CredentialsPositions
Education and Training
- Sholtz-Leeds Professor of Medicine, Department of Medicine at NYU Grossman School of Medicine
- Vice Chair, Clinical Affairs Dept of Medicine
- Director, Division of Gastroenterology & Hepatology, Department of Medicine
Education and Training
- Fellowship, Montefiore Medical Center/Albert Einstein College of Medicine, Gastroenterology, 1993
- Residency, New York Presbyterian Hospital - Cornell, 1991
- MD from Cornell University, 1988
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Kats's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven to ten WOOR It's theChairman of Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Kats's Corner hereon wri iHeartRadio. So glad you
(00:42):
could join us this morning. Wehave a wonderful show for you today,
a very interesting topic which is theinfluence of bacteria in the intestinal tract and
the connection between the gut and brainhealth and potential implications for colon cancer screening.
To help us with the conversation,I've asked doctor Mark Perchapin, who
(01:07):
is a clinical researcher in the division. Is the director of the Division of
gastro Entrology and Hepatology and the ViceChair of Clinical Affairs in the Department of
Medicine at the NYU Grossman School ofMedicine at NYU land Going Health. He
is also has a title of Professorof Medicine and he's done lots of research
(01:29):
in the area of prevention and earlydetection and the treatment of gastro intestinal cancers
and also to improving the equality ofendoscopy. He's an incredible educator. I
was reading his bio and he's receivednumerous awards for his recognition and clinical excellence
and leadership. He's received Clinical FacultyMentor of the Year award in addition by
(01:53):
vote of his peers Nationally, Doctorpur Chapin received in twenty twenty two a
Lifetime Award gastro Entrology. A realleader in the field and I'm really excited
to have this discussion with you today. Mark, thanks for coming on the
show and really appreciate it. Oh, it's great, Aaron. First of
all, thank you. I feellike we're neighbors. We're both part of
(02:15):
NYU Landon and also urology and gasterentrologyare neighbors as well. Yes they are.
Yeah. By the way, Igrew up on wo R Radio and
so I'm really thrilled to talk toall your listeners. Okay, it's an
important topic and I'm really excited tobe on your show. So thank you.
Yeah, well I didn't I didn'tknow that your radio history. So
(02:36):
that's always nice to hear. Andyou certainly have an incredible amount of clinical
research and experience in the area ofthis microbiota. Maybe you can just tell
us a little bit about this andwhat it means for people. Sure,
So, I think people think ofthe guests are intestinal track as a lot
of different organs, but actually it'sreally just one organ. And the way
(03:00):
I like to think of it asjust a long tunnel going from mouth to
rectum. It travels through the stomach, the small intestine, the large intestine
known as the colon, and outthe rectum, and then we have attachments
that are there to really help digestand process the food that comes through.
And so if you enter the mouthand exit the rectum, you're really just
(03:22):
traveling through the body. And whatwe don't realize is that what's lining that
entire gastron testinal tract is not justthe cells of our own body, but
the cells of the microbiota, whichare bacteria that are healthy, that are
our friends, that are good forus, that help us in so many
different ways of not only fighting infection, but processing our food, helping us
(03:46):
secrete hormones. And truthfully, wenever really paid any attention to it.
We just thought of it as contamination. But actually there's a whole, really
organization of how the cells in ourbody that make us up as individuals interact
with the cells of foreign organisms thatare bacteria and fungi and even viruses,
(04:11):
so that as a whole were oneorganism in symbiotic relationship that allows us to
process all the stuff to come throughthrough. Yeah, that's really fascinating.
Is it something that we're born with, Like when you're just born, do
you do you have that those bacteriain you as in fungi and so forth
as you mentioned, or is itsomething that you accumulate as you as you
get older. Yeah, it's reallyacquired, and it starts with coming through
(04:33):
the birth canal. And people havelooked at is there a difference between a
baby that's born through a natural vaginalbirth versus cesarean birth. Is there a
difference in the way the bacteria colonizeit's holding a baby to a parent.
When a baby feeds, all ofthat skin, what we call microbota,
(04:56):
actually enters the body of the baby, and so you start getting colonize with
different bacteria. And by the way, the bacteria in our body changes with
our diet, so people who eatpredominantly meat will have a different subset of
bacteria than those who are plant based, and the plant based diet is a
much healthier micro environment. And bythe way, we are more in number
(05:19):
foreign DNA meaning bacterial and other DNA, than we are human DNA, where
in many ways we're more about thebacteria than we are about human DNA,
and it's kind of amazing when youthink about it. Actually, one of
my favorite books growing up was HG. Wells War of the World, and
the way that the aliens that areinvading in that book actually die off is
(05:43):
not because of any weaponry or humantechnology, but it's there not having resistance
to the micro environment. And thatbook was written in the eighteen hundreds,
I think the eighteen sixties, sowe're not the first to really think about
the importance in science fiction novels.In the eighteen hundreds they're talking about it.
