The ND Is In: Healing with Naturopathic Medicine
03/25/2020 | Season 1, Episode 12
We've all been there…you seek relief for a nagging medical issue, only to have your doctor just treat the symptoms. And all the while, you aren't getting better — it’s frustrating! That's where a naturopathic doctor can help. A different breed of doctor, NDs work with patients to identify and treat the root causes of their health issues, to provide more holistic solutions to chronic conditions. In this episode of Be HEALTHistic, Dr. Drew Sinatra welcomes fellow ND and Healthy Directions colleague Dr. Irfan Qureshi to discuss the different ways naturopathic doctors are impacting health care. From treating patients to researching and developing nature-based health solutions, they explain how naturopathic doctors can help you, why treating the gut is so essential to naturopathic medicine, and why the gut-body connection is key to your overall health.
First, the doctors discuss their backgrounds, what attracted them to a holistic approach to healing, and why they embrace the principles that naturopathic medicine represents. From seeking out root causes of health issues to fostering patient empowerment to using more natural therapies, the doctors talk about the benefits of a more personalized patient experience. Then, Dr. Irfan explains how his focus on the research and development of quality nutraceuticals is making an impact on health care by giving patients more natural treatment solutions. Next, the doctors discuss how fundamental gut health is to every system throughout the body — making the gut and microbiome a central focus in naturopathic practices.
Then, the doctors zoom in further on gut health and discuss the microbiome. From the mysterious symptoms and causes of leaky gut, to the reasons why gut-related and autoimmune diseases are on the rise, to the impact of antibiotics on the gut microbiome, Drs. Drew and Irfan break it all down. Finally, they offer proactive tips for how you can strengthen and protect your GI health daily — including an anti-inflammatory diet, nutritional support (prebiotics and probiotics), exercise and stress-reduction tactics.
You won’t want to miss this informative episode of Be HEALTHistic, where our doctors explain the benefits of naturopathic medicine, why and when you’d want to seek out a naturopathic physician, and the crucial role that the gut plays in our overall health and well-being.
LINKS & RESOURCES
- Dr. Irfan Qureshi, ND is Vice President Product Development and Quality Assurance at Healthy Directions. For several years, he worked in private practice as a naturopathic physician in SeaTac, WA, specializing in chronic diseases and autism. Dr. Qureshi has also authored and coauthored several articles for peer-reviewed publications.
- Visit the Healthy Directions website for more health and wellness content and information!
- Check out the Healthy Directions Articles Archive, where you can search for specific, health-related content from all of our Healthy Directions doctors and experts.
- The focus of the discussion today was naturopathic medicine and its benefits; read this article from Dr. Drew on what you may not know about naturopathic medicine.
- Both Dr. Drew and Dr. Irfan attended programs at Bastyr University; find out more information about naturopathic medicine and the university.
- Interested in seeing a naturopathic doctor near you? Find an ND via the American Association if Naturopathic Physicians.
- Leaky gut was a major topic of the conversation; Dr. Drew shares some valuable tips here on leaky gut syndrome: what it is and how to treat it.
- For bonus content from Dr. Drew on leaky gut, watch this video on how to heal leaky gut syndrome with natural remedies.
- For even more facts on leaky gut, check out this information from Healthy Directions colleague Dr. David Williams on leaky gut, including causes, symptoms and diet tips.
- The doctors talked about the power of the gut-brain connection; read this article from Dr. Drew on psychobiotics: the gut-brain connection.
- Throughout the discussion, the doctors stressed the gut’s connection to various systems in the body; see this article from Dr. Drew on the connection between autoimmune disease and gut bacteria.
- Gut diversity is also important to GI health; find out more from Dr. Drew on gut diversity: the importance of yeast and bacteria in the microbiome.
- Drs. Drew and Irfan talked about the importance of nutritional support for gut health; check out this article from Dr. Drew on the differences between probiotics and prebiotics: benefits, food sources and more.
- Want to find out even more about your microbiome — what it’s made up of, how to nurture it, and how your gut is connected to each body system? Watch this 4-part video series by Dr. Drew on gut diversity, how to nurture the gut, gut sensitivity, and gut connections to the rest of the body.
- During the Wellness Wisdom segment, Dr. Drew mentioned a Harvard Health article on the power of the brain-gut connection; check out the full article on how the brain-gut connection explains why integrative treatments can help relieve digestive ailments.
Dr. Drew Sinatra: We've all spent too much time chasing relief from a medical problem, only to have our doctor just treat the symptoms. All the while, we aren't actually getting better. It's frustrating! That's where naturopathic doctors can help. We are a slightly different breed of doctors — we work with our patients to identify and treat the root causes of their health issues to provide solutions for their complex medical issues. Today I'll be joined by my colleague, Dr. Irfan Qureshi, and together we'll give you a chance to see the different ways naturopathic doctors are having an impact on healthcare. From treating patients, to researching and developing nature-based health solutions, we'll share some of the most important things you need to know about how naturopathic doctors can help you, what to consider when visiting a doctor, why treating the gut is so important to naturopathic medicine, and why the gut-body connection is truly key to your overall health.
