Dr. Miloy: If you were to ask me what plagues humanity, the number one thing, it’s faulty programming. Most humans programming is 90% complete by the age of seven, eight, nine years of age, and it's just learned and is taught to them. A person spends the rest of their life trying to unlearn that. It's unfortunately years of suffering. It's just it's unnecessary. So if we can change our programming, and we can at any stage of life, that's good. It's even better if we can do that for our children. Welcome to Becoming Virtuosa, the podcast that encourages you to become your best virtuosa self. Each week Dr. Susan Crockett goes where the scalpel can't reach, exploring conversations about how to be, heal, love, give, grow, pray, and attune. For the first time ever, she's bringing the personal one on one teaching that she shares with individual patients to you on this broader platform. A weekly source of inspiration and encouragement designed to empower you. By evolving ourselves as individuals. We influence and transform the world around us. Please help me welcome board certified OB-GYN specializing in minimally invasive GYN surgery, internationally in the top 1% of all GYN robotic surgeons, a certified life coach, and US News top doctor, your host Susan A. Crockett, MD. Dr. Crockett: Welcome back to The Dr. Crockett Show. Today is a really special episode with my very good friend and medical correspondent Dr. Reed Miloy, who is an internist in Kerrville, Texas. If you missed it, go back and check out part one of microbiome magic. We had such a great interview about this topic, and there were so much discussed that we decided to break it up into two parts. This is part two. Part two will make a whole lot more sense if you go back and watch part one. Again, as always, thank you for listening, make sure to like, subscribe, and share with your friends who may find this information helpful. Have a great day. Without further ado, Dr. Reed Miloy and myself on gut microbiome. So we've got three R's so far. We have remove. Dr. Miloy: Yep. We've got so far we've removed. Dr. Crockett: We replaced. Dr. Miloy: We've replaced. Dr. Crockett: Then we've reinoculated. Dr. Miloy: We reinoculated. Dr. Crockett: What's the fourth one? Dr. Miloy: That would be repair. Dr. Crockett: Repair, I like that one. Dr. Miloy: Okay, so we want to repair or replenish. So repair, we're trying to help those enterocytes, the epithelial cells that line the GI tract, help them to repair themselves. Fiber, we talked about 25 to 30 grams per day. L-glutamine is they just love glutamine. Those cells just eat it up. Dr. Crockett: You can buy l-glutamine? Dr. Miloy: You can. Dr. Crockett: Okay. Dr. Miloy: You should know why. We don't want people just to go out there and start downing bottles full of that. Dr. Crockett: Can you eat it in something else, like food? Dr. Miloy: Well typically dose it in a product, either a powder or capsule, and yes, it can come in foods. So fiber, l-glutamine, omega-3s. The microbiome loves to have its omega-3s. So that's important. Polyphenols are things that we find in things like grapeseed extract and green tea. Polyphenols there. Pomegranate extract. You can literally, part of the protocol I use for my patients who are low on akkermansia is not just giving them akkermansia, but also giving them polyphenols to support that akkermansia. Because akkermansia loves polyphenol. Dr. Crockett: Those are plant based kind of medicinal. Dr. Miloy: All of those are plant based foods and then zinc. A lot of people are getting zinc and a multivitamin, but getting 30 milligrams a day is very reasonable thing to do. Dr. Crockett: Okay, cool. Okay. Dr. Miloy: Then there's a host of other things that you can do there, but those are some of the core things to help repair. There's products out there that helps support the GI tract as well. So an experienced practitioner could help somebody with that. Dr. Crockett: Okay, so that's four. What's five? Come on. You're killing me with suspense. Dr. Miloy: Five is rebalance. This gets back to what we've talked about before is living a balanced life. Getting the appropriate amount of exercise and sleep, mental health, and nutrition. All right, you want to take care of those four pillars of health. Dr. Crockett: The four legs of the table. Dr. Miloy: The four legs of the table of health. Because without those, you're just kidding yourself. Somebody's out chasing around for the latest Wildberry from the Amazon basin or some strange elixir. I mean, those shortcuts they just simply don't work. Dr. Crockett: When if you don't have the four basics to begin with then all of this other stuff just. Dr. Miloy: You're kidding yourself. It's like shooting a BB gun at a charging African bull elephant. It's just not going work. Dr. Crockett: Okay. So we talked about the inoculation thing already, the stool transplants, which I think are so fascinating. The twin study that they did on Netflix, the thing I want to mention about that was how quickly they gut is willing to heal itself. Dr. Miloy: Yeah. Dr. Crockett: So our gut turns over, all of our cells in our body are