What do sleep, mucus, and, plant diversity have in common? They're all important aspects of a healthy gut and immune system, which is what I connect the dots on today with my guest – friend and sister MD, Dr. Robynne Chutkan.
Multiple studies have confirmed dramatic links between the health of our microbiome, the trillions of bacteria that live in our digestive tract, the health of our intestinal lining, and that of our immune system. Low fiber diets, limited exposure to nature, and sometimes overzealous use of pharmaceuticals like antibiotics and others have affected our gut health, possibly providing a link to greater susceptibility to certain infections. In her new book, The Antiviral Gut: Tackling Pathogens from the Inside Out, Dr. Chutkan shares her research on the groundbreaking gut immune connection and offers a plan for any of us trying to support our immune health by supporting our gut to reduce our risks of viral illness, as well as those who want to recover gut wellness as part of restoring overall health.
Dr. Chutkan is an integrative gastroenterologist and the author of Gut Bliss, The Microbiome Solution, and The Bloat Cure, a graduate of Yale University and Columbia Medical School. She's a faculty member at Georgetown Hospital and the founder of the Digestive Center for Wellness in Washington, D.C. A former governing board member and training committee chair of the American Society for Gastrointestinal Endoscopy, she's authored dozens of scientific articles and lectured globally on the role of the microbiome in health and disease. A frequent medical expert on numerous television shows, including the Today Show, CBS This Morning, and other media outlets. She's passionate about introducing more dirt, sweat, and vegetables into her patients’ lives.
Okay, that's her professional bio. But on a personal level, I met Robynne many years ago at a conference that we were both teaching at, the Food As Medicine Conference for The Center for Mind Body Medicine, and Robynne was speaking before me on the conference schedule. It was one of the first times I've ever thought to myself: okay, I just can't get up there. I cannot speak after this woman. She's just that hot and that smart and that good at what she does. I went up to a mutual friend of ours, Kathy Swift sometime later, and I said, Okay, I have this total girl crush on Robynne. And Kathy said, Well that's funny because Robynne said the same thing about you. So I'm just going to tell you we have a mutual admiration society going on here. I absolutely adore this woman as a friend, as a brilliant colleague, and I'm so excited to introduce her to you if you haven't met her yet.
In this episode, Robynne and I dive deep into gut health with some very important and actionable takeaways. Right in time for cold and flu season, and all year round. You'll walk away from this episode with so much knowledge and insight into keeping you and your family's microbiome and immune system healthy!
Join us as we discuss:
- Dr. Chutkan's experience in medical school and how she became excited to enter the field of gastroenterology
- Dr. Chutkan's experience having a sick baby and finding the root cause of her ailments by digging into her medical history
- Advice for mothers wanting to support their children's microbiome
- Why sleep is SO important for gut health and immunity
- How the gastrointestinal system works and why it is truly the center of your immune system
- Why diet diversity may be one of the most important contributing factors to gut health
- 6 tips to truly optimize your gut starting today
Make sure to follow me on Instagram @dr.avivaromm to join the conversation about this – and all – of my On Health episodes!
Follow Dr. Chutkan on Instagram at @gutbliss and find her new book The Antiviral Gut here. You'll find the entire show transcript below for your convenience, so bookmark this page to refer to it in the future!
On Health Episode Transcript: Optimizing Immunity Through the Gut-Immune Axis
This conversation has been edited for clarity and length.
Aviva: Robynne, welcome!
Robynne: Right back at you sister with everything you said. And, people say, I saw this doctor, I saw her on the website and I listened to her podcast and I say, , she is every bit as fantastic as she seems on the website and on the podcast and on Instagram and with everything else. So I am so excited that we are here, we're almost together. We're together virtually.
Aviva: I'm really excited too. I was meeting with a woman the other day who I interviewed for the podcast, who's this phenomenal reproductive justice attorney, Julie K. Julie happens to have a relative who lives 20 minutes from my house and we got together and we were just talking,, she's our age, she's in her fifties, I'm doing the total giveaway here. She's just really smart and she's very dedicated and committed to the work that we're doing. And, I don’t know about you, but I'm having girlfriends our age who are already retiring, but I want to keep bringing my work to the world.
Aviva: We were just talking about what a gift it is to have women colleagues who are mature and experienced and just super dedicated to be in the room with. I always feel that way when I'm with you, so I'm grateful to have you here.
Robynne: Thank you so much. And you know, to that point though, I have to say, I also feel a great deal of gratitude to be able to really be the architect of what I'm doing at this point in my career. In my fifties, to not be having to turn up in a hospital setting at the crack of dawn with a bunch of colleagues who maybe don't quite understand what I'm doing. And to really say, you know what, this is what I want to do next. Whether it's write a book, or launch a podcast or, you know, do virtual courses, or whatever it is. To really have that grace and latitude in our lives at this point to do that is an incredible gift.
Aviva: Oh my gosh, I'm going to listen to that over and over. I just love that.
Robynne: It’s a lot of work, too.
Aviva: I'm doing it too. I was just talking with a business coach about that yesterday. She's said, “Well, what is it that you most want in your life? And when you see your friends who aren't working anymore at a job, what does it conjure up for you in terms of that kind of ache that you feel for wanting that?” I said,” It's not the ache of wanting to not work at my job, it's the ache of wanting to really be able to craft – to architect – as you say, that time to deep dive into the book writing and the teaching and the things that get it out in the bigger world.
Before we go into all of the seriousness of what we're going to talk about, I have to just ask you if you're willing to repeat a story. When I interviewed you for my book launch for Hormone Intelligence, I asked a question: “What's one thing about you that really is a story that nobody knows?” What you shared with me took me so by surprise and I thought was one of the funniest things I had ever heard. If there was a prize for stories in those interviews, you took it. So this is about your boarding school experience. You know exactly where I'm going.
Robynne: Oh my goodness, yes. I'm from Jamaica and so I finished high school young, at 16. I went to do a gap year and part of the gap year was in France. And I didn't speak any French, which my parents somehow didn't seem to think would be a problem for me, going to school in France. I was n a little town called Evian, where the water's from – the Evian water we drink – but the little town where I lived was even smaller – Évian-les-Bains ( les bains just means on the water) and it was like, 200 people. And I got there and I figured out, okay, I'm gonna tell these people, I'm Bob Marley's cousin because they know who Bob Marley is. So I'm like, yeah, he's my cousin. He is not my cousin. But so I got some notoriety by saying I was Bob Marley's cousin.
Aviva: All right, you go to Yale for college, you go to Columbia for med school. And I will say that there's no way of putting it. I mean, when I went to my first gastroenterology rotation, I still close my eyes and the first thing I see the first time I go into a colonoscopy – cover your kids' ears Moms if you don't want them to hear this – but literally, it’s the scope going up to the anus, It was the biggest butthole I've ever seen in my life on the screen. And then we do the scope and the gastroenterologist was showing us around in the intestines and there was some residue, tomato skins from the prep that the person had done – hadn't cleared out the tomato skins.
