WEBVTT 00:01.965 --> 00:04.548 (bright music) 00:11.085 --> 00:13.752 (intense music) 00:32.460 --> 00:33.360 Wow, we have had 00:33.360 --> 00:35.987 some fantastic presentations today, haven't we? 00:35.987 --> 00:38.970 So I'm gonna change things up a little bit, 00:38.970 --> 00:41.340 and start to talk about diet and environment 00:41.340 --> 00:43.140 and the role that these things play 00:43.140 --> 00:46.680 in brain health, brain function. 00:46.680 --> 00:47.760 I have a little disclaimer. 00:47.760 --> 00:49.860 I originally wanted to title my presentation 00:49.860 --> 00:53.987 The Microbiota-Gut-Brain Axis Visceral Hypersensitivity 00:53.987 --> 00:56.147 in the Low FODMAP Diet. 00:56.147 --> 00:58.620 I decided that was probably a little too long, 00:58.620 --> 01:00.360 so instead, I shortened it 01:00.360 --> 01:03.243 to The Gut-Brain Axis in Visceral Hypersensitivity. 01:04.290 --> 01:05.688 And you know, I saw that the title 01:05.688 --> 01:09.120 of today's symposium was Wired Together. 01:09.120 --> 01:11.940 I thought that was such a great theme for my talk. 01:11.940 --> 01:15.360 Today, I'm gonna talk a lot about our brain, 01:15.360 --> 01:17.100 but not the brain that you think I'm gonna talk about. 01:17.100 --> 01:19.620 I'm gonna talk about what we call our second brain, 01:19.620 --> 01:22.353 and by that I mean our enteric nervous system. 01:23.940 --> 01:27.150 If my pointer, oh, I have to turn it on first, there we go. 01:27.150 --> 01:28.740 I'm gonna talk about our enteric nervous system, 01:28.740 --> 01:30.330 also known as our second brain, 01:30.330 --> 01:32.670 and this is our gastrointestinal tract. 01:32.670 --> 01:34.410 The gastrointestinal tract is home 01:34.410 --> 01:37.980 to a mesh-like network of 500 million neurons. 01:37.980 --> 01:41.520 That's five times the number found in the spinal cord. 01:41.520 --> 01:45.060 It produces 90% of our body's total serotonin, 01:45.060 --> 01:47.430 50% of our body's total dopamine, 01:47.430 --> 01:50.400 and it's capable of regulating itself autonomously. 01:50.400 --> 01:51.810 That means it can work independent 01:51.810 --> 01:53.520 of our central nervous system. 01:53.520 --> 01:54.870 It also is able to communicate 01:54.870 --> 01:57.870 with our central nervous system via the vagus nerve, 01:57.870 --> 02:01.503 where it's in bi-directional communication with our brain. 02:02.610 --> 02:05.700 And you really can't talk about our second brain, 02:05.700 --> 02:08.490 our enteric nervous system right now without talking 02:08.490 --> 02:11.160 about the bacteria that live in it, 02:11.160 --> 02:13.260 and I have some news for you guys. 02:13.260 --> 02:18.260 Me, you, all of us, we are more bacterial than we are human. 02:18.840 --> 02:22.350 Bacterial cells outnumber human cells 10 to one. 02:22.350 --> 02:24.840 You have 100 trillion bacteria living in you, 02:24.840 --> 02:28.740 on you, all over you, and these cells are capable 02:28.740 --> 02:31.590 of doing amazing things for our health. 02:31.590 --> 02:34.230 I wanna take this kind of as a time to talk a little segue 02:34.230 --> 02:38.100 about when I had the opportunity to meet one of my heroes 02:38.100 --> 02:40.680 in research, a guy by the name of Rob Knight. 02:40.680 --> 02:45.030 He's like the Michael Jordan of gut microbiome research, 02:45.030 --> 02:47.010 and he was telling us this fascinating story 02:47.010 --> 02:51.000 about how they followed the gut microbiome of people 02:51.000 --> 02:53.670 and were able to map out their behaviors by looking 02:53.670 --> 02:57.180 at how people's microbiomes were being exerted 02:57.180 --> 02:58.440 on their environments. 02:58.440 --> 03:00.900 And so what they did was they looked for all sorts 03:00.900 --> 03:03.150 of different bacteria in a public restroom, 03:03.150 --> 03:05.527 and they were looking for fecal bacteria, and they're like, 03:05.527 --> 03:07.560 "Hmm, where are these fecal bacteria gonna be?" 03:07.560 --> 03:09.720 They expected to see 'em on the toilet handles. 