Dr. Pal Manickam joins us for an enlightening discussion on gut health myths, daily practices, and lifestyle modifications. This episode dives deep into practical strategies for a healthier gut.

Let's enjoy the transcript

Dr Pal: Like how I go to the gym and train my bicep, could I train my stomach muscles also? By eating good food which is high fiber. The most common cause of constipation is lack of fiber

intake. Okay, and also lack of water intake. The most common cause of bloating It's constipation. Was there ever a case where you just told a person drink more water and it cured them?

Welcome to the office of gut and butt.

Ryan:Dr. Pal Manikam, a gastroenterologist, health educator, and a content creator with over 2 million subscribers on YouTube. He talks about gut health, time restricted feeding, and mostly plant based diet and his passion for health extends beyond his practices and social following.

He's also the creator of Medcom, a standard comedy show that combines his sense of humor with his background in medicine. We welcome Dr. Pal Manikam who will bust all of the gut health myths first time ever on health shot podcast.

Dr Pal: How are you finding India this time around? Super, wonderful. Always good to be in India. Always a good pleasure to connect with you. I was just so excited when I realized that Christmas time that you were coming into India. So I was like, I told my team, let's meet Dr. Paul because you know what? Here's a gastro doctor, surgeon.

Who tells people fast and eat less. So my kind of guy. So it's going to be like funny for me to ask you questions and our followers confuse us for each other. Anyways, so I said, let's open it up to them. And what are the questions that your followers or my followers had? I'm the gastro, which is the gut department.

So a quick fire of about 15 20 questions, doctor's really busy, he's given his surgery time to us. So we really get cracking. Okay. So first question. Somebody asked me, I always face constipation and bloating though I'm a vegetarian. The assumption is vegetarians are holier than thou. And I always face constipation and bloating, though I'm a vegetarian, meaning what vegetarian is untouchable in the gut system.

And I eat out once in a while. So first things, Dr. Pal, constipation, what is it? And bloating, what is it? And do vegetarians also get a tappat?

Ryan:Okay.

Dr Pal: So, uh, the most common cause of constipation is lack of fiber intake.

Ryan:Okay.

Dr Pal: Okay. And also lack of water intake. Usually what we tell my patients, whenever the patients come in with constipation is the first thing is increase your water intake to minimum 2 liters of water per day.

And then increase your fiber big time, at least 25 grams of fiber per day. And that's a lot. Until you consciously include it, you are not going to get it, uh, based on the current, uh, eating habits. And then the most common cause of bloating is constipation. Because the pope is held back in the gut usually, you know, uh, the dysregulation of the brain, gut access, and there's a development of bad gut bacteria in, we call this as sometimes chronic idiopathic constipation or atypical bowel syndrome, constipation.

But regardless, there is this dysbiosis where there is brain gut access as dysregulated. And now talking medical options. , speaking of medical options, was there ever a case where you just told a person drink more water and it cured them? To be honest, that is the treatment, but people think that I need to give the medications only then they will be reassured.

Okay, good. This is a good doctor. And obviously, you know, we recommend people to drink water as a doctor. How do you prescribe water? Is there a magical way that you do it or anything like that? Yes, I do. I do. So, you know. Um, even my personality and also my education is usually not theoretical. So I always do practical, uh, waste and trips and I share that with my patient.

So we calculate eight glasses of water per day. So I tell them to drink one glass before meals and one glass after meal, breakfast, lunch, dinner, six glasses, and then one glass at 10 AM morning snack, and then PM snack. You're all done. Awesome advice. Staying with the same thing, one of our followers asked us, Can dehydration, lack of water, cause stomach cramps?

Oh, yes, you know, uh, so see I in my channel as well always have been promoting hormonal balance Correct circadian rhythm and there are only like few major important hormones that we need to be really considerate One is the you know, insulin melatonin cortisol Um three major hormones that I absolutely worship and love and everybody should love and worship as well So these hormones love water Hi.

Ah, so, you know when you give water they just like They are having a party out there, they're basically swimming in the pool. Um, so basically you increase the quality of these hormones by providing them water for the uninitiated to stomach cramp or with the easiest way we could describe what a stomach cramping, uh, female say like I got cramps, right?

And then here, somebody is talking about a gut cramp. And then Virat Kohli gets a calf cramp. So as a doctor, can you kind of give us like a layman opinion of, is it a knife poking us or somebody socking you in the gut? What is it like? So cramps itself is a muscular contraction, correct? Where it happens in calf, it's a skeletal muscle contraction.

When it happens in the gut, it's smooth muscle contraction. Oh, we have muscles in the gut. My gut is nothing but muscle. So could I train that like a gym training? Uh, like, you know, how I go to the gym and train my bicep. Could I train my stomach muscles also by eating good food, which in by fiber, that is the exercise for the stomach.

So that's the exercise was to eat correctly, eat correctly, and not do this in the kitchen. So no stomach crunches as doctor says, uh, and speaking further, we're going to talk only about Bonafollow as one. Somebody asked us. So is xylem husk or what we call in India is isabgul good for gut bacteria? Can I consume it every day?

So xylem husk is a wonderful option. We also give it to all my patients in the U. S. as well. It comes with a brand called Metamucil. Um, there. The idea behind that is, as we talked about, fiber is absolutely critical for the gut. Uh, in our modern days era, we don't get enough fiber, so we add these fiber supplements.