Narrator: Welcome to Be HEALTHistic, the podcast that is more than just health and wellness information — it's here to help you explore your options across traditional and natural medicine, so that you can make informed decisions for you and your family. This podcast illuminates the whole story about holistic health by providing access to the expertise of Doctors Steve and Drew Sinatra, who together have decades of integrative health experience. Be HEALTHistic is powered by our friends at Healthy Directions. Now, let's join our hosts.
Dr. Drew Sinatra: Hi folks. If you like what you hear today and you want to listen to future conversations on all things integrative and holistic health, subscribe to our podcast on Apple Podcasts, or wherever you download your favorite podcasts. Also, check out and subscribe to our YouTube channel, which will feature video versions of our episodes plus video extras you won't want to miss. And finally, we have more with me, Dr. Drew Sinatra, my dad, Dr. Steve Sinatra, and other Healthy Directions experts over on the Healthy Directions site. So visit HealthyDirections.com to explore our database of well-researched content information. And of course, you can always follow us on our social media channels.
Dr. Drew Sinatra: Well, Irfan…welcome to the show.
Dr. Irfan Qureshi: Thanks, Drew. I'm glad to be here.
Dr. Drew Sinatra: Well today, you and I are going to be talking about naturopathic medicine — what is naturopathic medicine, why should people go see a naturopathic doctor. And you, having lots of clinical experience after graduating from naturopathic medical school, having a practice…it sounds like you've been all over the world, I actually want to hear more about your experiences, learning all these different medicines. And then you also have experience with formulation of product and everything, and quality assurance, so I kind of want to dig into that, as well.
Dr. Drew Sinatra: Irfan, in your bio, I noticed that you studied the Unani system of medicine. I'd love to hear more about that.
Dr. Irfan Qureshi: Well, the Unani system of medicine is actually a system that dates back thousands of years, and it really started with the Greeks. So in the Arabic language, Unan actually refers to Greece — but what happened was after the Greeks took it up, it was then taken to the Middle East by Arab practitioners. So the Arab practitioners of the time, the healers, were infatuated with this system because there was a ton of logic behind the theory of the four humors — which is what the system is based on. After the time of the Arabs though, it migrated to the South Asian subcontinent, and that's where I went and I studied the Unani system of medicine. And it's interesting, because as you know in the Indian subcontinent, there is also the Ayurvedic system. So a lot of the practical treatments have been…are now intertwined between the two systems.
Dr. Irfan Qureshi: So you have the Unani system and the Ayurvedic system, kind of, living side by side. And while their origin stories are very different, the way that practitioners treat their patients is very similar — and so a lot of the therapeutics that you'll see used in the Unani system are also used in the Ayurvedic system, and vice versa.
Dr. Drew Sinatra: Got it. Okay. And I'm sure that this ties in to why you became a naturopathic doctor in the first place?
Dr. Irfan Qureshi: Absolutely. Drew, as you know, I think we all kind of have unique stories in terms of why we went down the path of becoming naturopathic doctors. And from my perspective, really, it was the fact that my father actually had an ethnic food store in the Pike Place Market in Seattle where I grew up. And so growing up in the store, we were always exposed to different ethnic foods, spices and herbs. And it was mostly from the culinary perspective, and that's how I gained familiarity with herbs and spices. But it wasn't until I made a trip to South Asia, maybe after high school, when I discovered that there was a tremendous amount of herbal practice revolving around medicine.
Dr. Irfan Qureshi: So, my grandfather, for example, was using these different herbs — and he would visit these traditional healing practitioners, where they would use these herbs and spices that we commonly see in global foods and ethnic foods, as medicine. So it dawned on me that there was so much more to these herbs and spices than just the culinary benefits. And that got me interested in naturopathic medicine.
Dr. Irfan Qureshi: Now at this point, from the U.S. perspective, I had no idea what naturopathic medicine was — or whether that was even a field that one could study. And as I was finishing my undergraduate degree, I met somebody that was actually attending Bastyr University, our alma mater essentially, where we went to school. And he introduced me to the concept of naturopathic medicine. I was considering going down the medical path anyway — I was actually going down the path of becoming an allopathic doctor, because I was getting ready to apply to medical school, and that was really my first experience with natural medicine and naturopathic practitioners — and really, the principles of naturopathic medicine.
Dr. Irfan Qureshi: So, I actually studied more and more, read up on what naturopathic medicine is and how different herbs and spices and different modalities, kind of, impact health. And I decided about a year later to apply to Bastyr, and so that's how I ended up getting in to the naturopathic medicine program there.