03:09.720 --> 03:12.120 Nope, they found dirt on the toilet handles, 03:12.120 --> 03:14.160 bacteria that lived in the soil. 03:14.160 --> 03:15.510 It turns out people are flushing 03:15.510 --> 03:16.680 the toilets with their feet. 03:16.680 --> 03:19.470 They also learned you should keep your toothbrush seven feet 03:19.470 --> 03:22.861 away from your toilet, if you know what I mean. 03:22.861 --> 03:25.080 Dr. Knight also explained to us 03:25.080 --> 03:27.240 that you can map out other aspects of human behavior 03:27.240 --> 03:30.030 by looking at the microbiota, and also talked 03:30.030 --> 03:32.580 about how some really interesting research coming out 03:32.580 --> 03:36.330 of Jeff Gordon's lab was showing that in germ free mice, 03:36.330 --> 03:38.700 these are mice without any microbiota, 03:38.700 --> 03:40.424 they displayed different behaviors. 03:40.424 --> 03:42.377 And it was just the beginning of this 03:42.377 --> 03:43.980 when we started to understand 03:43.980 --> 03:47.763 how our microbiota is capable of influencing our behaviors. 03:48.840 --> 03:50.130 What's really interesting when we talk 03:50.130 --> 03:52.530 about the microbiota is that, yeah, 03:52.530 --> 03:55.110 it's incredible that you're outnumbered 10 to one 03:55.110 --> 03:57.150 by the bacterial cells living on you, 03:57.150 --> 04:00.390 but even more incredible is the fact that the bacteria 04:00.390 --> 04:05.318 living in your gut possess 100 times more genetic material 04:05.318 --> 04:08.190 than the entire human genome. 04:08.190 --> 04:09.900 Let that sink in for a second. 04:09.900 --> 04:14.130 You really are not just human, you are a meta organism. 04:14.130 --> 04:17.970 You are this huge symbiotic organism where your behaviors, 04:17.970 --> 04:19.860 which you once thought you were controlling, 04:19.860 --> 04:21.480 might not be so controlled by you. 04:21.480 --> 04:23.490 They might be being controlled by microbes. 04:23.490 --> 04:26.190 I like to call this microbial mind control. 04:26.190 --> 04:27.023 This is the aspect 04:27.023 --> 04:29.250 that microbes are actually maybe controlling our behavior. 04:29.250 --> 04:30.120 People are laughing, right? 04:30.120 --> 04:31.350 That's scary, it's kind of crazy, 04:31.350 --> 04:33.240 but it shouldn't be that crazy to think about. 04:33.240 --> 04:36.180 We all know rabies, which is a microbial infection, 04:36.180 --> 04:39.060 can be very well controlling of our brain function. 04:39.060 --> 04:41.580 There's lots of other examples of microbes 04:41.580 --> 04:44.493 that can control behavior out in the literature. 04:45.990 --> 04:50.100 So that brings me to the microbiome gut-brain axis. 04:50.100 --> 04:52.380 You really can't call it the gut-brain axis anymore 04:52.380 --> 04:55.590 without talking about what the microbiota are doing. 04:55.590 --> 04:57.270 Why are we letting four and a half 04:57.270 --> 04:59.790 to six and a half pounds of bacteria ride 04:59.790 --> 05:01.680 around in our gastrointestinal tract? 05:01.680 --> 05:04.079 Why are we feeding them, what are they doing for us? 05:04.079 --> 05:07.080 And this is a really powerful symbiotic relationship 05:07.080 --> 05:10.380 that we have evolved to develop with our microbiota. 05:10.380 --> 05:13.140 So we now know that the gut microbiota are capable of, 05:13.140 --> 05:14.550 you know, synthesizing vitamins. 05:14.550 --> 05:16.095 They make a lot of the B vitamins. 05:16.095 --> 05:19.530 They're really important for educating our immune system. 05:19.530 --> 05:21.900 As our immune system develops from infancy 05:21.900 --> 05:25.380 up into about three years old, the microbiota also changes, 05:25.380 --> 05:27.120 and these two things educate each other 05:27.120 --> 05:28.530 and help each other develop. 05:28.530 --> 05:31.199 Germ-free mice, these mice that don't have any microbiota, 05:31.199 --> 05:33.540 they don't have very well educated immune systems 05:33.540 --> 05:36.399 and are very susceptible to developing autoimmunity. 05:36.399 --> 05:39.600 They also nourish gut epithelial cells. 05:39.600 --> 05:41.520 They produce short chain fatty acids 05:41.520 --> 05:44.400 that our gut cells can actually use for energy, 05:44.400 --> 05:47.280 and this is really important in keeping our gut healthy. 05:47.280 --> 05:49.740 And then a key in this is that they interact 05:49.740 --> 05:52.260 with our enteric and central nervous systems. 