Have you ever wondered why we go to the doctor AFTER we are sick instead of preventing the sickness to begin with? What if we could better predict how our health would be years from now? I had the pleasure of speaking with Dr. Marvin Singh about these topics and more. Read on to learn about how stress can be a bigger factor in gut health than what you think, how your mental health and gut health are closely connected, why “23 and me” isn’t the best test on the market, and why we are so drawn to “comfort food”.
What Is Your Background?
I am an integrative gastroenterologist. I did my undergrad in medical school, I went to residency, and I did a fellowship in gastroenterology. Along the way, I realized that we practice good medicine most of the time BUT mainly when people are sick. The problem is that a lot of the people aren't acutely sick; they are chronically sick. I felt like we were missing something as far as how we take care of people and practice medicine. Along the way, I discovered Andrew Weil. I decided to enroll in his program and it was a breath of fresh air blown straight into me.
I started using some of the things I was learning in my practice and my own life. I noticed a lot of changes quickly. It is the learning that takes the longest time. When you learn these things, you can make huge changes in small periods. Along the way, I started to try to use more natural treatments, mind-body connection, mind-gut connection and started seeing a lot of great outcomes. Now I am interested in trying to use all of the latest cutting edge science that we have available to use and help people on a larger scale. This is how I did it with myself. I did all of the tests on myself such as:
I tried to learn and understand about myself. Once I was able to figure things out I was able to optimise what I eat and how I live much better! I am now the prediction guy!
Where There Any Struggles That You Went Through That Sparked Your Interest In This Alternative Testing?
When I first got into integrative medicine I was overweight. I had fatty liver and my liver enzymes were elevated. The director of my fellowship told me I need to get in shape or I will have a problem later on in life. I thought I was pretty healthy because I wouldn’t eat fast food, I wouldn’t go out to eat, but that is just a mere component of health and wellness. I lost over 30 pounds in 3 months once I changed my lifestyle. The lifestyle element builds on each other because you start to do one thing, you then start feeling the improvement and that starts to give you the momentum to do something else to improve your health.
How things can snowball out of control they can also snowball INTO control…
- Once you start changing your diet, get rid of soda, reduce the alcohol, fast food, then you get rid of bad habits.
- You may get more energy, you may start to lose weight, and this will motivate you to exercise better.
- Then that helps you sleep better, when you sleep better you are more relaxed. Then you may try out meditation. And it wraps itself around a full circle. You keep this going and things continuously improve.
People in society almost assume that doctors would be healthy but doctors also have personal struggles. I think also, blindspots. Sometimes they are so specialised in one area, other areas might not be a big focus in the training. It is the byproduct of the training and the history of it and where it's at at the moment. -Kriben Govender
What Methods Did You Use To Keep Track Of Your Biomarkers?
There are so many accessible and cheaper tests available now more than ever! For example: you can get a complete stool analysis HERE. When I went through and tested myself, there were not as many tests available as there are now. Now you can check microbiome metabolite levels with a prick of your finger. Even microbiome testing has evolved.
With my original microbiome test I looked at:
-Genetic testing: to help understand what foods I need to focus on to prevent a deficiency
-Toxin burdens: To see what my exposure might be because these things all play a role in your overall health, metabolism, and how the whole body works.
-Whole-genome sequencing: I now know every single gene that has been sequenced in my body
Now I am in the comparing aspect of it all! I want to try different tests to see for myself. Hacking my way through how to use these tests in the best way possible.
We are going into an age where, whether it is the microbiome or its genetics, it is very personalized to individual circumstances. I used 23 and me years ago to get my genetic information. Then you can use different tools on the internet to dive deeper into it and see what your polymorphisms are. You can also get a breakdown with Rhonda Patrick HERE which is a very cost-effective way to see your polymorphisms. -Kriben Govender
Whole Genome Sequencing Test?
This is a saliva test. It is one of the easiest tests to do! You spit until you get to the fill line. The lid has a reagent in it that stabilizes everything and then you put it in the envelope and you send it off. It takes about a month to get the results back because it is your whole genome. You get the information back and it is very insightful.
