重塑第二大脑：解密肠道菌群、膳食纤维与压力卫生

What can unlocking a healthy gut do for your life?

It can recenter one of the most important organs we have and really with that have all these second and third hands effects that you wouldn't even maybe have thought of. All these influences on your mental health, on just your sleep quality, on your metabolism, on your weight, on how you just feel emotionally during the day. It's sometimes more important than genetics. And why would you not want to get into something that is so easy to influence and change and then has such a wide reach on every aspect of your health. What's the biggest myth about the gut that you wish would disappear? I think a lot of people are afraid that it's like too fragile, too sensitive, too stupid to handle things. And the gut is a very robust organ. If you treat it right and understand it most of the time, it can take a lot actually. And so sometimes when people think they have all kinds of sensitivities, some people do and then for other people's it's more something that damaged the gut. So now when all these foods come into contact, fructose, gluten, dairy and so on and so on, the gut always has an issue but that's more because it has an underlying general issue that you have to first take care of and then when it's all healed up and doing well again, you probably are able to eat all these foods again. But people then stop entirely, especially with IBS for example, and they say I can't have all of these things and I would say it you're right, you're not imagining this or you really can't at the moment but it's not because, you know, your stupid gut can't take it but because there's something underlying that we need to fix first and then slowly and surely you'll be able to have all these things again. Sometimes people have a little bit of a wrong view of the what their body is actually still capable of and what medicine and like things from the outside can do to it. What are the most common signs uh that the gut is not healthy? Very simple things are just the basics. Do you have a belly ache? How is digestion? Your body basically sends you a text every morning when you go to the bathroom. Might check it out. It's free. Just turn around and look. And then also some other things are also a bit more subtle when you look at the effect of an unhealthy gut on symptoms like anxiety, risk of depression, just an immune system that's out of check maybe influenced by some disturbances in the gut has an impact.

If someone wanted to improve their gut health, what should they eat more of? I would say eat more of things that you really like, but that are luckily also healthy. That's always the first step. Because what I see often times in in clinic was that people would eat these things because they heard they were healthy, but they hated them and then they just stuffed their face with the stupid kale that you know. And then always I said, "Oh no, that's not good. Let's look at like all these vegetable and fruit there are. Which ones of those do you like?" Cuz there'll be one or two that you like. And it's often way easier to go from there and then starting having just a bit more of that healthy stuff. Some people really like asparagus. Others will not mind having an onion more, you know, putting it in your sauce when you have like some ready-made sauce. Like just things you don't mind or that you really like the taste of and then have a little bit more of them. And I think that's always the starting point. Because drastically changing the diet also putting way more fiber in all of a sudden will just make you gassy or bloated because your gut is not used to that. And your microbes suddenly get all these foods. It's like a forest and then you just dump some fertilizer on it. What's that going to do, you know? Slowly change your diet, but with the things you like and the microbes like. That's a good compromise. Are there better foods for gut health? Like what would those be? Like what are the best foods for gut health? It is individual for some people because gut microbes are individual. Some people might have gut microbes that when they eat beans, it's wonderful. They got all their fiber, they do all the nice things. Some other people have got microbes where they are horribly bloated when they eat beans. And this relies on your gut microbes. So, I would say look at the different vegetables and fruit you if you want to, then go ahead and look for their fiber content. You will always have two types of fiber. One is water soluble, the other is water non-soluble. What does that mean? That means for example cereal or the skin of an apple for example. It has fiber that are not able to fully dilute into something gel-like when they are mixed with water. They'll just stay a bit like sturdy fibrous stuff. And those can mostly not be digested by the microbes because they're tough to really crack up. And they will just form bulk. And this bulk is good because it will knock on the walls of the gut and be like and the gut is very curious so it bounces back and this propels like digestion. This is really what gets your regular bowel movement so it's good to have. But this other type of fiber, the water soluble one, is usually what makes up the fruity flesh of the apple for example and in asparagus or when you just have carbs like rice and noodles and so on. If you cook them once, let them cool down, suddenly their content of like resistant starch and so with that soluble water soluble fiber rises. So just having your carbs cooked, cool them down and then you can even reheat them, makes them more prebiotic. So it prebiotic meaning food for good microbes in the gut. There are things that are good for the microbiome like let's say beans, onions, you know, green leafy vegetables. But if you don't crave them at all, start with ones that you crave cuz then that might mean you actually have the microbes that are eating them that make you want to eat it. And do we need a wide variety of fiber or is it something where we can just consume one or two foods and get all the fiber we need? No, the thing there's this rule, I think, by Tim Specter who made this prominently and it's it's very good and he made all the wonderful research for that, that if you have about 30 different types of fruit and vegetable a week, then you're really in a good window where there's so much variety of different foods that there can be a variety of different microbes eating them in your gut, which then contributes to your health. Does eating fiber reduce your risk of cancer? Yes. Why? When you look at cancer, there's different types of cancer. We have a hereditary kind of colon cancer, for example, but we have also colon cancers where we now have the leading indicators that the microbiome play a part in it. And also, when you look at fiber, what it does is also propel digestion. So, for example, all this metabolized stuff that really is ready to just get out of your body doesn't sit there for very long releasing also possible toxins, for example, and they then come in contact with your gut cells. So, there is a type of pro-inflammatory or then even pro-cancerous processes that are being influenced positively by fiber. And that is one by influencing the gut microbiome, two by influencing just the process of digestion itself, and then three also effects that have to do with metabolic risks of cancer. So fiber and the way it slows down the intake of blood sugary things for example, when you have spikes of blood sugar all the time, this can be pro-cancerous by multiple roots by making the immune cells a bit more aggressive by then, you know, promoting pro-inflammatory causes. So it's a very complex building, but the simple answer is yes. Fiber can protect you of colon cancer for example, and then other cancers that are related to those metabolic processes that I mentioned.