05:52.260 --> 05:54.780 They're capable of producing neurotransmitters 05:54.780 --> 05:57.000 and other metabolites that can influence the way 05:57.000 --> 05:58.650 that the enteric nervous system, 05:58.650 --> 06:01.650 this nervous system in our gut, is communicating 06:01.650 --> 06:03.150 with the central nervous system, 06:03.150 --> 06:05.519 and this bidirectional network is called 06:05.519 --> 06:08.880 the microbiota-gut-brain axis. 06:08.880 --> 06:10.260 Talking about these germ-free mice, 06:10.260 --> 06:12.000 this is the best model that we have 06:12.000 --> 06:14.430 for really studying the direct behavior 06:14.430 --> 06:17.970 that the microbiota-gut-brain axis can influence. 06:17.970 --> 06:20.760 And some really seminal studies, I mean, 10 years ago now, 06:20.760 --> 06:22.277 these studies were published, found 06:22.277 --> 06:27.030 that germ-free mice have increased anxiety behaviors, 06:27.030 --> 06:29.460 increased panic-like behaviors, 06:29.460 --> 06:31.680 and that if you were to give them microbiota 06:31.680 --> 06:35.098 from just free-living, regularly housed laboratory mice, 06:35.098 --> 06:37.410 then you could actually alleviate 06:37.410 --> 06:40.470 some of these anxiety behaviors in these germ-free mice. 06:40.470 --> 06:42.480 What was even more importantly discovered was 06:42.480 --> 06:45.420 that if you gave them E.coli, a kind of pathogenic, 06:45.420 --> 06:47.178 not very good bacteria, 06:47.178 --> 06:50.700 then it would completely reduce the beneficial effects 06:50.700 --> 06:52.200 of giving them regular bacteria. 06:52.200 --> 06:55.500 It didn't have any benefit of reducing anxiety, 06:55.500 --> 06:59.070 but if you gave them Bifidobacterium infantis, 06:59.070 --> 07:01.620 a very common probiotic bacteria, 07:01.620 --> 07:03.510 you could reduce those anxiety-like behaviors 07:03.510 --> 07:05.610 even more than regular bacteria could. 07:05.610 --> 07:06.780 So this kind of pointed to the fact 07:06.780 --> 07:09.360 that a single bacteria could influence 07:09.360 --> 07:12.240 behavior so powerfully, and that's kind of, you know, 07:12.240 --> 07:13.890 one of the things that we have to talk about 07:13.890 --> 07:16.530 when we're talking about the microbiota-gut-brain axis is 07:16.530 --> 07:18.240 how powerful these bacteria are 07:18.240 --> 07:19.803 in influencing our behaviors. 07:21.120 --> 07:23.970 Now, alterations to the gut microbiota, 07:23.970 --> 07:27.751 this is called dysbiosis, often occur morbidly 07:27.751 --> 07:30.600 with gastrointestinal and psychiatric symptoms, 07:30.600 --> 07:32.640 but other sorts of things too, 07:32.640 --> 07:36.172 such as autoimmune disease, metabolic disease. 07:36.172 --> 07:39.780 Even relationships with cardiovascular disease 07:39.780 --> 07:42.620 and bone health have been shown to occur with dysbiosis. 07:42.620 --> 07:45.180 So this term dysbiosis is kind of vague. 07:45.180 --> 07:47.250 It's because we don't really know what it's supposed 07:47.250 --> 07:50.010 to look like, what the microbiota is supposed to look like. 07:50.010 --> 07:51.900 What we know is that it's an ecosystem, 07:51.900 --> 07:54.690 and that diversity in any ecosystem is good, 07:54.690 --> 07:55.890 but if you lose diversity, 07:55.890 --> 07:58.380 you seem to lose the beneficial effects. 07:58.380 --> 08:02.850 So dysbiosis is very commonly seen in autism, 08:02.850 --> 08:03.720 and the hallmark 08:03.720 --> 08:08.010 of autism dysbiosis is this complete loss of diversity. 08:08.010 --> 08:11.970 You see that instead of 1,000 or 1,500 species, 08:11.970 --> 08:14.040 all of a sudden these people only have 400 species 08:14.040 --> 08:15.723 of bacteria living in their GI. 08:16.770 --> 08:20.588 The majority of the bacteria live in the colon, 08:20.588 --> 08:23.970 with smaller amounts living in the small intestine, 08:23.970 --> 08:25.500 and really again it just comes down 08:25.500 --> 08:27.960 to having a very diverse microbiota. 08:27.960 --> 08:28.957 People always want to ask me, 08:28.957 --> 08:30.990 "Well, what is a good microbiota?" 08:30.990 --> 08:31.823 We don't know. 08:31.823 --> 08:34.803 All we know is that diversity is key of any ecosystem. 