But I do love thinking about thebacteria as being something that is our
(06:06):
friend, that our helps us,and not in the way we think of
it as in commercials where you're alwaystrying to kill bacteria to sterilize. Yeah,
it's interesting. We always think abouta bacterial infection as something that's bad,
but here you're saying that we're acquiringbacteria as we're as we're aging,
as we get older, which isa normal process which actually helps us in
(06:29):
maybe even in our immune system aswell as in digestion. Is Is that
a good way to think about it? Absolutely? In fact, we're finding
more and more in the research beingdone that the bacteria and the immune system
are linked, where the changes inthe bacteria in the lining of the colon
(06:49):
and in the intestine, but particularlyin the colon will trigger the immune system
to either rev up or down regulate, and we're seeing much more autoimmune une
diseases where our bodies are fighting ourselves. And some people believe that there's so
much hygiene and cleanliness, which ofcourse is a good thing, that our
bodies are not being exposed to thenatural bacteria in our environment, and so
(07:13):
we're kind of hyper regulating. It'slike turning the gain or turning the thermostat
up. So we're seeing conditions suchas ulcer of colitis or Crone's disease or
rheumatoid arthritis, conditions where our bodiesare attacking ourselves, maybe because they're not
being down regulated by the normal bacterialmilieu that we normally see. But we're
not seeing because our environment is differentnow and our food is different. I'm
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sure that people that are listening,I'm wondering, well, you know,
what is my microbiome like? Andis there a test or some way that
I can say you allude to sometype of dietary things maybe very helpful.
Maybe people that are eating a lotmore red meat maybe are going to have
a different type of you know,a platform or a spectrum than people that
(07:57):
are plant eaters. Mostly are theretests a home tests or even tests that
can be done by in the doctor'soffice to check your microbiome. So,
unfortunately, there are no tests thathave been validated. There are plenty of
companies out there that say they willtest your stool and they'll give you a
whole array of things coming back,and I see them all the time,
(08:18):
but they've never been val validated orshown to have any clinical significance. So
I like to look at it theother way. I like to look at
not what you take to make healthybacteria as a probiotic. A probiotic is
by definition, a bacteria or anorganism that's supposed to help with your health.
(08:41):
And people see probiotics all the time, particularly in pharmacies, and truthfully,
we don't really have good data thatprobiotics make a difference. So I
like to think about prebiotics. Prebioticsare the things you eat that induce a
healthy micro environment, and it reallyis your food, and the healthier your
food, the better your bacterial miluse. So you don't really need to test
(09:05):
it. Really, you know whatyou eat and that's your test. So
for example, what's interesting is heartdisease that's induced by a lot of red
meat. It's not the red meat, it's the byproduct of the red meat
being processed by certain bacteria that producestoxic chemicals that can be harmful to the
heart. So obviously, if youeat red meat and moderation doesn't mean you
(09:26):
have to stop. I want peopleto recognize I'm not telling people that they
have to stop eating things they enjoy. It's all about moderation imbalance. So
if you put red meat in moderationand add to it colorful fruits and vegetables
which are very healthy, you cangenerate a very diverse and very healthy group
(09:46):
of microbiota or microbacteria that can inhabitthe GI tract that can make you feel
not only healthier, but actually strongerwith better mood. This has been shown
over and over then many ways.Our mood is also induced by the bacteria.
And I think we know that whenwe eat really unhealthy, we feel
sluggish, we feel sleepy, sometimeseven cloudy in our thinking. But if
(10:09):
you eat healthy and you exercise,and again don't mean you have to go
to a gym, you eat healthy, you walk, you're outside, your
engage in physical activity, we justfeel better. That's all related. It's
not only about the bacteria, butthe bacteria being healthy in our gut is
in many ways a marker of overallhealth. Wow. Yeah, I mean
(10:31):
I can't argue with that. Imean in my own life as well,
and I try to eat properly andexercise almost every day and eat the right
things and try to reduce red meatsand not eliminate it completely. But you're
right, if you go off thatand you start, you know, not
eating well or having some sugars,or you just don't feel as well,
(10:52):
and your brain does become a littlecloudy, and you do get moody and
you get angry. And I've noticedthat in my own life. I just
want to go back to one thingabout the probiotics, because I do have
a lot of patients that ask meabout that, especially if they're taking an
antibiotic. Let's say they need anantibiotic. Let's say we do want a
biopsy on them and they're going totake an antibiotic, so they have an
infection taking antibiotics, is it?You know? In those situations, should
(11:15):
you take a probiotic or it doesn'tmake a difference. You know, I've
always been a big fan of probiotics, but truthfully, the data is not
there yet that it really makes adifference. Intuitively, it makes sense,
but I think the issue is wehave billions of colony forming units of bacteria
in our call in for example,which is the large intestine. You take
an antibiotic, you're affecting millions ofbacteria. A probiotic is one, two,
(11:41):
ten, twenty strains of bacteria isthat really going to fill in for
all of the other healthy bacteria that'sbeing killed. Probably not. And I
think we're not there yet because probablywe need AI to help us really determine
the millions of bacteria that we needto take to help supplement the good bacteria
that might be killed by an antibiotic. What I do recommend. I do
(12:05):
think that eating fermented food like yogurtis helpful, and I do think that
again, trying to make sure thata diet is rich in fruits and vegetables
that are colorful can help really determinea wider variety of bacteria to regrow when
we're not only knocking out the badbacteria with the antibiotics, but the good
ones as well. But unfortunately,I don't think we're there yet with probiotics.
(12:28):
Now that being said, there aresome people tell me they take certain
probiotics and definitely helps them, andI say, by all means continue,
I don't think probotics hurt people,but whether they really help or necessary is
yet to be seen. I dothink the research down the line is going
to figure out what grouping of bacteriawill help us in certain conditions, whether
(12:50):
it's antibiotics, or certain disease states. So I do have a lot of
hope, but unfortunately we're not thereyet with the research. Now I've heard
of a procedure where you can actuallydeliver healthy human a stool is something called
a fecal transplant that could be eitherdone in it by a naso gastric tube
(13:13):
I think, or in a capsuleform. Can you tell us a little
bit about this, Yeah, Aaron, of all the things in my career,
I've been a gaser intrologist for overthirty years now, this is the
craziest of all things. And Ialways say, why didn't I think of
this? Because, as I toldyou, I've done research on probiotics for
years. But the idea of takingstool, human stool that is healthy and
(13:37):
repopulating somebody who doesn't have healthy stoolwith stool which we think is just an
absolute one waste product of the humancondition and use it as a therapeutic as
a medication. When you think aboutit, it sounds nuts, but it
actually works because ul is actually teemingwith bacteria and if someone who has healthy
(13:58):
bout I'll have it and healthy digestion. Their stool is actually going to have
healthy bacteria in it, and someonewho has unhealthy bacteria that need healthy bacteria
to help them get over an infectioncan actually benefit. So right now,
there is actually one condition which isan infection of the colon known as Clustridium,
(14:22):
the sea seal or the letter sediff. Sea diff is a bacteria.