People get freaked out saying that they don't want to know this or that but it is one thing to be proactive vs waiting until you have a problem then reacting. To increase your longevity and quality of life, it is better to be proactive. If I know that I have a couple of different risk factors for let’s say, colon cancer, then I will know what to do to prevent it. This doesn’t mean I have it, it just means I am more at risk and have a genetic predisposition to it. Then I am going to look and see what the most effective way to modify my risk is.
There can be actions to take and then you can pay closer attention to yourself. Maybe you will get screened more often or if you did develop a tumor then you can get it removed before it becomes a problem. It is the people that don’t use this information and don't realize how helpful it can be, that wait until they have a problem and then they have to deal with the problem. Medicine is good at dealing with the problem but it is much better to be proactive and try to prevent it from happening rather than waiting for it to happen.
There are a lot of different companies that do these tests:
They are all looking at whole-genome sequencing. It is still not super cheap but I tell people that when the whole genome was sequenced for the first time it cost 100s of million of dollars. We went from that to a few thousand in a short period of time; it is a great accomplishment. As time goes by and technology gets better the price will drop as with everything.
How Do These Technologies Compare To A Direct To Consumer Like “23 and Me”?
Some of these other tests are just looking for a certain number of gene snps. They are looking for mutations in a particular gene. Whether it's 23 genes, 45 genes, or 100 genes, it still is not the same as your whole genome. It is the same with certain stool tests. Some of these tests are only looking for a whole handful of microbes. You get a little bit of information and some insight. That might be okay because they are cheaper but:
-It is not as accurate
-It doesn’t give you as much information
You may find out you have one really bad gene for colon cancer and then you think “Oh wow I am going to get colon cancer for sure - they said positive, so it’s positive!”
But what if you have 10 genes that protect you against colon cancer? That tells you a different story, right? You may still be concerned, you may still be interested in trying to optimise and change, but you don't have to be so freaked out. You have a mix of genes that will counteract that. It is the same thing for many microbiome tests. You do one test and there may be 25 or 50 microbes that they are looking for. They tell you your proportion of good to bad. But the value is so low because you aren't looking at the entire microbiome. It is not the individual bugs that are the problem. It is what is happening in the whole system that is important. If you are interested in a great accurate stool test, you can get one HERE.
For Example: Let’s say you are sitting in an empty room. 10 guys walk in the door. They look like regular guys but as soon as someone sits next to you they say “by the way, all 10 of these guys just got out of jail and they all killed two people.” At that point should you be freaked out? Most people would say yes I would be worried and looking for a way to get out! What if I turned around and said: “All 10 of these people, while they were in jail, actually became very religious people and their life’s goal has been to help people.” What if they helped rehabilitate a dozen inmates themselves while they were in jail? And now they are all together, to start a nonprofit to help other people. Would you still say that those 10 people are bad guys?
This is the same thing with the microbiome. You can have 10 bacteria that look like they might be bad but are they collectively doing something bad or not? That is the key. It is good to know who the players are but it's even better to know what they are doing as a collective system.
The technology is so new. We went from growing bugs on plates, then using morphology, to classifying them. Now we are using DNA based technology where we don’t even know what most of these species, strains, and sub-species are. We are still classifying them. The naming is changing and they are discovering new ones because it is based on DNA. We are getting right into the gut and going on an excursion of discovery and finding new species. That's how exciting this field is. But there is only so much that we can glean out of it so far. -Kriben Govender
What Influences The Microbes In Your Microbiome?
There are so many influences on these microbes as well. We all talk about nutrition, which does play a large role. But when I am giving a lecture I usually talk about diet last. I want to emphasize that the other components of your life play just as equal or as important of a role.
For Example: When there is chronic stress, you have these stress hormones (catecholamines), that are produced in the gut. When these chemicals are present in the gut they are what we call quorum sensing. They can bring the other bacteria to the site of where the issue is happening and they can become pathogenic just by being together. Someday who might not be a bad guy might become a bad guy just because you're stressed out.