08:36.510 --> 08:38.907 And how do you develop dysbiosis? 08:38.907 --> 08:40.920 You really don't need to look any further 08:40.920 --> 08:43.410 than kind of the common American life, right? 08:43.410 --> 08:45.690 This is, there's so many things in our life 08:45.690 --> 08:49.050 that are so bad for our gastrointestinal system, 08:49.050 --> 08:52.560 so antibiotic over-prescription, overuse. 08:52.560 --> 08:55.080 You know, the CDC estimates that one third 08:55.080 --> 08:57.780 of antibiotic prescriptions are wrongly prescribed. 08:57.780 --> 09:00.240 We have a huge problem with overuse of antibiotics. 09:00.240 --> 09:02.850 I know when I was in college, if my roommates had a cold, 09:02.850 --> 09:04.871 he'd be like, "Oh, I'm gonna go get some antibiotics from," 09:04.871 --> 09:07.020 you know, and that's a viral infection. 09:07.020 --> 09:08.430 You don't need antibiotics for that. 09:08.430 --> 09:09.600 We have huge problem 09:09.600 --> 09:12.090 with the over-prescription of antibiotics, and obviously, 09:12.090 --> 09:15.300 antibiotics are broad spectrum and can alter our microbiota. 09:15.300 --> 09:18.870 I was so happy to hear about the talk about exercise, 09:18.870 --> 09:20.951 because we're finding that sedentary behaviors 09:20.951 --> 09:23.400 such as, you know, a lot of sitting, a lot 09:23.400 --> 09:26.970 of TV watching can even result in changes to the microbiota, 09:26.970 --> 09:28.800 so physical activity is really important, 09:28.800 --> 09:32.550 because you give your microbiota feedback for it to change. 09:32.550 --> 09:35.580 Obviously, what you eat is gonna be really important 09:35.580 --> 09:37.320 in determining your microbiota. 09:37.320 --> 09:38.850 Whether you're eating fermented foods 09:38.850 --> 09:40.800 and kind of inoculating your gut 09:40.800 --> 09:42.367 with healthy microbes is critical 09:42.367 --> 09:45.900 for helping develop a healthy microbiota. 09:45.900 --> 09:47.100 And then hygiene, 09:47.100 --> 09:49.591 we live in this very hygienic environment these days. 09:49.591 --> 09:53.160 The hygiene hypothesis was put forward 50 years ago 09:53.160 --> 09:56.268 when it was first noticed that people living on farms had 09:56.268 --> 09:58.860 much lower incidences of allergies 09:58.860 --> 10:00.480 than people living in urban areas, 10:00.480 --> 10:02.700 and that was the initiation of the idea 10:02.700 --> 10:04.350 that we live too hygienic. 10:04.350 --> 10:06.750 We don't get out in the soil and play anymore. 10:06.750 --> 10:10.380 We wash our food so much, we're no longer giving our bodies 10:10.380 --> 10:12.390 that diverse microbiota that they need. 10:12.390 --> 10:14.631 And when we have dysbiosis, what happens? 10:14.631 --> 10:18.090 Well, studies from Jeff Gordon's lab show 10:18.090 --> 10:20.988 that if you were to take a dysbiotic mouse 10:20.988 --> 10:23.550 who you fed too much fat, 10:23.550 --> 10:26.850 and now that mouse has become obese, and you were to take 10:26.850 --> 10:28.610 just the bacteria from that mouse's gut 10:28.610 --> 10:31.200 and transfer it to a lean mouse, 10:31.200 --> 10:33.270 you could make that lean mouse obese. 10:33.270 --> 10:34.140 So we're starting to see 10:34.140 --> 10:36.030 that it can really influence health. 10:36.030 --> 10:37.590 Another obvious aspect of health 10:37.590 --> 10:40.185 that it can influence is the health of our gut. 10:40.185 --> 10:43.710 And so once you have that altered microbiota, we run in 10:43.710 --> 10:47.850 to a lot of chronic low-grade intestinal inflammation, 10:47.850 --> 10:50.492 and that chronic low-grade intestinal inflammation can 10:50.492 --> 10:53.330 really lead to something called visceral hypersensitivity 10:53.330 --> 10:56.268 and irritable bowel syndrome. 10:56.268 --> 10:59.271 Now, irritable bowel syndrome presents often 10:59.271 --> 11:03.810 as either diarrhea predominant or constipation predominant, 11:03.810 --> 11:06.540 and almost always is associated 11:06.540 --> 11:08.040 with visceral hypersensitivity. 