TMAO and Cardiovascular Risk Factors

Welcome to Everyday Wellness podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives reconnecting with Fan favor, Dror William Davis. He's a cardiologist and New York Times best selling author of the Wheat Belly book series. He's also a medical director and founder of the Infinite Health program and chief medical officer and co founder of Realize Therrapeutics Corp that is developing innovative solutions for the disrupted human microbiome and author of the book, Super Gut Today we spoke about how the microbiome is influenced by key changes in a woman's life, including Premature delivery, how our modern lifestyle is disrupting our microbiome the influence of specific endotoxins for Fertility and uterine health. Statistics on antibiotics use and how this influences not only the development of endotoxemia and dysbiosis, but also increases our risk of developing cardiovascular disease The impact of statins The role of endotoxemia in recurrent atrial fibrillation Cardiovascular disease spepecific challenges navigating our current healthcare paradigm The role of the Gyko Calix TMAO dietary scripts that he follows and thinks are particularly important and how he addresses and makes suggestions around appropriately prescribed antibiotic use, alwaysways a fascinating conversation with Dr. Davis, easily one of my favorite recent conversations I've had on the podcast and why he will be likely back for A third conversation, if not later this year early in twenty twenty seven He doctor. Davis, so good to have you back on the podcast. Welcome back to Everyday Wellness. Thanks for having me Yeah. I know in our last conversation, which we covered so much information surrounding the gut. And at the very end, the inflection point, you said, I'd love to come back and continue the conversation and talk more about the female and vaginal microbiomes because in many ways, they're fundamentally part of this larger microbiome of our bodies Let's start the conversation there. I know that the microbiome, as I remind my own listeners, The microbiome is really extensive. It's not localized to the gut microbiome. It involves every single organ system in the body. And because of the proximity of the gut to the vaginal microbiome, there is quite a bit of interplay there Absolutely. This came tension my attention as a cardiologist, What am I doing talking about the microbiome? Because I have a daughter in law who delivever her third child Now this is a woman who has no shortage of resources. She comes from a lot of money And she has literally a dozen doctors and no one, not a single doctor mentioned the importance of the microbiome including for such critical issues as trying to stack the odds in favor of full term delivery In other words, if a woman delivers it twenty eight weeks, say, twenty seven weeks, twenty eight weeks catastrophic. The child will be in the neonatal ICU for weeks, if not months,'ll be on a ventilator, We'll be given multiple rounds of antibiotics will have impaired neurological immunological psychological development for a lifetime Mom and dad are gonna get a bill for a million dollars or more. Maybe insurance covers part of it and they are financially ruined Good chance of that happening And so you would think that obstetricians, etcetera would tell pregnant moms, everything there is to know to delay Delivery to full term Nothing was said Even though the science has matured dramatically. there are many things a woman can do. Something is stupid simple As Omega three fatty acids, the evidence is quite clear This is not speculation. This is not based on a single little study from Witchaog, Kansas. This is multiple studies that have shown that ladies who get a sufficient quantity, typically north of three thousand milligrams I remind people that omega three fatty acids are a component of food. And when we talk about food, we have to talk about gram quantities, typically, not milligram quantities And so if a woman gets three grams, three thousand mill or more of Omega Thetti asses She has stacked the odds Heavily, heavily in favor of full term delivery Nothing was said. That's just one issue, one simple issue. and of course, Omgazy Fatiaz is importance continues for the child because it's important for neurological maturation because DHA, the DHA specifically important for brain maturation. And yet, of course if mom iss deficient because the average American woman gets about a hundred milligrams one gram, ero point one grams over meegath fetty aces. then the child who breastfeeds cannibalizes what little mom can provide and it's insufficient for full neurological maturation. Or if mom converts the formula, there's almost nothing. in the way of algae source DHA. because what they did with formula formulation As they said, let's mimic what the average American woman gets in Omega Th'es the child in breast. In other words, let's mimic almost nothing that women get provide debt to the child. That's one issue. that's Omega Th'es. And there's so much more now that we get into the world of microbiome, there's so much more a woman can do to enjoy a full term delivery and then ensure advantage for the child in neurological and other forms of maturation Well, and I think it's so important because I think that when we're thinking about prenatal care, you know, many of the listeners that to this podcast, that's in their distant memory. Their kids are teenagers, young adults or they're, you know in middle or high school And I think back to Even though I worked at a big tertiary care center as an NP when I was pregnant with both of my boys and they had know a top notch NICU, and every once in a while I had to go up to that floor in the hospital And I used to remark all the time that I think for the average person, they don't fully appreciate what it's like when you have a baby that's less than thirty weeks of age. And the degree of technology that is involved in order to allow that baby to thrive because they really, you know, they're in their own little incubator maturation process. But so many of these parents, when I would interact with them, they would tell me, you know, we've been here for six months, we've been here for four months, we've been here for three months. And to your point about just even the financial impact of a lengthy NCU stay the degree of stress that we create, and we know that stress influences the microbiome quite substantially and significantly When I'm thinking about our modern day lifestyle and just kind of big picture, thinking about the net impact of our modern day food choices, the amount of stress, the fact that we don't sleep well, we're binge watching Netflix instead of going to bed. Do you think that there is sufficient research that's suggestive of there are gender differences in the