Dr. Drew Sinatra: That's such a good story. I’ve got so many comments I have, just from hearing that. First off, Pike's Place Market — what a place to be. I mean, that must have been incredible, growing up in that scene.
Dr. Irfan Qureshi: I was there, pretty much, every weekend, I would say throughout…all the way up through high school. You're right. That place is just so phenomenal from a cultural perspective. The type of people you see there, they're just so interesting because they all have such different backgrounds and you're exposed to so many different cultures just within that one market.
Dr. Drew Sinatra: Exactly.
Dr. Irfan Qureshi: It's phenomenal, really.
Dr. Drew Sinatra: And for our listeners, Starbucks originated out of Pike's Place Market back in the 70s.
Dr. Irfan Qureshi: That's right. That's right. So my dad's store was essentially three doors down from Starbucks.
Dr. Drew Sinatra: Oh my gosh. That's so incredible. Wow!
Dr. Irfan Qureshi: Yeah, it was great.
Dr. Drew Sinatra: Did your dad drink coffee?
Dr. Irfan Qureshi: He's more of a tea drinker.
Dr. Drew Sinatra: Okay. Okay. All right. So, another piece there that I want to kind of comment on is you were doing this whole traditional medical school route, just like what I was doing in my life, too. What was it for you that turned the switch, that was like — I want to go to naturopathic medical school instead? What was it for you that changed?
Dr. Irfan Qureshi: I think it was really just the wide variety of different approaches a naturopathic doctor can take to assess and treat a patient, versus the options that are available to standard medical doctors. We all know about the traditional medical paradigm where they've actually, I think…medical doctors have over the years unfortunately become more technicians than practitioners, right? And there really isn't any sense of individualized treatment in the conventional medical paradigm. So that was really what attracted me to naturopathic medicine — just the variety of treatments, the different approaches, looking at the person as a whole, as opposed to looking at just treating the symptoms that are presenting.
Dr. Drew Sinatra: Yeah, exactly. And I think that's really what helps define us as naturopathic doctors are some of these principles that were taught and that we practice with our patients. I'll list off a couple of these and we can talk about some of them. One of the principles is “do no harm.” Next principle is “doctor as teacher.” Then there's “the healing power of nature.” There's “treat the cause,” “treat the whole person,” and then “prevention is easier than cure.”
Dr. Irfan Qureshi: That's really, I mean, in a nutshell obviously those are the principles, but that's really what naturopathic medicine thrives on. It's really the recognition that, first of all, each individual's unique. But that innately, we all have the healing power to heal the body within us, so the body has the power to heal itself. So it's the realization that what we're trying to do as naturopaths is really support that process, rather than suppress that process. So, once we develop individualized therapies based on the patient that's presenting in front of us, we really see that person as an individual. And that individual requires, at times, different interventions that will support their own healing process depending on where they are in the cycle of their health or disease. And so, that's really what “the healing power of nature” is about.
Dr. Irfan Qureshi: And I think one of the other ones that you touched on was the first “do no harm” concept. Now I think as naturopaths, there's a myth that we're anti-drug or anti- any therapeutic that will do harm to the body. And I think that's the wrong way to look at it. I think the right way to look at it is that first and foremost, our intent is to use the most natural, the most noninvasive, the safest therapy available. And so in that sense, there's really the order of therapeutics, what we call the order of therapeutics. So if you can treat a person, an individual, the whole, using the least invasive therapies possible first, then that's what a naturopath is going to strive to do.
Dr. Irfan Qureshi: But we're not anti-drug or anti-establishment from that sense, because ultimately as practitioners, our goal is to heal the patient. And whether that's through the use of these least aggressive therapies or more aggressive therapies, we're open to that.
Dr. Drew Sinatra: Mm-hmm. Yeah, because ultimately, we would like to use more natural therapies with people. But sometimes, let's say, someone's coming in with a hypertensive crisis and their blood pressure is 210/130. In that moment, I will likely give a diuretic or some other anti-hypertensive medication, just to get it in a lower range. And then, we can really start to work on the other things that may have contributed to that in the first place. And I think that's sort of the beauty of the medicine is that initially, yes, we're going to use a medication. But the end goal is to get them off that medication, and to really get at the underlying causes for why that hypertension developed in the first place.
Dr. Irfan Qureshi: Absolutely, and from that standpoint, just taking that a little further — it's not that we don't treat the symptoms, because obviously the patient is presenting with certain symptoms that they're interested in resolving. But we take it to the next level, as well. So in addition to the symptomatic relief — which is critical, to get that patient out of that situation, whether it's pain or the hypertensive crisis that you just mentioned, we need to address that. And naturopaths definitely address that, but we're looking at it at a different level. We're looking at it from the level of, what's the root cause, why is this person having this issue? And so, treating on that philosophical level really allows us…again, I keep going back to this concept of holistic medicine and looking at the person as a whole, but it allows us to see the individual and everything else that might be contributing to that hypertensive crisis or the pain that they're in, and addressing those causes along with supporting them in relieving their symptoms.