What causes the inflammation inside of us that you mentioned? For example, very simple link is sugar. When you look at sugar, it is high energy and immune cells will realize that they have now this budget of energy to spend. And of course they are pro-safety, and of course they say, "Oh, I'd rather have some more safety guards and some unnecessary inflammation than too little." So this is a little bit the tendency they're leaning towards. Well, because when you look at our history, thousands of years, it's always better to have this additional safety, but we rarely ever had enough energy for that. Our energy budget was always limited, cut off at the very, you know, necessary things. And suddenly we have all this energy to spend. And then the immune system as we see is a bit switched on by sugar. It goes a bit more into the aggressive direction because it can, you know. And this is one process that sugar will tip off. And we see for example people drinking soft drinks high in sugar for 10, 20 years, they have a significant elevated risk of like inflammatory diseases. And this isn't always the one cause why someone has an inflammatory disease. It's different other possibilities, pollution in in our are making the immune cells irritated and aggressive, our genetic um predisposition where there's less calming signals you know in an immune system for example, all these other things. But for example, sugar is one of them and it can tip off these processes and this then can have a range of effect. And there's different types of sugar, too, right? Like there's naturally occurring sugar in fruits. But then there's like white sugar that's refined and then high fructose corn syrup. That is true and you can definitely say that this like concentrated high fructose corn syrup is like one of the ones where we see these ungood effects if it's administered in a too high dose the clearest. But I'm I'm not convinced by these things saying have a date instead because there's just the same molecule in it. The fiber of the date and might slow it down the take up a little bit. But if you have like, you know, dates that have been made to be this big and super sweet then they're also full of sugar. So I would say don't kid yourself. How did you get interested in the body? I think it all started in my teenage years when I suddenly got a skin disease um and I realized that I know nothing about my body. I'll be hanging around in this body, you know, for another 70 years or so, and I just don't know how to like understand all these processes with this suddenly coming from and I have to go to a doctor who tells me then, "I'll just put this on it." Helps a little bit, then comes back and I realized, "Oh, I just have to like do what he says cuz I have no idea." And then I started reading and I started like being surprised and understanding so much more. Also realizing that it gives you quite a friendly kind of power when you know more about the body. What was the skin condition? Well, I had like these open wounds coming up and then he said, "Oh, it's like eczema or something." And I put steroids on it and it went away, but then it just came back. And I thought, "Well, this can't be it for the rest of my life, you know, so what else is there?" And I found all these things about the gut, about after probiotics sometimes things like this can pop up or how food can even show up on the skin. So, that was just a topic I got into and then I tried all these things very unscientifically at the same time, this and this and a little bit of that. But after a while I realized, "Oh, it was getting better." I could visibly see how it was getting better and how I could help myself just by trying things out and by having more knowledge. You were experimenting on yourself. Yes, definitely. Some of the things I wouldn't recommend today with the knowledge I have now, but you know, I I was young and just did it. What was one of the crazier things you tried? I overdosed on zinc and then I really back then I just got a really sensitive smell. Like I could smell things from further away. At least that was my impression and experience. Wait, so if you overdose on zinc, you can get like a superpower? I read later on that this may be possible. And I just had this happening to me, so I thought, "Oh, well, wow, okay." And is that when you decided you wanted to be a doctor? Yeah, before that I wanted to go into like energy engineering. Um I'd already done like internships and I was really into that, but then I realized, oh, I can read these medical texts and even like papers or books for hours on even if I'm really tired. And so, something within this topic is like grabbing my attention and it's really easy for me to get into. And especially when I discovered the gut, that was it. From there on, you know. What's the link between the gut and the immune system? Well, there's lots of immune cells residing in the walls of our gut and they're checking out what's going on. At least in you know, the gut is one of like the heart of our immune system? I mean, the immune system has different locations where it's being trained, but the gut is a very large and a very center one. Because especially there's all these exchange happening with the outside world. When you look at us from the outside, you would almost think the skin is the biggest surface to the outside world, but the gut is a huge one where you have all these substances coming in crossing the wall into the blood of our So, that's a quite intense