When people come to me talking about their bloating and I start asking about their stress they ask “I didn’t ask about my stress, I was asking about my bloating.” But to handle the bloating we have to talk about stress too. It is a very important part that we are learning more about.
Diet is a big driver of the microbiome- equally as important are things like lifestyle factors, exercise, movement, sunlight, circadian rhythmicity and environmental exposures. It’s like we cannot look at one thing. We are an organism that is connected to the environment and we are being impacted by environmental stimuli. Simple things like being exposed to sunlight can trigger a whole raft of interactions in the microbiome. -Kriben Govender
It is very complex, yet very simple. The complex part is that we don't understand everything. We do understand that it happens and we may be chasing these ideas forever. There are several ways that we can get the same result. And this is how the body is designed.
How Do We Optimise Our Minds?
The other emerging field is the other little colony, your mitochondria. They might be archaea based remnants of a very ancient microbiome. They are ancient dinosaurs that thought “you know what, the best way for me to survive is to become a part of this animal's cell so they will always need me.”
It seems complicated but for me, it always comes back to how we evolved and nature. Because even though we don't fully understand these things we know that we came from nature. It is like nature has the answers.- Kriben Govender
This makes me think about Dr. Siegel’s work. He has redefined how the mind works. How the mind works is exactly how the human body works. He talks about integration and when a system is integrated you have harmony and things work well. When you don't have this integration, either there is chaos and/or rigidity. Something is not going right when things don't work together. To first understand how to bring in integration you need to understand that our mind is not just within our bodies, it is actually between us. It is inside of me and it is interacting with my environment. We are all connected.
Just like all of the elements, these are all connected to each other as well: the genes, the microbes, the immune system, the brain, the gut, and the heart. Once you realize that this is the concept of which your brain and your mind works then you can learn how to optimise it. How do you open the door and gateway into integration? It is through kindness and compassion:
-Taking care of your environment
-Taking care of yourself
-Not being mean to the guy next to you
-Not harming someone else
-Not doing something bad
-Help your environment
It is the same concept for the inside of your body.
If you give yourself the ingredients that your body needs to do the job that it was born to do, it will do the best that it can under your circumstances. Everyone's circumstances are different and we can't undo the past but we can optimise the present. It’s not about the past or future it's about the present. That's the way the mind works and that is the way the body works.
There is something beautiful about gratitude and also doing good. Helping others and spending time with people that you love. We can talk about the science of the microbiome and all that jazz but it's pretty simple to be kind. -Kriben Govender
You are innately programmed to react to something. I tell people “don't react, respond.” The Dalai Lama teaches you that when something happens you immediately want to react to it, that is your human nature. But if you take 3 seconds, relax, sit back in your chair, and appreciate what just happened and think and decide what I should do in response to that. It will end up being different than what your reaction would have been.
It is that flight or fight response that wants to manifest initially. Just having that present state awareness, catch yourself, breathe, and then respond rather than react. -Kriben Govender
The Gut/Brain Connection
The microbiome is very closely connected to the brain and the nervous system. There is a nerve called the vagus nerve. It is like an information superhighway. Information is constantly zipping up and down and it is a two-way road. The gut sends information to the brain and the brain sends information to the gut. And it happens so fast that you wouldn't even know that it's happening. When you feel the pleasure of eating something that you know is a cheat food, you are having that gut brain connection right there. The brain can influence the composition of the gut-microbiome. Situational stress can change the composition of the gut transiently so that you can adapt to the situation.
This whole organism, that we call the human body, is a very adaptable organism. We NEED to be because if anything happened, we would die. For Example: If you had a fire in the backyard and you were breathing in smoke and you died. There has to be different levels of adapting to the situation. You might get sick but you aren’t going to die. The human body is quite resistant as a whole organism. Mostly because of these types of things. When the situational stress occurs, the microbiome changes, and it may be changing so that you can adapt to that situation or stress. The microbes do not know what the problem is.