Dr. Drew Sinatra: Yeah, well said. Well said. And another principle, too, that I think is really profound is the “doctor is teacher.” And what I like about this is that we're really encouraging self-responsibility with our patients. So they come in, and we teach them certain diets or foods they may want to include. We tell them the importance of exercise, reducing stress in their lives, making sure that their environment around them is clean, that they're taking the right vitamins and minerals, and all that sort of thing. And what I love is that over time, it's funny, it's like over many months, even many years, they start to know what to do when they get sick, or when they develop a certain pain, or they have a headache, or they have some indigestion. They already, kind of, know what to do — and that's what I love about the medicine, too, is that over time we're teaching them to be their own doctors. And that, to me, is just beautiful.
Dr. Irfan Qureshi: Yeah, it's really phenomenal, Drew. You hit it right on the head, and “doctor as teacher,” I mean obviously, that's all about patient empowerment, right? It's about them taking their health into their own hands — and it's not passive medicine, it's active medicine, right? Because you're then involved. As the patient, you want to be involved in your own health and healing, and by passive medicine, it's kind of like what a lot of the modern medical paradigm is all about. It's about — you have a symptom, you suppress it with a specific drug but then you're not looking at the person as a whole, you're not treating everything else that's contributing to that symptom. With active medicine, it really opens the patient's eyes and it's empowering to the patient, because they realize that their health is their own responsibility and that diet, lifestyle, nutritional supplementation, there's so many other factors that contribute to health. And they just become very conscious of all of these factors, and that allows them to live a healthy life, as opposed to just being symptom free.
Dr. Drew Sinatra: Yeah, well what I always tell people is, I guess, looking at the comparison of traditional medical doctors and the naturopathic doctors — for acute care medicine, I always like to think of medical doctors, let's say like an ER physician. They are so incredible, what they do. They have such amazing knowledge around what to do if you break your leg, if you get into a car accident, if you have a heart attack. So I always tell people, don't come see me. Please, do not come see me…go to the ER, they are going to patch you up. They are going to take care of you, because that is really where they shine. And I always tell people for naturopathic doctors, if you're looking for more support with chronic disease, I think that's really where we shine. And that's including conditions like diabetes, or cardiovascular disease, or cancer, or chronic GI conditions — and the list goes on and on.
Dr. Drew Sinatra: Because really, I think, what's missing in conventional medicine is sort of the personalized approach that you were talking about. And there's a lack of response with that active medicine that you were talking about, as well. It's sort of, well, you've got this symptom…well, just take this medication and we'll see you later. Well, we're really trying to get to the root cause of why that symptom may be presenting in the first place. So I always tell people, naturopathic doctors, we really do shine with more chronic disease.
Dr. Irfan Qureshi: Absolutely. I mean I'm not abdicating conventional medicine at all, because there's a time and place for conventional medicine — and the emergency situation, the acute situations that you're describing, that's really where they shine. And there's no doubt that they've made tremendous strides at treating those types of situations. But you're right, I think naturopathic physicians definitely thrive at chronic conditions — whether it's diabetes, hypertension, autoimmune conditions, digestive health, different areas where the conditions become chronic and are life-long situations, I think that's where naturopathic doctors really shine because of the individual approach that we take.
Dr. Irfan Qureshi: So that's not to say that we work in isolation from the conventional system of medicine. We're both very complimentary to each other, right? So there's a place for conventional medicine, there's also a place for naturopathic medicine. And really, if you want to address the cause, that's when you turn to naturopathic medicine.
Dr. Drew Sinatra: So Irfan, you've had a medical practice where you've gained so much experience from your patients, you've learned from them. And now you've entered into a new role, working for Healthy Directions and supplement development and quality assurance. How has that impacted the outreach that you can have for helping people?
Dr. Irfan Qureshi: I think going back to what we talked about earlier, in terms of how I came to naturopathic medicine and how we all have unique stories of how we've come to naturopathic medicine, I kind of consider this an evolution, from my standpoint. I think as naturopaths, we can really help people in multiple ways — and one of them is as you're doing, with a thriving clinical practice, working with each individual on a one-to-one basis, and really impacting their lives and improving their health. I think another way to do that, and what I realized through the path that I took, was that I was really excited about the burgeoning amount of scientific research that was being conducted on some of these common therapeutics that we've been using for thousands of years. Not only the therapeutics, but also the philosophical elements, the approach to health, the whole body treatment, etc.
Dr. Irfan Qureshi: And so being excited about the research side of things, I decided to take a detour from my clinical practice and really pursue research and the development of nutritional supplements. And that's kind of what I focus on here in my role at Healthy Directions. And I think, from my perspective, what I wanted to do was to see how I could make the biggest impact possible on people's health. And one way to do that as a naturopath obviously, like I said, is what you're doing in clinical practice. But I think another way that we as naturopaths can contribute to the healthcare issues that we face in this country, are through collective solutions and more global solutions, like researching nutritional supplements, their ingredients and creating formulas that are really efficacious.