microbiome that are a reflection of our modern day lifestyle meaning? Do you think because women are the caretakers of their families in most instances, Do you think that the influence of microbiome changes are most impactful? I would imagine yes, because you we know that the microbiome is conferred to the baby if they' vaginal delivery. someone already has an unhealthy, inhospitable microbiome, that gets transferred to the baby upon birth. Because women have a uterus And the Witterers is prone to inh. to inflammation. So veryy interesting sty from Italy, for instance Women who have had multiple failed pregnancies, miscarriages You know, this is catastrophic I have a friend, for instance who had five pregnancies, lost all five. at about two or three months. I meanm catastrophic emotionally. whyy would this happen If we believe the evidence in this one Italian study, for instance Women who have miscarriage have much higher rates, much higher levels of lipopolysaccharide endotoxemia. That is, the breakdown products of fecal microbes in their at bloodstream And if you obtain some of the endometometrial fluid So pelam and mitial flluid. much higher levels of lipopoly of these microbial byproducts from the GI tract and much higher levels of inflammatory mediators, like various interleukins and tumor crosis factor alpha So women who have multiple miscarriages, higher levels endotoxin in their bloodstream from microbes, higher levels of endotoxin in their endometrial fluid. Now in this one study, they oddly gave these women a small dose, one billion, which is very small of bifyobacteria longum, a strain of bifotobacterial longum. And it almost, not quite, but almost normalized both blood and endometrial levels of endotoxin The question is, of course Where this endotoxin come from the GI tract, off course, the gastro intestinal. And it's my suspicion that's almost always from the small intestinine, not the col A lot of work is focused on the colon where fecal microbes are supposed to be, you're supposed to have in a healthy person two, three, four percent or so of your colonic microbiome, pardon me, is meant to be those fecal microbes like E coli and clelella and Sracea and pseudomas, names that might be familiar to listeners because they're often pathogens also that cause urinary tract infections and other infections. But they've been allowed to proliferate because of our exposure to antibiotics So in the US, according to the CDC, six hundred fifty thousand prescriptions are written Every day every day, six hundred fifty thousand prescriptions every day for antibiotics. Most children receive, so what for every thousand children about thirteen hundred prescriptions are written every year for antibiotics. In other words, we are wildly overexplained, now sometimes necessary. Often not, of course. written, for instance for an upper reststate viral infection But this wild over prescription of antibiotics and probably other factors too likeike exposure to glyphosate, which is an herpic of course it's also an antibiotic that selects for fecal microbes And other things, preservatives in food that are antimicrobial in food, but also in you Emulsifying agents like polysorbate Aent pickles and salad dressing, ice cream, and a long list of other factors have disrupted our microbiome. But one of the net effects is it allowed the excessive proliferation of these fecal microbes. We say protobacteria. And one of the odd things is that these proteobacteria have been allowed to not just over proliferate But then ascend into the twenty four feet of small intestine. and the small intestine is very permeable. It's supposed to be permeable That's where we absorb nutrients like amino acids and vitamins and minerals but allows the entry of microbial breakdown products, but specifically endotoxin Lpo poolysaccharide endotoxin. And that's how the microbiome in the GI tract exports its effects to the brain for the skin to the joints to all other parts of the body. And so drives Insulin resistance, type two diabetes, weight gain in the abdomen Cognitive impairment, dementia. Parkinson's disease fibromyalgia, muscle loss, loss of bone density, skin rat. In other words, we've got to reconsider all we thought we knew about human health in light of the contribution of a microbiome in the GI tract Something I hear constantly from women in our community and something I understand personally is this Nothing about your effort has changed and yet our bodies are responding differently Your midsection feels different. yourour blood sugar is much less stable and your cravings may have shifted And let's be honest, your energy probably isn't what it used to be As a nurse practitioner with over twenty five years of experience, I want to be completely transparent with you about why Estrogen is one of the body's master regulators of metabolic health The influences how we store fat, how our tissues respond to blood sugar changes, and how efficiently our metabolism functions at the cellular level As estrogen shifts during perimenopause and menopause, the same lifestyle choices, diet, exercise, sleep genuinely do not produce the same results. This isn't a failure of effort. It's a precise biological transition, and most solutions don't address the root causes That's why I want to tell you about m acute hormonal metabolic control It's formulated with S equal, which is a highly bioavailable phytoestrogen that supports healthy estrogen signaling We know that eighty percent of women cannot produce S equL naturally because it requires specific gut bacteria most of us just do not have. This formula bypasses this entirely. It also includes a particular bacterial strain B breve, which works via the gut hormone access to support estrogen pathways and help ease occasional bloating and chromium to support healthy blood sugar balance. This is a targeted cellular support for the transition we are all in and's designed specifically for women in perimenopausea menopause and built around what actually is effective Go to wWW dot mitoQ. com slash Cynthia and get ten percent off your first order Again, that's mIT oq dot com slash Cynthia to get ten percent off your first order Well, do you reflect back because I know from our last conversation, I had shared, I worked in clinical cardiology for sixteen years, and I know you practiced as a cardiologist for many, many years Can you imagine in your medical training, can you imagine how much it would have changed the way that you approached patient care had you known the microbiome existed that time your science. I think it's going to transform the whole world of cardiac care. And it will change what you and I did for many years. It's going to change to how we manage atrial fibrillation. and congestive heart failure coronary plaque rupture, heart attack and sudden