But the problem is, we need to add it very slowly, because every individual is different. So sometimes fiber can precipitate abdominal bloating. So most of the times what happens is I take ask them to take psyllium husk They take one day and then they get bloated and this like, you know, this doctor is not good.

Let's go to different doctor. Oh So you should talk very very slowly Sometimes you might be able to even take two to three capsules that you'll be surprised sometimes you'll be able to eat only one or Even better is forget about psyllium husk and just take fiber through natural sources until you reach 25 grams of fiber per day minimum So 25 grams of fiber is the key thing, try and find it from natural sources.

I think the human race wants more convenience of a powder or

Ryan:pill,

and they're not willing to go back and check what are the foods which have fiber and how can I take that at my daily diet. But, uh, but you know, it's a long process. Even I myself didn't know what was the fiber content in multiple food ingredients.

So educating yourself by seeing Ryan's channel, in terms of how much fiber is there in every ingredient. Uh slowly and steadily what happens is that even without your knowledge You will start incorporating all these ingredients. So you do a lot of colonoscopies and endoscopies So you put a camera in and you check people's guts both from top down and bottom up correct When people eat really good or have good fiber, are you as a doctor able to see a good gut and a bad gut?

Absolutely. Yes. So when we put the camera down, we can see how inflamed, how angry the stomach is. You can see that? Yeah, absolutely. When we put a camera down. So that means people, because they can't see something, they're not able to link that they are slapping their gut. Correct. But they're slapping it inside.

Ah, so that's the dangerous part. So it's too late sometimes before they come to you and not too late. Uh, I mean, to a point that yes, regarding in terms of symptoms. Yes. You know, it's too late. What are the symptoms we should look for? Like what are the symptoms I should look at or our followers should look for so that we don't have to put a camera down our throat or up our butt.

So, uh, there are two paths to that. Okay. So the up your butt is colonoscopies. Yes. And I do that when patients don't have any symptoms at all. Ah, okay. Expand please doctor. So it's a screening procedure. Why should we do screening? So in United States, when you turn 50, the medical insurance pays me. to do the colonoscopies on every patient.

And what are we looking for? We're looking for growths inside the colon. We call it as colon polyps. What are these polyps? These are like similar to skin growths. It can grow inside the colon based on your genetic predisposition, what you are eating, lack of fiber, lack of physical activity, obesity. All these are risk factors for formation of these pre cancerous colon polyps.

And these screenings that you do, doctor, on these 50 plus people, Have you found people who you have saved their lives? Absolutely. I mean, this is my date I'm a superhero on a daily basis. Wow. Wow. Wow So sticking with the gut and i'm going to come back to this colonoscopy and endoscopy Uh, I think in a lot we got like about 25 or 30 percent of people asking this one question, which is Doctor, what are the remedies for acid reflux?

So my first question to you. What is acid reflux? And then who are the guys who are going to save us? Okay. Acid reflux is basically reflux of the stomach acid back into the esophagus. Reflux means what? It comes back? Re gurgitation. Basically, it comes back. Basically, the acid should be in the stomach alone.

But unfortunately, something has happened where the sphincter muscle, that is a muscle at the end of the junction of the foot pipe and the stomach, it is supposed to close. It's like a gate. It's a gate. It's a door. So if that doesn't close properly the acid comes out. So when you eat Food goes inside the stomach the acid is secreted by the stomach and it gets broken down into small pieces Correct, and then the lots of acid is being secreted because we eat a lot so what happens is if this If this door the door closes as soon as the stomach the food goes in the stomach But if the door is open because acid is secreted acid comes back into the esophagus Awesome.

There's a funny question we got from one of our followers. Okay, my stomach, speaking like in third person, my stomach, not me. My stomach is not digesting ghee or fried foods. If I eat those foods, I pass tools with mucus and I get loose motions. What should we answer to such a follower? So, um, maybe he's very sensitive to those foods, correct?

But isn't it common sense? You eat, eat something, it's going to slap you, you should avoid it. Uh, may, so there are two paths to it. One is if you eat more, yes, that is the So you mean to say that sometimes we can fly under the radar by eating less of that? Ah, correct, correct, exactly. So first thing to this person is that you need to decrease the fried fatty foods whenever, whatever he is eating.

But let's say that he still has the problem even after decreasing it. That is where we say that your stomach is very sensitive. We need to fine tune your stomach, hand hold your stomach, and love your stomach back. For those who are uninitiated, but follow you and follow me. What is the meaning of mucus in stools?

So mucus is the intestinal lining secretes some fluid. It's like a stickiness when you blow your nose. Does it look like that mucus when you blow your nose? Yes. Is it a clear white mucus or is it like when you get a cold, which is green mucus? So it's usually yellowish mucus. And then, you know, we see that while we are doing the procedure colonoscopy.

So if I potty and I look down, I should technically not see mucus with my stool in generally not generally not and if I see a lot of mucus it could be a sign of an problem. It could be a simple problem like, you know, irritable bubble syndrome or something like that. Or it could be a relatively more, uh, you know, complex problem like inflammatory bubble disease like Crohn's disease or ulcerative colitis.