It's an organism that will overgrow inthe large intestine in the colon and
produce a toxin. It can makesomeone very sick, and the greatest risk
of getting sea diff is having verypowerful antibiotics on board, which kill off
(14:43):
all the healthy bacteria and kind ofopen up the space for the sea diff
to take hold. I like touse the analogy when I describe to patients
of a carpet. If you wouldjust pluck out big chunks of carpet,
you would then have the dust accumulatein those areas. So when you actually
kill some of the healthy bacteria,this organism sea diiff can overgrow, particularly
(15:07):
if it's already in there. Sometimessea diiff is sitting in that bacterial milieu
but has no ability to grab hold, or some people get exposed to it.
Either way, it can be verydangerous, can make people very sick
with diarrhea, and sometimes people evenneed their colones removed because they get so
sick and develops that severe colitis.So it could be very dangerous if SEEDFF
(15:31):
is present and not responding to medication. Taking the stool of someone who's healthy
and transplanting it either through colonoscopy orthrough their pills, now that people can
swallow that release in the large intestine, can actually cure seediff. In fact,
it's almost one hundred percent effective incuring plusterating defesial infection. Isn't that
(15:54):
unbound? That's incredible, That's incredible. Again, this is a major infection
that all of the the people inthe hospital are very concerned about because,
as you mentioned here, we usea lot of antibiotics and we do see
this. It can be very debilitatingfor patients, causing fever and abdominal cramping.
I don't have to tell you you'veseen this probably thousands of times in
your career. So are people donatingtheir stool for these fecal transplants? How
(16:19):
does that work? But it's morethan that. There are companies because the
stool has to be rigorously tested makingsure they're no viral infections. Right,
You don't want to give someone aninfection. And yeah, so there are
companies that now are taking human stooland processing and testing it so that it
is ready to be used for someonewho would need a fecal transplant. And
(16:41):
of course we're looking at what arethe important organisms as I mentioned before,
to see can we create something andthat's being done right now and study can
we create a pill or an enemathat can actually mimic human stool and the
important organisms that potentially can combat seediff. But at this point, like is
(17:02):
it something that you would write aprescription for, like a fecal It's not
as simple as that because there aredifferent deliveries. Usually what would happen you
would get a gaserentrologist who specializes insea diiff or an infectious disease doctor or
patient is hospitalized and need some moreurgent intervention. But yeah, most medical
doctors know about this. And ifsomeone we're fighting seediff, or let's say
(17:26):
someone has recurrency diff they've had thisthird or fourth episode because sometimes you treat
it, there are good medications totreat it, and then it comes back
out a twenty five percent risk ofit coming back. In those cases,
you might do this as an ambulatoroutpatient procedure, and then eradicate it once
and for all. So it's notjust people who are horribly sick from the
(17:48):
disease. It might be people ofrecurrency diff as well. Yeah. I
also wonder because you mentioned how themicrobio may affect other diseases. You mentioned
arthritis. I think you said maybecrohnes are all sort of colitis. And
I wonder in the future if someonecould look at their panel of microbiome and
see if it was deficient and thensupplement it with a fecal transplant. I
(18:10):
don't know that's right. And bythe way, not just the colon micro
environment. People have looked at thefloor of the mouth and connected that to
certain other conditions, potentially heart diseaseor even pancreas disease. So we're trying
to look at all different areas wherebacteria reside, which is in the gi
tract, particularly the colon, butthe mouth also the skin is a big
(18:33):
place where bacteria reside. For women, the gynocologic tract has a lot of
different bacterial microbata. Yeah, we'veseen in my field in urology that certain
bacteria in the mouth you say thatcan overgrow can also be related to a
rectile dysfunction. That they've done studieswhere they actually analyze veins in the penis
(18:56):
and then remove them and find bacteriathere. Really fascinating. We're talking if
you're just tuning in here to cancer'scorner. Fascinating discussion with doctor Mark po
Chapin, who is a director inthe Division of gashtra Entrology and Hepatology and
the Vice Chair of Clinical Affairs inthe Department of Medicine at NYU Grossman School
of Medicine. He is open foryou are seeing patients and open for patients.
(19:19):
Is that right? Yeah? AndI have a whole team. I
have a team of over three hundredand fifty doctors in our divisions. Wow.
Sure, people. We love notonly caring for patients, we also
love trying to push the needle forward. You know, what is the next
thing that we can do to helpour patients and help our population. Really
fascinating new discussion. You mentioned aboutinflammatory bowel syndrome and that's connected to microbiome.
