m going to address this and then condense everything and communicate that in Gutbliss.”

There are two main themes, one is the mechanical aspect of what was going on in people’s guts that I think they weren’t fully appreciating and the other is something happening physiologically but at a microscopic level and that’s a microbiome. From a mechanical point of view, it’s this 30-foot digestive superhighway that goes from the mouth to the anus and all the traffic jams along the way. For people to understand, for example, the stomach has a bedtime. The gastric contractility slows down to a standstill once the sun sets.

If you’re eating the majority of your calories, if you’re sitting down for your big meal three hours after the sun has set, it is not going to be digested in a timely fashion. You are going to have heartburn, reflux, feel bloated, etc. Once you explain that to people, you can eat the same amount of food but you have to split it up differently. You have to figure out a way to eat more early and eat less later. If you do that, in a significant percentage of people having reflux symptoms, the reflux symptoms will go away.

I was seeing all these people being slapped on a proton pump inhibitor, which this class of drugs works amazingly well. They’re good at what they do, which is to completely shut down the acid pump in your stomach but it comes at a cost because now you’ve interfered with digestion. You don’t have stomach acid. The digestive enzymes aren’t going to work optimally. It’s going to interfere with the absorption and assimilation of nutrients. It’s going to mess up your microbiome.

We can solve all of that by explaining to people that they have to not overfill their stomachs late at night. Explaining that the caffeine that they’re having or the four cups of espresso are opening up that valve and they need to have less. Maybe not none but less. Explaining diverticulosis, how that works, and the stool is getting caught in these potholes. If you sweep the potholes through with some psyllium husk or increase fiber, you’re not going to have symptoms.

On the microbiome side, I don’t think the microbiome causes everything that’s wrong with us but it is at the root of many of the diseases we see. Particularly, my area of expertise if you will is autoimmune diseases, Crohn’s, and ulcerative colitis. We were seeing many scientific articles and many clinical articles about the disruption of the microbiome as being one of those important triggering factors that could lead to inflammatory bowel disease, especially in people who are already genetically susceptible.

It wasn’t something that was being addressed on the more conventional side. It was like, “You have ulcerative colitis. Sorry to hear. Here’s a steroid. Here’s a biologic. See you.” While those drugs play an important role in people with refractory disease, they shouldn’t be the first line of therapy. I wanted a practice where I had the room to sit down with people and do the forensics and get in there and then offer them some solutions that were less fraught with side effects than what we traditionally have.

I always love it when everybody keeps repeating the same things and they’re in different fields. I was talking to somebody who is a Harvard psychotherapist and his thing about caring for your mental health through managing your gut health, your insulin, your weight, and some other things. You have a different level of confidence because you’re in the science, you’re seeing the studies, and you’re also dealing with the patients. When you’re starting, how do you even create a strategy to say, “I want you to try this.” How did you know? I feel like you had to start putting it all together and creating the prescription for it versus what they taught you at school.

You’re right. I feel like I had a world-class education, particularly at Columbia for medical school residency. I was a chief resident there. I was at Columbia from ‘87 to ’95. It’s a long time, eight years. Also, two years on my GI fellowship. I got incredible training. This whole question of, why do you have ulcerative colitis? Why do you have gallstones? That didn’t figure in prominently.

It was almost a coincidence, Gabby. When I came to Georgetown to join the faculty in ‘97, shockingly, in 1997, I was the first woman they had in the GI faculty. I had great male colleagues. GI is this odd field where still the statistic is about 70% of the patients are female. When I was doing my training, 7% of the docs were female. Now, we’re into the double digits. We’re not quite at 20% but we’re getting there.

At the same time, we were seeing this other phenomenon where there was a great desire for gender-concordant physicians. Women wanted female OBGYNs and they wanted female gastroenterologists. Men often want male urologists. I get that too. At the end of the day, the best doctor for you is the one who’s going to listen to you and you’re going to have a dialogue with them, etc.

When I got to Georgetown in 1997, there was a big demand for people to see a woman. I had this readymade practice. This is a generalization. I know as many men who are interested in root causes. At the time with what I was seeing in the clinic at Georgetown, the women wanted to know why. Why is this happening? What can I do? They were coming to me and telling me, “I’m doing this. This is what’s going on.”

One of my first experiences with this was, in my inflammatory bowel disease clinic, a woman was about my age at the time. We were maybe 30 or 31, and she had severe Crohn’s. She worked at the hospital. She’d been on steroids and an early form of biologics when it came out. She left Georgetown and went to New Jersey for a different job.

She came back a couple of years later and came back to see me. I was happy to see her. She seemed she was doing great. I remember sitting there saying, “What are you on?” I’m ready to take my notes and she was like, “I’m not on anything.” I gasped, I was like, “What? You’re not on anything.” I was worried for her. She told me what she was doing.

This was a couple of decades ago. It seemed like this wacky diet. She’d cut out all processed foods, white foods, sugar, and dairy. I was like, “You’re feeling well but let’s see what your colon looks like.” I had done her previous three colonoscopies so I knew her colon inside out. Her colon looked completely different. All those narrowed areas were healed. All the deep ulcers she’d had were healed.

Gabby, I was shocked. I was shocked by the idea that diet could heal, not just make you feel better in terms of the number of bowel movements or how you felt but the gold standard, which is what we call mucosal healing. Her colon could go from severe Crohn’s to normal with diet. It was magic to me and I was like, “I have to learn more about what she’s doing. This is crazy.”