When you were in medical college, were you given stool samples to look at and see what is mucus and what is without mucus? And I absolutely loved it.

I got a gut feeling. I want to really enjoy your profession for the rest of your life. Okay. So the reason I'm asking these questions is because, uh, you know, Oh, one thing. Yeah. More than mucus, the most important thing is blood. Oh, we shouldn't see blood, right? There are two types of blood, right? Fresh blood and old blood or something like that.

Can you tell us about that? Yeah. So more than mucus, blood and stool is considered as a red flag. So fresh blood would look like red blood. Huh. So stool could be bright red. Yes. What is that problem? Most likely it is hemorrhoids. You got to understand that we can get skin problems inside our gastrointestinal system and it could bleed.

Yeah. So what if I bleed in the stomach? Then the color of my stool changes to black. So if I look at black, and when we're talking about black, what is black like this? Black like my hair. Like the mic black? No, I don't have hair, but still, if you have. Or just my black. It turns that black? Yeah, yeah, yeah.

Very dark. So normally stool is brown in color, light brown, dark brown. The reason that it is black is if there is a bleeding in the stomach, the acid digests the blood, which is red in color, that turns into black and calms down the intestine. So those of you who got a black tongue and black stool. See Dr.

Pal immediately. No, see a good doctor locally as well. We don't need to wait for him to fly down to America. But these are things that people actually never discuss at the dining table or in families. Like I would share something very intimate with you and the followers. Around 10 years ago, I had hemorrhoids and it was one and, um, you know, I took a lot of turmeric supplement and a lot of omega and a lot of protein powder, no fiber.

And I guess I started getting blood in my stools. So I kind of got it treated with a rubber band kind of thing. And the doctor explained it's a very harmless procedure and got it done. Very interesting is why am I telling everyone about this? It's when I went to my mom and I said, I'm going in for a medical procedure, which is very simple.

And I'd be out in two hours. She said, I also have hemorrhoids like, okay, uh, your grandfather also had it. And then I was like, what about your brothers and sisters? I never asked them. So I picked up the phone and started calling all my uncle and aunties and chachas and chachis and everything. And guess what, Dr.

Pal, everybody, everybody had it and no one was silent about it. So is it true that people don't discuss their bowel movement and gut problems? And it's a, it's a very like a taboo topic. Yeah, absolutely. And that's why I combine humor into this very taboo topic. What's your biggest, what's your biggest joke to a patient at the table?

I said, welcome to the office of gut and butt. Gut and butt. Almost like Beavis and Butt head.

Now, we have a lot of people who follow us who will be pooping every day and be eating every day. And mostly they come to me because they eat wrong. And there's one problem I can't solve in eating is when people live in PG's, paying guests and hostels. And that's most of struggling India today. People who watch us, who are building their careers and all.

And they want to work late nights and all. And they're saying that, how do I control gastric if I stay in our PG's and hotels? Because they add baking soda to food. So, you know, there are some modifiable factors and there are some non modifiable. What secret agent can we take to protect us? That's what I'm saying.

So there's modifiable factors and then non modifiable factors. Non modifiable factors is looks like in this person where they are giving baking soda in the mess and he doesn't have any other option to modify that. Uh, best case scenario is stop it. But as a medical doctor, do you think baking soda does a kujjili or irritate your gut?

It completely depends upon the individual. It's bio individual. It's like, I can't stand coffee. It irritates my gut. But for somebody else, coffee is amazing. I'll tell you an example for research wise, they said that coffee, chocolate, citrus fruits have aggravated the acid exposure because it increases the acidity.

So before five years, 10 years before we used to tell all patients when coming into the office, stop chocolate, stop coffee, stop. But the patient is telling me that when I eat chocolate, it is nothing is happening to me. I'm okay. But when I drink tea, yes, that is happening. There's a bio individuality. The same way when I told recently, somebody have guava to increase your vitamin C.

This is, I got a throat infection and I get cold. And I actually saw this in a few of my clients that there's a bio individuality. So no one size fits all in food. Yeah. Does the same hold true for medicines? Yeah. So that's why, when we talked about the Psyllium husk, some patients may be able to tolerate it.

I had a patient who got Psyllium husk constipation. It could. He's like, I just can't touch it. I couldn't poop for two days. So I don't know what happened to that Celia Musk in his gut, but you know, the baking soda option, um, is there anything we can do to counter it? Um, so what I tell my patients is whenever there's a non modifiable risk factor where you really absolutely love this baking soda, it's okay, but see whether you're able to check all the other risk factors that you can modify, like sleeping properly, eating right at the other times and all those things.

Okay. Simple, Dr. Pal Singh, go to the nutritionist. So risk for fatty liver and how it can be reversed. Now, does the liver come in the gastro department? Yes. That's what's called gastroenterology and hepatology. Hepatology is liver. Ah, so I learned something today. So doctor is also a hepatologist. Oh, uh, hepatology.

So there is one more year of fellowship where people do just liver alone. And in the entire human body. Let's say you are not a gastro or a hepato, according to you, which is the most important system? Gut. The gut. Even if I'm not a gastro, I'm going to say gut. Yeah, I know there's a joke that somebody said that, you know, all the organs had a, had a meeting at a discotheque.