And I'm in the elevator afterward with my classmate, we were sharing the rotation together, we're in a crowded elevator at Yale Medical School, and all of a sudden, in the crowded elevator I hear this [slupring] sound, and then all she says is: “tomato skins”. And I could not stop laughing. So it's not really a very, sexy profession, right? It's not like dermatology or OB/GYN,, you know, the things that women want to help other women. Although I will say the gastroenterologists are some of the most fun people to rotate with.
Robynne: And we always have a packet of lube in our pocket. So always, you know, you need Surgi-Lube, I’ve got some. We do have some perks – free rectal exams!
Aviva: So what is it as a young medical student that grabbed your attention about gastro?
Robynne: I have to say Aviva, it was a process of elimination. I'm sure you went through a similar process. I really started medical school convinced I was gonna’ be an orthopedic surgeon. My dad is an orthopedic surgeon, my older brother is an orthopedic surgeon. I thought, right, I'm gonna be an orthopedic surgeon. And literally within, you know, seconds, maybe 90 seconds of my orthopedic surgery rotation, I was like, Yeah, this is not for me. This is fine. There's a lot of hammering and drilling and it's very interesting. It's not how I want to spend my life.
And then I thought I would want to be a general surgeon because I was still thinking about something surgical. But I found, and I don't know if you had this experience too, but my general surgery rotation, it felt very, it was such a military vibe to it, you know, it was a lot of yes or no sir, almost saluting the chain of command or the chief resident, the resident, the junior resident, all the way down to the medical student. And it just seemed very regimented. And like you, I'm a little bit of a hippie.
Aviva: For me, I loved surgery and I love the intricacy of surgery. There were two things about it that were not a grab for me. One is that if you specialize, you're kind of doing the same procedure over and over, which is great, you get really expert at it, but I need a little more variety. But the big thing was, I just couldn't stand being indoors all the time.
Robynne: Yeah. And you kind of hand over the patient when you come out of the operating room. So, I had a mentor, somebody I did some research with, a wonderful Australian gastroenterologist. He was funny and smart and sort of irreverent. And I started doing some research projects with him and was like, Wow, this is actually really interesting. And it's still very procedure oriented as you know. You know, having done about 18,000 colonoscopies and endoscopies. But there is a whole other side to it, to your point in terms of variety. So the procedures are, yes, colonoscopy can be repetitive. But I'll tell you, no two colons are the same. And this might sound hard to believe, but sometimes I'll see people on the street and I'll not recognize them. But then, when I think back to their colonoscopy, I'm like, Oh yes, this was the woman with an enormous polyp right at the splenic flexure. It took me half an hour to get that polyp out. So I do kind of have a better memory sometimes for someone's colon than I do for their face.
Aviva: It’s funny because as midwives and I think OB/GYNs and family docs,you know a vulva. Like there's this stuff you know.
Robynne: Remember that placenta?
Aviva: Great thing you want someone to know when you run into them at a party or the grocery store.
Robynne: So, there is still a uniqueness to each digestive tract, but what has been so exciting in the last 10 years is the divergence of the conditions and realizing that the old tools that we have, like colonoscopy, endoscopy, CAT scans, are fantastic for diagnosing colon cancer and polyps and gallstones.
But for the new conditions that we're seeing, the new and emerging conditions of dysbiosis, SIBO, leaky gut, these sorts of things, even Fatty Liver, we really need to have microscopic eyes when it comes to this. We need to cast a broader net and we need to have different tools and we need to rely a lot more on our clinical skills and less on our procedural skills. And so it's been an exciting time to sort of be at this frontier of the microbiome and how it relates to people with GI conditions. But it's also challenging Aviva, because in gastroenterology, there's still a lot of my colleagues who are sort of like, “Well, I don't believe in that.” And I'm like, “What? You don't believe? What do you mean? It's like saying, that's like you don’t believe in gravity.”
Aviva: I am curious about this: at what point was it, was it in the realm of conventional and traditional gastroenterology that you got exposed to these sort of out of the box concepts like the microbiome and intestinal hyperpermeability, which we call leaky gut? Or did you have to go outside to start to get exposed to that?
Robynne: It started at a very personal level for me – and I think you and I have discussed this – with my daughter who's now 17 and a half, so really about 17 and a half years ago through her birth. She was a C-section baby. She was minimally breast fed because my breast milk dried up after about a month. She had a lot of antibiotics, both prophylactically at the time of the C-section and throughout her first couple years of life, which I just didn't understand at the time. And I don't think any of us really did. Now it seems like every week there's a new article about early antibiotics and childhood obesity, about early antibiotics and autoimmune disease, about early antibiotics and cognitive problems. But you know, the awareness back then really wasn’t anything close to what it is today.
And so at the time I actually thought, “Oh, they're being really proactive, this is great.” She got the antibiotic at birth because I had the flu and I had a fever. They thought, okay, fever in the mom, even though we know it's a flu, we're going to give her antibiotics just in case. And this sort of ‘just in case’ approach turned into two years of literally monthly antibiotics. She became a very sickly baby and child. It wasn't until I really started to excavate what was going on, and ask, because even though I'm a physician, this was my first child and our only kid. So I didn't know, I would ask my friends, “Does your kid have the flu every month?” “Or, how many antibiotics have they been on?” And they were like, “None.” And you know, here Sydney is, one year old, and she's been on 14 courses of antibiotics.
And so I started to realize she was always just recovering from some sort of illness, sick or about to get sick. And it wasn't until I sat down, and I sort of obsessively filed these medical records, which I always think is a good idea. It's a good idea to keep an eye on what's going on. And I looked and I realized she'd literally been on 20 courses of antibiotics and she wasn't even in preschool yet. And this little seed started to germinate in my mind that she's actually becoming sicker because of the antibiotics. And, you know, the pediatrician was really a lovely woman, very well meaning, but nobody was really keeping track. It was like, let me skip a couple pages back in the chart. Okay. She was on amoxicillin last time. All right, we're gonna give her Ceftriaxone this time, or whatever it was.
And when I took my wad of prescriptions and my little spreadsheet and was like, Do you realize Sydney's been on, you know, 22 courses of antibiotics? I think it was shocking for her also. And again, the awareness of what this does, right?
So of course those first thousand days of life are so important as a microbiome is developing. You have a baby who's a c-section baby, and I know nobody knows this better than you, Aviva. So that baby has missed out on coming through the birth canal and being colonized with the mother's gut bacteria and the bacteria from the perineum and then has missed out on the human milk, oligosaccharides and breast milk that are feeding the baby's microbiome and then has been pounded every month with a new antibiotic, including at birth. And so her poor little microbiome was just struggling to develop, and that was really increasing her susceptibility.
And what I realized also is a lot of the things they were treating her for were viral, viral pharyngitis, vital otitis media. She eventually got tubes in her ears and that helped. But this situation of kids who have frequent antibiotics, when I really started to realize, okay, there is a connection between these two, was when I read an article in our GI literature. A study, a meta-analysis from my own institution where I did my GI training. Mount Sinai showed that frequent antibiotics in childhood is a direct risk factor and link to autoimmune diseases like Crohn's and ulcerative colitis. And we have data from Europe and data from Canada showing this increased risk with each round of antibiotics.