cardiac death, and the progression of atherosclerosis because it's clear that endotoxemia from the GI track The the most important cardiac risk factor f course, far more important than this stupid outdated issue of LDL cholesterol that should have been discarded decades ago, but it made it made a trillion Dollars for the pharmaceutical ind. It made a trillion dollars for the pharmaceutical industry. That's why John Q Primary Care still thinks that prescribing liipator or Zoor or one of those statin drugs is the solution for prevention of heart. Of course, this is ridiculous. It does not. It has almost no effect at all. percent is not a very good outcome So to illustrate to your listeners What does endotoxemia do in the way of cardiac risk factors Well, it reduces HDL Not HTL cholesterol, reduces HDL Particles It makes them smaller, and thereby ineffective in protecting you. inccreases small LDL, the real cause for heart disease. It increases VLDL very low density lpe of proteins, the first liver byproduct of consuming carbs and sugars. It increases liver denoval liypogenesis, the liver's capacity to convert carbs and sugars to VLl and triglycerides. it increases triglycerides It increases blood pressure, it increases multiple inflammatory measures like C reactive protein, various interleucins, TNF alpha It increases damage to the glycochalix lining of arteries that controls arterial tone and the fial dysfunction. In other words biosis by way of endotoxemia, disruption of the gatro intensal microbiome endotoxema is the most important cardiac risk factor there is becausecause it determines virtly all other risk factors. Not to say there aren't other things. so if you consume, for instance, the amlopecane of wheat and grains, you will provoke formation of small LDL particles that leads to heart disease. But you amplify the effect by endotoxmen from the gut microbiome So it's the gut microbiome is the amplifier of all cardiac risk factors. Yeahet, it's not even on the radar As you know, of most cardiologists, most doctors. The number one, why would they How do they justify the new eighty million dollar wing for cardiovascular care in the hospital? How do you justify thousands of dollars for angioplasty, bypass surgery, all those procedures that that continue to be the number one money maker for the health carere system. So there's this kind of differeiffnce putting a stop to heart disease because it's too darn profitable Yeah. well, I mean, there's a degree of cognitive dissonance and it's interesting to me, I'm ten years removed from traditional allopathic medicine And the volume of questions that I get for the podcast, we get in my DMs, we get sent to the support inbox. There are so many women that are still being prescribed statin agents just because they have a high LDL. And I'm like that's not even the full picture. Like you stop and do not go. and it's interesting, the Jupiter trial came out in twenty sixteen while I was still in part of this large practice And I was effectively told, because I went to my colleagues and said, you know, how are you fielding questions about this study And you know, we had this kind of vibrant discussion and I remember saying, it's not a question of if but when women will develop diabetes if they start statin therapy. And I said, why aren't we screaming this from the rooftops? Like instead of not empowering our patients to reverse their metabolic health issues Why are we encouraging them to take a medication, and this is not medical advice for my community. I'm just talking about the realities of practice Why are we encouraging women to take a drug without giving them fully informed consent? I mean, that has to be part of the conversation. And that's a study that's ten years old, and there's lots of subsequent research since then First do no harm. Yeah, right. Good luck with that, right? There's plenty of harm in conventional practice. The tragedy is, of course, as you know, that once you start to understand how heart disease is caused You come to recognize very quickly. It should involve zero drugs. It should not oblie use of statin drugs aspirin vibrates. T whatever, name your drug. There is no need to ablate to fully address risk for meaning coronary disease, of course We're not talking about other things like cardomopathies or disase From a coronaryed dominant form. When we say heart disease, as you know, we're talking about coronary disease attacks, sudden cardacath death, big issues. And of course, the leading cause of death in this country and the rest of the world So Tist Statin does almost nothing That's silently applauded becausecause that is the money maker for the health carere system. It's not cancer. It's not bladder infections. It's cardiovascular disease,nt Conary disease specifically. Why would you put a stop? Why would you close this spigot of revenue to the health care system when it makes so darn money. I mean, the statin drug industry, that sayss one drug, one class of drugs trillion dollars behind that is angioplasty, heart catheterization, CT carneate angiography, implantation defibrillators, all the things that involve are There's a time and place for all these things, but to an extraordinary degree are unnecessary because of the indifference and neglect. Carner events Yeah, I think it's a huge issue. and it's one in three women will die of heart disease. and I remind women all the time that know we are largely protected until we go through into menopause because of the estrogen effects and how estrogen influences nitric oxide production. I mean, there's so many things that happen as it pertains to, you know, kind of ot and getting back to the gut microbiome, I think you bring up so many good points because how many people listening in atrial fibrillation, we used to call it the holiday heart. It was always around Christmas, New Year's. We would have a lot of women and men that would come in. Maybe they were on vacation, maybe they were visiting family, they were eating and drinking differently than they normally did In inevitably, they would come in in atrial fibrillation, which in and of itself is a concern because you can embolize the little clots and throw them to the brain, which can be problematic. but never making that inter that kind of connection between endotoxemia gut microbiome changes and propensity for arrhythmias, that to me is fascinating Yeah, so as you know, there's emerging data to tell us that endotoxemia from the gas intesta tract is the cause for recurrent atrial fibrillation. that is if somebody has a recurrence, it's likely from an increase in the blood level end of toxin from the GA Trek But there's also another part of this and that is Why does the atrial muscle fibse? That is, why is there atrial fibrosis in the first place? That's an unanswered question