And everyone was posturing that I'm the best in Dr. Pal's body. Brain says I'm number one. The nose said I'm number one. The heart said I'm number one. Everybody said number one. And then when the, when the anus. Sphincter muscle said, I'm number one. Everyone laughed at the, at the sphincter. Innocence. Okay.

You guys are laughing. He decided to shut up everyone by stop working for three days. All other systems shut down or open up an inappropriate circumstances. That's even worse. That's even worse. In my gastroenterology, they say that the most important function that any other organ cannot do is use anal sphincter muscle.

That anal sphincter muscle to work properly. There's so many things that has to go right. And, and correct me if I'm wrong. If people have a lot of stress, your anal sphincter muscle goes for a toss. Absolutely. That's where you see this, you know, fecal incontinence where they're not able to hold stool and they have leakage.

Yeah. That happens mainly, mostly in neurological patients. That's why they say there's a gut brain axis. Okay, we'll talk about that a little bit further, uh, but we were talking about risk for fatty liver and how it can be reversed. What's your take to people? So fatty liver, we see that every day on a daily basis, two main risk factors, one is alcohol and the other one is obesity.

But the problem is we drink alcohol and we eat biryani as a side dish.

Ah.

Dr Pal: So there are three B's that goes for fatty liver. One is biryani, beer, and belly fat. People don't give up biryani and beer. Then they deny that they have belly fat. So, so we got our cast, uh, task cut out. Look, the doctor, the gastro is saying, get your belly fat down, get your beer down.

That's alcohol. Correct. And basically biryani for those who are uninitiated and not from India, it means food, eating too much of food. Biryani? Yeah. Yeah. Biryani itself is an emotion. That's a different story. Do you know the highest sourced food on the e commerce platforms in India is biryani? Which is why there's this full startup generation of different biryanis happening because we just love biryani.

And so I think keep eating biryani because you'll keep Dr. Pal and me in business. Okay. What is the alternative to white rice for South Indians from Telangana? So I have a wonderful hack for it. I love white rice. Okay. I always include white rice. Yes. Brown rice is good, slightly better, but I don't like the taste of the brown rice for me.

So I always do white rice, but I just make sure that I have at least three servings of vegetables along with the white rice. No matter what I try to, if I have only one vegetables, then I increase that serving. So make sure that you have this fiber from additional sources when you have it. It's like when you go out partying, make sure there's one person who is not drinking.

I think that's the equivalent of vegetable being there with rice. You're celebrating with rice and the vegetables are behaving like the, uh, the driver that's going to take you home and responsibly like everyone, low blood sugar level, you know, I'm going to take care of your fiber. The police is a gastroenterologist when they have no fiber is there.

Okay, good. We can leave. Yeah. You're not cutting a fine ticket at that point. Okay. I'm a 21 year old girl. Why do I have gastric issues when I eat fast food or oily foods? Um, is this, is this a misnomer that young people have indestructible guts? Yes. No, this, this might be true in one way because their abuse has not been translated into clinical symptoms yet.

So, but. If you talk to a 40 year old like me, everybody will tell you that I wish I would have eaten right between 15 to 30. I think the long term damage I mean, all this damage is long term. It doesn't happen right away. And the actual effect happens 10 to 15 years after. And that is the problem. In fact, the question has the answer itself.

Because why do I have gastric issues when I eat fast food or oily foods? As a nutritionist, I would tell you this. The answer is in your question. Fast food and oily foods cause gastritis. You are, you are, you're being activated. And just because you're 21 years of age, doesn't mean you're immune to it. It just means that Dr.

Paul gets you much younger as a patient, you know? So take care of what you put into your body. So I say that, you know, people say, Oh, I have hemorrhoids. Whenever I sit down, uh, I have pain. I said, don't sit down, sit up.

The patient must be thinking, which doctor have I come to right now? But, uh, with a sense of humor, okay, we are moving from the solid department to the gaseous department. So vapor department, after every meal, there is gas formation in my stomach, gas formation in my stomach. So let's gas this gas form in the stomach.

Does it form in the small intestine? Does it form in the large intestine? And. Why is that gas production? What could be the reason? Yeah. So there are two main reasons. I think main problem with many people over here is I think irritable bubble syndrome, IBS, where your stomach and colon are extremely sensitive.

And the reason they became sensitive is because it has not been fed the right amount of food that the intestine wants. And what happens is through due course of time, it's always a balance between your good gut bacteria. and your bad gut bacteria. You want good gut to be up, bad gut to be low, so that the balance is perfect.

But because of the processed foods, ultra processed foods or whatever you are doing, this balance is reverse. And this bad gut bacteria loves sugar, loves carbs. So you eat carbs, they make you crave for carbs, you eat carbs, and then the bacteria digests and then releases CO2, releases gas. And then that can manifest as bloating.

that can manifest as flatulence and that's why we call there is a condition called SIBO. We call it a small intestinal bacterial overgrowth. So they're not supposed to be there at that small intestine? In that much amount of amounts. So working with doctors is a privilege that I always have and Dr. Pal for me is on free time with me right now on my podcast HealthShots.

So we can ask him any question that you've asked a very relevant question. Doc, somebody asked us. How to reduce creatinine levels in a diabetic patient? I have two sub questions there. What is creatinine and who is diabetic? Okay, so diabetes is an easy answer. Okay. Where you have like increased glucose levels, your pancreas, insulin regulation is not happening.