process. And of course, the immune cells cells will be there to just see what's going on and really be sure that there's nothing, you know, wrong happening. [laughter] And there they'll also learn tolerance. Usually in an healthy gut, that's the training boot camp of tolerance. They'll be like, some peanut came, but it was all right. Our cells are still doing fine. And then all these immune cells are gathering and saying, oh, this is peanut. It's It's a seems to be quite okay because we're still doing fine. And sounds like a really funny process, but it's happening every day all the time. They're just training this tolerance. And of course, then when your gut cells aren't doing so well, there's maybe little wounds or it's been stressed or the protective mucus layer is down, then the immune cells might be wondering, hmm, maybe the peanut is not so good for us because the cells aren't looking so good. So, should I be watching out for peanut next time? So, these are some of the processes that can lead, for example, to sensitivities or allergies or just a gut that's not feeling well. There's a lot of supplements that are pre- and probiotics. Are there foods that we could take for the prebiotics? Definitely. It's all the same stuff. It's have your veggies, heavy fruit. It's uh So, they have prebiotics in them? Absolutely. And as I said, usually in the in the fruit, you see that the the skin of the apple, for example, has the water non-soluble fiber, and then the flesh has the water soluble fiber. And those are prebiotic. And you can basically pick any vegetable. Then you have some like banana that have a little less, but if you pick a green banana, for example, the starches are not yet unpacked, so it's not so sweet cuz unpacking the starches making some sugar out of them makes the banana sweet. But if it's really green, then this hasn't happened so much. So, there's more prebiotic in them. So, that's why in some countries green bananas are also used when you have some diarrhea because they might help with feeding good microbes, which then fight off the diarrhea-causing microbe.

All right. I want to talk poo. Yes, that's [laughter and gasps] You became famous partly for making people think differently about poop including myself. What are we still getting wrong about poop? Well, I think the thing to get wrong is just to ignore it really. In Germany you have two different kinds of toilets. We have one toilet where it goes into the water which is I think the American and Canadian types that you will know of as well. And then we have this toilet which is has a presenter. It's like so you will just have it presented there and from here you can flush it then with water but you will really see and also not to go into too much detail but you will smell a little bit more too. So there it's really hard to ignore. Um but I mean, you can also look at it in in other ways. There's for example the behavior it has when it's floating. When there's no air bubbles in it at all that means bacteria haven't really done their work at that job there so it sinks to the bottom immediately without sometimes swimming a little bit. So, that's a sign that you're not digesting properly, for example. Can be a sign. Then, if you have lots of fats in your stool still, it's a sign that maybe you're not digesting fats really well. You might even get that checked out if it's very prominently there. Then, of course, you have just things like structure and color where you can get some hints from. Um as I said, really black color or blood reddish color, that's always a warning signal. There's also things like it being a bit more to the greener side or yellowish or something. And gray is a warning signal as well. And then when it comes to consistency, I think um this is for most people probably the thing that they realize the most. You know, we have the Bristol stool scale. It's written in wonderful like British language with like you know, uh smooth and soft like a snail or something. [laughter] It's really fun to check it out if you want to. But there you can see that if you go more to the constipated side, what forms are already indicating that. Um and then you can of course also realize diarrhea or stool being too soft, I think often times is an overlooked problem because it can mean that your mucus is not intact or your digestion is not going so well. There is um maybe that is predominantly German, I don't know, but I can say that people were also a bit embarrassed about the topic when it all started in Germany 10 years ago. But there's like a literature piece where they describe like the holy perfect way where you go to the toilet and you don't wouldn't even have had to wipe because it was so perfect that there was no wiping necessary. [laughter] So, I think what that actually indicates, and that was way before we realized this scientifically, is that when you have a very proper intact gut mucus lining, then it will really surround the last bit of digested stuff and really pack it up so it doesn't really touch much um of your skin or mucus area when it comes out and it just is a clean business. What about size? The toilet cloggers is Well, the perfect toilet cloggers would be the one where they just have so much fiber that this really gives them a lot of bulk or mass or whatever. Um, and then the not so perfect ones is when really you're not digesting so well, so you haven't taken up all the food and too much of it comes out unprocessed basically. That is not such a good thing. And