It’s this peculiar thing in medicine. A lot of patients who don’t ask and don’t tell have been, over the years, if not ridiculed dismissed by medical professionals when they say, “I’m doing X, Y, or Z.” It’s changing now. If we think back to years ago, it was a different time. There was this meeting in Capri, Italy that I wanted to go to. It was a young investigator’s meeting. I was squeaking in under the wire age-wise. I said, “I’ve got to present something that’s going to be completely different so I’m going to get selected to go to this all-expense-paid meeting because I am going to cooperate.”

I did this quick survey in my clinic asking about the use of complementary and alternative medicine techniques like diet, meditation, acupuncture, herbal therapy, or whatever. I found out that 70% of the patients were doing some complementary or alternative medical technique in conjunction with whatever I was prescribing. Most of them, I had no idea. It was kind of don’t ask and don’t tell. If you want to know, I’ll tell you but I’m not going to volunteer it.

Dr. Robynne Chutkan caption 1

Dr. Robynne Chutkan – The children who are the sickest are the ones who have been on antibiotics preceding the diagnosis.

I did go to Capri. I presented my findings. It was fantastic. It lit a spark, like, “All these patients are doing this and they’re paying out of pocket for it. These are not services that are covered. It must be helping.” I started to experiment and to try a lot of these diets myself and to also ask patients, “Are you doing this specific carbohydrate diet? What’s going on with that?” In 2014, I did a study in my practice, a retrospective study, looking at the results of a specific carbohydrate diet. Are you familiar with that diet, SCD?

Yes. Will you share it so people get a real sense of it?

It’s the first cousin of a paleo diet. It is what’s considered a low-carbohydrate diet. We found something very interesting in that study. We looked at a couple of dozen patients with Crohn’s and ulcerative colitis and we found that more than half of them were able to either stop medication or reduce the dose of medication. There was significant mucosal healing when we sculpt them. It wasn’t just symptomatically. The overwhelming majority of the patients reported they were doing better symptomatically.

When we look at those important tangibles, like, “You’re feeling better but can you stop the medication or reduce the dose? What does your colonoscopy look like?” Those numbers were dramatic. Here’s the thing that was interesting about that study. Everybody in the specific carbohydrate diet is eliminating certain things, processed gluten, refined sugar, and lactose-containing dairy.

The people who were interpreting it as breaking eggs for breakfast, chicken for lunch, and steak for dinner with two broccoli florets, weren’t seeing the same improvement. There was a correlation with the amount of fiber intake. People who are ramping up the dietary fiber or plant fiber we’re doing much better.

That’s a tricky thing in this population because when there’s active inflammation in the gut, sometimes those high-fiber foods aren’t well tolerated. That’s when I came up with all these different ways of blending with green smoothies, soups, and so on. What I realized is that what was going on was it was changing the composition of their microbiome, eating all those high-fiber plant foods.

Yes, the absence of processed refined carbohydrates is helpful but the presence of dietary fiber in terms of modulating the microbiome and changing the composition of the gut bacteria and, in that way, healing the inflammation was what was moving the needle. After that study, that was when I was like, “We can make a difference here.”

The thing I love about my practice is it’s non-denominational. If you come to me, as a lot of people do, and say, “I am on this biologic or steroid and I want to get off it,” I’m your gal. Let’s work hard and do it. We have about a 70% to 80% success rate. Unlike biologics, which put people into remission only about 30% to 40% of the time, this approach doesn’t have a side effect of cancer or infection. It’s a health-improving effect.

On the other hand, if you’re doing fine on those drugs, I’m not going to take you off them if you’re doing fine and you don’t want to get off them. If you want to get off them and we’re not successful, I will be the first one to say, “You need to be on this medication. Your disease is now at a point where diet and lifestyle are going to reverse it.” It is using whatever tool in the toolbox we have to get the patient to the destination. It’s great when we can get people off these drugs but sometimes we can’t and that’s fine too. I love not whipping out my prescription pad but it is there at the ready when needed.

I have a few questions about that. Your business is hard. It’s a hard business to be a doctor. It’s with insurance and time. Are you encouraged because the model is set up pretty much to have your pad out and in and out? Are you finding a way to do this and live in both worlds?

The one thing that I would like to figure out more successfully is when I left Georgetown, I started a practice where we didn’t take insurance. The simple reason for that is I went from a model where I was doing a lot of colonoscopies for which we and the hospital are well reimbursed for doing procedures. A procedure takes twenty minutes to do, the hospital makes a lot of money, we make a lot of money, and everybody’s happy except the patient. Yes, it’s great if you’re screening colon cancer but if you come in with bloating and I’ve scoped you when it’s normal and you’re still bloated, I haven’t done very much for you.

Gastroenterologists, over the years, have become incentivized to create practices that are high-volume procedures. The minute we sit down to talk to a patient and the clock starts ticking, we’re losing money because the reimbursement for the office visit is low. The insurance companies know, “These doctors are scoping people all day long. They’re making tons of money.” Often, what’s happening in a gastroenterology practice is the gastroenterologist herself or himself isn’t even seeing the patient. That’s a physician’s assistant, a nurse practitioner, or somebody who may be well-trained but doesn’t have the same experience. It’s not cost-effective for the gastroenterologist to see the patient.

When I changed my practice, I was now in a practice where the consultative piece was key. The procedure also played a role but it was that interaction and that excavation if you will that was the important piece. I was like, “If I spend more than ten minutes doing this, I’m now losing money.” I wasn’t taking insurance. Sometimes my visits are an hour and a half. On the flip side, it also meant that only people from a certain demographic who could afford to pay were seeing me and that bothered me a lot. If you have something that you think is valuable and that you’ve shown has value, how can you scale it?