turning over all the time. Like, I think a skeleton, you get a new skeleton every 10 years or something like that. Dr. Miloy: Every 10 years. That's right. Dr. Crockett: Then things like skin and hair and nails are much faster, but so is gut. Yeah, so they're the study that the Netflix twins studied, and the one that's called You Are What You Eat. They did an eight week study, and they were able to see astonishing laboratory and physical fitness results in people in eight weeks in this twin study. I think that when you talk about making changes about replenishing gut and feeling better, I think it's much, much shorter than that. I think within days, you can start feeling better. Within two weeks, you can start seeing healing the gut lining. Dr. Miloy: Absolutely, absolutely. It's amazing. When I sit down with patients and I go over their test results and we're able to show them what's actually happening inside their GI tract, they can now see it. It's no longer a ghost. Then you come up with a treatment plan and you go watch these folks execute the treatment plan, which is really easy. Really, very quickly, they tend to turn things around. It depends on the condition. Yeast can take a while to get rid of. But it can take up to six months or even longer to fully repair a microbiome. Sometimes up to a year, we think. So. But if you have the good habits, and if you're putting the right, once again, if you're feeding the microbiome like you were feeding the rest of your body, then all of a sudden you get this incredible synergy. Things start to get better quickly. Dr. Crockett: Yeah. Yeah, I think that's really encouraging. Because it's one thing to hear oh, it takes six months or a year to get it, right, but I don't want you guys to be discouraged. You'll feel better after eating one whole food plant based diet. You'll feel it. But the additive effects of that multiply really exponentially very quickly. Dr. Miloy: There are people that when they try to eat healthy, eat a whole food plant based diet, their belly flares up and almost invariably, I suspect that these folks have imbalance. Dr. Crockett: So you've got the overgrowth. Dr. Miloy: The overgrowth, the SIBO. Dr. Crockett: Yeah, I've run into a couple people like that. Most people though feel better when they start shifting it. The other thing I want to ask you about is aging. So what changes in the gut microbiome specifically with menopause because that's a huge part of my listening viewership. But also, I've had people tell me, my older geriatric patients, tell me that their gut doesn't work the way it used to when they're in their 70s and 80s. So what happens? Is that inevitable? Dr. Miloy: I don't think we fully understand. We don't know the whole answer to that question. But I think we're beginning to learn some important things. Number one. Dr. Crockett: So stay tuned. Listen to us in five more years. We’ll have an answer for that. Dr. Miloy: Don’t go anywhere. I mean, we talked about hypochlorhydria, which is low acid environment, right. As we get older, the stomach, like everything else may be struggling to make adequate amount of acid and keep the pH. Once again, a lot of people on those chronic proton pump inhibitors that suppress acid, pancreatic insufficiency. The pancreas is no different. So as we age, all of these things are coming into play, and they're affecting how the microbiome is functioning. My fundamental belief at this stage of my career from what I've seen over the years is that it is lifestyle. We talk about feeding the microbiome. Well, we could say, we want to feed it what? Not just these healthy foods that we're talking about, but we also want to feed it exercise. So there's more evidence starting to come out athletes have healthier microbiome. So exercise. Then if we're not getting adequate sleep, we're going to have chronically elevated cortisol levels. So that's a stress hormone. That's going to affect immunity. That can get you into trouble there. A lot of women who go through menopause are having to sleep disturbance. This is a big. Dr. Crockett: It is a big thing. Dr. Miloy: Problem that a lot of primary care physicians struggle with treating with a patient. Dr. Crockett: It's interesting because the primary reason for that initially is estrogen drops and then you get hot flashes, and that hot flashes disrupt the sleeping pattern. So bioidentical hormone replacement therapy or body neutral hormone replacement therapy can help that a lot. But even in women that have a hormone replacement therapy, we still see, I still see a huge portion of my patient population with sleep difficulties. One of the primary patterns that I see is they'll sleep until like two or three o'clock in the morning and then be wide awake. I did some of my own testing. I put a CGM monitor, a little continuous glucose monitor on, and I watched what was happening to myself at that three o'clock in the morning thing. My glucose levels started going up. It wasn't because I was eating because I was asleep. It's a cortisol rise. So I've been just playing with that a little bit. But the thing I always tell my patients