11:08.040 --> 11:10.650 And the reason I'm talking about irritable bowel syndrome 11:10.650 --> 11:12.840 at a brain health symposium is that 11:12.840 --> 11:14.508 when this hypersensitivity occurs, 11:14.508 --> 11:17.068 we see that there's a lot of communication 11:17.068 --> 11:18.807 to the brain via the gut-brain axis, 11:18.807 --> 11:20.770 and this can result in pain, discomfort, 11:20.770 --> 11:23.490 anxiety, and other adverse reactions. 11:23.490 --> 11:26.670 A lot of people are suffering from irritable bowel syndrome. 11:26.670 --> 11:28.860 20 to 30% of the population has 11:28.860 --> 11:31.080 diagnosed irritable bowel syndrome. 11:31.080 --> 11:32.280 Who knows how many people have 11:32.280 --> 11:35.493 undiagnosed food sensitivities and irritable bowel syndrome. 11:36.600 --> 11:38.550 And what's really interesting is that 11:38.550 --> 11:42.330 a lot of this can be communicated via the gut-brain axis 11:42.330 --> 11:43.830 where you know, you obviously have 11:43.830 --> 11:45.540 some gastrointestinal manifestations 11:45.540 --> 11:47.280 with irritable bowel syndrome that all lead 11:47.280 --> 11:49.490 to decreased quality of life, but you also have 11:49.490 --> 11:51.671 these extra-gastrointestinal manifestations 11:51.671 --> 11:54.450 that can lead to decreased quality of life. 11:54.450 --> 11:57.490 And what do I mean by extra-gastrointestinal manifestations? 11:57.490 --> 12:00.840 I mean these comorbidities such as panic disorders. 12:00.840 --> 12:03.180 20 people with IBS have panic disorder. 12:03.180 --> 12:05.940 20% of people with IBS have panic disorders. 12:05.940 --> 12:09.840 30% of people with IBS have generalized anxiety disorder. 12:09.840 --> 12:11.310 Almost 50% of people 12:11.310 --> 12:13.653 with IBS have major depressive disorder. 12:15.270 --> 12:17.970 You can find some numbers for strong correlations 12:17.970 --> 12:19.950 with bipolar disorder, schizophrenia, 12:19.950 --> 12:22.830 and alcohol and drug abuse with IBS as well, 12:22.830 --> 12:24.240 so this is definitely something 12:24.240 --> 12:26.910 that is not just impacting the health of the gut, 12:26.910 --> 12:28.950 but it's also impacting the health of the brain, 12:28.950 --> 12:30.510 and ultimately, the quality of life, 12:30.510 --> 12:31.740 'cause that's what we're all about, right? 12:31.740 --> 12:34.320 When we're talking about Alzheimer's disease, ADD, 12:34.320 --> 12:37.170 dyslexia, these things are all things that eventually affect 12:37.170 --> 12:39.068 quality of life, and we all wanna have 12:39.068 --> 12:41.518 the absolute highest quality of life that we can. 12:42.540 --> 12:43.710 So what can we do, right? 12:43.710 --> 12:46.028 I'm here to give you guys some solutions. 12:46.028 --> 12:48.660 There are some really interesting nutritional approaches 12:48.660 --> 12:50.730 that I wanna share with everyone, 12:50.730 --> 12:53.160 and really they're about alleviating the internal stressors 12:53.160 --> 12:55.440 and trying to fix that microbial imbalance. 12:55.440 --> 12:57.420 The very first thing that we have is 12:57.420 --> 12:59.250 a probiotic based intervention. 12:59.250 --> 13:01.620 There was a very nice meta-analysis 13:01.620 --> 13:03.690 of all the probiotic interventions 13:03.690 --> 13:05.130 that have ever been done in IBS, 13:05.130 --> 13:07.110 and let me tell you, there are a lot, this field 13:07.110 --> 13:10.380 of microbiota research is just exploding right now. 13:10.380 --> 13:12.960 And reviewing thousands and thousands of studies, 13:12.960 --> 13:14.407 the authors concluded that probably 13:14.407 --> 13:17.790 the best interventions use a single organism, 13:17.790 --> 13:20.310 they use lower dosages of organisms than you would see 13:20.310 --> 13:22.170 with a lot of other interventions, 13:22.170 --> 13:24.150 and they use often Saccharomyces boulardii, 13:24.150 --> 13:28.020 which is a probiotic yeast, or Bacillus coagulans, 13:28.020 --> 13:30.240 this is a spore-forming soil bacteria, 13:30.240 --> 13:32.280 bacteria normally found in the soil, 13:32.280 --> 13:34.683 not something that we have in our diets very much anymore, 13:34.683 --> 13:37.920 or some of the more common probiotics such 13:37.920 --> 13:42.600 as Lactobacillus plantarum or Lactobacillus rhamnosus GG. 13:42.600 --> 13:44.970 And I think the probiotics stuff is fascinating, 13:44.970 --> 13:46.383 absolutely fascinating, 13:47.302 --> 13:48.780 but what I think is even more interesting is something 13:48.780 --> 13:51.960 called the low FODMAP diet, and I just wanna share 13:51.960 --> 13:55.170 this quote about the low FODMAP diet with everyone, 13:55.170 --> 13:57.840 and it is unlike most dietary manipulations tried 13:57.840 --> 14:01.590 in the past to alleviate gastrointestinal symptoms of IBS. 14:01.590 --> 14:05.580 All studies on low FODMAP diets have consistently shown 14:05.580 --> 14:08.481 symptomatic benefits in the majority of patients with IBS. 14:08.481 --> 14:10.920 That is really powerful. 