The pandemic pushed us and I created a course called Drug-Free IBD Remission Without Immunosuppression. It’s not drug-free because there are many drugs we use for inflammatory bowel disease that I consider below the line in the sense that the toxicity is low and the efficacy is still good. By drug-free, we mean trying to avoid immunosuppressive drugs like steroids and biologics, and so on, the ones that are more fraught with side effects.

We beta-tested that course with about 25 people. It was a four-week course. I put a lot of work into it. We have these workbooks and then there’s an audio lesson and then there’s a live Zoom with me. I loved it and they loved it. I thought, “If we can create something low-cost, what do my first ten visits look like with a new IBD patient?”

If I can condense that into a four-week course and I can give them all the foundations about how and why we get IBD, the risks and benefits of conventional and alternative therapy, and then get into the food and the lifestyle and with all the scientific references there and everything and I can give that to somebody at a fraction of what it would cost for them to travel and come and see me, wouldn’t that be great?

We beta-tested it. We’re getting ready to launch it again in 2023. We made a few little tweaks based on that beta testing group. I realized that I love direct patient care but I also love patient education. I love being able to give people information without a commercial piece. I’m not here to sell you any supplement. I want to give you good advice. I want to teach you how to be a better advocate with your doctor. Let me give you a little script almost.

Don’t go in there saying, “I don’t want to be on any drugs.” Go in there saying, “I appreciate this well-thought-out plan you have for me. However, I want to try a dietary approach. I want you to be my partner and I want you to be with me through this. If it doesn’t work, I’m going to circle back and we’ll figure out what we need to do from a pharmaceutical point of view.” I’m a big believer that you got to be transparent with your doc. Don’t fire them unless they’re an asshole, in which case fire them and find somebody new.

[bctt tweet=”How do you keep your gut lining healthy? I will say, first of all, do not do it primarily by taking a supplement.”]

How do you bring them along because I was brought along? Before my eyes were opened to what this stuff could do, I thought, “This is hocus pocus. What are all this diet and lifestyle stuff?” My patients educated me and I want them to educate their doctors so that we can change the profession from within so that conventionally trained doctors can have a better understanding and can see with their own eyes as I did with my patients what’s possible and can have an approach that’s more both, hand and with these different modalities.

I’ve seen that you are encouraging people to be their own best advocates. What I also like about that is it’s giving them the power but it’s also making them accountable. That’s the thing. I can’t come and see you and you say, “Gabby, this is what I’m seeing,” and I don’t change one thing and expect you to make me feel better.

It’s just how the world is, which is we need to be accountable but we also need to be able to stick up for ourselves. I appreciate that. Maybe we can drill it down. You talked about how you can go to third-world countries and they have a little autoimmune disease compared to countries like us, Europe, Canada, and things like that. It’s probably because of the volume of processed food and medication.

The medication is huge.

Medication kicks your guts ass. I don’t know who I was talking to and they were saying, “Anti-inflammatories will put holes in your microbiome.” You’re like, “What do you mean?” People take that like candy, “This hurts and that hurts.” We’ve talked about food and some of that. Can we talk about some of the other things that we have that are commonplace that are tough on our microbiome? Also, more and more everyone talks about the microbiome. We know what it is, viruses, bacteria, and fungi. There’s a lot of it. It’s on us. It’s in us. Sometimes we don’t understand how important it influences everything.

I love to talk about these trio of things in the gut. Once you understand how these three things work, you understand a lot about gut health, stomach acid, gut lining, and the microbiome. Let’s start with the microbiome because you summarized it beautifully. It’s these trillions of organisms that live in and on our bodies, mostly in our gut, and they’re the ones doing most of the work. You think about, who’s digesting the food? How is it getting broken down into these constituent pieces? Who is synthesizing the vitamins? Who is growing new blood vessels? Who is training the immune system? Who is turning genes on and off? All of these things.

If we think about the gut-immune connection, for example, we have gut bacteria like Bacteroides fragilis that we call B-frag, one of the common intestinal microbes. B-frag hangs out in the gut lining. When they see a potent virus come along, they kick the gut lining to trigger the release of something called interferons, so-called because they interfere with viruses. Whoever named interferons, I love that. The interferons release this whole immune cascade to fight the virus. It’s the Bacteroides fragilis that trigger this in the gut lining, this release.

You start to say, “If your population of B-frag is not up to snuff, maybe you’re not going to get that sufficient interferon release. Maybe you’re not going to be able to clear this virus.” They are actively involved in all of these things, in the immune surveillance, activating genes, and all of these different things. That’s the gut bacteria, the microbiome. Over the last decade, we missed the boat. We were busy super sanitizing ourselves when we probably should have been getting a little bit dirtier. To your point about the less developed world versus the more developed, another thing is the exposure to nature, to soil microbes.

What did you call it?

The Hygiene Hypothesis.

We’ve become unwild as you say. Everywhere we go now, it’s always with sanitizer. I joke and it is and it isn’t funny. I always say that, during COVID, especially when everyone was cleaning and wiping down everything, that’s the stuff that keeps us strong, all the stuff around. I’m sensitive if somebody feels vulnerable. That’s not what I’m talking about. We used to say, “Maybe we should all go and lick railings because, at this point, we’re all getting so clean that we’re making ourselves more vulnerable.”