The problem is, when you are chronically stressed or anxious and there isn’t any apparent reason for it. It is not like someone is banging down your door, or that your house is actively on fire. With chronic stress, your brain is tuned in to feeling like that is happening all of the time. Then those transient changes in the microbiome become chronic changes in the microbes and that may be a trigger for inflammation. All that does is feed the originating process. That is why it can be hard to break through the cycles of anxiety and depression. It takes a multi-prong approach to peel back the onion and find out where the areas you need the most work on and try to work on them individually. To try and get back to that stable point.
What Are Actionable Steps That People Can Take To Feel The Best Every day?
My favorite way of explaining this is using this equation:
S = P x R --> Suffering = Pain x Resistance.
A Buddist philosopher came up with this. We are all going to experience pain in life. It is impossible not to. But suffering could be optional if we understand and appreciate our resistance to that pain drives the suffering. If I walk out to the parking lot and I see that my car is on fire, that is the pain. I could react in two different ways:
I could be so angry = My life sucks, why does this always happen, I have no way to get to work. You gave yourself 100 units of resistance. Maybe 10 factors of pain so you have 100 x 10 = 1,000 units of suffering.
- You walk outside and say “oh wow this sucks but this car was kind of old and I was thinking of getting a new one anyway.” Maybe this is a blessing in disguise. Maybe you didn't make the resistance a 0 but maybe a 1. But 10 x 1 is a heck of a lot better than 10 x 100.
A lot of this is in the understanding that there is a difference between reacting and responding. It is a tough concept to implement regularly. One of the things that can help you get there is to learn a mindfulness practice. Learning breathwork and learning to use these techniques regularly when you are not in these stressful situations because when you are in these stressful situations then you always will be because you are a human being and you live on earth.
There will always be something that is happening. When those situations arise you now have a tool that is integrated into your being! You can call upon this on-demand and it will work much better. When the black cloud is on top of your head, it's very hard to push it away. But if you understand that when you see the black cloud coming from a mile away, you can do these things and allow yourself to understand that there is a difference on:
how to respond
how to react
how to handle this.
Remind yourself that you are in the present moment and you will not let anything from 10 years ago bother you today.
You are going to worry about right here, right now and use this practice to help you get through that pain that is about to show up on your doorstep. That is one nice technique that is the cheapest that everyone can use. Being still, and appreciating the present!
I have mediation practice every single day first thing in the morning for 20 minutes. This is such an under-appreciated element of the gut-brain connection. Marvin highlighted the bi-directional gut-brain communication. Often so much is focused on getting the gut right to get your brain right. But it's also equally as important to get the brain right to get the gut right. Have a mindfulness practice and a gratitude journal. All of these things help to foster a good present moment frame and having the ability to not be reactive to circumstances when they go wrong but stay still in the moment and reflect. A lot of the struggles that we have in our lives are in our heads. For Example: someone cuts in front of you in traffic and you think “what a terrible person.” But what if this is a mom that is about to give birth and her husband is rushing to get her to a hospital in time. It’s a different frame. You don't know the things that are going on in that person's life but we often jump to the most negative conclusion. Instead, just be mindful that a lot of it is just imagined.-Kriben Govender
Even if it's hard to figure out why you can follow this concept called “fake it until you make it” you should try, When someone cuts in front of you, you are never going to know why they did that. Your initial presumption is to go with the negative: That guy is a terrible person. But he could have just gotten a phone call to go to the hospital because his wife is dying and he has 5 minutes to get there. If you knew that before you had that Most of it is imagined anyway so why don't we resonate towards something positive because we don't actually know. The brain is guessing as to what the reason is why this person is behaving in a way that we don't like. Make a joke out of it because you are never going to know the answer anyway.
Human beings want to be compassionate. We want to care for each other. It’s just that the stresses of life sometimes muddy the water. Sometimes we need to remind ourselves of the compassion and so many of the problems in our whole world would be better if a lot of other people did that too.