Dr. Irfan Qureshi: And I know with the work that you and I do together, that's exactly what we try to do. And so we have a larger global footprint and a larger global impact through the products that we create, and that's really what excites me about spreading this message of nutrition and naturopathic medicine to a broader community.
Dr. Drew Sinatra: Well, I want to comment on that, because I never told you this. I was so happy when you came on board to Healthy Directions, because knowing that there would be another naturopathic doctor there to help formulate products was amazing for me to have access to. Because the way that we're taught in school, how to formulate, might be different than other people who know how to formulate. We take into account let's say, with looking at an herb like licorice root, for example. It has all these different properties, but there's also sort of energetic qualities within licorice root, according to different traditions around the world, like Ayurvedic or something like that. I'm so happy that you and I have formed this team together, where if I need some research, I look to you because I know that you have this wealth of knowledge around the research, which is something that I just don't have time to do in my practice. I'm so focused on the patient care piece, I don't have time to really look up a research about this herb, or this particular nutrient, or this supplement. And so it's so helpful to have you here, to really expand our knowledge around all these medicines.
Dr. Irfan Qureshi: Well, I appreciate that, Drew — and I think we make a great team and I totally agree with you. I think having similar backgrounds, studying at Bastyr, going through the naturopathic medicine program really gives us a synergistic relationship. Coming from a similar place and similar philosophy really helps us assess what's going to make the patient or the customer better — and that's really where we want to be coming from, is creating efficacious products. And I know that you're passionate about that, and I'm tremendously passionate about the research, so I think we make a great team.
Dr. Drew Sinatra: Absolutely. Well let's dive into one of the fundamental principles of naturopathic medicine that is ultimately related to what we're talking about today, and that is the importance of the gut and really working on the gut, making sure the gut is in healthy shape. Because what we were taught in school and what we see clinically, and that you obviously see in research, as well, is that there's this huge gut-brain connection, gut-skin connection, gut-liver connection, you name it. The gut is connected to all systems of the body, and it's so important that we do address gut health when we work with patients and obviously when we're formulating supplements, as well.
Dr. Irfan Qureshi: Absolutely. I'll harken back to the earlier discussion we had about the Unani system and the Ayurvedic system, and really it's many of these traditional systems of medicine that have seen gut health as being core to overall health. This is kind of a new idea for Western medicine, but really, for the past thousands and thousands of years, practitioners always started treating health conditions through the gut. They look at it with that lens. Something that I came across that's always kind of stuck with me early on in my naturopathic education — you know the saying that goes, "The road to hell is paved with good intentions." Well, there's a saying, I mean I can't take credit for it, obviously it's something that I came across. But basically it's “the road to health is paved with good intestines.” And it's so true. It's so true when you look at it.
Dr. Irfan Qureshi: And you're right, in terms of the connections that we're making now, based on traditional medicines principles, now researches are making connections between the gut and every system in the body. So, it's so critical how the microbiome influences every system in the body, and this research is just now coming to light.
Dr. Drew Sinatra: So when we were in school, you probably had the same experience working in the clinic that I did. But you'd have a patient come in with eczema, and the go-to sort of protocol would be like a gluten-free, dairy-free, anti-inflammatory diet. We'd add on some probiotics, some fish oil, some other anti-inflammatory support, and with most patients, their skin would improve. And so back then the concept of leaky gut was around — and we did sort of use that term loosely, like the increased intestinal permeability — but it was really cool being present during that time where the research wasn't there yet to kind of support all this, but yet we had all this old medicine behind us to use as a framework. Because we knew that the gut was so important for helping many conditions, in this case, eczema. And I just love seeing that evolution of the research coming in, just to support what we knew for so long. It's great.
Dr. Irfan Qureshi: It's phenomenal, and really I remember back to my Bastyr clinic days and one of the first things that one of my mentors said was, “when in doubt, treat the gut.” And it's great to see how the research has really begun to support that concept, and it's taken it to the next level. Because we do see how fundamental gut health is to all of the different organs and systems throughout the body, and immune function, and autoimmune conditions — and how they're all related to the health of the gut.
Dr. Drew Sinatra: Exactly. And you, in your practice, I was reading about in your bio, you treated children with autism — so I'm sure you noticed a gut-brain connection there?