And so I started asking the patients in my practice – In my practice, I see a wide range of things, but I'm particularly focused on autoimmune diseases in the gut- so I started asking my patients who had Crohn's and ulcerative colitis about their childhood and I was really startled to find a lot of them were c-section babies. They had not been breast fed or limited breastfeeding. They had been given a ton of antibiotics for various reasons. And then I started seeing it in the scientific literature and then I realized, oh, doctors actually don't know this. Like, how can we be the last ones to know? Yeah. You know, I'm sure you experience this where the patients are reading and they're learning and the doctors were just kind of doing what we've always done.
Aviva: I kind of came at it from a different direction in that I was the hippie mom. My oldest is 37.
Robynne: So you had her at five?
Aviva: Yeah, I had her at five! He got his first fever when he was like 14 months old. So I took him to the wonderful pediatrician – family doctor that we had who came and did a home visit after his home birth and she wanted me to put him on an antibiotic. This was 37 years ago, so I was concerned and confused and didn't know what to do. I got the prescription filled and I brought it home, and I went to give him the first dose and I poured it into the little baby measuring spoon. I looked at it, it was this pink orange bubble gum smelling stuff. And I was like, okay, wait. She just told me he had a viral infection, so why am I giving this antibiotic? I knew enough, I was already, you know, studying to be a midwife and I was already an herbalist. So I called her up and I said, “Hey, I really respect what your concerns are, but can I wait on this? He's breastfeeding, he's hydrating, he's comfortable.” And she said, “Sure, give it 24 hours.” And of course, within 24 hours he was improving. And I never gave the antibiotic.
Now, you know, we're both physicians, we're both moms. We both want to encourage people to absolutely use the antibiotic when you need to use the antibiotic. But I was part of that early realm of resistance to antibiotic overuse and really challenging physicians and encouraging my women who I had midwifed their babies, to also learn to be comfortable just asking the questions.
Fast forward now almost four decades later, before COVID, antibiotic resistance was the single biggest global public health threat facing all of us – and it's largely due to overprescribing by physicians and also to its use in the animal industry. The CDC has spent two decades now trying to get physicians to reduce their antibiotic prescribing. It's gone down from like 70% of over prescribing to maybe 55% to 60%. So for those of you who are mamas who are listening to us and you're like, “I don't wanna end up in that situation,” the CDC has a website section called “Get Smart”.
If you just Google “Get Smart CDC”, they actually give you indications for all the common kids things, like sore throat, ear infection, and they break it down like, is your baby or your child under two? Is your child under six months? Is it a one-sided or two-sided ear infection? So you can look that up yourself or you can just go sit with your family doctor or your pediatrician or nurse practitioner and just have them pull that up so that you're not just guessing. You're not just taking an emotional reaction and saying, “Oh, I heard Robynne and Aviva talk about this and I don't want my kid to have that” because there are times you need them. But you can actually do the educated, very simple research of saying, “Yes, this is a time, it's absolutely needed.” Or, no, this is not a time, It's absolutely not. And there is also a gray zone where they'll say, this is a watch and wait or, individual judgment. Do not be afraid to ask the questions.
Robynne: And the asking of the question is the most essential thing. I love the fact that you were what, 19, 20? – really young at the time, and even though you were starting to do your training, you weren't a physician. You weren't even a midwife yet. But something – that sort of mom intuition – told you- hmm. And here's the thing, her answer that, sure we can wait – studies show that pediatricians prescribe antibiotics about 60% to 63% of the time when they think the parent expects it.
Robynne: And 7% when they don't.
Robynne: So what does that tell us? There's an enormous wide expanse of gray zone. Where an antibiotic really isn't necessary. I also love that you prefaced it when you spoke to her by saying, “Hey, I, you know, really respect your opinion, etc.,. But I have this question.” Because one of the things I am always admonishing people to do is to not fire your doctor, but to bring them along with you on the journey. Right? And maybe you need to educate them a little bit and they're educating you and you're educating each other. I mean, if they're an asshole, then fire them for sure. That's a whole different thing.
Robynne: But somebody not knowing isn't necessarily a reason for you to move on. It's really how they respond when you bring up that kind of query. So I think if you really engage them in a dialogue and say, “Here's why I'm concerned about using antibiotics. You know, my child has been on a lot of antibiotics up until now. I've read reports about how antibiotic use in childhood can lead to problems like with childhood obesity, with autoimmune diseases, with asthma, etc.,. And I'm concerned. And there are great guidelines for that too, about when you need to treat a fever versus not.”
But here's the thing, one of the really, to me, I mean, there are so many things in this book that were sort of outside my zone as a gastroenterologist related to the gut – and one of them was this concept of fever. So we think of fever as something that needs to be treated. But when you think about it, fever has been preserved throughout gazillions of years. It has been preserved with us as a response because it plays an important role. So it's both a response to an illness, infection, inflammation, etc.,, as well as a sign that something's going on. But we treat it as a symptom.
One of the really startling statistics is that viruses like polio virus and some other fairly virulent viruses replicate 250 times faster at normal body temperature compared to when you have a fever. So your fever is your body's way of slowing down viral replication. And what do we do? We go and reach for the Motrin, the Tylenol, etc. And so again, it's really important to know when are the times for you or your baby, when there is a fever, when should you treat. And, as you said, Aviva, there are some great guidelines for that. But to not just reflexively reach for that, because what you may be doing inadvertently is, lowering your body temperature and allowing that viral replication to proceed at a much faster rate than it would have if you had let the fever run its course. There are o many fascinating things about our body: stomach acid, the gut lining, mucus, fever, all of these things that we don't really think about, but they're all there to protect us. They serve really important roles. And so one of the really exciting things for me with this book is explaining to people what this stuff does. And I'm super excited by it. I'm like, isn't this great? So it is exciting to sort of spread that news of like, hey, your body can do all these things.
Aviva: I know, it's so interesting. I was giving a talk the other night as part of the gut reset that I offer, and I just got inspired to talk about mindful eating, which is part of the program. But I ended up sort of guiding this little visualization around mindful eating and about chewing. And it dawned on me just how many of us are eating dashboard meals or keyboard meals and not chewing. And we forget that we have these digestive enzymes in our mouth. So I have so many patients who are like, should I take digestive enzymes to help my food break down more? And you know, they have so many different gut problems and I'm realizing, so many of us are just not even starting with healthy digestion by chewing the food so that the stomach acid can then act on it. And then the digestive enzymes can then act on it, and we can absorb our nutrients. It's like we're bypassing or overriding so much of what nature does.
Robynne: I love that. I mean it really starts even before the food gets into your mouth with just the sight and the scent of the food and the salivary amylase starts to release. And so then if you're just kind of gulping it down from there, you're doing exactly what you said. You're not really allowing optimal digestion to occur. And when optimal digestion doesn't occur, optimal absorption and assimilation of the nutrients doesn't occur. I mean, what do you think? We are in a culture where people are interested in taking something. What do you think is behind that as opposed to sort of understanding how the body works and letting the body do its thing? Why do you think we're so primed to want to actively do something?