14:10.920 --> 14:14.430 In the field of nutrition, we don't often get to say 14:14.430 --> 14:16.440 that something has unanimously affected 14:16.440 --> 14:18.450 any sort of disease outcome. 14:18.450 --> 14:21.510 Nutrition is just usually just one factor. 14:21.510 --> 14:23.880 Sometimes our hands are tied in nutrition, 14:23.880 --> 14:25.590 because we can only do a little bit, 14:25.590 --> 14:27.570 but this diet is so powerful. 14:27.570 --> 14:30.982 I remember when I found out about this diet in I think 2011, 14:30.982 --> 14:34.440 2012, it was only being used in New Zealand and Australia, 14:34.440 --> 14:37.041 and it's slowly spreading across the world right now, 14:37.041 --> 14:39.300 and being used for more therapies in IBS, 14:39.300 --> 14:41.283 being put into more clinical trials. 14:42.360 --> 14:44.430 I do have to admit, the first time I heard about it, 14:44.430 --> 14:48.600 I was like, "Low frog mats, low fog hats? 14:48.600 --> 14:50.610 What in the world is this?" 14:50.610 --> 14:52.059 So let me take a second to explain 14:52.059 --> 14:54.330 actually what FODMAPs are. 14:54.330 --> 14:58.321 These are fermentable, oligosaccharides, disaccharides, 14:58.321 --> 15:00.480 monosaccharides, and polyols. 15:00.480 --> 15:02.850 That may seem very abstract still, 15:02.850 --> 15:04.535 but I bet a lot of you are very familiar 15:04.535 --> 15:07.890 with a very common FODMAP intolerance that leads 15:07.890 --> 15:12.360 to GI distress and some psychological issues too, 15:12.360 --> 15:14.237 is lactose intolerance. 15:14.237 --> 15:17.670 Lactose is a disaccharide that if you can't digest, 15:17.670 --> 15:19.950 it makes its way into our large intestine, 15:19.950 --> 15:23.520 where these FODMAPs can then be fermented, 15:23.520 --> 15:25.290 and if you have visceral hypersensitivity 15:25.290 --> 15:27.810 because of an altered GI microbiota, 15:27.810 --> 15:31.440 that fermentation presents itself as extremely painful, 15:31.440 --> 15:34.410 and can trigger anxiety, can trigger depression, 15:34.410 --> 15:36.900 can trigger all sorts of behaviors. 15:36.900 --> 15:40.080 And then also if these FODMAPs aren't digested or absorbed, 15:40.080 --> 15:42.990 they can exert osmotic effects in the large intestine, 15:42.990 --> 15:45.180 which pulls a lot of water into our GI, 15:45.180 --> 15:46.710 and that can lead to diarrhea as well. 15:46.710 --> 15:49.500 So there's a lot of really interesting information out there 15:49.500 --> 15:52.198 about what different FODMAP intolerances people have, 15:52.198 --> 15:56.700 and there are really five categories of high FODMAP foods 15:56.700 --> 15:58.860 when we're looking at the high FODMAP foods. 15:58.860 --> 16:01.819 We have fructose, which is a monosaccharide 16:01.819 --> 16:04.767 that's a very commonly problematic FODMAP, 16:04.767 --> 16:09.180 and this can be foods like high fructose fruits 16:09.180 --> 16:13.590 such as apples and pears, honey is also about 50% fructose, 16:13.590 --> 16:15.750 and then obviously this big problematic is 16:15.750 --> 16:17.233 high fructose corn syrup. 16:17.233 --> 16:19.607 I just talked about how lactose intolerance 16:19.607 --> 16:22.410 and dairy foods can be a really big problem 16:22.410 --> 16:23.430 for a lot of people. 16:23.430 --> 16:26.160 And then we have our more complex carbohydrates, 16:26.160 --> 16:29.430 such as the fructans and galactans that are found in wheat, 16:29.430 --> 16:33.360 onion, garlic, lentils, legumes, and this kind of, 16:33.360 --> 16:35.490 you know, beans, beans, the magical fruit, right? 