That is why is atri so the atria of course, little sacks on top of the heart are largely kind of passive, low pressure sacks, but they play a big role in rhythm determination, of course. Well, why would the atria muscle, itss muscle be replaced by fibrotic tissue and there by electrically unstable tissue. Why would that happen? That's a work in progress. It's my suspicion though, a lot of it's due to glycation glucose modification of proteins because muscle is protein, of course And a glycation occurs glucose modification of proteins occurs every time your blood glucose exceeds one hundred milligrams for Dlier. So one of the great innovations lately has been the CGMs, the continuous glucose monitors because it exposes all the nonsense that comes from a lot of dietary advice. from the U. S. Department of Health and Human Services from the American Diabetes Association from the American Heart Association from the Academy of Nutrition of Diet who' been telling us things like, well Cut your saturated fat and cholesterol more healthy whole grains and everything else. Coca Cola and soft drinks in moderation. Now people are starting to recognize that advice is fatal leads to repeated cycles of high blood glucose. there by glycation, I believe, of atrial tissue, and it sets you up for atrial fibrosis, therey electrical instability and atrial fibrillation. And then we have this issue of very neglected and tooxemia, that is the provocateor, the provocative factor that causes recurrences. And so if we're going to give your patients Warfarin or some other anticquagulant beta blocker And NastTy, as you will know, anti rhythmics are horrible.. How many deaths have you seen on drugs like amiodorone, right? So do all all the all drugs. You have to have special treat you prescribe Tkusin at least and it was you had to do it yearly and patients had to be hospitalized for three days three days when you initiated treatment because you had to rule out lethal arrhythmias that could happen. So imagine any drug that's designed to treat an arrhythmia can cause an arrhythmia. That's why sometimes patients are monitored to your point. sorry. I wanted to interject that because that was always the thing that I would say to my patients, okay, you know, we've consulted with electrophysiology. We're going to start these anti arrhythmics. and I have to be honest and tell you The reason why we're doing this in the hospital so we can monitor you closely. And then inevitably every once in a while, a patient would say, is that because you want to avoid having an untoured event? And I was like, exactly I lost count off a number of people I've seen die from anti rhythics, from drugs that were supposed to prevent fatal rhythms that actually causeed. And that was much worse, of course in the nineteen eighties and nineties. We used to go to the caronary care unit And we'd have when computers became a thing quify This goes way back. We would quantify the number of single PVC's tplets, two PVC's, premature of and from conf fact in a row ts runs of ventricotachycardia, runs of these rhythms. Because we thought we thought back then that these were signs that you could have sustained rhythms that would cause cardiac arrest. And we would introduce drugs until it became clear that the drugs actually caused death and did not prevent those they reduced the number of those those beats, those irregular beats, but it did not save lives. But that was abandoned many years ago, but it continues to a great degree, as you know today in drugs for atrial fibrillation and other issues that the drugs are actually harmful And yet we have this issue where the real causes of heart disease like glycation endotoxemia are not being addressed. I think it's going to be a couple of generations Our colleagues say things like, you know, you've got ventricular tachycardia, you've got atrial fibrillation. You've got a cardiomopathy. you've got congestive heart failure from two myicardial infarctions. You have atrial fibrillation. We need to address your microbiome And I don't see that happening in our lifetime. It's going to take a long, long time. This is why I tell people If your doctor is not educated and even worse, not interested in being educated because there's no money in it It's up to the individual to be educated and learn how to do these kind. And the great thing of course, is taking control of microbiome type isish and dietary isishes is something you can do on your own without the doctor. In fact, the doctor is often an obstruction doing these things because they'll say stupid things like, o, Cynthia, did you consult Dror Google again stupid thing, right? to block you from taking individual action. No, I think you bring up so many good points. and I think the purpose of podcast is to educate listeners to ask questions, do their research work in conjunction with their provider, because ultimately, whether it's a physician a nurse practitioner, a PA or whomever, them to get the get the communication going because I think that's half the battle and the degree of cognitive dissonance that I still encounter, even though I'm ten years into what I would like to think of is very being progressive and open minded, and I'm open minded enough to acknowledge that sometimes even I have to po or, you know, if someone brings something new to me, I'm like, all right, I have to kind of I have to kind of read all the research, think about it, and consider that I may not be correct about this particular entity backack up a little bit because I think this conversation around cardiovascular disease and heart disease risks and arrhythmias is really an interesting one if you were practicing right now in cardiology, what would be your approach to talking to patients about risk factor modification? So you've touched on the diet piece, you talked about omega three s. What would be areas that you would really want to focus or zone in on when you're counseling or talking to patients about risk factorsyond you know, the kind of metabolic health markers that we know are hugely impactful. First of all, you have to opt out of all health carere insurance and hospital privileges because they will screen you for how well you adhere to guidelines as determined by the pharmaceutical industry. So as you know, if you have a patient come to the hospital with an infR a heart attack or unstable engine or some equivalent And they go through whatever. let's say a heart cathitization, get a extend, whatever. they get discharged. The hospital will have a checklist. Did you discharge your patient on aspirin, a beta blocker, an AC inhibitor a statin drug, they will essentially mandate what you give that patient And so and if you don't you're going to be penalized by the hospital. You may even lose privileges over a period of time. In other