Dr. Irfan Qureshi: It's a funny story, Drew. So one of the things I did after graduating from Bastyr was, I took a job in Singapore. And this was working as a naturopathic practitioner practicing alongside an osteopath and an acupuncturist, kind of in a traditional, whole health clinic, a multi-disciplinary clinic. And it just so happened that the acupuncturist had a daughter who was autistic, and I had not really studied autism to any great extent while I was at naturopathic school at Bastyr. But he handed me a brochure where all it was talking about was the relationship between autism and some of the symptoms that were being experienced by autistic children, and leaky gut. And that really just made a switch go off in my brain, because fundamentally all of the conditions that I had been treating up to that point, including autoimmune conditions, all had a leaky gut component to them, and that was really philosophically how I started many of my treatment protocols.
Dr. Irfan Qureshi: So it was kind of a natural transition to be able to treat autistic children, and relieve their GI symptoms, and even some of their systemic complaints just through addressing gut health. Autistic children, for example, have a lot of GI issues; a lot of alternating constipation with diarrhea, bloating. We know that fundamentally there's a connection between gluten and casein, which is the protein found in milk, obviously, with some of the symptoms that we see in autism and other chronic conditions. And so, a lot of it was about relieving their constipation or diarrhea, removing gluten and casein from the diet, and eliminating other allergens to see if that led to a benefit in their overall health. And it was fundamentally just amazing to see how much you could influence their overall health by alleviating their GI symptoms.
Dr. Drew Sinatra: Mm-hmm. So reducing inflammation in the gut essentially led to a decrease in inflammation in the brain.
Dr. Irfan Qureshi: It's phenomenal, Drew, and we know that there's a direct connection between the gut and the brain, and that's through the vagus nerve, right? And so the brain already has a direct connection to the gut, and the gut is sending information to the brain, the brain is relaying information back to the gut. And it's interesting, Drew, I was reading a study the other day where, it was a review paper, and they were talking about how the brain can actually, through the vagus nerve, detect whether there are pathogenic bacteria sending signals to the brain through the vagus nerve, or whether there are healthy bacteria sending signals to the brain through the vagus nerve. And in response to that, the brain can change the way it responds physiologically. So whether it's an anxiety increasing response or an anxiety decreasing response, it's all dependent on the signals that are being relayed through the vagus nerve. It's amazing, really, just how direct that connection is.
Dr. Drew Sinatra: Mm-hmm.
Dr. Irfan Qureshi: And then with leaky gut, as you know, that really impacts the lining of the intestines. And so when someone has leaky gut, you've compromised the barrier between the GI tract, the inner part of the GI tract and, really, circulation overall. So once those tight junctions between those intestinal cells are broken or damaged, you have all sorts of things that shouldn't be traveling between the intestinal lumen and your circulation that are able to get through. Whether it's undigested foods, whether it's bacterial yeast byproducts, metabolic toxins, anything that we consume through the diet can then get through those leaky intestinal cells. And once it's in circulation, obviously, the effects are systemic. Those things can go to the brain and impact brain health, but they can also go to joints, to your heart, to your liver, all throughout the body.
Dr. Irfan Qureshi: So really, the integrity of that intestinal barrier is fundamental to health overall.
Dr. Drew Sinatra: And it's not easy trying to determine if someone really has leaky gut, because there's so many different factors that can contribute to it. There's chronic antibiotic use or other drug use, like proton pump inhibitors. There's chronic stress, there's the diet that we choose to eat that might be high in sugar and processed carbohydrates and other junk in there, and the list goes on and on. And then, of course, looking at someone holistically, you've got…well, you might have headaches, you might have joint pain, you might have skin rashes, you might have fatigue, you might have some depression, anxiety. And then you really need to decide, is this really coming from the gut.
Dr. Drew Sinatra: And unfortunately, we really don't have great tests for leaky gut, at least clinically. There's really…there's a zonulin test out there with a stool sample. I don't know how good that is, I don't really rely on it all that much. So I really do rely on the whole symptom picture, and of course looking at all the different factors that may have contributed to that leaky gut. And then putting all that together, then decide to come up with a plan to treat the leaky gut — and of course, it takes time. It doesn't happen overnight when you start really healing the gut. It can take many, many, many months, and that's sometimes hard for people to digest is this long process it can take for the gut to heal.
Dr. Irfan Qureshi: You know you're right, you're right, Drew. I think primarily, from a naturopathic standpoint, we would go by the presenting patient, right? And the symptoms that are being presented. There are no real reliable tests for leaky gut. There are some that give us indications, though, that leaky gut might be present. So once you've determined based on the symptom picture that the patient is presenting with, and the amount of systemic symptoms that are occurring in that patient, you can kind of take the next step and do some confirmatory testing. Now, I don't know if you've used the lactulose mannitol urine test, for example, but these are basically two sugars. One is a higher molecular size, and the second one is a smaller molecular size — and one of them passes through the intestinal tract normally and is found in the urine, whereas the other one is not supposed to pass through. And so if you see a lot of the sugar that's not supposed to actually get through the intestinal tract in the urine, you know that there's increased intestinal permeability. So that's one indicator.
Dr. Drew Sinatra: Why do you think there seem to be more gut-related diseases today?