Uh, creatinine is a measurement of your kidney function. The only way that we can find your kidney is working or not is a blood test. Okay. If we shut down all the blood tests in the world, there is no way that we can find your kidney is damaged or not until it turns advanced. So creatinine is a basic essential thing.

So why are we talking about diabetes and creatinine is diabetes on a long term, uh, in long term effect, it causes end organ damage which is including kidney. So we call that as diabetic nephropathy where because of the uncontrolled diabetes The glucose levels have compromised the kidney function and how do we know the creatinine level will go up?

And we know on the routine blood check when people do it for diabetes and that's why patients with diabetes get routine blood checkup You know, they check their eyes they check their foot because eyes is because of end organ damage of the eyes and foot because the nerve supply to the foot gets Compromised where they will not even feel hot or cold.

So they step on a floor Even with hot water, they will not be able to figure out which means the glucose levels in the body is so high That it has compromised the function of the nerves. That's called diabetic neuropathy. When it damages the retina of the eyes It's called diabetic retinopathy. And when it damages the kidneys, it's called diabetic nephropathy.

And the last one is I am a gastroenterologist You know what I heard in all of that I just saw a sugar molecule slapping me Sugar slapping my eyes, sugar slapping my heart, sugar slapping my kidney. Is that what it's doing? Pretty much high amounts of sugar where you're not able to manage. Again, comes back to the long term abuse of the body.

And so basically I think, so when the person's asked us how to reduce creatinine levels in a diabetic patient. So the answer is decrease the glucose levels, kidney function will get better. Do you think fasting would help? Absolutely, absolutely. You know, uh, Have you had any crazy cases where, you know, The blood tests are like of all these kidneys and liver and whatever blood markers you check Like they're all crazy And then you had a person change their diet and do fasting and have you seen miracles in like very fast period?

Yeah, you know this fasting circadian rhythm is very close to my heart. So what I did was I started this Weightless program. It's called new me new me new me. Okay, it's an online weight loss program where I Figure out whether they are diabetic or not by a simple 35 year old coming in, you know, I need to lose weight So we do some blood work and then you would be surprised whether a1c level which is the measurement of your diabetes Is sky high like 11 and normal is around, you know, like I don't even know that you know, right?

So then I said that oh, you know, I sit with them in my clinical practice That's what I do, you know, and then I check with them in terms of Uh, okay. Let's start with your fasting regimen. Initially, we don't go like one meal a day. No severe fasting because of the insulin diabetes regulation is a little bit very tricky.

Fasting works, but very carefully in diabetes along with the supervised regimen under a physician guidance. So can I say that you truly are a doctor that prescribes fasting as a form of medical treatment also? As a prescription.

Ryan:Yeah.

Dr Pal: Very individualized. Very individual. That's the key. That's the key.

Yeah. I don't go extremes. At the same time, one plan is not for the same for everybody. I can say, okay, go for like 6 p. m. I don't think that's the way. Doctor, this is a female asking this question. Due to PCOD tablets, polycystic ovarian disorder. I mean, you know that, but for those who are not aware outside.

So women have this condition which affects their ovaries. They take a tablet. I'm not aware what the medication is. So she says, I'm not able to consume any proper food, any suggestions. So PCOS is not a disease. It is linked to your circadian rhythm.

Ryan:It's

Dr Pal: linked to your hormonal imbalance. Unfortunately, women are at a disadvantage compared to us.

Because women have so many hormones to be balanced. Estrogen, progesterone, all we have is testosterone and we get away with it. And they go through so much hormonal changes every month. Can you imagine? Every cell is dying and then waking up again generating again every month. They go through a lot for them To have a good balanced hormones, the circadian rhythm has to be even on the top of the game.

And, uh, the medication that she's talking about is metformin. What metformin does is it just tries to improve the sensitivity of the insulin. So the insulin works a little bit more so that the ovum follicles and everything can, um, come out with good quality by collaborating with estrogen progesterone.

So as a doctor, would you say that's one part of helping women along the PCOD journey or reducing it? Is weight loss big time? Weight loss is not one part. That is the major part. If they lose weight, they will not be on any medications at all. My mind is going 30, 000 cycles a second because nowadays I'm getting a lot of teenagers, 18, 19, 20, 21 year old girls coming into a nutrition clinic with PCOD condition and could one of the prescriptions be I need to get your body fat percentage down?

All your prescriptions should have it. But that's a no brainer. It has to be. I think the bottom line mechanism is because of this disturbance. Now she says she was not able to consume proper food. So I don't have teenagers or girls or ladies consume proper food all the time. But do you think that metformin can also, uh, blunt your appetite or affect you?

Metformin can influence your, uh, gastric, uh, disturbance. As a gastro, you've seen people that take medication and it changes their Ha, so we usually saw diarrhea. People take metformin and then they just start having, like, more loose stools compared to before. So then we decrease the dosage, we adjust accordingly.

Somebody's asking, can we have tea or coffee once in a while? I feel gastric discomfort when I consume it regularly. My mother in law, she's a gynecologist. She's a South Indian. She loves a coffee. This sounds like her right now. Please suggest whether I can drink it once in a blue horn. No, absolutely.