words, they have control over how care is dispensed You have to if you want to do what you think is right You really can't participate in conventional healthcare. So what I did And by the way, so as you know in cardiology, Eing and weekend coverage is an issue. because none of us can work twenty four hours a day, seven days a week. And what I saw was I would have patience on the things I thought mattered On to have my colleagues say, Oh, that's stupid. stop all of that So it's a battle, it's a battle. But what I would do is of course, we start with lipoprotein analysis, not cholesterol testing. cholesterol testing, it really should have been discarded decades ago. It's so outdated,' so antiquated We do lipoprotein testing. That is the particles in the bloodstream that actually cause heart disease along with other measures that assess insulin resistance and inflammation and the microbiome the real cause of coronary disease. And so If we think about There's more a heart disease causation, of course than small dense LDL But small dense LDL kind of tells the entire story. So I tell people If I said your LDL cholesterol, the conventional measure is one hundred and eighty milligrams per deceliliter What does that tell me about you Well, it might say your total cholesterol is higher, but those two are related. Right LDO is calculated from total cholesterol and vice versa It might Some might say, Well, you had tooch saturated fat, right? Bacon? and other oils, right? But we know where that led, right? The idea of cutting saturated fat was a contributor to the worldwide epidemic obesity, type two diabetes, cognitive decline, etcera. But that's it. All LL chesro because it's not a real number result of the so called Fried towd calculation fromrom the nineteen fifties. And so what if I said you instead We we did lipoprotein analysis. I use NMR nuclear magnetic resonance, very common, very inexensive And your small dense LDL is eighteen hundred Nanomoles per liter. partarticle count per volume What do I now know about you Well, I know that you have overactive liver process, Denov lipogenesis converting carbohydrates to VLDL and thereby small LDL. You have high triglycerides, you have high VLDL. you have high blood pressure Measures of inflammation are higher C reactive protein, Nalleucs, TNF alpha You have insulin resistance, your fasting insulin is higher, your fasting glucose is higher You have too much abdominal visceral fat you have endotoxemia. In other words, It's not one thing like LBL cholesterol. It's an entire constellation, a universe of factors that lead us down the path of coronary disease. Yet there's this wacky, ridiculous perception that it's one fake thing this fictitious thing, LDL cholesterol that is the cause of heart disease. This is This is incredibly absurd It is the dominant way of thinking among our colleagues and that the solution is in the way of this stupid class of drugs Statin drugs that have made all we need to know is it made a trillion dollars. That's why it's so popular because as you know practice. All it takes is that guy in a three piece suit, the girl in the mini skirt, sales representative come to the office says, Doctor, we love what you're doing. Can we invite you to a key decision maker? Meeting in Orlando, Florida, all expenses paid That's all it takes to get the Dger continued to participate in this shade. called LDL cholesterol and statin drugs It's interesting when I was still seeing patients in clinic they would have lunch and learns. and I would always, you know, I always took my lunch to work. and so I would walk in through the lunch and learn. I would grab my food and they always wanted me to sign The form They wanted all the prescribers to sign this form. And I used to always politely say, I respect what you're doing. Most of my patients can't afford your med And there are never enough samples in the office. And they were just always theyre ten aboutod, we really respect your honesty. And I would say and also, if I sign that form, that is information that anyone can access has access to that I have participated with your lunch and learn. Now, when I first started as a nurse practitioner in the early two thousands, that's when they would have these big trips would I had a whole heart failure clinic that was paid for by the makers of Cg When I think about this, I mean, the clinic was sos, but I'm just saying that they had all these bells and whistles that they gave us But I think from a lot of levels, I think sometimes patients aren't aware of all these semantics, all the things that make it harder to practice the way that you want to. thoseose checklists notwithstanding Let's talk about the glycochalics. I think this is fascinating. and I love the interplay between dysbiosis, which is something that you' an end ofoxemia and how that impacts the glycochalics So for your listeners who are unfamiliar, the Glycokalics, of course, are these finger like projections that line arteries and controlled tone That is how constricted or relaxed arteries are And it's chronic constriction, of course, that leads contributes to the development of aettherosclerosis, coronary disease stroke, et cetera. And so Gregel Kalx is crucial And we also say endothelial function that is because it's the internal lining of arteries, the endothelium that is the source of the glycocalics. You know, one of the great things I paid attention to is the importance of A hyaluronic acid of all crazy things. I got here indirectly. I actually formulated a product for ladies' skin Because I do a lot of things and one of the things I was talking about was the restoration of a specific micro like the Basils rotere And one of the effects of this microbe is better skin as well as supportpping musculature and emotional health generosity, desire for human companionship But the ladies would always say to me, Oh, we don't care about that other stuff. We just want better skin What? Really? Okay. So I did a small clinical trial And we did validate improvement in skin. We did something called highigh resolution skin ultrasound. which is a measure you can measure dermal thickness. It's not the epidermis on the surface that determines skin health. It's the layer underneath the dermis. And we got a marked increase in dermal thickness, much more than you would expect, say, than from just taking college and say. And it did generate all those wonderful effects from the skin trial We saw all kinds of other effects. I did not expect, by the way, reductions in waist circumference, for instance. restoration of youthful muscle. So in effect, I think It kindind of a youth preserving or youth age reversing type effect. but one of the things we used was hyaluronic acid And I got thinking a lot about this because the modern lifestyle is hyaluronic acid depleted