(19:42):
What about colon cancer itself? Notonly the inflammatory conditions in the colon,
but cancer. Is that is thatsomehow relating back to the microbiome as
well. So I just want tomake the clarification that we actually haven't determined
if bacteria themselves are a cause andeffect of inflammatory balll disease. What we've
(20:06):
determined is that the immune system isupregulated and certain bacteria are pro inflammatory and
others are anti inflammatory. But wehaven't determined the cause and effect of inflammatory
ball disease with specific bacteria. Andwhat the construct is is that maybe not
being exposed to bacteria and diversity ofbacteria in younger in our life actually allows
(20:30):
our immune system to be a littlehyper regulated and consequently more prone to create
inflammation. So it's a bigger picture. It's not necessarily a single organism or
two. And that's in the worldof inflammatory ball disease. There's also the
irritable bowel syndrome, which is waymore common. That means there's no inflammation,
(20:51):
but the bowel itself is either creatingtoo much fluid causing diarrhea or not
enough, causing content the patient bloatingand cramping, and that may very well
be part of the bacterial milieu.Again, we're still doing research on it.
We haven't figured out the actual details, but there are certain bacteria that
(21:12):
create more gas than others and maycause bloating. And if there's more secal
residue in the colon, meaning thatpeople are not evacuating completely, stool has
organic material and bacteria, and thebacteria ferments that organic material and create a
lot of gas. So some peoplewho aren't evacuating completely and moving their bowels
(21:36):
and are constipated may actually have alot of gas and bloat that can be
fixed by using a gentle laxative likemagnesium or polyethene glycol which is on a
lot of over the counter preparations tohelp them move their bowels a little more
regularly, can actually make them feelbetter. Now, as far as colon
cancer is concerned, there does seemto be certain bacterial profiles associated with patients
(22:03):
who are more risk for colon cancerand colon polyps. Again, we don't
have specific bacteria that quote cause coloncancer, but we're beginning to think that
actually a lot of the food that'seaten that puts patients at high risk is
not working because of the food isnot good, but the food creates an
unhealthy bacterial milieu, a microboda thatpromotes polyps, which can turn into cancer.
(22:27):
Foods include red meat, as wementioned before, alcohol and really fatty,
greasy foods also might actually produce anunhealthy micro environment. So again it
all comes down to health and wellnessin broad strokes, healthy diet, fruits
(22:48):
and vegetables, keeping our weight,and check exercise like walking. Walking is
such a great exercise, and it'sbeen shown that exercise decreases the risk of
colon cancer as it does decrease hypertension, high blood pressure, or decrease obesity
and diabetes. So you know,what's good for the body is probably good
for the colon and vice versa.Yeah. Absolutely, these are really wonderful
(23:12):
tips. Thank you so much forletting us in educating us about this in
your career. Are you do youthink that you're seeing more colon cancer now?
And is it younger people as well? That's what I've been hearing,
But you're you're experience. It's interesting. We described over twenty years ago,
we wrote a paper we said wethink we're seeing more call and cancer in
(23:33):
younger people and less call and cancerand older We're actually doing an incredible job
for people over the age of sixtyand sixty five of really dramatically dropping the
rates of colon cancer through screening.Colonoscopy, stool testing for microscopic blood have
kind of been game changers. Imean, it's the prototype of a public
(23:53):
health initiative to get screened and toprevent cancer. And our screening age store
today fifty. So we're seeing olderindividuals not getting colon cancer because of screening.
The problem is that we're seeing ina significant uptick in younger patients with
colon cancer, particularly in their forties, but even in the thirties. And
(24:14):
so if anybody's listening, if someoneis having symptoms, they're having pain,
change in bowel, habits, bloodin the stool, please get that evaluated,
particularly rectal bleeding. Do not assume, if you're a younger individual in
your twenties, thirties, or forties, that new rectal bleeding is hemorrhoidal,
even though it probably is. Don'tmake that assumption. Go to your doctor
(24:36):
and have that evaluated. Because alot of times early on set colon cancer
and younger individuals presents with blood inthe stool. I don't want to scare
people because the majority of time thatwe have blood in the school it's not
related to anything significant. But forthose that it is they need to be
evaluated. And what ends up happeningis younger people just ignore their symptoms saying,
(24:59):
oh, it's nothing, it's notthing, and present much later with
the diagnosis of something more significant.What are your thoughts on the home test?
I see them advertised on TV alot, the coll of Guard and
things like that. Is that Ithink they're great. I think the best
test is the thing that gets done. I really do. I think that
every home test should be done inconsultation with your physician, make sure you
(25:22):
need it and it's the right test. Because if patients, let's say someone
has a parent who a colon cancerin their early sixties or late fifties,
they're at higher risk, so theyshould not be getting the home test.
They should be getting a colonoscopy.If someone has a genetic predisposition for cancer,
they should be getting a colonoscopy.But for average risk individuals, any
test is better than none, andif they do the home test and that's
(25:45):
positive, then they have to geta colonoscopy. So I look at it
as a two stage test. Firststage is either the stool test called a
FIT, which is looking for microscopicblood in the stool or a colon guard
which is basically a fit plus DNAand then if those are positive, they
must absolutely must get a call onus to be the follow up. Well,
this has been excellent education and justso important for all of our listeners
(26:10):
out there. And it really isso important to get tested and to be
screened, especially as you mentioned,if you're having any symptoms or family history,
and all the information that you gaveus about diet and the microbiome today
just really fantastic. I want tothank you so much for coming on the
show, doctor Mark port Chapin.Mark port Chapin is the director in the
(26:32):
Division of gesher Entrology and Hepatology andthe vice Chair of Clinical Affairs at the
NYU Grossman School of Medicine and theDepartment of Medicine. Mark, thank you
so much. I really appreciate youcoming on the show. Thank you so
much. We'll definitely have you onagain. Well, let's the end of
the show. Everyone. I hopeyou enjoyed it as much as I did.