then sometimes you can see it even as a side effect of antibiotics because the antibiotics kill off all these bacteria and they have quite some weight. They have a mass, you know. They are sometimes described as an organ of its own. So you're basically losing a little bit or a bigger part of that organ and that can sometimes amount to a bigger volume, but it's not necessarily a bad thing if you can handle it well. How do we rebuild our gut after a dose of antibiotics? People in different life stages are more susceptible to the like disadvantageous changes antibiotics induce. So we see especially small kids and, um, seniors, um, in studies that they have a harder time going back to their microbiome after round and of antibiotics. Then we have all the adults in the middle area of this. For them it's like 50/50. Some of them will actually go back quite well and others will never replenish the microbes they've lost. And some of them might have been even like some nice family in inheritance pieces, so to say, but they will not get back and that used to protect them of certain diseases or things before. So it is not with an easy hand that you should administer antibiotics just for every cold you have. And especially in the United States, I have to say, um, we see that this is a problem that is maybe responsible for the high number of people having problems with their gut. So that being said, what can you do? Of course you can have probiotics especially when you start having diarrhea while you're being on antibiotics. We've seen studies that probiotics help with antibiotic-induced diarrhea. So, especially for children also and the elderly, as I said, but also with grown-ups experiencing diarrhea that is an indicator probiotics could be helpful. Then we see that when you take probiotics after a round of antibiotics, there is two effects. One is that they can help lower your pH value by, for example, bifidobacteria or lactobacilli who produce these acids can have a beneficial effect cuz you know, again, good bacteria thrive in those environments, others might not, so it it will help. But it can also have an effect that they take up niche and room of your initial microbes. And then when you stop taking them, they're gone and yours don't return the same way because they were being like kind of like pushed to the side. So, it's not only a good thing. So, this is where prebiotics are also really important. As I said, feeding your good microbes that will actually stay with you and that feed off like good foods. What are the warning signs that someone should see a doctor instead of trying to fix it themselves? Well, the typical warning signs are just like heavy, like extreme, like really pain that you don't usually have or don't know. Then we always have the black or the bloody stools that you should get checked out of. Weight loss, night sweats, those are like the really severe common ones, but also things like if you have a tendency towards diarrhea and it lasts more than three, four days, then I would also think of having that checked. And then if you have a really bad constipation, for example, um that can be something that you already know, you've had it since you were a child or you've had it for a long time, then I would always say it's not uh an act of immediate attention, but it can always be improved. So, it makes sense to go somewhere and check some things out, but if it's suddenly stop starting, that suddenly you're constipated and you don't even know why. You didn't used to be like that. That's something you should also have checked out pretty soonish. Yeah. Are we pooing wrong? There is an aspect that is a bit disadvantage. And this is this um seat of toilet that looks like a chair, you know? And we sit on it in a posture that we would usually know from, you know, sitting on a chair. And our body has the smart mechanism of having a muscle going around the end of the gut and then, you know, holding it back a little bit so that we stand or when we sit in that position, not all of it is like immediately in the position to come out. So, it creates this curve. When we put our legs up a little bit, you could say like a 30° angle from just being horizontal, then this gets loosened up. And then there's not this curve anymore, but it's rather a bit straight. And, you know, this is just the natural position when we squat outdoors when we go to the toilet. And this is then a better, anatomically speaking, a better way to go to the toilet because you need less pressure and you're not pressing against, uh you know, your own muscles holding stuff back. And this way can reduce the risk of hemorrhoids or diverticulosis, which we see less of in countries where people still use a squatting position when they go to the toilet. So, it is a good idea to maybe try to emulate this. And you can do so with a little stool in front of your toilet where you just, you know, put your feet on. I've heard now so many people report back to me that this has helped them or that they really miss it now when they go elsewhere. They will use like the tiny bin in the hotel toilet to put in front of the toilet so that they have this position because it just feels more natural. And there's been a study on that um by Dov Sikirov, a researcher who compared these different sitting positions and could show that it's much easier or also feels better for people that they really got everything out when they are rather in that situ- like position than in a normal chair stool position.