because've the whole idea of cuters, saturated fat and cholesterol Because most modern people over the last sixty years banned consumption of organ meats So almost nobody eats brain anymore They don't eat pancreas or heart or tongue If they have chicken or fish, they throw away the skin. All those things rich in hyaluronic acids. So we lead this lifestyle devoid of hyaluronic acid And hyaluronic acid is so crucial. It's a fiber, of course. It's one of the few fibers, by the way source from animals Most fibers, of course, come from plants Here's a fiber source from very few fiber source from animals and we've abandoned it But if you restore hyaluronic acid, we're only beginning to appreciate the benefits We know that skin is better. It increases dermal collagen Hyaluronic acid stimulates fibroblast production of collagen It increases moisture retention in the derma layer So there's skin benefits. Ladies know this. Do they say, oh, don't tell about halonic is. I put it right here I one hundred and twenty dollars for an ounce No, takeake it orally and youll get those effects and you get body wide effects. So if you put it here, what does that do for the skin on your neck or your nothing. You take it orally. so it improves skin Dermal thickness, skin moisture, it increases joint cartilage It increases joint production of cartilage collagen in cartilage. It increases the volume of synovial fluid in joints, the lubricating fluid in your knees and hips It's probably one of the most important cardiovascular risk reducers. Because of the issue you raise, the glycokaic. What's the glycoaics made of Hyaluronic acid. So that evidence has not been performed, but it needs to be done that is hyaluronic acid in the diet is probably one of the most important things you can do for heart health and arterial health and reduction of blood pressure and eththerosclerosis So howon I gas, this thing we abandon. So it's yet another item on the list Bunders made because of the reducce your saturated fat and cholesterol message. abandon all dietary sources of hyaluronic acid alsoso collagen We don'tat tough cuts of meat often, we don't eat organ meats, and we don't get collagen. And we now know, of course, collagen is instrumental in skin health Join health. may be arterial health And so it's having to undo a lot of the lessons we thought were true because of the blunders of dietary advice. Yeah. I think, you know, there's been probably more harm done bad nutritional advice and I'm thinking about Anssel keys and you know, bastardizing fats is a huge proponent. alking I can't think of a better person I'd like to ask about TMMAO as this gut derivive compound linked to cardiovascular risk What are your thoughts? Do you think it's overstated, legitimate What are your concerns about this? And for listeners, this is triethyl alamine N oxide. So even I have to write it all out. otherwise, I will forget what it stands for Yeah. So Dr. Stan Hazen at the Cleveland Clinic initiated that research And he He says he showed that consumption of any animal product Poultry, fish, beef, pork, whatever increases the blood level of this market To, we say, right? And that it is a blood clot provoking factor. It causes platelet clumping which is a factor in arterial clots, not venous clots like thrombombalic disease, but RTial clots Well, how did he show that? Well, he fed people various meat products, animal products versus vegetarians and vegetarians had lower Cclusion by Stan Hazen and the media All animal products cause heart disease and stroke because of blood clot formation. I had a lengthy conversation with Stan Hazen. And there are things not in the published literature. For instance, Olive oil turns the entire thing off Also assumed that the microbiome was a black box. That is, everybody has the same microbiome. What was not said, was that it's people with an over proroliferation Cardiobacteria, fecal microbes, and bacteridides species which is the current problem in the microbiome in modern people. Over proliferation of proteobacteria and bacteridities uce T Mo. So it's not the food, it's not the input It's the processing by the microbiome that leads to this is not my speculation, by the way. this is well borne out in the microbiome science that most physicians do not read, do not participate in, don't talk to microbiologists. And so it's a microbiome issue Here's what I also suspect because Stan Hazen, while he's a responsible researcher, I think he was charged The Cleveland Cinic is a cutthroat exploitative, I know, I lived in Cleveland for five years And I think he was charged not with generating research so much generenating research that gains headlines. And so he's also bashed rithrol, for instance, similar reasons. It caused blood. Thatit. E ryrol is a a natural sweetener, apppples in pears, reallyally So I think there's a lot of nonsense coming out of there not to t give us information that empowers us But they give us information that draws attention by the media to the Cleveland Clinic. Yeah, it's interesting. The thinging because I trained at Hopkins was publisher Parish. And if you've worked at big research institutions, there's so much pressure on the researchers to get information out there. And I would imagine clickbait stuff gets a lot of attention, gets a lot of traction, a lot of downloads. I'd love for you to share with listeners what do you eat in a day? I mean, this question came up multiple times when I mentioned because many of my listeners have bought your most recent book, Super Gut. and they were asking me, what does Dr. Davis consume in an average day? Are you comfortable sharing like what do you eat for breakfast? what do you eat for lunch? what are you eating for dinner? I think people are curious. based on all of your incredible knowledge, how are you integrating some of your principles that you embrace into your lifestyle You know, there certain principles we follow that give you back control over how you eat and what you eat So for one thing, we never limit calories. It's ridiculous to cut calories. Iillustrated most recently by the GLP one aggonist nonsense that's going to kill people, by the way. It's a whole another conversation, of course. We eliminate the gliadin protein of wheat and grains because the gliadin protein within gluten is converted to opioids. and these opioids don't make you high. they are appetite stimulants So eating more grains is in effect a way to stimulate your appetite hugely. We don't limit fat. There's no reason to limit fat. The science that was purported to suggest that we need to limit saturated fat and total fat was misinterpretations and very bad science. So there never was science to tell us to limit saturated fat and total fat And so No grains that stimulate appetite Don't limit calories, donon't limit fat And that