Tune in every Sunday here on wR Katz's Corner. We'll have a
great show for you next week.This is doctor Aaron Katz. You've been
(26:53):
listening to Katzer's Corner. Come backevery week to hear more straight talk on
a wide range of men's health topicsand advice on how to live your healthiest
life. The proceeding was a paidpodcast. iHeartRadio's hosting of this podcast constitutes
neither an endorsement of the products offeredor the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Kats's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven to ten WOOR It's theChairman of Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Kats's Corner hereon wri iHeartRadio. So glad you
(00:42):
could join us this morning. Wehave a wonderful show for you today,
a very interesting topic which is theinfluence of bacteria in the intestinal tract and
the connection between the gut and brainhealth and potential implications for colon cancer screening.
To help us with the conversation,I've asked doctor Mark Perchapin, who
(01:07):
is a clinical researcher in the division. Is the director of the Division of
gastro Entrology and Hepatology and the ViceChair of Clinical Affairs in the Department of
Medicine at the NYU Grossman School ofMedicine at NYU land Going Health. He
is also has a title of Professorof Medicine and he's done lots of research
(01:29):
in the area of prevention and earlydetection and the treatment of gastro intestinal cancers
and also to improving the equality ofendoscopy. He's an incredible educator. I
was reading his bio and he's receivednumerous awards for his recognition and clinical excellence
and leadership. He's received Clinical FacultyMentor of the Year award in addition by
(01:53):
vote of his peers Nationally, Doctorpur Chapin received in twenty twenty two a
Lifetime Award gastro Entrology. A realleader in the field and I'm really excited
to have this discussion with you today. Mark, thanks for coming on the
show and really appreciate it. Oh, it's great, Aaron. First of
all, thank you. I feellike we're neighbors. We're both part of
(02:15):
NYU Landon and also urology and gasterentrologyare neighbors as well. Yes they are.
Yeah. By the way, Igrew up on wo R Radio and
so I'm really thrilled to talk toall your listeners. Okay, it's an
important topic and I'm really excited tobe on your show. So thank you.
Yeah, well I didn't I didn'tknow that your radio history. So
(02:36):
that's always nice to hear. Andyou certainly have an incredible amount of clinical
research and experience in the area ofthis microbiota. Maybe you can just tell
us a little bit about this andwhat it means for people. Sure,
So, I think people think ofthe guests are intestinal track as a lot
of different organs, but actually it'sreally just one organ. And the way
(03:00):
I like to think of it asjust a long tunnel going from mouth to
rectum. It travels through the stomach, the small intestine, the large intestine
known as the colon, and outthe rectum, and then we have attachments
that are there to really help digestand process the food that comes through.
And so if you enter the mouthand exit the rectum, you're really just
(03:22):
traveling through the body. And whatwe don't realize is that what's lining that
entire gastron testinal tract is not justthe cells of our own body, but
the cells of the microbiota, whichare bacteria that are healthy, that are
our friends, that are good forus, that help us in so many
different ways of not only fighting infection, but processing our food, helping us
(03:46):
secrete hormones. And truthfully, wenever really paid any attention to it.
We just thought of it as contamination. But actually there's a whole, really
organization of how the cells in ourbody that make us up as individuals interact
with the cells of foreign organisms thatare bacteria and fungi and even viruses,
(04:11):
so that as a whole were oneorganism in symbiotic relationship that allows us to
process all the stuff to come throughthrough. Yeah, that's really fascinating.
Is it something that we're born with, Like when you're just born, do
you do you have that those bacteriain you as in fungi and so forth
as you mentioned, or is itsomething that you accumulate as you as you
get older. Yeah, it's reallyacquired, and it starts with coming through
(04:33):
the birth canal. And people havelooked at is there a difference between a
baby that's born through a natural vaginalbirth versus cesarean birth. Is there a
difference in the way the bacteria colonizeit's holding a baby to a parent.
When a baby feeds, all ofthat skin, what we call microbota,
(04:56):
actually enters the body of the baby, and so you start getting colonize with
different bacteria. And by the way, the bacteria in our body changes with
our diet, so people who eatpredominantly meat will have a different subset of
bacteria than those who are plant based, and the plant based diet is a
much healthier micro environment. And bythe way, we are more in number
(05:19):
foreign DNA meaning bacterial and other DNA, than we are human DNA, where
in many ways we're more about thebacteria than we are about human DNA,
and it's kind of amazing when youthink about it. Actually, one of
my favorite books growing up was HG. Wells War of the World, and
the way that the aliens that areinvading in that book actually die off is
(05:43):
not because of any weaponry or humantechnology, but it's there not having resistance
to the micro environment. And thatbook was written in the eighteen hundreds,
I think the eighteen sixties, sowe're not the first to really think about
the importance in science fiction novels.In the eighteen hundreds they're talking about it.
But I do love thinking about thebacteria as being something that is our
(06:06):
friend, that our helps us,and not in the way we think of
it as in commercials where you're alwaystrying to kill bacteria to sterilize. Yeah,
it's interesting. We always think abouta bacterial infection as something that's bad,
but here you're saying that we're acquiringbacteria as we're as we're aging,
as we get older, which isa normal process which actually helps us in
(06:29):
maybe even in our immune system aswell as in digestion. Is Is that
a good way to think about it? Absolutely? In fact, we're finding
more and more in the research beingdone that the bacteria and the immune system
are linked, where the changes inthe bacteria in the lining of the colon
(06:49):
and in the intestine, but particularlyin the colon will trigger the immune system
to either rev up or down regulate, and we're seeing much more autoimmune une
diseases where our bodies are fighting ourselves. And some people believe that there's so
much hygiene and cleanliness, which ofcourse is a good thing, that our
bodies are not being exposed to thenatural bacteria in our environment, and so
(07:13):
we're kind of hyper regulating. It'slike turning the gain or turning the thermostat
up. So we're seeing conditions suchas ulcer of colitis or Crone's disease or
rheumatoid arthritis, conditions where our bodiesare attacking ourselves, maybe because they're not
being down regulated by the normal bacterialmilieu that we normally see. But we're
not seeing because our environment is differentnow and our food is different. I'm
(07:36):
sure that people that are listening,I'm wondering, well, you know,
what is my microbiome like? Andis there a test or some way that
I can say you allude to sometype of dietary things maybe very helpful.