What does constipation actually mean? Constipation um can is well, the problem of having the feeling you're not really emptying all the way when you go to the toilet, of having a too hard to too difficult time to go to the toilet. You really need a lot of force to get stuff out, or even need to like help a little bit, manipulate so that you can get it out. It can be too hard. So, these little pieces of stool like a goat would have, for example, is a good indicator that it has just spent too much time in the gut already got all the liquids and then some more. So, it's really like dehydrated a little bit. Those are different aspects and can have different causes. For some people, it's just in the very end that they're having a hard time coordinating it really getting out. For others, it's all the way before that that it's too slow. It's at somewhere it's being like not transported fast enough. And that can happen with a low fiber diet where you just like have pizza and pasta and white flour and that's it basically. So, there's different causes for that. But, um a way to handle it is almost always easy and has really great results. And I've personally never experienced a patient that didn't get better with just some simple tricks here and there. And then, of course, there are some severe cases where really something's off motility disorders where since birth you've had a super horrible hard time to go to the toilet. And there we need to be a bit more creative, but there's also wonderful solutions for that now. What are the tips and tricks when you say that? Some more fiber, some more probio- probiotics in your diet. There's things like flaxseed, chia seeds, um these things that you really need to add some additional water also to really have them soak up and really, you know, have some material that the gut then can propel forwards. Those are very simple things. How important is chewing? Chewing is a good thing if you want to take some work off your stomach off the hands of your stomach cuz the stomach really then has to get all this muscular work going if things are not chewed correctly. And it's exit, so to say, will only let very tiny particles through. So, if you don't chew well, it has just a bit more stuff to do. And also, you tell your brain what kind of nutrients are coming in when you're tasting them already. So, actually just looking at certain foods will start the process, but then really having them in your mouth will already get some things going and some juices flowing. It's a nice thing, but I also have to say a lot of the foods we eat nowadays don't necessarily need the chewing anymore. When you look at highly or ultra-processed foods, they're so almost falling apart into sugar particles. White bread, white pastries, white flour stuff. I mean, you can chew, but it'll be very soon just sugar in the very first you know, inches of your small intestine. It's all sugar going into the bloodstream. Go deeper on the ultra-processed foods versus sort of nature's foods, if you will. So, when you look at all these advices we get all the time about food, right? There has been an era for something like the Taylor Swift eras, you could almost say. There's been the era of having low fat in order to not put on weight. There's been an era of having everything less sugar, sugar substitutes. Now, when we look back at these discoveries, scientific opinions, you could say, but of course with evidence, then you can say, "Well, they're not entirely wrong, but they really weren't entirely true also." And what we're looking at now, which era are we in now? I think this is now the era where we say, "Ah, probably it's about the ultra-processed foods that are bad." You know, we still have some of the remaining advice like, of course, don't have too much sugar. That's still a very good advice. And I think here, the nice thing is to have a clear amount, which is 25 g. This is what the World Health Organization say. This is the amount of sugar you can have without it in the long run affecting your health. And then when you look look at fats, it's still true to say it's good to have like polyunsaturated fats are good, olive oil. Don't heat it up too much because then it breaks apart and can like reshape chemically, not be so good anymore. But those are the things that still keep standing. But the rest of it, people say, "Well, rather have the full-fat yogurt, you know, because not engineering it so much or also the way it is digested is a bit more natural to the body and doesn't have all these horrible effects we earlier thought." And now when we look at people having diets without all these additives, we see how healthy they are. And we see even when we have people stopping their usual diet with all these processed foods and going back to a more natural diet without all these additives, we can track all the effects and they right away shown that it's much more healthier for their body that's good on them. So get an idea that oh, maybe you know, that was the thing. How long does that take if I if I stop consuming, let's say I move from a diet of highly ultra-processed foods to more natural. How long does it take for my body to adjust and start to show signs of progress? Some effects you'll see after 3 days. Some of might take, you know, 1, 2, or 3 weeks, but that's really the amount of time. You hardly ever take more than that in the department of the microbiome to reach all these really nice good changes cuz you know, they eat every day. So if different foods comes in, they adjust every day. And then of course you have more more long-term things metabolically speaking, your cholesterol for example, also just your overall immune function or stress hormones. These things can indirectly be influenced. And those will take a little bit longer cuz you still have all this storage fat for example, when you talk about blood lipids or also just feeling better when your immune system is