When I have a bad experience, I create a simple reframe. Your imagination is powerful. The brain can't tell the difference between what is imagined and what is real. It is like when you are watching a scary movie - the body’s physiology is reacting like this chainsaw massacre guy is going to kill you. Your body is having all of these reactions and that's how powerful your body and mind is. -Kriben Govender
Eating And The Gut-Brain Connection
Eating also works with the gut-brain connection. Eating is not just a digestive experience, it is a multidimensional whole-body experience. The brain will take in:
-What you are listening to
-What you are feeling
-What your mood is
Then it packages it in together with what the actual food is and how it makes you feel once it is inside your body. It also relies on how your digestive tract feels and the metabolites formed by the process of digestive.
This is where comfort food comes from. For Example: Maybe when you were a teenager you broke up with your first boyfriend or girlfriend and you were really sad. Then you had a candy bar right there and you ate it. Just for 5 minutes that candy bar made you feel good. That sugar released the dopamine, you got serotonin, and you felt good for 5 seconds. Fast forward 20 years later and you broke up with your fiance. You are in the grocery store and your brain is going to tell you “candy bar.” Your brain remembers that one time you were really upset and you ate that candy bar that helped you feel good. The brain can remind you to get the candy bar.
It could be the same reason why people cry when they hear a particular song or when they smell chocolate chip cookies and remember that grandma made them. The brain packages all of these pockets of information into little bundles and stores them as memories. It will call them into action when you want or don't want it to. The key is realizing and understanding that “the brain is wanting me to get a candy bar and I know that I can control my actions. This is an urge to satisfy something that is not going to get me a long term benefit. Instead of eating the candy bar, I am going to have a cup of green tea and do my meditation for 20 minutes. After this, if I still need something sweet then I’ll need something sweet. “ But after this usually that craving will pass.
Make that intervention before that black cloud comes. Understand the tools that you can use and use them at the appropriate time. You will fail many times before you get it right. You can’t beat yourself up over it. Do these practices whenever you can and as often as you can. Learn from your experience on:
-What does not
-What is the best situation
You just need to keep doing it over and over again. Your brain has learned to equate sadness with chocolate bars because of that breakup. You can reprogram it too, you just have to make the effort to do it because you've been living more years and it is already ingrained. BUT it's not like this it will be like this forever. You can take that “app” that is downloaded in your brain that says “sadness=candy bar” to “sadness=asparagus.”
You get the same dopamine surge from this because you've programmed your brain to feel that way.
For me now it is a nice organic chocolate bar. I eat an 85% dark chocolate because it is great for my gut, it has a lot of polyphenols, and I get a dopamine & serotonin hit at the same time. Plus it is feeding my gut microbiome. The best thing is to be aware of these programs that are running in your head. Don't take them for granted. See how you react to certain circumstances or how you react with foods. Just be very cognisant that a lot of these programs are from childhood. Things like meditation, yoga, or even acting classes can help. Anything to make you more aware of the biggest screen ever, your mind. It is a massive screen that you are watching all of the time. Watch what stories are going on in your brain and be aware if something is not serving you, reframe, and reprogram if you need to.-Kriben Govender
You may even think, “I have a food sensitivity to XYZ food because every time I see or eat the food I get nauseous.” But it could be more than meets the eye. You could have an allergy or sensitivity but sometimes people may have a problem that is coming from a deeper place. It could be that you got into a bad accident with your family when you were 3 years old and it was just when you were leaving the pizza place. Even though you were 3 years old and you might not even remember that it actually happened. It could be that your brain has equated fear and anxiety and stress with pizza. Now your brain says pizza = not good because of that and not a food sensitivity. You can reprogram this!
It is almost like little triggers that came from negative scenarios. It may be an allergy or it may be something that is sitting in the mind from trauma. That is why you see studies with correlations between cognitive behavior therapy and microbiome composition. What is happening from those stimuli. Talking through issues that could be very deep-seated and then dealing with it has a benefit to your gut health as well. -Kriben Govender
What Is The Most Common Thing People Come To Your Clinic For?
