In the Reformation Health "ASK AN M.D." series, we interview specialists in the areas of medicine, health and nutrition to get to the bottom of all of your most burning questions.
This is Part One of a two-part interview with Dr. Leo Treyzon - Clinical Chief of Gastroenterology at Cedars Sinai, in which we get to the root of all things gut health, nutrition and weight loss. In Part One, we discuss gluten intolerance, leaky gut, why to not skip breakfast, and the importance of adopting healthy lifestyle habits early on in life.
And it wouldn’t be a converstion with Dr. Treyzon without multiple mentions of BGDC (bloating, gas, diarrhea, and constipation).
If you have any additional questions for Dr. Treyzon, make sure to leave a comment, or email email@example.com.
Thank you so much for speaking with me today. Let’s start with a little bit of information about your career history. What made you decide to become a Dr, and more specifically, go into the field of Gastroenterology?
I’ve always been interested in medical science, and in particular medial science, and my experience in medical school was very fulfilling and eventually I found this pathway to gastroenterology through mentors. I was intrigued by the conditions they were seeing. I got a chance to shadow them and participate in their research, and that too for me was very interesting. Eventually I found my way into how nutrition and food and lifestyle make an impact on gastrointestinal health and disease processes, and I went into nutrition as a separate pathway.
So, while we’re on that subject, tell me what your findings are of late around nutrition, and how that impacts gut health, and maybe some things people can do to avoid some of the more complicated gastrointestinal issues they might face if they aren’t integrating proper nutrition into their daily lifestyle.
What I’ve observed in the past two years in particular, is how powerful diet is in the treatment of functional bowel diseases. Functional bowel diseases – as opposed to inflammatory or obstructive diseases, or cancerous sydromes causing gut health disruption – are interesting because people suffer quite a bit, but we can’t exactly pinpoint what the problem is. That’s what a functional bowel disease is. It means you can’t point your finger to it and say “this is the disruption going on”, and often what happens is we either try medication, supplements, or dietary intervention. And to my surprise, nutirional interventions have been quite potent and powerful in alleviating in not altogether curing patients’ problems. And that’s contrary to my experience in traditional Western medicine where we always give medications or supplements or something along those lines to cure patients’ illnesses.
Examples of which would be asking people to restrict gluten in their diet, and their headaches go away. Other things would be eating non spicy foods, or avoiding citrus products if they experience heartburn and acid regurgitation. And perhaps minimizing special types of fiber if they have gas and bloating. So those are simple interventions for functional conditions. Ive been surprised by how many people and how much they are helped in their conditions like Irritable Bowel Syndrome, by simple dietary interventions.
So you mentioned that there are also obstructive and inflammatory conditions. Can those be avoided or minimized by dietary changes, or are those more of a genetic issue or medical malfunction that occurs that can’t be treated or prevented with diet?
Obstruction is a relatively rare process in most people’s health. Of 1,000 people with abdominal discomfort, maybe one will have true obstruction of some sort. Such as lacerations from Crohn’s flares. In this case, a low fiber, lower fiber, lower roughage diet would actually be recommended. Conversely, high-fiber, high-roughage foods would be indicated for someone who has, for example, chronic constipation, gas or bloating. They just need bulk foods. And we know that fiber is good for heart health too. So sometimes we combine these interventions depending on what kind of constellation of conditions they have. So someone who is a fast-food eater tends to have heart disease and they get constipated or bowel discomfort. We ask them
To try a high-fiber diet, either with supplements or with food, and they would feel better and perhaps also, their heart condition would get a little bit better. So that’s an example of that.
But getting back to your other question, inflammatory, so one interesting observation is that I feel like a lot of people that don’t feel well in their bowels , feel like the bowels are “inflamed”. Like they feel like they’re not digesting well and they feel like their condition is inflammatory in some nature.
Is that where maybe they would experience visual bloating, or is this INTERIOR inflammation that’s not visual?
That’s actually a really good question. Absolutely not. I don’t think that bloating, distention, discomfort, maldigestion, are inflammatory conditions. In my experience they are non-inflammatory sensitivity syndromes. So an example is lactose intolerance. If you’re lactose intolerant like most of the people in my family are, and you try to drink a glass of milk, and you get severely distended and bloated, maybe even diarrhea or constipation, some people might say “I feel like my belly is inflamed”, but that’s not the case. They’re just intolerant of the sugar that’s in milk called “lactose”. And what happens when we do that is we can’t digest it, the bacteria can do things with it, and the byproduct of that malabsorptive process is gas and bloating, which manifests as pain and discomfort.
And when there’s so much gas, you feel distended. But most people commonly mistake distention and discomfort with inflammation, and that’s not the case. In general there’s not that many inflammatory conditions of the bowels.