We are. That has been proven. It’s tricky during a pandemic because you want to limit exposure, particularly in vulnerable populations. It’s recognizing that super sanitization from the highly plasticized food chain to the use of these chemicals and personal care products to the food we’re eating, which is also full of antibiotics, depending on what we’re eating, that we are super clean. We have about two-thirds of the variety, the diversity of gut bacteria, when we look at people in more indigenous situations like the Hadza tribe in Tanzania or people in the Amazon, who are also being threatened now with industrialization, etc., their lifestyle.

It’s fascinating. Gabby, when you think about it, when you look at what’s happening externally in the world with overfishing, deforestation, etc., urban sprawl, and how the natural world is disappearing, the same thing is happening in our gut. It’s happening at a vastly accelerated process. We’re in the largest species die-off since the dinosaurs. We’re losing species thousands of times faster than we should be in the natural world. The same thing is happening in our gut for the same reason, the same urbanization.

I’m happy that we have chlorine in the water. I don’t have to worry about getting cholera when I drink some water from the tap. At the same time, urbanization and widespread sanitation are important. I’m glad that I have indoor plumbing. This is all good but it does come at a price when we add to that the fact that the food is also highly pesticides and we are overmedicated.

The trick is, how do we rewild ourselves while living in the real world? Do we have to go all the way back to our Neolithic ancestors? We don’t. We do need to pay attention to where our food is coming from and what we’re eating. We do need to get exposed to more soil microbes. We need to get outside in nature. We do need to get a little dirty. We need to let our kids get a little bit dirty. We need to use medications more judiciously. These are the big categories of things.

I said anti-inflammatories but antibiotics and a lot of things can be damaging to your gut. Let’s say you have somebody, and they’re having a lot of gut issues. Intuitively, they feel like, “Things aren’t right.” What is the starting point? Maybe we could make it simple and stupid and have a few scenarios to give people an exit sign at least to go towards.

Let me circle back and say the other two things. We talked about the microbiome. The gut lining, it’s the only thing protecting you from the environment in your gut. In terms of non-steroidal anti-inflammatory drugs, that’s what it’s poking holes in the gut lining. You need an intact gut lining to protect you from all the stuff you swallow including viruses to protect them from being able to penetrate through.

Also, stomach acid. The role of stomach acid is to provide this ideal pH for digestion to happen and also to denature viral protein and kill pathogens that get in through our mouth. We have more ACE2 receptors for SARS-CoV-2 in our gut than we have in our lungs. That’s why people have so many GI symptoms with this virus.

Dr. Robynne Chutkan caption 2

Dr. Robynne Chutkan – You can eat the same amount of food but you have to split it up differently. You have to figure out a way to eat more early and eat less later.

Now you go and block stomach acid, you’ve removed one of the major defenses your body has to keep you safe from viruses. Now with that virus, the protein is not going to get unraveled because you have no stomach acid. It’s going to infect the intestinal cell and get into your body. This triumvirate of stomach acid, intact gut lining, and a healthy complement of gut bacteria, there’s a lot more but that’s the foundation I like to remind people of.

Is one more vulnerable? Is one easier to heal and one is more complex than those three?

Of the three, stomach acid is the easiest. If you are on a proton pump inhibitor like millions of millions of people are, you want to be sure you need it. If you are taking this just for heartburn and you have not explored eating earlier, dinner, elevating the head of your bed, cutting down on caffeine and alcohol, and eating a less fatty diet, which will improve the gastric emptying, all these diets, and lifestyle things and you’ve been slapped with this PPI without any discussion of that stuff, you need to rewind and see.

For the vast majority of people with Reflex symptoms, when they make those changes, it doesn’t mean no caffeine or no alcohol, it means less of this stuff. Smaller dinner and bigger lunch and breakfast. When you do that, the vast majority of people are able to come off those drugs or take something for reflux more episodically instead of every day. The stomach acid thing is easy because in the absence of those drugs, your stomach acid is there and it’s there to protect you. In that one, it’s a matter of, let’s not sabotage this thing that is there to protect us.

Do you poo-poo apple cider vinegar? I had a friend and for a period of time, I don’t know if it was stress or something was going on, would do a shot of apple cider vinegar. They got some relief from it.

We don’t have a lot of clinical trials showing that this does a lot but it’s a pretty benign thing. Especially if you’re doing it, you should be doing it fairly diluted so it’s not too acidic. If you’re doing that and it’s helping you, it’s fine. For people who have been on acid-blocking drugs for a while where sometimes their stomach acid levels haven’t come back up, it can be more helpful. An average healthy person who has stomach acid probably doesn’t need it. If you’re taking a couple of diluted shots of it, it’s fine.

The stomach acid one, that’s a pretty easy one. The gut microbiome, we also have great evidence to suggest that food can play a big role. The idea that you can go take a probiotic pill or powder and your microbiome is fine, not so much. Fermented foods, we know that a tablespoon of sauerkraut, which is about ten grams, can contain two dozen different strains of bacteria as well as all the metabolites those bacteria are making that are also helping. It’s like live medicinal food in a different way from taking the bacteria.

When you’re having something like fermented food, if you’re having sauerkraut or kimchi, you’re getting the fiber from you from the cabbage. That’s the prebiotic, the food for the bacteria. You’re getting the probiotic, the live bacteria itself. You’re getting the post-biotic, the metabolites they’re making all in this tablespoon of sauerkraut, a living medicinal food. Things like that can be inordinately helpful.