Provided if it is, if your stomach is okay with it, when you got, when you, when you got a wound and it's hurting you, you can't go and dig into that wound is, is what you're saying. But when you do all the other stuff, right, the wound will be healed and you can go back to your routine. So are you saying that?

Kind of dig a little bit deeper and see why you're facing a problem and don't blame tea or coffee There could be other triggers. That's what you want to tell your mother in law. Yeah

My mental health Affects my digestion. How can I fix it or improve it? Sleep. Meantime, your mental health and your digestion Is linked with a common mechanism called sleep. That's why you're talking about circadian Which is part of the sleep cycle and the wake up cycle. Your body needs rest We were just abusing it so much.

Just slow down, take rest, make sure that you have 7 hours of quality sleep. Your body's hormones are so powerful than what you think I am predicting and I can see the future and I can see the Present. I'm in dr. Paul's Consultancy clinic. He's writing on his prescription pad less watching of Netflix no binge watching of Netflix Acidity will disappear gut brain axis will improve if you're watching Ryan's channel, it's okay We are only 45 minutes and watches during the day time, not at the night time.

Yeah, exactly. We're child, we're children friendly. How to overcome vitamin deficiencies in vegetarians? In America, do you see a lot of vegetarians? Huge. Lot, lot of our Indians are vegetarians, right? And there's Not Indians, American people. They're also, they're deficient. Yeah, it's becoming like a fashionable statement.

So, so What's it like? I would love to be the fly on the wall in your consultation room. Somebody comes in like, Hey doc, I'm Viggy. I'm vegan. I'm vegetarian. And then you're looking at them and you're like, what are you looking for? Are you looking at the blood test? Are you looking at anything from their body?

How does it work? How does your brain work or mind work with such people walking in? When they say they're vegetarian? Like how are you clinically diagnosing people? Um, Like for example, somebody walks in. Can you say that they're vegetarian or vegan? Very difficult. But the moment they tell you that, then So, but actually I can say based on looking at the stomach and colon, I can guess, educated guess.

Ah, so I've seen, and you see vitamin deficiencies from that? No, no, no. Vitamin deficiency, we're talking about B12 deficiency. Correct. As you know, uh, long term. That is not a huge problem because even if you are deficient in B12, supplementation takes care of the problem. Um, so that is not a huge thing.

What I was trying to say was gut bacteria loves vegetarian food more than non vegetarian food. That is kind of proven on basic science research and also clinical research as well. So, when we do the endoscopy, uh, camera going to the stomach, we see, I personally feel like the stomach is less angry. And I ask them, oh, you know, are you, after the procedure, I ask them, are you a vegetarian?

They'll say yes. Same thing, you know, if I do a colonoscopy, I don't see any polyps at all. And then that patient will be a 65 year old Caucasian man. How come you are not having a polyp? You eat, your diet is like processed meat and everything. Uh, he said, no, I'm a vegetarian. So I'm gonna throw a little bit of controversy into the pot.

There are doctors out there in the West for the Western Caucasian Population that are recommending only a meat diet carnivore diet the carnivore diet, right? So you've heard about this carnivore diet Yeah, have you seen carnivores come in and do the endoscopy and you're seeing disaster inside of them a lot of polyps But have you also seen like the vegetarian a clear gut is it bio individual also for people?

Yes Yes, absolutely the bio individual but the probability the probability is lower in a vegetarian diet But doesn't mean that you know meat is wrong What I'm what I'm trying to say is our gut bacteria loves fiber and fiber is in vegetarian food If you're having on vegetarian make sure that you have lots of fiber as well I'm going to be having my steak with a lot of broccoli, cucumber and zucchini.

So that's what I want to be doing. Yeah. Yeah. So one thing I want to tell you is I always tell my patients don't choose vegetarian or don't choose non vegetarian. Be Dr. Palletarian. What's that? Dr. Palletarian. Dr. Palletarian is, you know, three meals a day. Yeah. Seven days a week. Yeah. 21 meals a week. Yes.

And out of this 21, 80 percent vegetarian. So 15, 16 meals is vegetarian, the remaining four meals, you go non vegetarian and you can eat whatever you want. If you're eating red meat, limit to 500 grams per week. That's a nice one. I've never heard before. Limit non vegetarian to 500 grams. No, no, red meat, red meat, 500 grams per week if possible.

Nice one. One common problem in gastric issues we are seeing is that, um, more and more of the teenagers, more and more of the working individuals, are complaining of gastric problems and we're talking about an age group of 15 to 30 but you're seeing a lot of older people. So is there something that you're seeing in your practice where more youngsters are coming in with gastric problems?

So I have, when a patient walks in, there are only two age groups that walks into my patient office. One is 60, 65 and the other one is 20, 30. So the 20, 30s are walking in because of abdominal pain, cramps, bloating. Uh, Oh, this food is not adapting to my gut. You know, what should I do? And the first question that I ask is what are you doing in terms of a profession?

And most of the times, especially in India, uh, when I see patients, uh, they work for a foreign company in U. S. and they work night shift and they work from 10 p. m. to 6 a. m. Where the graveyard shift graveyard shift because it's in us. It's the morning time, correct? And Again, you're disturbing a circadian rhythm The first thing that goes wrong when you're disturbing a circadian rhythm is gut and that's where they say go with your gut I'm gonna go a little star trek on our podcast the gut microbiome.