Maybe people that are eating a lotmore red meat maybe are going to have
a different type of you know,a platform or a spectrum than people that
(07:57):
are plant eaters. Mostly are theretests a home tests or even tests that
can be done by in the doctor'soffice to check your microbiome. So,
unfortunately, there are no tests thathave been validated. There are plenty of
companies out there that say they willtest your stool and they'll give you a
whole array of things coming back,and I see them all the time,
(08:18):
but they've never been val validated orshown to have any clinical significance. So
I like to look at it theother way. I like to look at
not what you take to make healthybacteria as a probiotic. A probiotic is
by definition, a bacteria or anorganism that's supposed to help with your health.
(08:41):
And people see probiotics all the time, particularly in pharmacies, and truthfully,
we don't really have good data thatprobiotics make a difference. So I
like to think about prebiotics. Prebioticsare the things you eat that induce a
healthy micro environment, and it reallyis your food, and the healthier your
food, the better your bacterial miluse. So you don't really need to test
(09:05):
it. Really, you know whatyou eat and that's your test. So
for example, what's interesting is heartdisease that's induced by a lot of red
meat. It's not the red meat, it's the byproduct of the red meat
being processed by certain bacteria that producestoxic chemicals that can be harmful to the
heart. So obviously, if youeat red meat and moderation doesn't mean you
(09:26):
have to stop. I want peopleto recognize I'm not telling people that they
have to stop eating things they enjoy. It's all about moderation imbalance. So
if you put red meat in moderationand add to it colorful fruits and vegetables
which are very healthy, you cangenerate a very diverse and very healthy group
(09:46):
of microbiota or microbacteria that can inhabitthe GI tract that can make you feel
not only healthier, but actually strongerwith better mood. This has been shown
over and over then many ways.Our mood is also induced by the bacteria.
And I think we know that whenwe eat really unhealthy, we feel
sluggish, we feel sleepy, sometimeseven cloudy in our thinking. But if
(10:09):
you eat healthy and you exercise,and again don't mean you have to go
to a gym, you eat healthy, you walk, you're outside, your
engage in physical activity, we justfeel better. That's all related. It's
not only about the bacteria, butthe bacteria being healthy in our gut is
in many ways a marker of overallhealth. Wow. Yeah, I mean
(10:31):
I can't argue with that. Imean in my own life as well,
and I try to eat properly andexercise almost every day and eat the right
things and try to reduce red meatsand not eliminate it completely. But you're
right, if you go off thatand you start, you know, not
eating well or having some sugars,or you just don't feel as well,
(10:52):
and your brain does become a littlecloudy, and you do get moody and
you get angry. And I've noticedthat in my own life. I just
want to go back to one thingabout the probiotics, because I do have
a lot of patients that ask meabout that, especially if they're taking an
antibiotic. Let's say they need anantibiotic. Let's say we do want a
biopsy on them and they're going totake an antibiotic, so they have an
infection taking antibiotics, is it?You know? In those situations, should
(11:15):
you take a probiotic or it doesn'tmake a difference. You know, I've
always been a big fan of probiotics, but truthfully, the data is not
there yet that it really makes adifference. Intuitively, it makes sense,
but I think the issue is wehave billions of colony forming units of bacteria
in our call in for example,which is the large intestine. You take
an antibiotic, you're affecting millions ofbacteria. A probiotic is one, two,
(11:41):
ten, twenty strains of bacteria isthat really going to fill in for
all of the other healthy bacteria that'sbeing killed. Probably not. And I
think we're not there yet because probablywe need AI to help us really determine
the millions of bacteria that we needto take to help supplement the good bacteria
that might be killed by an antibiotic. What I do recommend. I do
(12:05):
think that eating fermented food like yogurtis helpful, and I do think that
again, trying to make sure thata diet is rich in fruits and vegetables
that are colorful can help really determinea wider variety of bacteria to regrow when
we're not only knocking out the badbacteria with the antibiotics, but the good
ones as well. But unfortunately,I don't think we're there yet with probiotics.
(12:28):
Now that being said, there aresome people tell me they take certain
probiotics and definitely helps them, andI say, by all means continue,
I don't think probotics hurt people,but whether they really help or necessary is
yet to be seen. I dothink the research down the line is going
to figure out what grouping of bacteriawill help us in certain conditions, whether
(12:50):
it's antibiotics, or certain disease states. So I do have a lot of
hope, but unfortunately we're not thereyet with the research. Now I've heard
of a procedure where you can actuallydeliver healthy human a stool is something called
a fecal transplant that could be eitherdone in it by a naso gastric tube
(13:13):
I think, or in a capsuleform. Can you tell us a little
bit about this, Yeah, Aaron, of all the things in my career,
I've been a gaser intrologist for overthirty years now, this is the
craziest of all things. And Ialways say, why didn't I think of
this? Because, as I toldyou, I've done research on probiotics for
years. But the idea of takingstool, human stool that is healthy and
(13:37):
repopulating somebody who doesn't have healthy stoolwith stool which we think is just an
absolute one waste product of the humancondition and use it as a therapeutic as
a medication. When you think aboutit, it sounds nuts, but it
actually works because ul is actually teemingwith bacteria and if someone who has healthy
(13:58):
bout I'll have it and healthy digestion. Their stool is actually going to have
healthy bacteria in it, and someonewho has unhealthy bacteria that need healthy bacteria
to help them get over an infectioncan actually benefit. So right now,
there is actually one condition which isan infection of the colon known as Clustridium,
(14:22):
the sea seal or the letter sediff. Sea diff is a bacteria.