Increasing the amount of dietary fiber can change your microbiome. Going and getting a probiotic off the shelf is minimally helpful. It’s like taking a vitamin versus changing your diet. Are there situations? Sure If your vitamin D is low or if your B12 is low. For the average person, taking a multivitamin versus making a dietary change doesn’t compare.

When we talk about eating fermented foods, is there a better time? Is it by itself prior to eating? Is it on top before the meal starts? Does it not matter?

It doesn’t make a big difference. For the average person who maybe doesn’t love fermented foods, I don’t mind some sauerkraut, especially if it’s something with an apple and kraut or something like that. With the green apple, that’s good. I don’t love kimchi even though I like spicy food in general. You don’t have to eat a ton of it. It could be a tablespoon every couple of days.

The other thing that makes a huge difference, Gabby, is what we call MACs, Microbiota Accessible Carbohydrates. These are things like lagoons, whole grains, oats, and also foods that are high in a type of fiber called inulin, garlic, leeks, and onion. This stuff is all good. Every single dish I make has leeks, onion, and garlic in it.

Whether it’s a stew or a soup, whatever it is, it always has that base of leeks, onion, and garlic. Even if you’re not the kind of person who wants to sit down and eat a big leafy green salad, of course, you need those too. Let’s say that’s not your thing. Adding in more leeks, onion, and garlic makes a huge difference. The food counts.

There was a study that was done several years ago, a study out of Harvard, published in the journal Nature where they took nine volunteers and they put them on a high fat, high animal protein, Atkins-type diet. It was pork rinds and prosciutto. They rested those same nine volunteers for about five days and then they put them on a more plant-centric diet, jasmine rice, lentils, and fruit instead of pork rinds for snacks. They found that not only did the microbiome change dramatically within about 30 hours but they saw different genes that were switched on and off changing too.

What I like to remind people of is the best study we have about creating a healthy microbiome, which is the American gut project study from 2018. That study found that it’s the diversity of plants that you eat that makes a difference. It doesn’t matter whether you call yourself a vegan, a flexitarian, a pescatarian, or a lacto-ovo vegetarian. The label was not important. It was a simple matter of how many different plants. The magic number was 30 different plant foods. That includes fruits, vegetables, nuts, seeds, grains, spices, and herbs.

If I have oatmeal in the morning, I make it with almond milk, oats, pumpkin seeds, walnuts, blueberries, a little shaved coconut, and a little maple syrup. That’s seven plant foods from a bowl of oatmeal. I can make a salad and put thirteen plants in it, especially if I add a little basil, a little cilantro, and add some of those herbs and spices. It is the sum total. The other stuff you eat, it’s great to cut down on the refined sugar, cut down on the meat, and all of that. At the end of the day, are you eating enough plants?

I have a lot of friends who are devoted vegans and for lots of different reasons with animal rights, which is important for the planet. There are many incredible reasons to adopt a fully plant-based diet. I like to take a more inclusive approach. What I found with my patients is getting them to eat more plants. In that study I referred to, with the patients on SCD, the Specific Carbohydrate Diet, the ones who were eating more plants did a lot better even if they were still eating some animal protein.

When you think of it from a health point of view and when you take out the ethical piece and the planet piece and if you want to look at it through a more narrow lens from health, you can dramatically improve your health simply by upping the amount of plant fiber that you’re eating and the diversity of plants.

Dr. Chutkan, as a culture, we know this. I wonder because you meet with patients. Why is it hard for people? Is it because it takes a little effort, especially if you make it at home? Is it easier to take the pill and I don’t have to think about it? They don’t understand the full ramifications of that approach. What do you think the barriers are? I’m always fascinated that it’s hard for people to change their behavior.

[bctt tweet=”The answer here is less about taking a pill to fix it and more about stopping what you’re doing that’s hurting it.”]

It’s a great question and it’s one that I think about a lot for my patients and sometimes in my own life. It’s a couple of things. One is the culture, the family culture. What is your family culture dynamic? Do you sit down together? Your kids are still pretty young.

No. They’re big. We break bread as a family, even if it’s a dogfight. With one kid, I’m like, “We are a family and we are having dinner.” You can be mad and sit there.

They get bigger, homework, and different things. The culture of sitting down together is one thing. What’s your family culture? The time? It does take time to shop. I’d like to get to the farmer’s market out of the supermarket if I can to shop and prepare it. No question, it tastes better when you’re doing that food. Also, convenience. We start valuing other things more than we value this. The biggest thing is we have a medical culture that does not put an emphasis on it. We have a medical culture that prioritizes pills over diet and lifestyle.

You have somebody with adult-onset diabetes or hypertension and their doctor is like, “Take this.” Maybe their doctor has not even had a conversation with them about what to do. They’re not going home and valuing like, “I need to start cooking with less salt and eating less processed food. I need to up my plan.” It’s not just that it hasn’t been emphasized, it hasn’t even been mentioned by the person and the institution that’s supposed to be in charge of this. Many people see this as fringe because their doctors aren’t talking about it.

I’ll read you an email that I got. This email brought such a smile to my face. My husband and I were having dinner and we were sitting outside by the water. We ran into some friends and they had a friend visiting with them from Florida and their friend who was visiting is a physician. He is a well-regarded ophthalmologist from out of town. We started chatting and they told him I was a gastroenterologist and he mentioned that he was having some trouble with diverticulitis.

He said, “Gastroenterologist keeps putting me on antibiotics.” I was like, “That’s a terrible idea. It’s going to make you more susceptible. I’m going to send you three things. I’m going to send you my one-pager on diverticulosis and diverticulitis to look at. I’m going to send you a link to the free office hours I do every Tuesday. One I did a couple of months ago on diverticulitis. I’m going to send you my nutrition guide.”

