Transcript
Dr. Ramnarine:
If we want to improve patients' long-term outcomes, the gut might be one of the most important places to start. But what does that look like in everyday practice?
This is NutritionEdge on ReachMD. I'm Dr. Shelina Ramnarine, and today I'm joined by Dr. Terri DeNeui to explore how the gut microbiome plays a central role in strengthening overall health. Dr. DeNeui is a board-certified nurse practitioner, as well as the Founder and Chief Science Officer of EVEXIAS Health Solutions.
Dr. DeNeui, welcome to the program.
Dr. DeNeui:
Thank you so much. I'm honored to be here.
Dr. Ramnarine:
So to start us off, Dr. DeNeui, how is our understanding of the gut microbiome evolving, and how might that reshape our approach to preventive care?
Dr. DeNeui:
In my practice, for the last sixteen years, I moved out of the space of hospitalist medicine and emergency medicine into private practice with a cornerstone on looking at preventive wellness strategies. But one of the things I noticed was probably about forty percent of my patients just really didn't feel their best no matter how much we tweaked, optimized hormones, and put them on certain supplements and nutraceuticals. And so there was something missing. This was probably about 12 years ago when I really started exploring this.
I don't believe in accidents, but I stumbled upon a really great lecture at a conference that was focused on the gut. And they weren't really at the time talking a lot about the gut microbiome as much as this concept of leaky gut. Leaky gut became the first trendy conversation around the gut. But the more I explored this idea that the gut plays a central role in our health outside of just digesting, processing food, and extracting nutrients, I really started exploring it at a deeper level. I began to look for ways to help my patients with their gut.
But over the last probably six years, there's really been a surge of interest, with studies being published and more and more people talking about the gut microbiome as not only its own ecosystem. It plays a role in every single body system. And I became really passionate about educating about it because even as gut specialists or GI doctors, we just are still narrowly focused that it's really just about digestion and elimination, and it's really so much more.
Dr. Ramnarine:
So in everyday clinical practice, where does gut health fit into a proactive, prevention-focused model of care?
Dr. DeNeui:
It really fits no matter what your specialty practice is, because again, it plays such an integral part in whole-body health. We've heard the gut be called the “second brain.” There's this gut-brain axis that is really important for people to understand. So patients who come in with your everyday complaints of anxiety, fatigue, and other really vague symptoms often have a root cause in what's called gut dysbiosis. We can talk about that a little bit more later. But primarily, what we're taught in school is to address those complaints with a prescription medication that just masks the symptoms, oftentimes not very well, rather than getting to the root cause. So this paradigm shift in medicine from the allopathic symptom-based model to a root cause model is really exciting.
From a clinical perspective, pretty much almost every complaint a patient walks in with—short of a cut on their finger or something that very obviously had another cause—when we're talking about everyday issues that people come in and complain about, it starts oftentimes in the gut. When we're looking at cardiovascular disease, there's these molecules that are released in the gut from an overgrowth of bad bacteria called lipopolysaccharides, and they're highly inflammatory; now we're seeing them as a root of cardiovascular disease. We see the same inflammation from the gut express itself in the brain in the area of mood disorders. Like I said, in depression, anxiety, and even adult or childhood ADD, we're seeing a lot of issues with gut dysbiosis and the gut microbiome being a root cause.
It’s the same thing especially with hormones. The gut is now being referred to in many clinical studies as a full-fledged endocrine organ. It plays such a vital role in hormone metabolism and excreting hormone metabolites that we don't want to keep in our body through the stool and bowels, and that's hormones that our body makes. That's hormones maybe that a woman or a man might be taking with hormone therapies. It doesn't really matter.
So really the list goes on and on. Assessing gut health as a baseline in all patients, no matter their age and no matter what they're coming in with a complaint of, unless, like I said, it's sinusitis or a sore throat or some of the typical complaints. When we're talking these vague complaints and chronic disease processes, like metabolic disease, insulin resistance, diabetes, PCOS, hormone imbalances in women, and endometriosis, these all have a root in the gut.
Dr. Ramnarine:
And how do you help clinicians and patients move beyond the idea that gut health is limited to just gastrointestinal symptoms?
Dr. DeNeui:
Educating physicians, other clinicians, and patients is key. That is really where it starts. So when we have patients come in our office, primarily we're an advanced endocrinology clinic, so we focus a lot on hormones, but we always have a conversation about the gut. Everyone gets a little questionnaire that asks them basic questions about the gut, like, "Do you have gas and bloating or abdominal distension after eating? Do you have abdominal pain that is unexplained? Do you have constipation or diarrhea? Are you having daily bowel movements?" And those are the obvious things. But when we're looking at other symptoms of anxiety and depression and ADD, or a patient comes in on multiple cardiac meds because they have a history of cardiovascular disease or hypertension, we talk about the gut.
There's some key basic labs that every doctor gets on every patient that can really clue you in that there's some gut inflammation going on. But there's some basic tools that clinicians, if they go deep and get educated on how to properly assess, can really implement some easy changes with their patients to put them in the right direction.
A lot of people make this conversation super complicated, and it can be. You can go down the whole road of very complex GI mapping, which I think is great. But you want to make it tangible for clinicians and patients, especially when people are learning. You don't want to make it so complex that it's overwhelming, and then they just say, "Ah, forget it. I'll just keep doing things the way I'm doing them."
Dr. Ramnarine:
Education is such an important tool.
For those just tuning in, you're listening to NutritionEdge on ReachMD. I'm Dr. Shelina Ramnarine, and today I'm speaking with Dr. Terri DeNeui about the foundational role of the gut microbiome.