Focusing on the gastrointestinal side of things I see a lot of people with bowel and bloating issues. Either they are going to the bathroom too much or not enough. Heartburn is also something else they come in for. Those are the symptoms most people have.
First, I make sure that there are no warning signs that would require a colonoscopy or a scan of some sort. Sometimes, things that can sound simple like a change in bowel habits could be a tumor in the colon. We want to make sure that nothing major is going on. Even when we do a scan, most times nothing is going on. You have to dial back and try to see where these symptoms could be coming from:
-Is it a medication?
-Are they sleeping enough?
-Are they drinking enough water?
-Are they exercising?
All of these things that we talk about with lifestyle drastically affect how the digestive system works. Even heartburn. People that are on antacids and still have heartburn, there is no way there is acid still in their body. The problem may be stress because 30% of reflux is stress-induced. The stress is slowing down the stomach and it isn't functioning as well as it should be. Throw that on top of low acid and you have a recipe for undigested food and now regardless of the antacids you are taking, you get reflux.
You make sure you do the right thing by practicing the right kind of medicine then you use as many integrative approaches as possible that are practical. This will help them optimise their symptoms as naturally as possible. Integrative medicine is the best of both worlds.
Some people may need medicine for the time being in hope of transitioning off
Some don't need medications and they are okay with trying natural therapy
Everyone has a different feeling and philosophy and I just try to help them from that perspective. I also talk about diet, sleep, and stress because it makes a huge impact. I am not scared of using medication but if we can do without it then even better. Every medication is a chemical you put into your body. That can complicate things down-stream as well.
It’s like you are going back to nature as much as you can to deal with the issue and only using medicines when they are really needed.-Kriben Govender
What Is Precision Medicine?
Many tests are direct to consumers. People are getting them and trying to read them themselves which is fine but it’s not just about the microbiome, the genes, or the immune system, it is about all of it together. If you only look at 1 or 2 tests, you aren't looking at the whole picture from every test. The hard part is in taking all of these pieces of information from these tests then bringing them together to make some sort of action plan. At the end of the day, there is only one question anyone ever asks and it is “what do I do to help this” That is the problem with every test that exists. They give you suggestions but really you're not taking into account every test.
In my practice, I am taking all of this information and I am coupling it together with whole-body imaging, CT, coronary calcium score, the microbiome, and genetic testing. Then figuring out where there is a pattern. I don't rely on a single test, I like it when I can find the same answer in 2-3 different places. To me, this seems like something that would be real. For example: this person really does have a leaky gut because they had markers for it on 2 different tests. We should then tell them to do this or that so we can help fix the situation and monitor it.
Precision medicine to me is finding out what your body is saying, what messages are stored in your body, and trying to interpret those messages to stay on top of health. It is better to stay on top of health rather than being underneath disease. It is not just going to get your physical every year, which is better than nothing, but real precision medicine is an ultra physical exam. We want to know what we are doing and we want to stay on top of it so we can stay healthy.
If There Is One Thing You Could Do For Your Gut Health What Would It Be?
Integrate fermented foods into your diet. You can do it yourself, you can also find good fermented products and try to integrate that into your routine. You can ferment anything so you can figure out what you like along the way. We want to have a strong diverse resilient microbiome. And how you do that is by having a lot of different players that can add different kinds of value to the system. It is not about 1-2 guys, it's about the whole system. By adding in a variety of fermented foods, we can make the system more resilient by making it more diverse.
You can learn to make fermented foods HERE! You only need to get a culture once! Then you have it for the rest of your life. There are anywhere between 50-100 different strains of probiotics in milk kefir not to mention all of the functional peptides. -Kriben Govender
Our mental health and gut health are closely correlated. Learn how to deal with stressful situations with a mindfulness practice, eat fermented foods to improve your gut health, and invest in a few tests to better predict your health for the future! Share this with a friend that could benefit from this information!