I sent that to him on the weekend and he sent me back this email, which brought such a smile to my face. He said, “Hi, Robynne. Thank you so much for the info. I finished watching your office hours presentation as well. I find it amazing that NONE of my doctors have ever explained this to me. Your patients have been most fortunate to have you as their doctor. I will be making some immediate lifestyle changes to alter my disease course. It was great meeting you. Thanks again for taking the time to share this information.”

This doctor is at the top of his game. He’s one of the most well-regarded doctors for what he does. He’s a retina specialist. He didn’t know and none of his doctors have ever explained this basic connection. I find that shocking. If you have highly trained medical professionals who don’t know and they’re seeing other highly trained medical professionals and nobody is talking about this, you start to see why we are not valuing this as a society. We have to shoulder a lot of the blame as physicians. It’s not part of our medical education so we need to bring those things closer together.

I always say we’ve gotten so advanced and civilized that we are going back to the basics now. When we started talking about bone broth years ago, I thought, “For your grandmother and my grandmother, this was part of the way you lived.” It makes sense. I appreciate the way you frame that and understand that if the doctor or the institution isn’t saying, “This is how it’s important.”

How would a busy and stressed-out person who’s trying to get through their day be able to make that space? Unless they have the environment around them to go, “I need to value this as well.” Certainly, it’s easy. Sometimes it’s even less expensive. It’s all these things. I have sensitivity to it. I feel that the information is there.

It’s almost like people accept, “This is how it is now.” Especially as they get older, they go, “It’s part of aging.” I always want to encourage people that they don’t want to fight to get older but they certainly can stay healthy. I don’t want to keep you for too much longer. Maybe we can finish though with the third. We did the stomach acid and we did the microbiome and then the lining. Is this the most complicated part of the formula?

It’s not complicated. The answer here is less about taking a pill to fix it and more about stopping what you’re doing that’s hurting it. One concept that I find amazing as a gastroenterologist is the idea that when food is in your gut, it’s not inside your body. It’s in this hollow tube that runs through your body. It’s in the environment.

For it to get inside your body, it’s got to pass through this highly permeable net that is our gut lining. That net is only one cell thick. This is not a thick barrier. It’s a thin barrier. It is selective in the sense that the little pores in the net are small. Anything that opens up those pores, increases the permeability. It allows things to get through that wouldn’t normally be able to get through like viruses, pathogenic bacteria, and undigested food particles that can then trigger a food allergy, toxins, etc.

How do you keep your gut lining healthy? First of all, you do not do that primarily by taking a supplement. You keep your gut lining healthy by avoiding the things that are harmful to it. Nonsteroidal anti-inflammatory drugs are at the top of the list. Antibiotics don’t just kill off gut bacteria but they also have a secondary effect on the gut lining. Those gut bacteria are involved in helping to maintain the integrity of the lining.

The food that the cells that line that epithelial barrier eat are something called short-chain fatty acids that are produced by eating a high-fiber diet. If you’re eating a low-fiber diet, you’re not producing enough short-chain fatty acids, the colonic sites are not getting their food, and the lining breaks down. We have some great mice studies that show that when you feed the mouse the high chow diet, the lining is intact and the mucous layer is intact. When they start to eat a low-fiber diet, the mucous layer disappears and that affects the gut lining. A high-fiber diet, avoiding NSAIDs and avoiding antibiotics. Don’t let the stomach acid unless you have

Gabby, this is another thing that I ponder. We want to do something, to take something. In my medical practice, I spend most of my time in my GI practice getting people to stop doing things. I’m like, “Bring all your medicines and all your supplements, everything.” I start tossing them in the rubbish bin one by one. It’s like, “This thing, not helping. This thing, hurting. This thing is interacting with these two other things causing a problem for your liver. This thing, talk to the doctor who prescribed this. Find out if you need to be on it. Can you be on a lower dose?”

In the book, in the plan, which I’m proud of, half of the book, in the section on medications and supplements, I don’t just give a list, like, “Don’t take these things.” For each one, I go through. Let me read you a little because this is a part I’m proud of. For example, steroids. I talk about questions to ask. The key point with steroids is that the risk is dose-dependent and cumulative. The higher the dose and the longer you take it, the greater the risk.

The other thing to know about steroids is that you can’t just stop them suddenly, they need to be tapered over a period of time. The main question to ask, number one, “Is there a lower dose I could take?” Your goal should be less than ten milligrams per day of prednisone. Number two, “What about taking the steroid every other day instead of daily?” Number three, “Could I try tapering the steroid and then plan to restart if my symptoms come back?” Number four, “Can you provide me the tapering schedule?”

Dr. Robynne Chutkan caption 3

Dr. Robynne Chutkan – We do need to get exposure to more soil microbes. We need to get outside in nature. We need to let our kids get a little bit dirty and we need to use medications more judiciously.

I go through possible alternatives, “Consider other non-immunosuppressive anti-inflammatories less well-absorbed formulations and synthetic forms of steroids that have fewer systemic effects. Here are some options to ask about.” I list all of them. I do that for every single class of drugs. Since I can’t be there with everybody, I want it to be like, “I am right on your shoulder hair. I am walking into the doctor’s office with you. I’m giving you a little script to ask.”