16:35.490 --> 16:36.630 This is what we're talking about, 16:36.630 --> 16:39.060 we're talking about the FODMAPs and beans, 16:39.060 --> 16:40.920 and then we have our polyols. 16:40.920 --> 16:45.920 Polyols is one of the less well understood types of FODMAPs. 16:46.800 --> 16:49.380 I guess if I really wanted to get the importance 16:49.380 --> 16:52.140 of watching out for polyols home to people, 16:52.140 --> 16:54.251 it's go on Amazon and read the reviews 16:54.251 --> 16:57.780 for the sugar-free Harbo gummy bears. 16:57.780 --> 17:00.990 They're horror stories from what these sugar alternatives do 17:00.990 --> 17:02.250 because they're not absorbed, 17:02.250 --> 17:03.690 they make their way into the GI tract, 17:03.690 --> 17:06.000 and cause all sorts of problems for people, 17:06.000 --> 17:09.660 ultimately leading to a lot of psychological issues. 17:09.660 --> 17:11.760 And so if you want a really comprehensive list 17:11.760 --> 17:13.500 of different FODMAP containing foods 17:13.500 --> 17:17.130 and their low FODMAP alternatives, this is a great link. 17:17.130 --> 17:18.390 Also just type it into Google, 17:18.390 --> 17:20.133 it'll come up right away for you. 17:21.780 --> 17:23.430 And so what's the protocol 17:23.430 --> 17:26.130 if people are put onto these low FODMAP diets? 17:26.130 --> 17:28.200 And really, people seem to only have to follow 17:28.200 --> 17:30.720 a low FODMAP diet for about four to eight weeks, 17:30.720 --> 17:33.507 and this is great, because people who are dealing with IBS 17:33.507 --> 17:35.460 and the psychological symptoms associated 17:35.460 --> 17:39.150 with IBS previously had to go on full elimination diets 17:39.150 --> 17:40.440 for the rest of their life. 17:40.440 --> 17:43.032 It was essentially, "Hey, eat one meat, eat one fruit, 17:43.032 --> 17:46.740 and eat one type of bread, and see if it bothers you, 17:46.740 --> 17:48.030 and then if that bread bothers you, 17:48.030 --> 17:49.320 swap it out for a different bread," 17:49.320 --> 17:50.490 and that was all they had. 17:50.490 --> 17:52.650 They had such limited variety in their diets. 17:52.650 --> 17:54.930 So by kind of categorizing and figuring out a diet 17:54.930 --> 17:56.640 that addresses all of these issues, 17:56.640 --> 17:58.875 they've really been able to decrease the amount of time 17:58.875 --> 18:02.340 that people have to spend on a low FODMAP diet. 18:02.340 --> 18:03.958 They watch IBS symptoms 18:03.958 --> 18:06.374 and look at quality of life in these patients, 18:06.374 --> 18:09.840 and some studies they see, you know, 18:09.840 --> 18:12.450 significant improvements of mood, quality of life, 18:12.450 --> 18:14.310 and other symptoms associated with IBS 18:14.310 --> 18:16.650 in as much as 90% of participants. 18:16.650 --> 18:19.290 With a dietary intervention, that is huge. 18:19.290 --> 18:20.580 That is so powerful. 18:20.580 --> 18:22.560 I don't even think that the actual interventions using 18:22.560 --> 18:24.870 medical, you know, using pharmaceuticals are reaching 18:24.870 --> 18:27.180 these kind of degrees of efficacy, 18:27.180 --> 18:29.220 so it's very, very powerful. 18:29.220 --> 18:30.990 And then you can actually go back 18:30.990 --> 18:32.340 to the FODMAP containing foods 18:32.340 --> 18:34.620 and start to reintroduce little categories, 18:34.620 --> 18:36.720 little pieces of those different foods, 18:36.720 --> 18:39.390 and see if they're triggers, and by doing that, 18:39.390 --> 18:41.100 you're able to improve quality of life even more 18:41.100 --> 18:43.710 in these people because you're now not only eliminated 18:43.710 --> 18:45.450 and restricted on uncertain foods, you're really able 18:45.450 --> 18:48.090 to figure out which FODMAPs you have your sensitivity to. 18:48.090 --> 18:49.080 A lot of people, for example, 18:49.080 --> 18:51.270 they're only sensitive to fructose. 