And we don’t consider Irritable Bowel to be an “inflammatory condition”. It’s an irritability condition. A sensitivity thing. So is gluten intolerance. Of 20 people who are gluten intolerant, maybe 1 or 2 will actually have Celiac Disease. But 18 or 20 have no inflammatory condition. They just can’t tolerate it, they don’t feel good when they eat it. That not feeling good might manifest as severe diarrhea or sever abdominal pain, nausea, even vomiting, but it doesn’t mean that they are really “inflamed”.
Like our markers of inflammation which are evolving every year, they just don’t detect any true inflammation in patient’s systems. A common term that’s being floated around is the concept of “leaky gut”. And what that is is some extrapolation of inflammatory conditions where patients feel “messed up” or “toxic” from eating certain foods or something. And we deduce that something is wrong and something is systemic because we extrapolate that something is leaking into the intestines and causing issues.
Now while we’re on the subject of leaky gut, this is definitely a buzz word these days, and it seems like there’s a strong focus on this and treating this in the wellness and holistic communities. Are you seeing more patients in your practice looking to alleviate the symptoms of leaky gut?
Right. Absolutely. So I consider “leaky gut” to be one of many different terms that people use synonymously with irritable bowel. Some practitioners may refer to it as bacterial overgrowth. Some practitioners may refer to it as fungal overgrowth or candida syndrome. For the most part I feel like this is semantic. But yes, I definitely see an increase in patients coming in to treat these conditions in my practice. But I think this is referral bias. In other words, because our practice addresses and treats these things successfully, more people walk in to be treated for this since someone who has referred them has been treated successfully. Other practitioners may want to focus on more life threatening conditions like cancers, so they don’t want to talk to patients about nutritional conditions. They only want to see patients who have super serious life-threatening conditions. So I don’t know if there is actually an increase in “leaky gut” conditions.
However, the data seems to suggest that there is. Meaning when we survey people across the country and include ALL patients, not just the ones walking through my door, we do seem to see increases in irritable bowel syndrome. Whether that’s due to processed foods, whether that’s due to genetically modified foods, whether that’s due to other things…but yes there appears to be a statistical increase.
So as a Gastroenterologist what would you recommend to prevent leaky gut, and to treat it if someone is experiencing symptoms of Leaky Gut Syndrome?
OK. So for the most part I would say, it’s important to realize which symptom is predominant. For some patients that might be diarrhea. For some patients that might be constipation. For some patients that’s bloating. For some patients that’s abnormal weight gain despite normal nutrient intake and normal energy expenditure. So I tend to focus on the symptom complex that’s most prominent. And in terms of recommendations to treat or prevent some complication of whatever they are suffering from, we tend to focus on those kinds of things.
So as a general rule, bloaters tend to not do well on a fibrous diet. So restricting the amount of fiber in one’s diet for a bloater would be important.
Is there a finite amount of time someone would want to eat a low-fiber diet knowing that in the long run, low-fiber diets are linked to an increase in cancers and heart disease?
So I think that this like life in general. What’s most important to you? If you’re magnitude of suffering or your level of suffering from bloating is an 8 our ot 10 and you have this distant goal of eventual heart health and cancer prevention through diet of all things, then you’re going to have to balance your priorities. In other words, why suffer through bloating on a daily basis for this theoretical downstream 20 year event by which time we’ll probably have better cures for in the near future. So it’s sort of like figuring out your priorities. And I would say that eating a LOWER fiber diet is not really going to put you in a bad state for heart health. The magnitude of risk is incredibly low. Whereas the magnitude of harm and discomfort from eating the wrong foods for the way you need to feel is a guaranteed universal.
So if you know that you feel bad when you eat salads, you don’t need to eat the salad, you’re going to do ok.
That makes perfect sense. Thank you.
Let’s talk a little bit about your personal theories around healthy gut flora, prebiotics, probiotics, making sure you have a healthy gut and this whole mind-body connection between the gut and the brain. I would love your personal input on this as a doctor in this field. Do you think people need to cut out packaged and processed food? Should they avoid fast food? Or do you think a lot of this is crack science and in general people can consume these foods and products without detriment to their gut health?
So gut health and overall health are measured in different factors. Gut health is the way you feel and also possibly the development of severe conditions. We know that severe conditions of the gut such as liver cirrhosis, fatty liver disease, colon cancer, stomach cancer, a lot of these conditions can be prevented by means other than diet. So I’m not too concerned about detriment to gut health as I am to other kinds of health outcomes such as heart health. Heart health sounds more important to me than gut health. Because I know we can prevent serious gut problems through our cameras and other things.