It's an organism that will overgrow inthe large intestine in the colon and
produce a toxin. It can makesomeone very sick, and the greatest risk
of getting sea diff is having verypowerful antibiotics on board, which kill off
(14:43):
all the healthy bacteria and kind ofopen up the space for the sea diff
to take hold. I like touse the analogy when I describe to patients
of a carpet. If you wouldjust pluck out big chunks of carpet,
you would then have the dust accumulatein those areas. So when you actually
kill some of the healthy bacteria,this organism sea diiff can overgrow, particularly
(15:07):
if it's already in there. Sometimessea diiff is sitting in that bacterial milieu
but has no ability to grab hold, or some people get exposed to it.
Either way, it can be verydangerous, can make people very sick
with diarrhea, and sometimes people evenneed their colones removed because they get so
sick and develops that severe colitis.So it could be very dangerous if SEEDFF
(15:31):
is present and not responding to medication. Taking the stool of someone who's healthy
and transplanting it either through colonoscopy orthrough their pills, now that people can
swallow that release in the large intestine, can actually cure seediff. In fact,
it's almost one hundred percent effective incuring plusterating defesial infection. Isn't that
(15:54):
unbound? That's incredible, That's incredible. Again, this is a major infection
that all of the the people inthe hospital are very concerned about because,
as you mentioned here, we usea lot of antibiotics and we do see
this. It can be very debilitatingfor patients, causing fever and abdominal cramping.
I don't have to tell you you'veseen this probably thousands of times in
your career. So are people donatingtheir stool for these fecal transplants? How
(16:19):
does that work? But it's morethan that. There are companies because the
stool has to be rigorously tested makingsure they're no viral infections. Right,
You don't want to give someone aninfection. And yeah, so there are
companies that now are taking human stooland processing and testing it so that it
is ready to be used for someonewho would need a fecal transplant. And
(16:41):
of course we're looking at what arethe important organisms as I mentioned before,
to see can we create something andthat's being done right now and study can
we create a pill or an enemathat can actually mimic human stool and the
important organisms that potentially can combat seediff. But at this point, like is
(17:02):
it something that you would write aprescription for, like a fecal It's not
as simple as that because there aredifferent deliveries. Usually what would happen you
would get a gaserentrologist who specializes insea diiff or an infectious disease doctor or
patient is hospitalized and need some moreurgent intervention. But yeah, most medical
doctors know about this. And ifsomeone we're fighting seediff, or let's say
(17:26):
someone has recurrency diff they've had thisthird or fourth episode because sometimes you treat
it, there are good medications totreat it, and then it comes back
out a twenty five percent risk ofit coming back. In those cases,
you might do this as an ambulatoroutpatient procedure, and then eradicate it once
and for all. So it's notjust people who are horribly sick from the
(17:48):
disease. It might be people ofrecurrency diff as well. Yeah. I
also wonder because you mentioned how themicrobio may affect other diseases. You mentioned
arthritis. I think you said maybecrohnes are all sort of colitis. And
I wonder in the future if someonecould look at their panel of microbiome and
see if it was deficient and thensupplement it with a fecal transplant. I
(18:10):
don't know that's right. And bythe way, not just the colon micro
environment. People have looked at thefloor of the mouth and connected that to
certain other conditions, potentially heart diseaseor even pancreas disease. So we're trying
to look at all different areas wherebacteria reside, which is in the gi
tract, particularly the colon, butthe mouth also the skin is a big
(18:33):
place where bacteria reside. For women, the gynocologic tract has a lot of
different bacterial microbata. Yeah, we'veseen in my field in urology that certain
bacteria in the mouth you say thatcan overgrow can also be related to a
rectile dysfunction. That they've done studieswhere they actually analyze veins in the penis
(18:56):
and then remove them and find bacteriathere. Really fascinating. We're talking if
you're just tuning in here to cancer'scorner. Fascinating discussion with doctor Mark po
Chapin, who is a director inthe Division of gashtra Entrology and Hepatology and
the Vice Chair of Clinical Affairs inthe Department of Medicine at NYU Grossman School
of Medicine. He is open foryou are seeing patients and open for patients.
(19:19):
Is that right? Yeah? AndI have a whole team. I
have a team of over three hundredand fifty doctors in our divisions. Wow.
Sure, people. We love notonly caring for patients, we also
love trying to push the needle forward. You know, what is the next
thing that we can do to helpour patients and help our population. Really
fascinating new discussion. You mentioned aboutinflammatory bowel syndrome and that's connected to microbiome.
(19:42):
What about colon cancer itself? Notonly the inflammatory conditions in the colon,
but cancer. Is that is thatsomehow relating back to the microbiome as
well. So I just want tomake the clarification that we actually haven't determined
if bacteria themselves are a cause andeffect of inflammatory balll disease. What we've
(20:06):
determined is that the immune system isupregulated and certain bacteria are pro inflammatory and
others are anti inflammatory. But wehaven't determined the cause and effect of inflammatory
ball disease with specific bacteria. Andwhat the construct is is that maybe not
being exposed to bacteria and diversity ofbacteria in younger in our life actually allows
(20:30):
our immune system to be a littlehyper regulated and consequently more prone to create
inflammation. So it's a bigger picture. It's not necessarily a single organism or
two. And that's in the worldof inflammatory ball disease. There's also the
irritable bowel syndrome, which is waymore common. That means there's no inflammation,
(20:51):
but the bowel itself is either creatingtoo much fluid causing diarrhea or not
enough, causing content the patient bloatingand cramping, and that may very well
be part of the bacterial milieu.Again, we're still doing research on it.