maybe not so angered by some additives or food processes or just a sensitive gut wall. This is I think a bit more individual and could take a bit longer. It seems like a lot of the knowledge that we've had over the years, the low fat/low sugar, also led to more processed foods. So, in order to reduce fat, we came up with substitutes for fat. In order to reduce sugar, we came up with substitutes, too. Is that true? Yeah, that's true. Especially when you talk about the low fat, there were all these processes to remove to have um that But I think what is actually a bit more the culprit here is the dopamine. Uh we have a lot of processed foods because we make it more appealing to our dopamine releasing cells. When they realize that you have a very high caloric density, they reward it because it means you ate just something very little, but it gave you a lot of energy. So, little investment, lot of turnout, and that is what those cells are about. And they reward it, not knowing what it does in the long term sometimes. And unconsciously oftentimes, but nowadays also targeted and very consciously, food industry has seen, okay, this is my target audience. Those are the cells that rave when something comes in, and they will motivate you to buy it again and again and have some more of it even. So, I think it's not really only the mistake or the wrongdoing of these hypotheses nutrient-wise or health-wise, but really also a dopamine system that screens out for reward louder and louder these days. And it understandably does though because it's being like, how do you say, wrenched? By social media, by processes that are not so fulfilling by time sometimes getting a bit tougher. People want a good feeling, and food is a way to get it. Is one way to think about food when you're in the grocery store just to look at the ingredient list and and a good sort of like heuristic is the fewer ingredients the better? Yes, and I do this all the time. And sometimes I'm really surprised as what I find when I look on the ingredients lists. Some things marketed as super healthy um and then you look at like this nice uh with all these foods and all this fiber and you look and it has like 40% sugar. That is like, what? Or some drinks they are oh, it's super healthy, wonderful juice, blah blah blah, and it has more sugar than Coca-Cola has. And I'm a bit like drawn to doing this now, and I buy these ready-made foods, and I have them as well. I think it's really difficult to cut them out entirely. Whatever half got is able to do that, applaud to you, but I think if you have a good like 80/20 ratio, you're good. So, 20% processed foods or stuff from the supermarket, fine. And then, if you manage to get, you know, to the 80% of like real foods that come like that from the soil or the tree, good balance. But, yeah, check out the ingredients list. And I check for um MCM. This is the methylcellulose and the polysorbate 80, so PS80, and carrageenans. It's really sometimes almost horrible to look at what substances are in these products. So, really go for the companies that look out for your health as well, you know.

What's the effect of alcohol on our gut microbiome, outside of sort of the obvious symptoms that people would think of with people who consume too much alcohol? Like, how would it manifest itself in our poo and our digestion? I don't know if you have this term, and it's not necessarily a pretty one, either. But, in Germany, we have this term of bierschiss, which means when you have too much beer, then you will just have this ungood poo, where you're like, "Oh, this is bierschiss." It's too It's too soft. It smells funky. It's something where you realize that wasn't a good idea, you know. And it's a mixture of alcohol annoying the immune cells, alcohol not being good on the nerve cells, alcohol um getting chaos into the microbiome. So, all of this comes together and gives you this weird weird text message on your toilet in the next morning saying, "What was that?" It's like our body's speaking to us, right? Like, it's giving us feedback. Well, it it is definitely a form of feedback, yes. What does coffee do? With coffee, it it contains uh polyphenols. It It contains antioxidants. So, it is not necessarily a bad thing. The thing that can be a problematic is the caffeine in it. If you have lots and lots of caffeine, it um has an effect on your dopamine system, not like drugs, but it um elevates the response of the dopamine system. So, that's actually also what you really wish for, the email of your boss saying, "Wonderful work, feels just a bit better, a bit more motivating, you're just bit a bit more like active fit in the day. And this is good, nice to have, we like to have it, but in in too large of an amount and that is the case when people then really have sort of withdraw when they don't have it in on vacation or somewhere in the plane or whatever, um then this becomes I think a bit problematic. And then you might think also of sleep because we've seen all the studies and rarely ever is science so clear on one point. There's always multiple opinions usually, but with coffee there's really not been a study where you don't see an effect. People will say, "But I have no trouble falling asleep." But then you see in all the measurements the quality of sleep after falling asleep is poorer. And then what do you need in the morning when you wake up? Coffee. So, it like becomes this vicious circle where I think um this is a main factor that then can influence the microbiome. The polyphenols and antioxidants, wonderful, they are actually good for the microbiome, you could say, but you can have them with decaf coffee just as well. And then when you have your coffee it within a time window select 00 to p.m., 00 p.m. perfectly fine and then you will be able to sleep wonderfully, but people have coffee after that I don't believe them that it doesn't do anything and I think if they could switch to