about that is don't get up, don't turn on your blue light, your blue screen. Just lay there and let your brain do what it's going to do and let your body repair and rest. Usually you'll fall back asleep. Even if you don't, your body's needing that rest time to repair. That's what the body's doing during sleep. If you just get up because your brain says it's time to get up and it’s three o'clock in the morning, you're shortcutting your liver and your whatever else from being able to repair. So should not get up. Don't look at your phone. Don’t look at your blue TV screen, computer. If you'd have to look at something, read something white like your magazine or your book, an actual piece of paper, and figure out what's going on with the cortisol level. This is going to segue into the next part of our conversation, I think, on a couple levels. So one, I want to talk about stress levels and cortisol. But I also want to talk about that little thing I just touched on with the mind and watching what's going on with the mind. So. Dr. Miloy: Yeah, that's a really key point. The anxious mind will wake up in the middle of the night. Once again, just a reminder, we want to think of the mind is the software of our brain, okay. The brain is hardware, and it's malleable hardware through neuroplasticity, but the mind is the programming. If you were to ask me what plagues humanity, the number one thing, it's faulty programming. Most human’s programming is 90% complete by the age of seven, eight, nine years of age. It's just learned and is taught to them. A person spends the rest of their life trying to unlearn that. It's unfortunately years of suffering. It's just it's unnecessary. So if we can change our programming, and we can at any stage of life, that's good. It's even better if we can do that for our children. So anxiety, sleep disturbance plays a big role. Women going through hormones. There's a whole host of things that are going on there. We need to get better at have helping women through that transition. People like yourself who are recognizing this and helping their patients is really where the rubber hits the road. Because nobody else is going to do it. It's up to the patients and the MDs and other practitioners to step up to the plate and start asking our patients how are you sleeping? That's part of my annual exam with my patients. Because we go through the table of health questions. It's just right up there at the top. Dr. Crockett: You know why we don't like to ask it? Because we don't know what to do about it. I don't want to ask a question and then have them say, Doc, I'm sleeping terrible. I'm like well, I'm a surgeon. Go see somebody else. Dr. Miloy: Go see Dr. Miloy. Dr. Crockett: Go see Dr. Miloy. No, I do talk to my patients about these things. That's kind of the basis for the show is we're taking the conversations about all the stuff that aside from the surgery part and putting it on the show here. Dr. Miloy: Yeah, absolutely. Not to kind of the conversation too much, but you take care of the table, you're going to sleep better. In other words, if you get that aerobic exercise 30 minutes a day and probably the most underrated thing is to get natural sunlight within the first hour upon awakening. 20 minutes of natural sunlight exposure. It doesn't have to be outside. It can be through a window. That's really important. Dr. Crockett: I use a sunlamp during the these dark days I have in the past. So one of the shows I'm doing soon it's going up, I don't have a date yet, is about morning routines. We're going to do your little segment about what you eat. I'm going to throw in some of the stuff like the exercise in the sun and then wanting and all that plus kind of my own routine in the morning. Ollie's routine in the morning. Yes, Ollie’s routine too. Yes. We sit and drink coffee together. Don't we doggy? Yes, and you get your cookies. Yes. So we're going to do that. But sorry, back to what you're saying. So talking about the table of the health. So you're not going to sleep well if you're not doing your exercise, eating well, managing your stress. Dr. Miloy: Caffeine is a big deal. For most people, it has a half-life of four to six hours. So if you're going to drink, consume caffeine, you want to do that in the morning and avoid it once you get past the noon hour. Dr. Crockett: Yeah, I don’t drink it past after the morning. Dr. Miloy: There's some folks they're just they're super sensitive or slow metabolizers. So it can take you know quite a bit of time for them to clear it out completely. Of course if you're stressed and anxious and you're putting a stimulant into your body, that can work against you as well. Dr. Crockett: I have a funny story about a friend of mine that has to do with that. She came into my office. That’s how we met. She was going through some challenges. She comes in with all of these health meds. A big old bag of like all her vitamins that she's doing because she's really healthy. She's gone and done her research and bought all these vitamins. She's like I don’t know what's wrong with me. She's transitioning through menopause and all this