Aviva: I think we're so driven by this sort of pharmaceutical model. “A pill for every ill” and quick acting fixes for things. The medical model has really instilled that in all of us. And then, with all due respect, functional medicine and the wellness movement have kind of piggybacked on that. I jokingly sometimes say, “If it's not a pill for every ill, it's a supplement for every symptom.” And we just want fixes rather than taking the ‘a little bit more work’ approach, which is doing the dietary changes, working with our lifestyle. And the reality is, all those supplements don't work if you don't do the other things anyway.
Aviva: So you went from being GI Doctor/Mama with Sydney going through all of this, and somewhere in there you bridge this gap of bringing this awareness into your work. And you mentioned things like leaky gut, SIBO, dysbiosis, still, and there are still doctors who are like, those things don't exist – when we actually know that they literally do exist. How did you bridge that gap to be comfortable doing this as a practitioner in a kind of environment that doesn't really support that? And what are some of the things you've learned about what people can do by healing their gut? Maybe segue into the whole immune piece and how you got inspired to do this book at this time.
Robynne: Yeah, I think that I benefited a lot from being a part of a conventional community, not just with my training, but I had been on the board of one of our large GI advocacy organizations, the American Society for Gastrointestinal Endoscopy. I chaired their training committee, the PR committee. I'd been on faculty at Georgetown for 10 years. And so when I started talking about this and when I wrote the first book, Gut Bliss, which is now almost 10 years ago, 2013. I was an insider. People knew me, like, “Oh yeah, this is my colleague. She's actually a really good doctor.” And so even though they weren't quite sure what I was talking about in the book, there was an element of trust and a familiarity. And that's why I think it's so important for those of us who are within those conventional medicine circles to really lead the charge. Because there is an element of trust when you're talking to your colleagues versus, “Oh, it's this other doctor, it's a naturopathic doctor, functional medicine doctor – they’re not part of our club.”
Aviva: Yeah. It was the biggest reason I went to medical school. I realized that if I was going to make systemic change, I had to speak that language and be recognized by those people as safe and trustworthy.
Robynne: Absolutely. And I'll tell you, my biggest referral base is other gastroenterologists. So after they've done two endoscopies and two colonoscopies and done all their tests, the patient now wants to talk about their bloating and gas. They're like, “Oh, you need to go see Dr. Chutkan, she's gonna sit down, she's gonna talk about all this stuff with you”. People complain a lot about their gastroenterologists not being interested in this other stuff. And when you think about the economics of it and how gastroenterologists are incentivized with getting a physician fee, maybe they own the endoscopy suite or they have shared it so they get the facility fee, the pathology fee, the anesthesia fee. I mean it's a lot of money for doing a procedure that doesn't take very long versus a fraction of the reimbursement for sitting down and talking to patients.
I'm a big advocate for a different kind of digestive wellness education. I feel like we need digestive wellness educators the way orthopedic surgeons have physical therapists. So you go to see an orthopedic surgeon and within two minutes they know you don't need surgery for your partially torn medial collateral ligament damage or whatever it is. But they don't just say, “Okay, you're fine, you don't need surgery.” They say, “Here, I want you to see my physical therapist, I want you to do 10 sessions with them and, and then work with them and report back.”
But we don't have that. So an endoscopy scopes you, “Yeah, it's fine. You know, it looks normal. But here's some Nexium, don't let the door hit you on the way out.”
Aviva: So we need gut rehabilitation, it sounds like.
Robynne: You know, if we could sort of take maybe like a health coach- nutritionist blended into one and give them more disease specific training, I think we could really get there. And that's what we need. We need people who are on the front lines with people who, okay, you have your diagnosis, you have celiac disease, you have irritable bowel syndrome, whatever it is. Now we're gonna help you work step by step through the diet and lifestyle change. And to your point, Aviva. not what supplements to take, but what is it that we can do with your diet to really improve your symptoms? What is it about your habits, your sleep, the stress in your life? All of these different things that are so meaningful.
I mean, the sleep data is incredible for susceptibility to viral illnesses. There's a study that showed that people who are chronically sleep deprived getting six or fewer hours of sleep a night are at a 76% increased risk of viral infection. We know that vaccines, all of these vaccines, not just for COVID but for influenza, for hepatitis, etc.,, they're much less effective if you are sleep deprived in the two days prior to the vaccine. I mean, people just don't know that, you know, they don't know how important sleep is for maintaining a healthy immune system. I mean, they might kinda look back and go, okay, I was really sleep deprived and stressed out and then I got sick. But I don't know if they're understanding that that's not a coincidence, that sleep is essential for rebooting your ‘computer in your body’ and making sure that your immune system is working well and that the basic science studies around sleep and the immune system are fascinating, showing the drop in T-cell immune function within one day of significant sleep loss. And honestly, I read Matthew Walker's book, Why We Sleep. And after that I was like, no more red eyes, you know, if I had to travel.
Aviva: I don't do them anymore either.
Robynne: Somebody wanted me to come to Vegas or something and, Oh, you can take the red eye back. I was like, No, that's not happening.
Aviva: It’s a deal breaker for me too, yeah. So, to me, the gastrointestinal system right now is probably the most exciting frontier in medicine. And I think for several reasons. One, I think it's the first time in the 40 years that I've been involved in the healthcare world that I'm seeing an awareness and an awakening to the fact that we need to get dirty, we need to get healthier foods, we need to be aware of medication overuse. There's finally this portal or doorway connecting these various lifestyle factors, these various things that have been very fringe in some ways into this very hard science realm of, this affects our gut.
Can you share what you feel are the most important points about what the gut-immune connection is? I know you're super excited about this too.
Robynne: Well, I think the first thing I want people to know is that most of your immune system is physically located in your gut – 70% to 80% of it is along the gut lining, primarily in the small intestines. So just in terms of where it is, it's physically in your gut, a lot of it.
The second thing is the relationship between the immune system and the gut bacteria. So you have the gut lining, which is just one cell thick. It's a razor thin lining. And that's the only thing. I mean, it's kind of frightening when you think about it, Aviva. It's the only thing protecting you from the outside world. When you swallow stuff and you ingest things and it's in your gut – it's in this long 30 foot hollow tube that runs from your mouth to your anus and everything in your gut is outside of your body.It has to pass through this membrane, this selective permeable membrane to get into the bloodstream to get into different organs. So the food has to pass through to get in, and hopefully viruses and toxins, etc., are kept out.