I read a study somewhere that they have started fecal bank transplants Can you talk to us about what is this fecal bank transplant? And is it true? that when they take, uh, the donor fecal and put it into a bad person, there have been incidences of improvement of the gut health. Yes, we do. You know, we do fecal transplantation for a disease called C.

difficile colitis. Okay. Where it is a bacteria that comes into the body and affects the colon and makes the colon looks very inflamed and angry. And, uh, no matter what medication that we give, we will not be able to Is it true C. difficile thrives in a non veg environment? Non vegetarian diet. No. I mean, why does this bad guy come into the body?

Oh because of you know, antibiotic exposure. So we do lots of antibiotics and You know, whenever there is factor as multiple antibiotic exposure, then you'll see the fissile. So we see this in children? Yes, but not that common. Not that common. Adult, big time. So an athlete one day came to me and says, so can I do fecal transplant because I heard that a faster athlete has better Bacteria, so can I get his poop into me?

So is there any logic to this? Do you see medical science going in that direction? I think five years from now we'll be talking some kind of sense, but not right now Okay, but multiple research are going in that field, but nothing concrete So but it is true in mice when you transplant a bad bacteria into a good gut bacteria, the mice will have behavioral problems, will have anxiety issues.

Um, well, that'll be translated into clinical practice. That's what people are doing right now. So is it true that before our body digests food, the bacteria in our gut, the microbiome, actually first eats the food? Uh, no, no, that's not true. Because when you, when you're eating, it goes in the stomach, the stomach acid digests the food, and then gets into the small intestine, and we get the first bite.

Ryan:Ah,

Dr Pal: small intestine has all these enzymes, like pancreas secretes enzyme digesting fats, you know, uh, stomach, uh, also secrete digesting proteins and carbs, all these are getting digested in your small intestine. And after everything is done, only the roughage goes into the colon. And that roughage should have fiber to feed the bacteria in the colon.

Uh, so they get the second bite, but we need to make sure that we feed them as well. Interesting. This is my question. It's a funny question How much of farting defines you to be a farter or not a farter? Is there a medical benchmark because people come to me and says I got a lot of gas So I asked them have you farted in my chamber right now?

So they know like you don't have a gas problem So how do we how do we advise people because people have different senses of laughter different senses of i'm strong You're strong. I am not strong from a farting perspective gas production burping and farting. What do you think is a sense of a barometer?

So I think it is again individualized. It's based on, you know, how frequent it is. And then, uh, key thing is what are the other GA problems that you're having? Let's say you're having constipation, you're having bloating, then that flatulence is a significant problem. Interesting. So What I do is I tell a person eat a certain food and tell me three to four hours later Are you creating more gas?

That's true. The first treatment that we do when patients come with flatulence is food diary Ah, so you document everything what you eat. And when is the most amount of gas production? If Tesla could only run on human gas, we would have Indigenous vehicles and the patients will ask me Sir, is has to be a written format or you want a video format?

I said, no, no, I was about to ask you, is there audio included in that? Like what level of velocity of noise are you creating? So much of volume of gas, so much of decibels. But jokes apart, as people get older, right? As I have gotten old and I'm moving towards my fifties, I've noticed in certain foods on certain days that I eat, I will produce more gas.

I will fart more. And sometimes it's, um, It's embarrassing because you try to get the silent fart and you know, it's the noisy fart that's also still good, but then you get the smelly fart as a gastro doctor. Are we looking for anything which can tell us that you need to change your diet or change your health in the gas department?

So whenever the flatulence is bothering, you know, whenever it is compromising the quality of life. So for example, I've sent many patients, you know, I'm in the meeting and, uh, you know, I need to run to the restaurant to have the gas released. Uh, and it is happening very repeatedly, and that's where the problem is, right?

And then invariably, as we talked about, most of the times, it is a, this, it is a lack of balance between a good and bad gut bacteria. Few common sense questions. Is it true that everybody in the human race has to go to potty first thing in the morning? Absolutely not true. Not true, right? Absolutely not true.

You've seen different patients potty at different times of the day. Even, you know, the normal bowel movement, you know, when you eat something and it comes out of the sphincter muscle, It's usually takes like, you know, 50 hours, 50 hours. So India, listen in carefully. You don't need to go to the toilet every day to decide that you have a constipation.

Absolutely. Now, if I ask that question, do people have a potty move? If it's 50 hours, you're talking about almost two days sometimes. Huh? So if you. Ideally, many of the patients will go like once a day because of the, you know, my athletes go two, three times a day because obviously I'm feeding them more, right?

Maybe a lot of fiber. We don't know. Yeah. But, but so, so let me, let me track back and I'll say that. Hey, actually a definition of constipation itself. It's not like if you don't go once a day, you see what is your normal baseline. So you go once every two days, once every three days is absolutely okay. But you have been going once every three days, but now it's once in seven days.

That's constipation. What is the change in the frequency of the bowel movement? I have this client of mine, and he constantly complains that I go to the toilet, I sit down, and I have sensation to potty, but nothing comes out. What is that called and what could be the probable reasons? It's called tenesmus kind of thing.