I have to thank my team at Avery and Penguin Random House because with each book, they have pushed more, “We want the prescriptive piece. We want people to know what to do. We want actionable steps.” It went from Gutbliss. It was the little plan, the sad gas, sugar, alcohol, dairy, gluten, artificial sweeteners, and soy. With The Microbiome Solution, it was a little bit bigger. With this book, it’s half the book.

It’s not enough to just tell people, “These things are problematic.” What are they supposed to do if they’re on it? You need to arm them with actionable information to talk to their doctor to think about this differently. In the sleep section, I have 28 different steps divided by category, mind, body environment, etc. to help people sleep. If you’re not sleeping, it’s going to affect your gut and your immune system. It’s going to make you more susceptible, we know that. It’s even going to make a vaccine less efficacious. It’s not enough to just go and say, “You need to get eight hours of sleep.” How do you do that? That’s the cool part about this one.

Dr. Chutkan, you have Gutbliss and The Microbiome Solution. Tell me exactly the title of this latest one.

This book is The Anti-Viral Gut: Tackling Pathogens from the Inside Out. It’s out on November 1st, 2022. It was a beast to write. It was harder than the first three combined but I’m so proud of it. From a public health point of view, this gives people information that could save lives. It’s not just to make your gut healthier but it can make people more resilient and that makes me happy.

I want to end on two things. One is there are huge markets for probiotics and such. We talked about fermented foods. Do you have the feeling, like, “That stuff isn’t maybe the best. It’s better to do it through the food and through scraping our lifestyle to these habits that support us.” Is there anything out there that you go, “I like that, it’s in the refrigerated section,” or how to use it?

There are things that can help. Even in my patients, the healthy ones, the one’s not feeling well, and the very sick ones, it’s always in conjunction with dietary change. I never hand somebody a prescription for something or a recommendation for something and say, “Take this, you’ll be fine.” There’s always another piece.

In my practice, the probiotic I use is called Visbiome. I use it at prescription strength for my patients with ulcerative colitis and Crohn’s. I don’t recommend that the average healthy person take that. We don’t have evidence that it’s going to do anything. I don’t take a probiotic myself. I try and eat a good high-fiber diet and occasionally fermented food when I can squeeze it in. When you think about this in a medical context, absolutely. I use this bio for patients with inflammatory bowel disease. I use it for some irritable bowel syndrome patients.

Does it work for everybody? Absolutely not. I have a good track record with it. Some people feel worse on it. It’s always with the dietary recommendations. Similarly, if somebody needs B12, it’s because their  B12 is low. It’s never, “You have a normal B12 level but take this extra B12.” It’s always looking at what is the individual clinical context. It makes it difficult to recommend something to everyone. The thing that I recommend to everyone is more vegetables, that can help everyone. In terms of what you need, it depends on what’s going on and what are you trying to fix.

Do you see people who come in and they have a pretty good lifestyle and they’re eating pretty well but they’re so stressed out and maybe they’re not recovering in their sleep that they can trash their gut that way?

Hugely. I see this clinically. We have incredible studies talking about the role of stress. If we think about college students at exam time, sleep deprived, stressed, and not eating well. What happens? They get mono, they get the flu, they get pneumonia, and they get sick. You have chronic stress and then you’ve acute stress on top of it.

While acute stress can confer a survival advantage, you’ve got the adrenaline and noradrenaline pumping so you can run away from the bear that’s about to attack you or whatever it is. The chronic stress that we live with erodes our immune system. It decreases the circulation of T cells in our immune system that can fight infection. It can increase pathogenic strains of bacteria up to 1,000 fold in an hour. It’s crazy.

We have a great study from the University of North Carolina Chapel Hill showing that for men with HIV, their progression to AIDS can be 2 to 4 times faster in the setting of chronic stress. Gabby, you think about the activation of latent viruses, who gets shingles? People who had varicella or chickenpox as kids and who are now stressed. Who gets a herpes outbreak? These are all things that come up in the setting of chronic stress. That is deleterious.

I have a patient’s story in the book that is a disguised real patient who was type A and obsessed about stuff and was getting sick all the time with stuff. I had to break it down to her, like, “You may not be able to do anything about the fact that you’re applying to medical school, you’re working, you’re doing research, and you’re doing all of these things. You can do something about your response and the stress response. What can you do to activate your parasympathetic system and calm yourself down and tamper down your sympathetic nervous system?” There are lots of actionable steps in there from simple exercises with the breath, forest bathing, Shinrin-yoku, and what you can do to bring stuff down in a non-pharmaceutical way.

I appreciate that. I always bring it up because people think, “I exercise and eat good.” I’m like, “But you’re Uber type A, stressed out, think it should be perfect, and that gets you in another way.”

You probably see that in the world of professional athletes, a lot of that. People are doing these things but there’s so much stress and pressure.

I experienced it myself. I will feel more inflamed, stiff, and achy and my tummy will get swollen. I can act all cool on the exterior but I know I’m trying to stress and lean into every single thing. I want to wrap this up not only by directing people to your book. Someone sees you and you’re dynamic. You have this all going for you. I want to say that my husband came with my oldest daughter, she was a baby, and I birth two more. I have three daughters, two biological.

I had to have two C-sections. One I was in labor for eighteen hours. My daughter is a beautiful girl. She has a large head and she would not come out. They took her out. Where I live in Hawaii, they don’t do VBAC so they were like, “We’re scheduling you.” If you don’t mind quickly share your story because it’s important that people understand that you had your own journeys with medicine or antibiotics. It’s not that you know everything and you’ve put it on all your patients but you’ve had your own path with this.