as best we can in a modern world, mimic the way humans, I have an idea I called the vegetarian lion. So let's say one of your listeners sees they're around a saafari in Kenya And they see a lion tackle a gazelle tear open his abdomen eat its intestines and liver and hard this person says that's disgusting. Let's cage that lion and feed it Super foods. D that Blueberries kale and lettuce What happens to the lion It's dead within who knows? a couple of weeks, something like that. Because you defied its dietary script written to its code, its genetic code Humans are no different. We have a style of eating written into our genetic code. And if we defy it, you might not die in two weeks. You may die in bits and pieces over ten, twenty, thirty years, whatever. So as best we can, we revert back to the way humans ate. our species ate For the first few million years Before we turn to the convenience of eating grains, which is very recent. People think it we've been doing it forever. No, no we did it, it's very recent and then made worse by silly things like dietary guidelines. The toes eat more of the wrong thing And so we revert back As best you can. So last night check, you and I did not get up this morning from our hut or cave gb fear axe or club and kill something. nor did we go into the forest or jungle and dig into dirt for roots and tubers or steal eggs from birds' nests. But that's kind of what we do We go back to eating animal products And you try to eat the entire animal. You don't just eat the meat, you try to get organs. Most modern people are so turned off by organ meats that you You have to kind of inch your way back, maybe fold, for instance, ground liver into your for something like that or pate, things like that. We don't lim it calories, don't lim it fat. Of course, vegetables food and foods that are rich in fibers because we need to nourish our microbiome So those are like mostly root vegetables, onions, garlic, shallots, legumes other root vegetables. frruit, of course, but modern fruit has been changed. of they've been hybridized and cultivated for sugar content and low fiber content. So we have to be careful with fruit In a modern world, it means mostly berries. Eggs, of course, because eggs have not changed that much. Farmers tend to feed their chickens crappy food So there's that, but in general, eggs are pretty good. So it's just reverting back to sim. And the other thing is because we've removed the appetite stimulating effects of the gllyidin derived opioid peptides and we don't live a fet Most of us eat like twice a day So I haven'tat yet. it's almost noontime where I am I haven't eat because I'm not hungry. People aren't hungry anymore. You eat when you're hungry, which is usually two meals a day. mayaybe an occasional snack. but the whole One of the other things that occurs is we rebuild a broken microbiome. antibiotics, glyphosate, all those things have caused loss of hundreds of beneficial species One of the species I pay a lot of attention to is lactobacillus rhotoride. and we know that microbe, the restoration of that microbe, which almost nobody has anymore, by the way, almost no modern person anymore in the last forty years retains this one microbe black missil's Radri Well, that's responsible for suppressing we say, hedonic eating, snacking. So you're no longer tempted by Doritos cororn chips, pretzels, candy bars, all the crap that the food industry tries to sell us. So eat maybe twice a day hunger and hunger, by the way, is very different It's not that annoying, desperate feeling that people get. They shove you out of the way at the food bar or you in food bar. It's instead this kind of soft reminder. In fact, you'll think, I'm a little restless Oh, that's hunger because you haven't eaten since yesterday and it's three o'clock in the afternoon. So the experience of hunger is completely different. And people who are interested in such things as intermittent fasting or time restricted eating, they'll find it's much easier becausecause that's how it's supposed to be If you were living in the wild and did have to kill something for your meal or dig in the dirt, you can't just snack all the time. of all Small meals every two hours Asurred and very harmful by the way We eat when we're hungry Where do fermented foods fit into the conversation for you? Are you a fan of sauerkraut, fermented vegetables, miso, tempe? Is that part of the conversation based on your principles You know, the Sondenberg couple, Justin and Erica at Stanford did a very wonderful study about three years ago or so And they it was very simple. The analysis is extremely complicated, but the principle is simple Paring consumption of fiber rich foods and fermented foods. as you point out fer, kombucha, sauerkraut, fermented veggies, yogurts, etcetera Hands down, it was the consumption of fermented foods that generated the greatest diversity in the gastrointestinal microbiome. I do a lot of think about this. So if you consume, let's say Suerkraut, off course, not the Suerkraut in the grocery store, that's brine and vinegar, but real fermented cabbage Kfir or whatever You're getting species like Lukonutag mesmeturides. Pedioccus pendessaceous or pediococcus acidalactici These are micro Y ella species. These are microbes. Oddly that don't colonize the human gastrointestinal tract You consume them, you poop them out So what good are they? Well, if we believe the evidence of the Soonenbergs, and this plays out in real life too They somehow open the door for restoration of other beneficial species not contained in the fermented food So you'll see a rise, for instance in Acromancia Falibacterium, Ruminic acaca, eubacteria species, lactospiracia, lactobacillus, bifotib bacteria. It somehow No one knows exactly how, but it's probably somehow just makeaking it more hospitable these microbes that were probably present in small numbers and sequestered in the mucus barrier, mucus lining or make you more amenable to gain it from other people in contact with things. no one really knows for a fact But there is an increase, a restoration of beneficial microbes with consumption of fermented food. So consumption of fermented food is actually top my list of things that people should do when they had this disrupted microbiome Thank you. I knew that. I wanted you to hear it because my community hears it so much for me Now For anyone that's listening, there might be someone, and I'm a good example, I've got a terrible sty, and both my internists and I have kind of been doing all the conventional things and we're trying to avoid oral antibiotics, but this I is pretty angry. If someone's listening and they have an appropriate indication, they need to go on antibiotic therapy, do you have some specific recommendations or ways to mitigate the impact on the microbiome for