decaf and just check it out for a few days and really be honest if their sleep is better now. And then they say it's not better at all, then you know, you do whatever you want. But before that experiment I would say have the experiment. Try it. Yes, try it. What effect does snacking have? There's different approaches to um frequency of food intake. Uh for some people they will really notice a difference when they keep a window of 4 hours in between meals. They will say, "Oh, this is so much better for me now." For others they don't. Um they get too low blood pressure, they don feel so well. And so it is again something where I would rather people listen to their own instincts and then have a healthy snack than say, "Oh, snacks are not good, so I shouldn't at all." There is some different um opinions on the time frame, like should we only eat from 00 in the morning to 00? Should we only eat when there's daylight out? Should we only, you know, have breakfast very large amounts of food and then small dinner? Should we, you know, there's all these different theories. And I don't think there's a common thing that is a solution for everyone, one fits all. I think there's not something like that. But it is good to experiment with it and really find out for yourself. And for example, when you look at visceral fat, like this sudden belly coming in in your 40s or something or afterwards, then oftentimes you see some improvement when you actually watch the times where you eat and if you have some time in between where you really don't eat or if you say, "After 00 in the evening, I won't have food until 00 in the morning." People will actually realize that there are some differences then. But as always, it's not a one-fits-all and I would just have people know about this and then experiment rather than tell them what to do. I was talking to a friend of mine uh before coming to see you today and she mentioned a gut cleanse. Mhm. Is that useful? Is it not useful? What is it? In the beginning, I have to be honest, I didn't like it at all because I thought it's so invasive. It's people thinking their gut cannot clean itself. Mhm. Because usually after 2 weeks, a gut really replenishes all its cells. So, if you just eat healthy for that time, you're good, you know? But I have to say, um I've heard so many patients um saying that it helped with like pain in the joints or with other things that I'm still not thinking it's this perfect solution for everything. It does have risks. We've seen patients um with trouble after or complications, not many, but it it's not without risk. But um for some they feel that it's good for their health and I'm a person that says that is the main thing. That is what health is about. So if someone reports that then I say, "Okay, good." But still it shouldn't be done too much. It is I think something to resort to when things have gone really wrong and you sort of feel like you need a reset. We've experienced patients for example with irritable bowel syndrome after colonoscopy being suddenly way better. And it's not because of the colonoscopy I think because we just checked with the camera for a few minutes, but it's maybe because they really cleaned cleaned everything out and could restock their microbiome a bit easier than they could have if everything's just stuck in place and you just throw some different foods on it. So now I'm more open to it and and think it does have interesting effects that I don't disregard anymore. Talk to me about supplements. So I think supplements and this whole fascination about them tickle me in a specific way. Once again, as I said, if someone takes something notices uh [clears throat] immediate shift says that oh, I really immediately feel like this because of it, then go for it. Check if all the dosages are right and if the quality is good because there can be some troubles with that, but then I'm not against it. But that being said we see that normal healthy grown-ups usually don't necessarily benefit from it. Some supplements even has dis- have disadvantages effects and big studies. Really, I'm talking big studies like vitamin E at a higher risk of people smoke having lung cancer. So what what was that all about? It's because you don't know all the effects one substance is will have on you. And there might be things that just occur naturally and if you have them powdered up or concentrated or well, whatever, if it's still in amount that's reasonable. But what I find people will miss while they're being on this whole supplement journey is they really go for all these nice slogans, but they miss the bigger picture. And the bigger picture is the picture that we have so much solid research on and it's the things your mama told you. It's sleeping well, it's eating well, it's dealing with your stress well, you know, um having some joy in life also accounts to that. Movement. And those are the things. And this is the big bug. This is the 80% of your health. And then some supplements might do 1 or 2%. They're good to you, but usually they don't don't do so much more than this. And uh so weigh it, you know. All this money, all this time researching, you know, and then these other things that have shown effects that are so important, really maybe put some of that time and energy and money in these departments as well. That's all I'm saying. Why is a walk after a meal a good idea? People will say that this helps you with your blood sugar because activating your muscles can really take um blood sugar and nutrients into your muscles and get them to work right away instead of just putting them in storage, so to say. So it's a hormonal metabolic reason. If people stress too much, like if they walk and their heart rises and they breathe really fast, so it's a stressful walk, then it's not necessarily good because stress will then do opposite effects. But if you really have a comfortable walk, that's what you want after a meal.