Dr. Robynne Chutkan book

The Anti-Viral Gut: Tackling Pathogens from the Inside Out

100%. I had to learn the hard way and it is what you described. Years ago, when I was pregnant, super healthy, and advanced maternal age because I was 39. I’m like, “I’m healthier than the 25-year-olds.” Long labor. I was right in about eighteen hours. They end up giving you labor-inducing drugs, which you don’t realize are going to increase your risk of a C-section when you get them. I ended up with a C-section. Because I had the flu and fever at the time, they ended up giving her prophylactic antibiotics in case putting her in the NICU.

She’s a C-section baby. She didn’t have the benefit of coming out vaginally where you swallow a mouthful of microbes and get colonized with your mother’s microbiome. C-section babies are colonized with hospital-acquired Staph aureus. That’s not what you want as your founding species. She got heavy-duty antibiotics at birth. My breast milk dried up after about six weeks because of all the antibiotics I’d been given. My kid was on antibiotics every single month. By the time she was two, she had been on 22 courses of antibiotics. The lovely well-meaning pediatrician wasn’t keeping track.

It wasn’t until she came back from the doctor with a nebulizer machine and four prescriptions, a new diagnosis of, “Now she has asthma. Here’s a steroid, antihistamines, a bronchodilator, and antibiotic.” I was like, “We’ve got to do this differently.” I’m always quick to say that I’m a physician and I was able to recognize some things. To veer off the path, I don’t recommend that people abandon their pediatrician by any stretch of the imagination.

I started to realize that all these frequent antibiotics were making her sicker. They were decimating her microbiome and increasing her susceptibility and decreasing her resilience. When I started to ask, I realized that a lot of my patients with autoimmune diseases had that same history and childhood, frequent antibiotics. I saw her dietary cravings change. She was a good eater. She ate everything. She had been hospitalized with a classic case of rotavirus, a diarrheal illness that kills about 500,000 children globally every year.

The children who are the sickest are the ones who have been on antibiotics preceding the diagnosis. That was her. She had been wrongly diagnosed with an air infection and put on antibiotics. When she got the rotavirus, she went into kidney failure and liver failure and was in the hospital. Of course, what did they treat her with? More antibiotics for a viral infection. She came out of that hospitalization like a sugar-craving monster almost overnight because of the changes in her microbiome.

Seeing that and realizing that there’s got to be another way. First of all, they’re treating viral infections with antibiotics that have no efficacy. She’s getting sicker and more susceptible. We had to make some changes to the diet and eventually overcame that. She’s two inches taller than me and healthy. She’s a kickass rower, super strong, still likes sugar a lot, and eats a lot of other healthy things.

For me, the most significant experience in my life was seeing my child so sick and realizing that these well-meaning doctors and their care were contributing. They weren’t recognizing the role of antibiotics in a baby who was a C-section baby, minimally nursed, etc. That set me on the path. As much as, every day, I’m like, “I wish I had to do over for that.” I’m also grateful because it opened my eyes and it allowed me to change my practice to help many patients who are struggling with that same foundation of disease.

Dr. Chutkan, first of all, every parent wants all kinds of a do-over, know that. It’s also that reminder. If someone’s reading and maybe they’re having a hard time medically, especially in this area, it’s that reminder that there are steps we can take towards that exit sign to heal ourselves most times. I appreciate the work that you’re doing and the courage that you have to say this because it’s not probably always the most popular message. As we go, would you remind all the places people can find you, the date, and the title that your book? Congratulations because that’s like a textbook that you’ve written there.

Thank you so much. I have admired you for so long. I was chatting with a friend earlier and I was like, “Got to go. Gabby Reece podcast.” She’s like, “Gabby Reece?” You are still very much a superstar, your athleticism, and your approach to life. You’ve been an inspiration for me and many other women. Thank you for that. It’s been a real honor to be on with you.

The book is called The Anti-Viral Gut: Tackling Pathogens from the Inside Out. It’s available online, on Amazon, Barnes & Noble, Books-A-Million, and wherever books are sold. You can find me on my website, RobynneChutkan.com or Gutbliss.com. We have some wonderful pre and post-order incentives even after the book is on sale on November 1st, 2022. I’ve put together an amazing Anti-Viral Gut Masterclass with ten other brilliant medical faculty. It’s a free masterclass. It’s going to be available in February 2023. You need to upload proof of purchase of the books. We’re thrilled to be able to do that.

Congratulations on that program. Dr. Chutkan, thank you for your time.

Thank you so much.

Thank you so much for reading this episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guests or even myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button and leave a rating and a comment, it not only helps me but it helps the show grow and reach new readers.

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About Dr. Kelly Starrett, Jill Miller & PJ Nestler

Dr. Chutkan Headshot

Robynne Chutkan, MD, FASGE, is a board-certified gastroenterologist and the author of the digestive health books Gutbliss, The Microbiome Solution, The Bloat Cure and The Anti-Viral Gut. Dr. Chutkan received her bachelor’s from Yale University and her medical degree from Columbia College of Physicians and Surgeons, where she also did her internship and residency and served as chief resident. She completed her fellowship in gastroenterology at Mount Sinai Hospital in New York. Dr. Chutkan has been on the faculty at Georgetown University Hospital since 1997. In 2004 she founded the Digestive Center for Wellness, an integrative gastroenterology practice dedicated to uncovering the root cause of GI disorders. Dr. Chutkan incorporates microbial optimization, nutritional therapy, mind-body techniques, and lifestyle changes into her therapeutic approach to digestive disorders.