hopefully a very short duration of antibiotic therapy. We're not talking about The people that are asking for antibiotics for viral infections, we're talking about true indications So that's a work in progress. One of the most important things is to obtain the fungal species Sacomceces Bllarde, of course. And we like to do it as a fermented sparkling juice So you get this microbe, you bu you can buy it at Target. Walmart. Most stores have floristore or other brands that have this sacramized Bllardi. It's a close cousin of sacramiz Serav Vicie. that's used to make wine and beer So we get sacromized ballardi, adapt the human body We take a capsule empty into any volume of juice. The juice simply cannot have any preservatives No sodium benzoate, potassium sorbate, et cetera emmpty the capsule into the juice, agitate lightly, loosen the cap because and then let it sit in your kitchen counter So about seventy degrees or so for seventy two hours or until there's no longer any sweetness detected when when you taste it. We want the sugars to be fermented out And it's converted among other things to carbon dioxide. So you see it bubbling within twenty four hours, bubbing like crazy, by the way. That's why you leave the cap loose becausecause if you have it tight, it'll explode. We don't want explosions in these kitchens And that's a cheap, easy way to get huge numbers of sacromized bllardi that is the one the crazy thing, like fermented foods It doesn't take up residence. That fungus does not take up residence. Its somehow feeds or cultivates the restoration or maintenance other species that you would otherwise lose during course of antibiotics. And of course, those fermented foods during the antibiotic only has very minimal benefits because the antibiot kills those microbes Fermented foods really play a big role also beyond the sacromoned Boodet. during and afterwards. And I've seen now this anecdotal. we do microbiome stool testing And we do see what appears to be preservation of an intact microbiome It may take weeks to months to do that I believe these strategies do work. Sacramice Bardi fermented foods. Ironically, the least important thing are probiotics. People think of probiotics as like the thing you do. No, they're the least important thing you do. They have a role. especially h the very short list of probiotics that actually do provide benefit because that's a problem in the microbiome world. and formulation probiotics. Most of them are formulated very haphazardly Somebody says, I think bifideracteria bifidom is good. Throw that in I like bread' is good. throw that in. They' haphazard collections of microbes not crafted for collaborative effects, metabolite sharing effects, There's all these factors that can go in. That's going to happen over time. One of the few microbiologists who actually knows how to formulate probiotics intelligently is my good friend. I spent the weekend with him in San Diego at a conference. dor. Rao Keno forty years academic career at Cal Polyteechen in San Louz Abispo And he actually formulates I have no relationship financially. and he helped formulate friends is a product called Sugar Shift That is an intelligent created probiotic But in general, propanyics are minimally beneficial That's going to change over time as people like Dr. Al Keno get involved intelligently formulate probiotics Oh, as always, I so love these conversations, doct. Davis. Please let listeners know how to connect with you outside of social media, how to get access to, you know, one of my favorite gut related books, suuper gut, or learn more about your work. Yeahes, so books super got Sper body is my most recent book where I focus specifically on this idea of what I call shape and body composition In light of the nonsense going on people being told that they either cut calories, get a bariatric procedure, or take a GLP one agonist to lose weight. Not being told that those methods, all variations on the theme of reducing calories. We'll abbreviate your life. We'll shorten your life by several years and the last few years will be characterized by Fs ers frailty loss of independence, acceleration of dementia, and you die younger The FDA approved a class of drugs that ensure early death. I'm amazed by this. They approve those drugs without long term outcome data Yet the data is clear. We have now, you know, a lot has happened the last five, ten years in the way of weight loss science. And one of the things we know from large databases likeike the N Haines database, the Epic Norfolk, Western European data, the Aspy data, sixty thousand people in total follow for as long as ten to twenty years People who cut calories. die younger. That is perurposeful loss of weight. pose. If you have cancer you that eliminating those people People who say I'm trying to lose weight, I cutting my calories, I'm using smaller portion sizes. I'm taking a Geopoint agonist. I had gastric bypass, lap band, whatever. People die several years younger It's amazing. That science is not Unknown. it's beinging done A lot of it comes from the NIH National Institutes of Health. And yet we have a world who thinks Cutting calories is the way to lose weight. No, it's a way to die younger. you may lose weight up front. And so oh anyway, that's the super b theme. And of course, I have thousands of blog posts my Wind Davesmd. com I also have a two way zoom I'll do tonight two hour to a zoom on my inner circle dot. DR Daves infant health. com Because as you know, you and I left conventional care Because it's awful. It does not deliver health It delivers revenue producing products and procedures benefit insiders whether it's the cardiologist or the hospital executive or the pharma executive or the medical device executive, it's not crafted for help. so I tell people Make yourself useless to the health carere system Be healthy Because if you're healthy, They don't care. They don't even understand. As you know, you probably have the same thing in your listeners. peopleeople go to the doctor, they're asked by the nurse or whoever. what medications are you taking? is they saying none What do mean none Everybody takes medication. What medication you taking? None. they think you're somehow stupid or neglectful because you have this incredible insight that health does not require pharmaceuticals. Except for hormones. I was to say I'm very pro HRT. I would say I'll interject that to say hormones are different. But for some of us, that's, you know, that's a huge differentiator Always a pleasure to connect with you. Thank you again for your time Thank you for all you do because NBC, ABC, C are not doing it. We've been barred from those media outlets, peopleople like you and me And so we rely on people like you to get the message out If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.