18:51.270 --> 18:53.220 They just don't absorb fructose very well. 18:53.220 --> 18:54.831 A lot of people don't absorb lactose very well, 18:54.831 --> 18:56.970 and they can eat the rest of the spectrum 18:56.970 --> 18:58.890 and not have to worry about it. 18:58.890 --> 19:00.876 But really what it all comes down to is that we see 19:00.876 --> 19:04.680 decrease in these psychiatric symptoms associated with IBS. 19:04.680 --> 19:07.890 We see a significant improvement in the quality of life 19:07.890 --> 19:11.100 for people who are really suffering from all the sorts 19:11.100 --> 19:14.703 of other aspects of, or other consequences of IBS. 19:15.690 --> 19:18.720 And so, you know, are there other applications of this diet? 19:18.720 --> 19:20.280 Not everybody has IBS, 19:20.280 --> 19:22.260 although I think a lot of people do have 19:22.260 --> 19:24.870 some sort of subclinical food intolerances. 19:24.870 --> 19:26.610 You know, we're talking about food intolerances a lot, 19:26.610 --> 19:28.302 and how those can influence behaviors, 19:28.302 --> 19:31.740 and so no, not everyone has IBS, 19:31.740 --> 19:33.420 but there are other applications of this diet. 19:33.420 --> 19:34.320 There's been studies now 19:34.320 --> 19:36.420 that have looked at fructose malabsorption 19:36.420 --> 19:38.550 for people who don't even have symptoms of IBS, 19:38.550 --> 19:40.560 they just don't absorb fructose very well, 19:40.560 --> 19:43.620 and those people have frequent bouts of depression. 19:43.620 --> 19:45.180 By removing fructose from their diet, 19:45.180 --> 19:47.460 they're significantly improving their amounts, 19:47.460 --> 19:48.930 or their bouts of depression. 19:48.930 --> 19:50.693 Again I talked about lactose intolerance. 19:50.693 --> 19:52.470 The sorbitol intolerance, 19:52.470 --> 19:55.080 this is a artificial sugar that's commonly used 19:55.080 --> 19:57.660 for a lot of those sugar-free treats that people eat. 19:57.660 --> 20:00.630 This is a really powerful polyol that can really cause 20:00.630 --> 20:02.730 some significant gastrointestinal issues. 20:02.730 --> 20:04.770 And then, you know, here's the big guy is 20:04.770 --> 20:07.380 the non-celiac gluten sensitivity, right? 20:07.380 --> 20:09.300 Everybody who's trying to eat gluten-free, 20:09.300 --> 20:12.150 and they're avoiding wheat, well, it turns out 20:12.150 --> 20:13.260 a lot of studies are now showing 20:13.260 --> 20:17.730 that it's not necessarily the gliadin proteins 20:17.730 --> 20:20.640 in that gluten, in that wheat that's affecting people, 20:20.640 --> 20:22.500 but it's actually the FODMAPs in the wheat 20:22.500 --> 20:24.180 that seem to be affecting people. 20:24.180 --> 20:25.650 So for people who are dealing 20:25.650 --> 20:28.890 with non-celiac gluten sensitivity and any of these issues 20:28.890 --> 20:31.800 associated with when they consume wheat, and they have 20:31.800 --> 20:34.237 all these sorts of, you know, people often say, 20:34.237 --> 20:36.976 "Oh, I can't concentrate if I've eaten wheat. 20:36.976 --> 20:38.760 You know, I can't sleep. 20:38.760 --> 20:40.470 I have depression when I eat wheat." 20:40.470 --> 20:42.000 A lot of this is actually thought to be related 20:42.000 --> 20:43.399 to now their FODMAP content 20:43.399 --> 20:45.780 of the food that they're consuming. 20:45.780 --> 20:48.630 A researcher did a little trick on his subjects. 20:48.630 --> 20:52.200 He told them that he was giving them a gluten-free muffin, 20:52.200 --> 20:54.030 but instead it was a FODMAP-free muffin, 20:54.030 --> 20:55.620 and he challenged them later with something 20:55.620 --> 20:58.470 that had FODMAPs in it, and saw that it really was 20:58.470 --> 20:59.906 the FODMAPs and not the gluten 20:59.906 --> 21:03.390 that was being so offensive to those people. 21:03.390 --> 21:04.650 So really I hope, you know, 21:04.650 --> 21:06.746 that this presentation has kind of opened people's eyes 21:06.746 --> 21:09.789 to a totally new dietary paradigm 21:09.789 --> 21:12.720 that is worth considering anytime 21:12.720 --> 21:14.820 that you're talking about someone's mental health is also 21:14.820 --> 21:17.430 the health of their gastrointestinal tract, 21:17.430 --> 21:19.950 and how these two things work together, 21:19.950 --> 21:23.460 and simply by carefully eliminating some foods 21:23.460 --> 21:24.930 and replacing them with others, 21:24.930 --> 21:26.640 you can have a significant improvement 21:26.640 --> 21:28.320 in their quality of life. 21:28.320 --> 21:29.173 So thank you. 21:29.173 --> 21:31.840 (intense music)