But the relationship between the immune system and the gut bacteria are that you have this thin lining on one side. On the inside, you have all the immune processes going on and, on the outside, you have the gut bacteria and of course you have a mucus layer between the bacteria and the actual lining. And there is constant chatter. So for example, when there is a gut bacteria called Bacteroides fragilis or B. frag, we call it – a very common gut bacteria. When B. frag, that is again, in the gut lumen, so it's outside of your body, senses dangerous viruses it sends a signal to immune cells in the lining and they release something called interferons.I love the name because they're called ‘interferon’ because they interfere with viral replication. I was like, whoever named interferons, interferons, is my kind of person. Like, let's just call it what it is. And so it's almost like the B. frag. kicks the interferons. It's like, hey, bad virus, let me give you a kick. And then that stimulates an inflammatory cascade with your immune system. You know, sending out the message to the T cells and natural killer cells and B lymphocytes to make antibodies, whatever needs to happen. But you can start to see then that if you don't have a healthy complement of bacteria, and for example if your Bacteriodes fragilis are, you know, lower than they normally should be, you are not going to have that signaling and you're not going to have an appropriate immune response.
Similarly, we know that gut bacteria ferment dietary fibers to something called short chain fatty acids, and those short chain fatty acids modulate the immune system. They're like air traffic control. We don't want it too high, we don't want too much of an immune response, because then you're gonna’ end up with a cytokine storm and you're gonna overshoot the mark. You're gonna end up destroying normal healthy lung or liver or brain tissue. You don't want an underactive immune system cuz then you're not gonna clear the virus. So for that, you know, I like to call it the goldilocks immune system. You need to have sufficient levels of short chain fatty acids and it's the gut bacteria like Faecalibacterium prausnitzii that are producing that.
So we have a study from about a year and a half ago that came out in the literature and there was one in the U.S. and one in China showing the same thing” that the composition of the gut microbiome was actually the most accurate predictor of outcome from COVID in terms of outcomes like respiratory failure, ventilation, ICU admission, and death.And the accuracy was 92%, which is higher than everything else combined. If you take comorbidities, age, gender, C reactive protein. If you take even the lab markers and all the demographics and put them all together, you don't approach 92%. But analyzing the microbiome and looking at the levels of F. prausnitzii as high F. prausnitzii equals good. And of course to get high F. prausnitzii, you need to eat a lot of fiber and then high Enterococcus faecalis, a different bacteria that is associated with penetration through the gut lining and entering to the bloodstream, high levels of that bacteria associated with a poor prognosis.
So it is, you know, it is just remarkable how much information is going on in the gut between the immune system, the gut bacteria, the lining, all of this. And you know, you don't have to have a shopping bag full of supplements to keep this stuff going. You need to eat some high fiber foods, have some good bowel movements, and, you know, chances are you gonna be okay.
Aviva: So you mentioned COVID as one example of predictive value of healthy gut microbes and providing some measure of inherent protectiveness against organisms. And you and I talked about this before and both agreed that we were on the same page that this doesn't mean don't get your covid vaccine.
Aviva: It’s what we do for overall health, and from what I've seen in my practice, it's not just viral infections. It's really deeply connected to autoimmune conditions as well. And we know the literature strongly supports this translocation of proteins or lipopolysaccharides from bacteria across that razor thin lining you mentioned, triggering a cascade of events in the bloodstream and in the immune system that can lead to autoimmunity. And so yes, we know COVID is this huge, important, significant issue, but autoimmune conditions are one of the top eight leading causes of death for women. And it's mostly women who are affected by autoimmunity. It's also mostly women who have the majority of gut problems. So can we talk about this autoimmune gut connection a little bit too?
Robynne: Absolutely. If people are interested in the history of this, David Strachan, who was a professor of epidemiology at the London School of Tropical Medicine and Hygiene. was tasked back in the 1950s with trying to figure out why in post-industrial London they were seeing such high levels of autoimmune diseases. So, too, they were really interested in hay fever, which is sort of like asthma and eczema. They were seeing skyrocketing rates amongst British children.
So he embarked on a 21 year study looking at kids from birth to adulthood to 21. He embarked on this epidemiological study of over 17,000 kids and he found two really important findings. The first was that kids who were in households with lots of siblings, where they were getting sick all the time, lots of childhood illnesses, they had very low rates of autoimmune diseases later on as adults.The second finding was that kids who were in more affluent households, who at the time in post-industrial London in the fifties and sixties, affluent equated to having more access to bathrooms, more bathing, more washing, etc..
Nowadays there is no correlation between your socioeconomic status and your level of hygiene. But back then there was, And so they found that these kids from wealthier families, particularly kids from small families who didn't have siblings and were better off and were bathing and washing more regularly, they had high rates of autoimmune diseases later on. And this was the basis for what's now called the hygiene hypothesis, which, you know, what's really startling Aviva, you know, is if you look at a map of the world today, you still see the high rates of autoimmune diseases in more developed countries like North America, Western Europe, etc. and lower rates in sub-Saharan Africa. But as countries become more developed, we're seeing this in India, we're seeing it in Saudi Arabia. Their rates of autoimmune diseases now start to skyrocket.
We had a wonderful fellow who we trained at Georgetown when I first arrived there in, my goodness, 1997, he was one of the fellows and he went off to run a large clinic in Saudi Arabia. And I saw him about 10 years ago. So fast forward about 15 years, and when he used to rotate in my clinic, he would say, Oh, you're nice, you're fun to hang out with, but I don't need to come to this clinic because we don't have IBD (inflammatory bowel disease – Crohn's and ulcerative colitis) in Saudi Arabia, And then fast forward 15 years, he's like, yes, now we have a clinic just for Crohn's and ulcerative colitis
So we're seeing it as countries become more industrialized. And it's everything, you know,it’s pesticides and processed food. It is the increased use of antibiotics. And of course there are lots of good things that come with industrialization too. Access to clean water,, people having sanitation and having access to toilets and so on. So it's certainly not all bad. Chlorination in the water got rid of cholera. But chlorination in the water also kills all the healthy bacteria.
So it is very much a double edged sword. I think part of the goal is to help people figure out how to create and maintain a healthier, more diverse microbiome without going back all the way to the cave. Right? How can we do that? And we have some really important clues from groups like the American Gut Project who published this incredible study in 2018 that looked at the composition of people's microbiome. They looked at over 10,000 people globally. And the interesting thing with this, Aviva, is it didn't matter the label, whether the person called himself a vegan, an omnivore, a flexitarian, a lacto-ovarian pescatarian, didn't matter. The single most predictive factor for the health of the microbiome was the number of different plant foods people ate in a week. The magic number being somewhere around 30. Right?
So 30 different plant foods and by plants, that's fruit, vegetables, nuts, grains, spices, herbs, 30 or more different plant foods per week was predictive of a much healthier, more robust, more diverse microbiome. And diversity is key. Just as we need diversity in the real world to thrive, we need diversity in our microbiome. People who ate 10 or fewer had a much less healthy microbiome. And, this is an important point because I have so many patients in my practice, and I know you probably do too, who say, I'm a really good plant eater. I mean I eat vegetables, you know, lunch and dinner. But it's the same peas, carrots and broccoli in heavy rotation. So, you know, getting out to the farmer's market, eating things seasonally, figuring out what to do with the rutabega when it arrives.
Aviva: Also lentils and other legumes are so important.
Robynne: Yes, they are amazing.
Aviva: Those can add a lot of variety too.
Robynne: Legumes are part of what we call MACs, microbiotic accessible carbohydrates, which are, you know, ideal food for gut bacteria to feed our gut bacteria and really help them pump out those short chain fatty acids.