other stuff. Oh, I'm so anxious. I can't sleep. She's just kind of breaking down. She takes like 60 bottles out and lays them out on the exam table. I'm like you know what? I'm not a naturopath. I know a little bit about these things, but like that was not my wheelhouse. I'm like okay, I'll sit and go through them. So I started sorting them out. There was like a pile on this side and another pile, like half and half. I like put my hands down, and I went okay. You see all these over here? These are stimulants. Dr. Miloy: Yeah, that's a problem. Dr. Crockett: She was on a bunch of stimulants like green tea and things that had caffeine in them that were hidden. She was having a lot of trouble from that. So we decided to kind of modify her vitamins and stuff a little bit. She started feeling a whole lot better. So I guess my point there other than that's been a fun story is we have to talk to people about what their what hidden stimulants might be in their diet and what they're taking. Dr. Miloy: Yeah, that's really important. For folks listening, I think bringing in your supplements to review with your care provider is really important. Now, some may be astute and up to date on that sort of thing, others may not, but they can really work against you. There can be drug interactions as well with some of these supplements. So we've got to be careful with what we're putting into our body. Then don't get me started on the whole quality and safety issue because that's another problem as well. There are a lot of great companies out there though that are doing good work and making good product. Dr. Crockett: Well, yeah, one of them is ours. Thank you for that little plug. We have a very small vitamin shop, it’s called Virtuoso Vitamins. We sell vitamins that are manufactured by a company that has FDA approval on all of them. So they're all pharmaceutical grade FDA approved. Not because they have to be because nutritionals like vitamins don't have to be. But because the company that we choose to buy from for our manufacturing, puts everything through FDA. So you know exactly what you're getting, unlike what you're alluding to which is what you see on the shelves and just the lack of quality assurance in a lot of those supplements. So I don't want to go too far into it. Dr. Miloy: But we can take this sleep disturbance thing and tie back into microbiome and anxiety, for example. About two-thirds the serotonin that the brain is going to use is going to come from the GI tract. If we have an unhealthy microbiome, we're going to have trouble with serotonin levels. We're going to be insufficient. Dr. Crockett: Which makes us anxious. Dr. Miloy: Which makes us anxious. Absolutely and depressed and so forth. So I like to say the standard American diet is the SAD diet. Dr. Crockett: Sad diet, right. S-A-D. So a lot of people take medications like SSRIs, serotonin reuptake inhibitors. The one thing that people don't understand about those medicines, they're great medicines. But if you don't make enough serotonin to be in that little gap between your neurons for it to do the neuro transmission then you can do all of the reuptake inhibitor medicine in the world, it's not going to work. Dr. Miloy: Yeah, and a lot of them do cause sleep disturbance. They have an effect on the sleep profile. So they have a place. They definitely have their place. But if you look at things that can be done naturally, I would say fixing the microbiome will take time, and that's very important for the just your whole body health. But immediate impact is aerobic exercise. A study was done back in the 90s comparing a very good, and well I would say very good SSRI called sertraline. Sertraline, I like it a lot because it does have very little disturbance of the sleep profile, but it can cause diarrhea. A lot of go there goes your microbiome business. That's the way it is in medicine. We've got to be careful. But the exercise worked just as well for depression and anxiety as the sertraline did. Dr. Crockett: I know that’s stunning. Dr. Miloy: It really shows you the impact of you know what you can do if you take care of business with your table of health. You can heal yourself. I think today more than ever folks want to take less pills. Dr. Crockett: Yeah, I see that. Definitely in my younger patients too. My kids’ generation is much more aware, my kids are in their 20s, and their generation is way more dialed into nutrition and health and eating than we were. Dr. Miloy: Much more sophisticated. They’ve got YouTube. Dr. Crockett: I know, they have all the information. Dr. Miloy: Yeah, they're out there absorbing this information. They're also looking at what happened to their parents and grandparents. They're saying I don’t want to be that. Dr. Crockett: I'm not going to be that. Thanks for listening to this episode of Becoming Virtuosa. To learn more, come visit us at DrCrockett.com, or find us on YouTube for the Dr. Crockett Show. If you found this episode helpful or think it might help someone else, please like, subscribe, and share. This is how we grow together. Thanks, and I'll see you next week. Love always, Sue.