One of my close friends is doing this experiment that I think you'll find fascinating. So he believes that food is the key to healing. ... I try try to like make this knowledge in a way palpable that you can then use it rather than just have it somewhere in the books. Your work is about listening to the body. What does it mean to listen to an organ? It, I think, means in the first place, um and that's an easy place to start to not cut it out of the picture, to not ignore it. We will now have people, for example, breathing dysfunctionally. So, people at workplace might have this phenomena where it's called email apnea, where they hold their breath when they hear the sound or they see a new email coming in repeatedly over the course of a day, or breathe really fast and too too deep or something, which really heightens the level of stress hormones, makes the muscles in the back clench up, sometimes give them cold hands and feet, feeling really stressed. Their workplace really can also stress them, of course, but there's an aspect of the body that we overlook and we don't use to our advantage just because we don't know of it. Or other things like the gut influencing depressive symptoms. Like all these physical like influences on our life, on our feelings, on our performance. If we just would know them to a degree that we don't ignore them anymore, then we can use them. Then we can have breath techniques like for 1 minute at 12:00 and 4:00 during the work day, and it really takes off some of these symptoms. You'd be surprised for some people. We will have people realizing they're noise sensitive when they travel. This is part of where their stress comes from. We will have students realizing the type of learners they are and be able to like learn better. So, really I think what I want is people to just have this smart body feeling that they can actually use it to their advantage and not be victim to like mysterious processes that they find overwhelming. Oftentimes not so much knowledge that does that. If someone changed only one thing about their diet after listening to this conversation, what would you want them to change? Something easy that the person likes and maybe cooling down your starches before you reheat them or just before you eat them, and then pick one vegetable that you like and just have it a bit more often. And then I think, you know, we haven't talked about these things so much, but I like to have people know that hygiene isn't about disinfecting your hands all the time. One of maybe most important hygiene you can have is stress hygiene. And understanding your way of going about stress in the terms of hygiene, I think is actually very beneficial for the gut. Go deeper on that. What we see is that there's an effect of stress um that differs depending on how long the stress goes on for. Short stress is not necessarily bad because it's like challenging your body. It's like doing a bout of exercise where you're just like doing something very difficult and then uh you're going back to calm all again. But stress that lasts longer than this has more unhygienic effects because it's not only a little challenge and then going back. When you look at the gut with a camera and then you really stress out the person, the walls of the gut go pale. So they would usually be pinkish because there's all this blood going on. Blood flow is going great, you know. But when stress happens the vessels really go small and the blood the gut doesn't get so much energy anymore because your system is giving all this energy to your brain and muscles to solve the problem or run away, you know. And then when you're in stress, your gut will really give up all of its energy. It's very good willing, good natured organ that says, "Oh, there's this big problem. Can't digest in all, you know, carefulness now." If you're really stressed, some people even throw up or have nervous diarrhea and that is just to get all these tasks out of the system so you don't have to deal with digestion now. And so you can use the energy for problem solving. The bad part is if this goes on for too long, you're really abusing this good willed organ and it doesn't have enough blood flow and energy to build enough protective mucus. So your stomach might be sensitive or your it like food particles get too close to the gut and you're not having enough blood flow to get all the immune cells in the right direction. Your immune cells might even get more aggressive. This can have to do with a lack of sleep. This can have to do with the mucus layer being too thin. So, suddenly they're exposed to all these things. So, they're like, "What's this? I don't like it." So, they get all aggressive. And so, your gut can get sensitive to food suddenly or have problems that it wouldn't have otherwise because it just doesn't have the resources to deal or do its job in the way it would usually do. And over a few weeks, that can have very detrimental effects. Also, some microbes, and that is maybe the most hygienic part of it all, they thrive on stress hormones. They are really able to deal with them very well, and others are not. You're kind of making an atmosphere for your gut. We're selecting gut microbes that thrive in an environment of distress, and those are not necessarily the good ones we see at least in studies now. So, seeing stress as something unhygienic, I think, is very accurate in that framework. And if you disinfect your hands, you're just making a lot of room. Suddenly, everything here is dead, and whatever comes next, if you touch a funny rail or, you know, something from the air flies there, it now suddenly has room. So, if someone's sick and you're touching it or, you know, pretty sure you touched something dirty or so, you know, go ahead. But the most important stress, I think, is not disinfecting your hands, but really looking out for your inner stress hygiene. So, we shouldn't be putting hand sanitizer on our hands like 10 times a day. Maybe not 10 times a day. I have to say I really like my my skin microbes. Should really wash your hands when you go home, and you touch your face and your mouth and so on before that. But other than that, I don't think it's so beneficial. You just select some creepy ones that don't care for the sanitizer. What's one sentence you want people to take away from this episode? I think, really, just the vitality and the wonderfulness of being alive. And it sounds so simple, but feeling this a little bit maybe makes it easier for you to, you know, do something for your body. Just have your body. And I've seen so many patients when they were at the end of their lives, suddenly realizing their body is so genius, was so valuable. They had it all these years. And it's good to see that, but it's also a little bit late. I want people to feel that earlier in life, so that's not one sentence, but it's really what I would want people to take away. Yeah. We always end interviews with the same question, which is what is success for you? Success is purpose rewarded by myself. It is that I know I did something purposeful, helpful, and I myself create the rewarding feelings, not people around them around me saying that was great or something. Um and that is the success that I feel most satisfied by.