Dr. Irfan Qureshi: I think there's several factors. You and I know that our environment has changed tremendously. The amount of toxins that we're exposed to — either through our food, our air, our water — that definitely is a contributing factor. But I think just as fundamental is really the amount of processed food intake that has occurred over the last several decades. The human body is not really used to processing all of these different chemicals that we find in our processed foods. Or, even the amount of sugar and refined carbohydrates that are present in our food, in our diet. And this really impacts, detrimentally I would say, impacts our microbiome and it causes a situation of dysbiosis.
Dr. Irfan Qureshi: And so, once you have dysbiosis — which is really an imbalance between the good and the bad microflora, whether it's yeast, bacteria or other microflora — that that can cause, directly cause, leaky gut through the toxins that some of these bad yeast, these bad bugs and bad bacteria, release. So I think that's really a fundamental reason why we're seeing a higher occurrence of some of these issues.
Dr. Drew Sinatra: So you think, really at the heart of it, it's leaky gut that could be driving a lot of these conditions?
Dr. Irfan Qureshi: I do believe that's the case. And really if you look at autoimmune disease, and one of the researchers I recently reviewed kind of termed leaky gut as a danger signal for autoimmune disease. And that makes sense, right? So we know that there's a genetic predisposition to autoimmune conditions, but in order for that predisposition to manifest in an individual patient, that requires some kind of trigger. And a lot of times what that trigger does is it causes leaky gut, and that's what allows those toxins and metabolic byproducts to get into circulation. And then based on the genetic predisposition that we have, they can impact the brain, they can impact the heart, they can impact the joints — and they manifest as these different autoimmune conditions. But really it's that trigger that's causing leaky gut which allows that condition to manifest.
Dr. Drew Sinatra: Mm-hmm. And for our listeners, if they do suffer from some sort of gut condition, there's many different things out there. We're talking about leaky gut and we didn't even get into IBS or IBD or anything else like that, but as a general gut discomfort someone might be having, whether that's bloating or constipation or diarrhea or heartburn, what are some basic things that we can do on a daily basis to help support the gut?
Dr. Irfan Qureshi: Obviously, first and foremost, you have to talk about diet, right? So it's eliminating processed foods, excess sugars, really eliminating things that are going to harm the gut. It's looking at an anti-inflammatory diet, for example. Because a lot of the symptoms that we're seeing in these conditions are related to the excess levels of inflammation, and that inflammation is being triggered by the fact that the immune system is overactive.
Dr. Irfan Qureshi: Now, Drew, you know that 70-80% of the immune system resides in the gut — and it makes sense, right? Because the guts are actually one of the main ways or routes of exposure we have to the outside world. So just as the skin acts as a barrier to some of the environmental factors that we see, the guts are really acting as a barrier to some of the dietary factors that we encounter. And so diet is really crucial, right, for that.
Dr. Irfan Qureshi: So then the next pillar of gut health is really nutritional support. And that nutritional support can come in the form of probiotics and prebiotics, and I like to describe prebiotics kind of as the multivitamins for your microbiome. Because prebiotics are fibers and other nutritional compounds that act as food to support the growth of healthy bacteria, healthy yeast and other organisms that allow your microbiome to retain its balance.
Dr. Irfan Qureshi: Now probiotics, as we've talked about before, are healthy organisms that thrive in the GI tract and balance out the bad bacteria, as well. So, taking a good probiotic is probably one of the fundamental steps to improving gut health.
Dr. Drew Sinatra: Mm-hmm.
Dr. Irfan Qureshi: So, Drew, what is your overall approach to supporting somebody's gut?
Dr. Drew Sinatra: I agree with everything that you said. I think that diet is probably the biggest pillar that should be supporting someone's health, in regards to gut health. I like probiotics, like you mentioned, as well. I also like to recommend that everyone is exercising, doing some sort of movement, that they have a stress reduction practice in their life, that they have community. And another big thing, too, is we have to look at all the factors that are contributing to this gut dysfunction that we're seeing today. And we talked briefly about these today, whether that was chronic antibiotic use or other medication use. The water we're drinking may not be as pure as we would like. There's different impurities in the water that could be having an effect on our gut. I even talked about a study once, where antibiotic residues are found in a lot of our rivers around the world. So we're getting low level exposure to antibiotics sort of on a chronic basis, and so a lot to do with gut health depends on prevention piece, or really, preventing a lot of we'll call it toxins from the environment from harming the bacteria and other organisms that are inhabiting our gut.
Dr. Drew Sinatra: And really, the whole antibiotic thing is a major concern. I'm trying my best to really only prescribe antibiotics when necessary. I had a patient yesterday, in fact, a pediatric, that developed pneumonia — and that is certainly a condition where you want to use antibiotics. And fortunately, the mom had experienced this with another previous daughter, where she didn't give the antibiotics immediately and so she waited one day, the fever finally broke that night, and then two days later the girl was back to playing and just having her old life back — and so she didn't need the antibiotics. So times like that are really special, where it's certainly a condition that you need to give antibiotics but in this particular one, she got by without using them. And so I was so happy that in the long term, her gut would be in better shape.