Aviva: And a lot of people got very spooked by lectins, we will not name the doctor who created a hundreds of thousands of dollars platform to promote this idea, but it's not really true. We do need grains and legumes.
Robynne: It's not true at all.
Aviva: Numerous studies have shown healthier weight, healthier levels of inflammatory mediators, healthier blood sugar, the list goes on. All back to these really important carbohydrates that we're getting from them. Okay. So we have a number of different conditions that you've mentioned, and I know you talk about at length in your new book, The Antiviral Gut, which I had the privilege of pre-reading and writing a blurb form I'm really excited about.
Robynne: Oh, we loved it that you were able to do that. Thank you so much.
Aviva: Thank you for inviting me to! We mentioned leaky gut, dysbiosis, SIBO, which is a form of dysbiosis. How do people know whether their gut is healthy or whether they're struggling with gut related syndromes or conditions when maybe they don't even have obvious gut symptoms?
Robynne: I love this question because I think it also speaks to, just as you said, the bag full of supplements. It also speaks to this idea – and we've unfortunately seen, different fields have taken advantage of this – trying to draw a straight line between symptoms and conditions. So I like to remind people that leaky gut is a mechanism, and you use the correct term for it, increased intestinal permeability. It means that your fishing net – the holes in it have been compromised and are a little larger than usual, and now things are coming through. So if you think about food sensitivities, now you may have undigested food particles that are coming through and triggering an immune response. But the idea that if you go and do the food sensitivity testing, which most of the testing out there is completely invalid and illegitimate, and I tell people, this is not worth the paper it's printed on and you come back with this long list of things you're supposed to avoid.
The first thing I'll tell people is, I'll ask, okay, have you had a reaction to any of these foods? And not a reaction like, I felt bloated, but you know, have your lips gotten swollen? If the answer is no, I will put all the berries and all the nuts and the things that are healthy back in and say, “I really want you to pay attention to your symptoms.”
But, you know, reminding people that an increase in intestinal permeability is one mechanism. There are other mechanisms, there are other things that can be going on in the immune system, and so not everything is caused by dysbiosis. Again, there are genetic predispositions, etc.
But if when I look at the categories, some of the things I encourage people to look at is, let's look at the medicine cabinet. Are you taking something that is interfering with your microbiome? We know from an article published in the Journal, Nature in 2021 where they looked at 41 different classes of medications and they found that 19 of them were very disruptive to the microbiome. So the obvious ones, we know antibiotics, acid blockers, steroids, things like that. But antidepressants were a big class. Artificial sweeteners are a huge class, too.
Aviva: We know that some also interfere with the gut lining, like the nonsteroidal anti-inflammatories. And if you don't have a healthy gut lining, it's very hard to have a healthy gut microbiome.
Robynne: Absolutely. And it's very hard to have a healthy immune response.
Aviva: You were talking about food sensitivity testing and I couldn't agree more with you. I was talking with a colleague recently about how frustrating it is that I feel like I'm spending probably 50% of my medical appointments with, I would say 80% of my patients, explaining why gut microbiome testing hasn't been legitimized in the way that it's being used. Or that food sensitivity testing, as you said, typically isn't worth the paper it's printed on. Or, why this or that or the other new supplement isn't really all that it's cracked up to be, that the data is cherry picked or written by the person who owns the company.
Robynne: Who is selling it? And to circle back to the testing, because that's such an important thing, first of all, I really encourage people to do testing through a company like American Gut Project, which is a nonprofit and makes their data available to researchers worldwide. So what they're doing is, they're helping to contribute to the science. So you're really sort of being a citizen scientist with that as opposed to a more commercial company where they're using your sample, they're sending you a result that may be valid or may not, and they're using it to then sell you something else, a product, a meal plan, or something else.
But even with microbiome testing, it's very broad brush strokes. Just like we can't do a full genetic analysis and know everything about you and how healthy you are. We can't do full microbiome testing and know that either. I mean, I think the most helpful thing with that is the diversity. And that can vary. You know, you can do a stool sample in the morning and one in the afternoon, the number can be fairly different.
Aviva: Also, unlike our genes which are relatively fixed, I've read some amazing data about the microbiome. How it's not necessarily whether you do or don't have this organism, it's whether you have this organism in relationship to having enough of another organism…
Aviva: But that you could wipe out a whole strain of what we would call beneficial organisms. And then you have what we would typically call a more pathogenic organism, but that organism can switch its functioning to take the place of the other organism. So you may see it on a gut microbiome test and think, “Oh, that's one of the bad ones,” but it's actually adapted its behavior so it's functioning as one of the ones you need.
So it's hard to know what to do with that information and I think so many people leave functional medicine practices with this testing in hand feeling like they're just a train wreck and there's so much wrong with them. And they'll also get results, especially with gut microbiome testing – they'll give you the organism and then across the line it'll give you all the diseases that can be associated with it…
Robynne: It’s terrible.
Aviva: So you just feel like you're a disaster waiting to happen when none of it may be true- true-and unrelated, or true-not true-and unrelated.
Robynne: Absolutely. I mean, there's no question that this is an exciting field and it's growing fast, but we are nowhere at the point right now where we can be using microbiome testing to diagnose conditions. And I wanna say that fairly clearly in a research setting, we are starting to develop different microbial signatures. So it's exciting to see, okay, with Crohn's disease, we know that we see these associations, but the sensitivity and specificity isn't there for one person to take their sample and say, “Okay, you have Crohn's based on the stool sample.”
There is fascinating data out of Cornell where they were able to take ME/CFS, Myalgic encephalomyelitis/chronic fatigue syndrome, and just from looking at a stool sample, diagnose Chronic Fatigue Syndrome, they were able to do the same thing. Not at Cornell, but somewhere else, a different study. They were able to diagnose long covid from looking at a stool study. But again, these are large studies, this isn't for the individual being able to use.
Aviva: It's not what you get from the stool test.
Robynne: No. And not from the commercial ones. You get a list of foods that you should or shouldn't eat. Sometimes they're nonsensical.
Aviva: Okay, so you have a patient who comes to you and says, I went to this integrative practitioner and I got all this stool testing and I got all of this food sensitivity testing and I'm having these symptoms and I really don't know what to do. I want to optimize my gut. Maybe she has an autoimmune condition, maybe she has gas and bloating. And she's also concerned about the relationship between her gut health now and her long term susceptibility to these diseases or her short term susceptibility to something like covid or the flu. Where do you start? Because we're saying ‘not so much’ on the testing. ‘Not so much’ on the supplements. We know that there are a lot of factors that we've mentioned, antibiotics, 40 other potential medications, herbicides and pesticides, standardized diet, how we're born (mode of delivery) – whether it's C-section, breastfeeding. All these things. And then here we are, these adults and we're saying, I want to have the healthiest gut possible. And I wanna add to that, we know that colon cancer has been on the rise amongst younger and younger people. And that's been almost entirely attributed to a low fiber diet.
So where do we start? Yes. What can we give people for good news and what they can do?