Where you go to the bathroom and you have the feeling of evacuation, but the evacuation is not happening. Which means that the brain is not talking to the gut properly. So it's like a biofeedback mechanism. Can that be retrained back again? Yes, absolutely. Yes. So they need to contact a gastroenterologist for that, right?

No, I know if you dive deep into it, the basic lifestyle changes will be the treatment of choice. Do you prescribe walking for any of these conditions? Gas, indigestion, IBS and all? So physical activity has been shown to promote good gut bacteria. So Exercising gives me good bacteria, which keeps my gut healthy.

So another prescription is please exercise. What exercise? So it actually anything, any, even walking is also okay, but it has to be a little bit of a faster pace. And I think walking shakes everything out of your body as it keeps moving. But sometimes strength training has been shown to, um, you know, promote all these, uh, it hits the right not on all the hormones and chemicals and that promotes more good good bacteria as well.

Awesome. Awesome. Doctor, final few questions. If you had to give everybody out there advice, because you have a camera inside people and you see the damage, what are the five tips that you would give everyone to follow as Dr. Paul's tips? So the first thing is you need to wind down after sunset. Wind down after sunset.

Number two, drinking water, at least two liters per day. Drinking two liters of water every day. Sleep big time, seven hours a day, minimum seven hours a day, and then number four, lots of fiber, lots of fiber, your favorite fiber food, my favorite fiber food is broccoli, oh, you love broccoli, I love broccoli, I also love broccoli, I ate a whole bowl this morning, I love broccoli and also spinach, the fifth one is meditation, I tell my patients that you need to start meditating at least two minutes a day to start with, and the reason is meditation is that non medication way To train your brain get access for somebody who has never been an initiated to meditation as a doctor How would you write that prescription meditation?

What should we do? What should I do sit down, huh? So I have never been meditated in the past Okay, so when I started to learn about brain get access get bacteria and how everything is like so related my Go to thing was okay. Where do we start? Okay, so I picked up this meditation called heart fullness meditation, you know I like this organization because my neighbor was doing this And then he asked me to come and then do meditation with him and they are a wonderful organization non profit and they're doing an everything for free.

They don't charge anything at all. Believe it or not, throughout the world, there is heartfulness trainers everywhere, where anybody who wants to get trained, you just go and see a preceptor and then they will train you how to meditate. Online or in person? In person actually, both online, in person, even Bangalore has it, Hyderabad has it, every So we're all gonna start meditation soon.

Yeah, if you find heartfulness heartfulness heartfulness awesome So those are the five tips from dr. Paul. Dr. Paul if you were not a gastro I know you would say stand up comedian, but if not a stand up comedian and gastro, what would you be? You know, I want to be a Lifestyle physician. Okay. I want to tell patients that family doctor.

Maybe if I know what's a family doctor And what's a lifestyle physician see family doctor is, you know treats all the problems, right? So let's say you have asthma, so he needs inhalers and he, uh, treats all those things. When I say lifestyle physician is, now I have figured out that all the problems is caused by the lifestyle.

Okay, and nutrition plays a big role. That's why I have a huge respect for what you do. Nutritionist is not easy job. So nutrition, generally seeing the patient as a whole and not just focusing on the asthma alone. And if I have a time, I will spend two hours with a patient every week for three months.

I'll make sure that they will never get a problem ever again so that they will never see a doctor. Awesome. Awesome. I want quick digestion. I want quick answers. And who better than Dr. Pal to give us a rapid fire? Okay. Eating sprouts, raw or cooked? To be honest, both are okay. Raw meat, good for your stomach?

Not good for your stomach. Raw meat. Yeah. Sushi? Oh, sushi. Okay. In general, our gut bacteria is better on Vegetarian diet. Let me put it that way. So, but does it mean that, you know, one time sushi or something is bad, but that's a gastrointestinal answer. There's this article saying playing microbiome for kids.

Your take? Yes, absolutely. So we should go back and get dirty? Absolutely. No question. Stop using too much of sanitizers and chemicals in the house? Yes, big time. What should we look in ingredients before buying them? The first three ingredients should not be sugar. First three should not be sugar. That's a good one.

Okay. How do we prep our gut for long use of antibiotic medicines? Antibiotics destroys the gut bacteria. So, so basically I always tell in all podcasts is that the biggest pandemic that we are waiting to happen is antibiotic resistant bacteria where we will not have weapons like antibiotics to kill the bacteria.

So limit antibiotic use as much as possible and only take antibiotic only when prescribed by a doctor. You cannot walk into a pharmacy and then say, please give me some antibiotics. Things in our system that we Indians are adopting that are very bad. Considering food as an emotion. Doesn't have to be.

Get logical. Tone it down a little bit. So doctor, I know your time is precious. We got you for a few minutes. And we answered everyone's questions. So, if you love Dr. Pal. And no, we are not the same person, we are two different people, but we both love each other. Comment below and we will share with you tips from Dr.

Paul's podcast, blog, as well as his Instagram handle, where you can directly get in touch with him. If you liked this episode, then please gift me a like, a share, or a subscribe, or better still, if you comment, I'll come back to you. And don't forget, let's stay tuned for a new learning coming in. But till then, your body is the most expensive real estate, take care of it.

Mentioned Resources

• Psyllium Husk: Fiber supplement to improve gut health.

• Heartfulness Meditation: Guided meditation resource Dr. Pal recommends.