We haven't figured out the actual details, but there are certain bacteria that
(21:12):
create more gas than others and maycause bloating. And if there's more secal
residue in the colon, meaning thatpeople are not evacuating completely, stool has
organic material and bacteria, and thebacteria ferments that organic material and create a
lot of gas. So some peoplewho aren't evacuating completely and moving their bowels
(21:36):
and are constipated may actually have alot of gas and bloat that can be
fixed by using a gentle laxative likemagnesium or polyethene glycol which is on a
lot of over the counter preparations tohelp them move their bowels a little more
regularly, can actually make them feelbetter. Now, as far as colon
cancer is concerned, there does seemto be certain bacterial profiles associated with patients
(22:03):
who are more risk for colon cancerand colon polyps. Again, we don't
have specific bacteria that quote cause coloncancer, but we're beginning to think that
actually a lot of the food that'seaten that puts patients at high risk is
not working because of the food isnot good, but the food creates an
unhealthy bacterial milieu, a microboda thatpromotes polyps, which can turn into cancer.
(22:27):
Foods include red meat, as wementioned before, alcohol and really fatty,
greasy foods also might actually produce anunhealthy micro environment. So again it
all comes down to health and wellnessin broad strokes, healthy diet, fruits
(22:48):
and vegetables, keeping our weight,and check exercise like walking. Walking is
such a great exercise, and it'sbeen shown that exercise decreases the risk of
colon cancer as it does decrease hypertension, high blood pressure, or decrease obesity
and diabetes. So you know,what's good for the body is probably good
for the colon and vice versa.Yeah. Absolutely, these are really wonderful
(23:12):
tips. Thank you so much forletting us in educating us about this in
your career. Are you do youthink that you're seeing more colon cancer now?
And is it younger people as well? That's what I've been hearing,
But you're you're experience. It's interesting. We described over twenty years ago,
we wrote a paper we said wethink we're seeing more call and cancer in
(23:33):
younger people and less call and cancerand older We're actually doing an incredible job
for people over the age of sixtyand sixty five of really dramatically dropping the
rates of colon cancer through screening.Colonoscopy, stool testing for microscopic blood have
kind of been game changers. Imean, it's the prototype of a public
(23:53):
health initiative to get screened and toprevent cancer. And our screening age store
today fifty. So we're seeing olderindividuals not getting colon cancer because of screening.
The problem is that we're seeing ina significant uptick in younger patients with
colon cancer, particularly in their forties, but even in the thirties. And
(24:14):
so if anybody's listening, if someoneis having symptoms, they're having pain,
change in bowel, habits, bloodin the stool, please get that evaluated,
particularly rectal bleeding. Do not assume, if you're a younger individual in
your twenties, thirties, or forties, that new rectal bleeding is hemorrhoidal,
even though it probably is. Don'tmake that assumption. Go to your doctor
(24:36):
and have that evaluated. Because alot of times early on set colon cancer
and younger individuals presents with blood inthe stool. I don't want to scare
people because the majority of time thatwe have blood in the school it's not
related to anything significant. But forthose that it is they need to be
evaluated. And what ends up happeningis younger people just ignore their symptoms saying,
(24:59):
oh, it's nothing, it's notthing, and present much later with
the diagnosis of something more significant.What are your thoughts on the home test?
I see them advertised on TV alot, the coll of Guard and
things like that. Is that Ithink they're great. I think the best
test is the thing that gets done. I really do. I think that
every home test should be done inconsultation with your physician, make sure you
(25:22):
need it and it's the right test. Because if patients, let's say someone
has a parent who a colon cancerin their early sixties or late fifties,
they're at higher risk, so theyshould not be getting the home test.
They should be getting a colonoscopy.If someone has a genetic predisposition for cancer,
they should be getting a colonoscopy.But for average risk individuals, any
test is better than none, andif they do the home test and that's
(25:45):
positive, then they have to geta colonoscopy. So I look at it
as a two stage test. Firststage is either the stool test called a
FIT, which is looking for microscopicblood in the stool or a colon guard
which is basically a fit plus DNAand then if those are positive, they
must absolutely must get a call onus to be the follow up. Well,
this has been excellent education and justso important for all of our listeners
(26:10):
out there. And it really isso important to get tested and to be
screened, especially as you mentioned,if you're having any symptoms or family history,
and all the information that you gaveus about diet and the microbiome today
just really fantastic. I want tothank you so much for coming on the
show, doctor Mark port Chapin.Mark port Chapin is the director in the
(26:32):
Division of gesher Entrology and Hepatology andthe vice Chair of Clinical Affairs at the
NYU Grossman School of Medicine and theDepartment of Medicine. Mark, thank you
so much. I really appreciate youcoming on the show. Thank you so
much. We'll definitely have you onagain. Well, let's the end of
the show. Everyone. I hopeyou enjoyed it as much as I did.
Tune in every Sunday here on wR Katz's Corner. We'll have a
great show for you next week.This is doctor Aaron Katz. You've been
(26:53):
listening to Katzer's Corner. Come backevery week to hear more straight talk on
a wide range of men's health topicsand advice on how to live your healthiest
life. The proceeding was a paidpodcast. iHeartRadio's hosting of this podcast constitutes
neither an endorsement of the products offeredor the ideas expressed.
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