Dr. Irfan Qureshi: That's wonderful, that's wonderful. You're right about the antibiotics though. I mean I think that's such a conundrum for us, with antibiotic overuse and all of that. And you know, at times, they can be lifesaving — and I think it's important that when we do prescribe or recommend antibiotics that we give supportive things along with it. So maybe a good probiotic, and maybe there are other things. Are there other things that you like, Drew, to do specifically when somebody is prescribed an antibiotic?
Dr. Drew Sinatra: Yeah, that's a good question. There are certain probiotics that I do give. One is Saccharomyces boullardi, that's a yeast-derived probiotic that I find to be pretty helpful. And depending on sort of what antibiotic someone is on, I might prescribe nystatin as a pharmaceutical to help reduce the growth of yeast. But in terms of probiotics, I do like Saccharomyces boullardi and other lactobacillus and bifido blends, as well.
Dr. Irfan Qureshi: Yeah, I think that's really important. Those are very key points, and especially because we know how adversely antibiotics can actually impact the microbiome, and for how long those effects can last. I mean it's not overnight that we recover the healthy microbiome. It could take months or even years to recover a healthy microbiome after antibiotic use. So, supportive measures are really key, and I totally agree with you on that.
Dr. Drew Sinatra: Yeah, exactly. Well, what are some takeaways from today's discussion? I'll list off one in the beginning and then you can jump in. We talked initially about naturopathic medicine, and how we have these principles that we practice — “do no harm,” “doctor is teacher,” “prevention's easier than cure,” “treat the cause,” “treat the whole person,” etc. And really, sort of, we gave our stories about why we became naturopathic doctors. What are some other takeaways from today's discussion?
Dr. Irfan Qureshi: I think from that perspective, it's really...the fundamental takeaway is to take your health into your own hands. Be aware and be conscious of your own healthcare. Take advice from your practitioners and other sources, but ultimately you're responsible for your health. So educate yourself on your own health.
Dr. Drew Sinatra: Well said. I love that.
Dr. Irfan Qureshi: How about you, Drew? What do you think is one of the takeaways from today's discussion?
Dr. Drew Sinatra: Another takeaway is really the importance of gut health in the overall systemic health that we experience. So, let's say someone is developing headaches or joint pain, we don't necessarily want to look at that in isolation. It could be an isolated event, but we also need to look at well, could the gut be playing a role in other symptoms that are presenting in the rest of the body. So, when in doubt, like you said — when in doubt treat the gut.
Dr. Irfan Qureshi: You're right, Drew. You're absolutely right with the diet piece, and I just wanted to add because we didn't really get a chance to touch on it in detail — but I wanted to emphasize the importance of identifying and avoiding any food sensitives and allergies that you might have, because that's fundamental to healing the gut.
Dr. Drew Sinatra: Absolutely, and I think we'll address that in a future podcast.
Dr. Irfan Qureshi: Yeah, I look forward to it.
Dr. Drew Sinatra: For today's Wellness Wisdom, I had recently read an interesting Harvard Health article on what we've been talking about today — the power of the brain-gut connection. We know now that there's a strong mind-body, brain-gut connection. So it should come as no surprise that mind-body tools — such as meditation, mindfulness, breathing exercises and yoga — have all been shown to help improve GI symptoms, improve mood and decrease anxiety. These modalities decrease the body's stress response by dampening the sympathetic nervous system, enhancing the parasympathetic response, and decreasing inflammation. This is more evidence that an integrative approach to wellness could improve your overall health and well-being.
Dr. Drew Sinatra: Remember everyone, if you liked what you heard today and you want to be an active member of the Be HEALTHistic community, subscribe to our podcast on Apple Podcasts or wherever you download your favorites. And subscribe to the Healthy Directions YouTube channel. You can also find more great content information from us and the Healthy Directions team at HealthyDirections.com.
Dr. Drew Sinatra: I'm Dr. Drew Sinatra.
Dr. Irfan Qureshi: I'm Dr. Irfan Qureshi.
Dr. Drew Sinatra: And this is Be HEALTHistic.
Narrator: Thanks for listening to Be HEALTHistic, powered by our friends at Healthy Directions, with Doctors Drew and Steve Sinatra. See you next time.
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Meet Dr. Drew Sinatra
Dr. Drew Sinatra is a board-certified naturopathic doctor and self-described “health detective” with a passion for promoting natural healing, wellness, and improving quality of life by addressing the root cause of illness in patients of all ages. His vibrant practice focuses on treating the whole person (mind, body, and spirit) and finding missed connections between symptoms and health issues that are often overlooked by conventional medicine.