With that said, I think that in general, preservative foods are dangerous. And I think they tend to be high calorie, and if they aren’t high calorie, they’re often loaded with artificial sugars which I find to be disruptive to overall health. We haven’t really found major health problems as a result of artificial sugars like Splenda, or Equal and Sweet n Low, we just don’t see that much attributable risk from those things, like we do from smoking for example. But I would say that symptom-wise, people don’t feel good when they are eating foods that are preservative-rich or ultra low calorie yet extra tasty. There’s usually a trick behind it. So there’s a reason why natural foods are more expensive and regarded as important, because they have healthy components in them that make people feel good and prevent diseases. So it’s kind of hard through nutritional science and observational science to prove that something that you’re eating is making you unwell. But as a whole we see that people who don’t eat natural foods and who don’t take time to prepare their foods, they tend to do worse.
We’ve also seen that meal skippers tend to do worse. It might have to do with insulin surges and things along those lines. You would think that depriving yourself of excess calories would probably be a good thing overall. In general less calories less to be good because we tend to run heavy in this country. But there’s overwhelming observation that people who skip meals – particularly breakfast- don’t do that well. And the reasons behind it are unclear, but it may be attributed to hormonal disruptions – homestatis of insulin and things like that.
Interesting. So do you think it’s actually better to eat a breakfast that’s maybe not super nutritious but you’re still eating breakfast, versus skipping breakfast entirely? Is it better to have a bowl of corn flakes rather than not eat anything in the morning? This is of course excluding intentional intermittent fasting.
That hasn’t been tested, and it would be hard to get at and the answer is no. I think you should try to eat healthy throughout the day. There’s a lot of debate on whether it’s better to be a grazer, or to eat 3 meals per day, or perhaps more like a caveman, you two calorie-dense meals. But what I’ve observed to be healthy in general would be three sensible meals per day, not over-doing it at those three meals, and not eating late at night. Not because it’s dangerous per se, but late-night eaters tend to get irritability conditions like reflux.
When we’re young and healthy perhaps we’ve gotten away with these habits and we still look good and feel okay, but later in life things change. Hormones change. Your genes tend to catch up with you. There may be some gene nutrient interactions that are signaled later in life, so just because we got away with it for so long, doesn’t mean that we’re in a good spot. I find that in our community here in Los Angeles, people are very cognizant of that, and even if they are looking great and feeling well, they are mindful of the fact that these kinds of investments that they make in their food choices might impact them later in life, so they are making smarter choices early in life.
An example would be getting adequate calcium intake as a young woman to prevent osteoporosis later in life. We find that the imprinting to your genes and to your bone health is determined more as a young woman than it is as an older woman, when you may already be suffering the consequences of poor nutritional habits earlier on. That’s why nutritionally vulnerable people – it may be a young person who is eating processed foods with her friends after school or something like that. So it’s really important for kids to have access to nutritionally valuable foods in adequate amounts.
So speaking of things like calcium, let’s talk a little bit about dairy, and meat and gluten if you don’t mind. Because a lot of what I learned during my certification through the Institute of Integrative Nutrition, you are encouraged to avoid those things because they are inflammatory to the system. So dairy, meat, wheat especially – there’s a lot of controversy around consumption of what and gluten – I’d love to know your professional input on all of that.
So dairy, meat and gluten. First of all, I should state that I consume all three of those, and I feel quite well. And I believe them to be important parts of most peoples’ diets. So I don’t advise anyone to eliminate dairy, meat or gluten when they are doing okay consuming these. I don’t see them as potentially harmful. Now there is a right balance in how much to eat. I think there’s certain amounts we could have a debate on and certain types of all of these things, but for the most part, I do think that they are important.
Like you shouldn’t over-eat any one of these in particular. I find that wheat products in particular tend to lead to being overweight, and feeling bloated.
What about just general gut health. What are three or five takeaways that a reader of this blog entry could turn to to – if not ensure – at least maximize gut health?
I think eating a calorically appropriate diet is very important. I think a diet rich in vegetables and fruit of various colors is important because it’s most likely to lead to a diversity of nutrients. I think that being aware of the impact that foods have on energy, on digestion, overall gut symptoms is incredibly important.
Don’t eat things that people tell you are healthy if they don’t agree with your body and the way that you feel.
If they cause flatulence, heartburn, constipation, pain, bloating, there’s probably not agreement with YOUR particular body, and just because something is “healthy”, doesn’t mean it’s the right thing for you.
For prevention of disease. There’s probably a synergistic role between food intake and exercise. Staying physically active and also emotionally well will probably have some synergistic benefit more than the individual contributions of these healthy things. So simple things done well – daily – make a big difference.
Please check back for the 2nd half of this interview, where Dr Treyzon and I discuss weight management, and we learn about Dr. Treyzon’s personal approach to health and wellness!