Robynne: So I will say, if I'm seeing somebody who has a serious autoimmune disease, like a Crohn's or ulcerative colitis patient, it is a different process than somebody who just says, I want to optimize my gut. Because with somebody with an autoimmune disease, what we're trying to do, the bar is higher. We're trying to put their disease into remission. And I'm really proud to say that in our practice we have about a 80% remission rate using primarily diet and lifestyle and the more benign medications versus the biologics that can work quickly and dramatically, but unfortunately have a risk of cancer and infection and so on. So we have a really good track record with that. It's not a hundred percent, it's about 79% to 80%. And it takes a really motivated patient because that is a much more rigorous regimen for what we need to do because we're trying to take actual ulceration in the colon and heal it. We're not trying to just have healthy bowel movements.
Aviva: And what's beautiful, for someone like you, and I've worked in conjunction with gastroenterologists around this, is, it's not like you're just making this data up. You can actually go in and look and you can see before and after.
Robynne: Exactly, yeah, you’re seeing the ulcers heal. And, I have to say as a physician, there's nothing more satisfying than seeing a patient with Crohn's or ulcerative colitis who was really sick, who was, you know, maybe not even able to work. Maybe really affecting their libido. Maybe not able to have an intimate relationship with their partner or care for their children. With women this is much bigger, and seeing not just when I scope them and I see, okay, all these ulcers, these strictures are healed, the inflammatory markers are better, they feel good. I mean, that is priceless.
Aviva: I've also seen in my practice, similarly, working with patients with IBD, has been incredibly satisfying. And I've had many women who have come to me in their twenties saying, I want to have children sometime in the next 5, 6, 8, 10 years, and I don't want to be on Methotrexate or Infliximab or one of these medications that you really don't want to be pregnant on either. And they're wanting to heal it. And you just see these transformations. But then you get the, for me, an external gastroenterologist validating and confirming that not only are they feeling better, but yeah, they don't need that medication or, they don't need the recurrent steroids anymore, which is incredible.
So okay, with someone with a higher bar, and I agree it's a very different approach, you are still working primarily with diet, lifestyle.
Robynne: Yes. Diet. Absolutely. And the medicine cabinet, because so often people are convinced that the medicine cabinet is where the cure is. And so often in my experience, the medicine cabinet is contributing to the problem. And I'll give you an example. I spoke to a patient over the weekend, the husband of a patient of mine, and she was so sweet and apologetic about being in touch with me, but her husband had been having low grade nausea, bloating, change in bowel habits, etc., for several months. He was put on an acid blocking drug, a proton pump inhibitor, over a dozen years ago by his very well meaning gastroenterologist for reflux. And she just kept him on this drug and now it was very clear to me within about, you know, two or three minutes of talking to him that he had dysbiosis as a result of the proton pump inhibitor, which is very well described. So he started having symptoms that were different from the reflux, low grade nausea, a little bit of bad taste, all these other symptoms. And they just kept saying, Oh, now the drug isn't working, let's increase the dose. Let's put you on a different drug. Let's do all of these things. And it was challenging, convincing him that the acid blocking drug that his gastroenterologist of over a decade had been giving him is actually the cause of the problem. And that we needed to get off that. And get his microbiome healthy.
Aviva: We know from studies done by companies that produce medications like Prilosec, that you can get severe rebound symptoms when you try to stop them. And most doctors are like: “Well, see, that's proof that you need to stay on it.
Aviva: When actually, it's rebound from the medication suppressing acid, and studies have shown that you can use those drugs symptomatically as needed, that you don't have to be on them continually. So again, there's this gap.
Robynne: You can use H2 blockers or antacids.
Aviva: Or DGL licorice.
Robynne: Absolutely. Yeah. Or you can eat earlier and a smaller meal. You can do so many things. And I think, you know, I think Aviva, that this is, we connect on so many levels, but I think the thing that we're both so passionate about is, we want to give people the information so they can understand what's going on in their bodies and they can figure it out. Like, ideally, you don't need to come to see me. Right? And, you know, I love how you get into the nitty gritty for women's reproductive health and all about menopause, etc. And you know, the body is, it's just a marvel. It's a remarkable thing. And so understanding how it works and how it all works together and being able to, to put that out to people is really such a privilege.
Aviva: Let's look at that in the realm of the framework of your book, right. The Antiviral Gut. Why that, why right now? And how to not just get healthy, but how to get healthy in a way that really optimizes immunity through optimizing the gut.
Robynne: Well, I'll tell you the motivation for the book was really simple. There was a study in July, 2020 that came out that didn't surprise me at all, but I think it surprised a lot of people. It was a population based study, 54,000 patients on acid suppression and specifically proton pump inhibitors. So I'm not talking about Pepcid or an antacid, I'm talking about Nexium, Prevacid, Prilosec, Pantoprazole, any of those proton pump inhibitor drugs that are very effective and completely block the acid in your stomach. So this population based study came out and it asked a simple question, does being on this drug increase your risk of COVID? And the answer was a definitive YES. If you are on one of these drugs once a day, your risk was double. If you were on one of these drugs twice a day, your risk was three to fourfold.
Aviva: It's almost not surprising because we know from studies done in the ICU that patients on these drugs have higher risks of pneumonia.
Robynne: Of course. Yeah, absolutely. We've known for decades that these drugs increase the risk of hospital acquired pneumonia, of C. diff, of foodborne illnesses like Campylobacter, of viral outbreaks on cruise ships, norovirus, rotavirus, etc.,. So any enteric infections, any infections that can get in through the gut, bacterial and viral. We have known that these drugs increase the risk. But I think in our sort of COVID panic, people were somehow just not sort of thinking rationally about this.
So then, Aviva, I asked a couple friends in medicine who were not in GI and they were like, I didn't know that, but now that you explain it, it makes sense. And then I asked a couple GI colleagues and they also somehow weren't putting it together. And that's when I said, Okay, I mean, I know the patients out there are smart and often they do know more than the doctors, but clearly this is something that, as you said, you and I, it's not surprising, but people weren't sort of putting it together. And then the data on the microbiome study came out showing that high levels of F. prausnitzii, were so predictive of a good outcome. So that study came out, a study came out looking at MISC, the multisystem inflammatory syndrome in children, showing that that was associated with increased gut permeability, high levels of Zonulin
They were finding it in the bloodstream, also in the stool. And I realized that what seems very elementary to me, which is this basic statement that the health of the host matters and that the health of the host may be as important or even more important than the potency of the pathogen just wasn't reverberating. And people were just terrified. And not to say, I mean, this pandemic was some scary stuff and you know, we were right to be, to be concerned, but reminding people that this stuff is predictable and it is often preventable. Not, you can't necessarily prevent getting it, but that there are factors that we know and a lot of the things, when we look at a lot of the factors that are associated with the worse outcome, like having heart disease or being diabetic, etc.,, those things are all conditions that also at their root have disruption in the microbiome.