So Dr. DeNeui, why is it so important to support the gut microbiome before dysfunction becomes visible?
Dr. DeNeui:
This actually starts in the womb. We're seeing a lot more gut issues in younger kids because, maybe with C-sections, they don't get exposure to good probiotics coming out of the vaginal canal. And so there's other, more integrated approaches to making sure those newborns get appropriate exposure.
So it starts there and then moves on through childhood. And one of the biggest ways to prevent gut dysbiosis is with diet. The standard American diet is very high in processed foods and other things that really cause a lot of gut dysfunction, so diet is a big part of the prevention conversation. And then, of course, stress is a really big one. There's a direct correlation between physical stress, emotional stress, and mental stress with the gut. Head injuries, kids playing football or contact sports, or just kids being kids and falling and hitting their head, or even adults—within 20 minutes of a head injury, and I'm talking a mild concussion, research shows that you have intestinal permeability.
Leaky gut is basically these tight junctions in your intestines that keep all the solid food particles out and basically transfer nutrients and proteins from food as it's digesting into the body. That becomes leaky, so the tight junctions have gaps in them from chemicals like zonulin. And those gaps cause larger proteins that haven't been fully broken down and that were never intended to be in the bloodstream to get into the system. And these things can cause an autoimmune response. The body recognizes it as foreign.
These things happen really young, so prevention is key with diet and mitigating stress. I've had conversations with integrative pediatricians who are really pro getting kids off of these screens and getting them outside and getting them playing. There's so many different ways, but it definitely starts with diet and monitoring stress. In teenagers especially, we're seeing so much depression and anxiety. so much of that has to do with their screen time, social media, and all the inputs that their brains just aren't mature enough to handle, and these things directly release chemicals that impact the intestinal permeability and lining.
And so you have two different things going on. You have leaky gut, but you also have gut dysbiosis, which is where bad bacteria overgrow in the gut. And that releases many chemicals that can disrupt the gut-brain axis and cause inflammation in the body. Food is very important in this respect, because we consume so much processed food and not real, whole food. So that really is the core of it—prevention through diet and lifestyle modifications.
Dr. Ramnarine:
So given this, how do you personalize nutrition strategies to support patients' long-term health?
Dr. DeNeui:
Everybody's an individual. I have patients that come in across the gamut. Some have come in for basic hormone evaluations, and then we optimize their hormones, and we address the things that are apparent to them first. But then I always am planting the seed, depending on some things that I'm seeing in their blood work, that we might need to have a conversation about their diet and lifestyle. We pretty much have figured out, and the data supports it, that most inflammation does begin in the gut. And inflammation is the root of cardiovascular disease, cancers, and neurological diseases, so it really plays a big role. So I integrate the conversation initially, and then we have greater conversations moving forward in subsequent visits.
Now, some of our patients come to us specifically because they've heard that we treat the gut. They’ve heard we do a lot of GI mapping and go deeper, and they've had these gut issues. They've known something's wrong. They've been doing their research, and they just can't find anybody to help them. And so, gut mapping is really important. We do gut mapping that really gives us a great clinical picture of what's going on in the gut microbiome. It tests for small intestinal bacterial overgrowth, H. pylori, parasites, fungus, and commensal bacteria or good bacteria. So it really helps you dial in on treatment strategies.
But for my average everyday patient who’s coming in to address their depression and anxiety and irritability, if I go ahead and have this big conversation all around the gut, it might be overwhelming. So you have to really meet people where they're at. If I sit down with a patient and they're eating a lot of processed food, and I tell this patient, "Well, you're going to have to stop doing this and stop doing that, and then I need you to do this and buy all organic and cook all your meals," it's too overwhelming. They're just going to go, "Oh, no, not going to do all that." So you have to get an idea of where someone is at in their journey and how much are they willing to work with you in this journey, which is really where most people start because a lot don't really understand that these vague symptoms that really could have a root in the gut, and they're looking for the allopathic answer. They're looking oftentimes for a magic bullet or a magic pill to make it all go away. But most of us didn't get there overnight. This is years of accumulation of insults to the system, and that's where we end up.
Dr. Ramnarine:
Along those lines, Dr. DeNeui, what are some practical ways clinicians can begin integrating gut microbiome-focused strategies into routine care?
Dr. DeNeui:
Great question. Start with a questionnaire. Every clinician's office typically has questionnaires when patients do new patient paperwork, and just make sure your questionnaire is addressing some key gut symptoms. Some vague symptoms I've already talked about—the gas, bloating, and constipation—those are obvious. But vague symptoms, not only mood changes, but rashes, rosacea, autoimmune disorders, PCOS, not sleeping well, low energy, and brain fog are all symptoms of leaky gut and gut dysbiosis.
So for gut assessment questionnaires, you can go online and find really good validated ones. And we just encourage clinicians to incorporate that in their patient paperwork. It's a tool that the clinician can look at and see that this patient is having a lot of symptoms that could be related to the gut, and that's what starts the conversation.
Dr. Ramnarine:
With those insights in mind, I'd like to thank my guest, Dr. Terri DeNeui, for joining me to discuss the role of the gut microbiome in preventive patient care.
Dr. DeNeui, it was great having you on the program.
Dr. DeNeui:
Truly my pleasure. Thank you.
Dr. Ramnarine:
For ReachMD, I'm Dr. Shelina Ramnarine. To access this and other episodes in our series, visit NutritionEdge on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!