So what I want to do is to arm people with the material so that they are not terrified and thinking this is just a random thing that's gonna fall from the sky. I mean, I loved in the mucus section, I talk about how super spreaders are related to the quality of the mucus, the thickness of the mucus, how active the enzymes are in your mucus. So if you have mucus that's not doing its job, that's not sticky and trapping viruses that doesn't have good enzymatic activity to break down the virus, you are more likely to spread it because a mucus, when you cough on somebody, it means that virus isn't destroyed.
It's great that we have fancy tests and all these different things, but at the end of the day, there's some really basic bodily functions and a lot of 'em are going on in the gut that are there to protect us. And we don't have to take an acid supplement, we just have to not block our stomach acid with a proton pump inhibitor or not do it every day if we can help it.
Aviva: So, Robynne, we know that from the study you cited before, eating a wide diversity of plant-based foods, 30 different types of foods a week. And I know when somebody hears that, they're like, “Oh my gosh, that's not achievable.” But if you think about just a salad – if you have a salad with romaine lettuce and some grated carrot and some chopped red pepper and some pumpkin seeds and some chickpeas and maybe some sprouts and some oregano, that's seven things right there.
Robynne: Seven. Yeah. I love to use the oatmeal example. So you use some almond milk, you have the oats, you have some walnuts, raisins, pumpkin seeds, blueberries, I like to put a little shredded coconut, that's seven with the bowl of oatmeal.
Aviva: So we've had 14 between breakfast and lunch.
Robynne: In half a day, we are halfway to our weekly goal.
Aviva: It doesn't mean you just eat 30 servings a week. You want to do what we're talking about every day. Yeah. But if you just think about those combinations, it's not that hard to achieve that variety. So that's one of the things, let's go through maybe four more things that folks can really feel like, oh. Well we did two, we did sleep, and we're saying seven hours a night to nine hours is the sweet spot. We are talking about food variety. What are three more things that folks can say, “I'm doing this for myself and my family?”
Robynne: A big one is getting out in nature. Not just because we know that we get our soil microbes, or are trying to get out of the sun, but because of something called the outdoor air factor. We've known about the outdoor air factor for more than a hundred years from the Spanish flu epidemic, 1914 to 1918.
What we saw was that soldiers who recuperated inside, and it was typically the officers. It was like, “Okay, you're an officer, you're gonna get to go inside and sleep in a bed.” They had a much higher mortality, up to 40% in some studies compared to some of the enlisted men who recuperated outside on cots. And we know that the OAF, the outdoor air factor, is defined as a germicidal constituent in open air that is toxic to pathogenic bacteria and viruses, etc.
So in addition to everything, this whole concept of shinrin-yoku, forest bathing, of it making you feel more relaxed and lowering blood pressure and decreasing risk for heart disease, we know that it's a potent antiviral defense mechanism, too. And not just for decreasing transmission, but also for recovery. So I want people to get outside more. We've been inside a lot with this pandemic. So getting outside is a really important one and important for your kids, and get a little bit dirty, get some soil microbes on you. So that's another big one.
Hydration is a huge one, and particularly for people who are struggling with post-viral syndromes. I know in my practice as a gastroenterologist, I would say, 25% of the conditions I see can be dramatically improved by just drinking more water. People are drinking a lot of flavored water and different things, straight up water. A good baseline is half your body weight ounces, whatever your body weight is in pounds. If you're 160 pounds, 80 ounces, if you're 140 pounds, 70 ounces as a baseline. And then everything you get on top of that is extra. And you gotta measure it because you know that the thirst mechanism doesn't kick in until you're already severely dehydrated. And why is water so important? Because it helps move the products of digestion from north to south. And we know that the stool is one of the major passages of elimination for viral illnesses. We want to get that out of the body, so we've got to sort of wash it out of the body. So being well hydrated is another really important one.
And, in terms of the, just to circle back to the food a little bit, I have a little rule I use for patients: My 1, 2, 3 rule: one vegetable in the morning, two at lunch, three at dinner. So now, it's gotta be six different plant foods. So if you do 1, 2, 3, you get six a day. If you do that five days of the week, you'll get to 30. So keep in mind, one plant food at breakfast, two at lunch, three at dinner. And you know, you can have fun with this. You can make a chart and do different things.
So we've talked about food and particularly fiber. We've talked about getting out in nature. We've talked about preserving stomach acid. We've talked a little bit about mucus. But the actionable thing there is to let it flow. Don't take that antihistamine or other things that dry up the mucus because then your mucus can't trap and expel viruses. Think twice before you reach for the ibuprofen or acetaminophen. If you have a fever, familiarize yourself with the guidelines, for when to treat a fever, either through my book or through the CDC website, American Academy of Pediatrics.
Aviva: I have a ton of stuff on mine too. And in fact, talk called Who's Afraid of Fever.
Robynne: Sleep is really important for optimizing the immune system. And I think the last one to talk about really is stress. We've seen that stress is a risk factor for poor outcomes in every viral illness. And also with post viral syndromes. I just saw in an article a couple days ago that came up on my feed saying that for post COVID, for long COVID, that preexisting depression, anxiety, chronic stress was a significant risk factor for who would have post viral symptoms. And again, you may not be able to do anything about the stressful situation, but there's a lot you can do in terms of your response. And, you know, the data for this stuff is fascinating. If you think about reactivation of viruses – who gets shingles? People who are stressed. Who gets herpes outbreaks? People who are stressed. So the stress is important for acute viral illnesses and, you know, making sure you have a good outcome. And also for preventing post-viral syndromes and recurrences of viruses. And so thinking about simple ways to activate your parasympathetic nervous system like, going outside for a walk, like doing 10 deep breaths, you know, whatever it is. There are so many ways, and I outline a lot of 'em in the book. A lot of them around breathing.
Aviva: One you're super committed to also is regular exercise.
Robynne: Exercise, yes. For healthy bowel movements, for reducing stress and for getting outside.
Aviva: Robynne, I could listen to you all day. I could talk with you all day. I love everything you have to share. It's so important, It's so cutting edge and it's so actionable and I'm excited to tell everyone that you have this book coming out. So tell us the name and where folks can find it.
Robynne: Absolutely. Thank you so much. Of course. I have my copy upstairs instead of right beside me, but it's called The Antiviral Gut: Tackling Pathogens from the Inside Out. It's available wherever books are sold, Amazon, Books-a-Million, etc. Or you can get it on my website, robynnechutkan.com. We have some great pre-order incentive bonuses. We have a great PDF of meal plan recipes, food guides, and also an antiviral masterclass in January that is gonna be wonderful. The pre-order bonus is going to continue even after the book is on sale. So think about signing up for one of those two.
Aviva: Robynne, love you. Thank you for joining me.
Robynne: Oh, love you too, sister from another mister.
Aviva: Yes, definitely sister from another mister. And everyone, I hope you have enjoyed meeting this incredible woman. As you can tell, she's brilliant. A powerhouse, phenomenal. I hope you'll get a copy of her book. Yes, I wrote a blurb, but I have no financial relationship to the book. I did it because it's just that good.
And we'll see you next time on, On Health. Thanks for joining us and taking care of your body, mind, and spirit by being here with us today.