April 28, 2025 • 25 mins
The gut and brain are in constant conversation, influencing everything from mood and motivation to digestion and hormonal health. In this episode, we unpack the fundamentals of the gut-brain axis, including the role of the microbiome, common medications that impact gut health, and how those changes can ripple into mental well-being. Tune in to build your foundational knowledge and start recognizing how pharmacy practice intersects with the gut-brain connection.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Lara Zakaria, PharmD, MS, CNS, CDN, IFMCP
Owner, Founder
Foodie Farmacist LLC
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Explain the physiological connection between the gut and brain, including the role of the microbiome in mental and neurological health.
2. Describe how some drugs can influence the composition and function of the gut microbiome.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-153-H01-P
Initial release date: 4/28/2025
Expiration date: 4/28/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm super excited
about our conversation today.
The gut and the brain are inconstant communication,
influencing everything from moodand cognition to neurological
health, mood and cognition toneurological health.
In this episode, we'll explorethe science behind the gut-brain
(00:27):
connection, the role ofmicrobiome and how pharmacists
can help patients optimize bothdigestive and mental well-being.
And to do that, we have afantastic guest expert with us
today, laura Zacharia.
How are you?
Speaker 2 (00:39):
I'm great.
Thank you so much for having me.
Speaker 1 (00:41):
Yeah, thanks for being here.
We appreciate you taking timeout of your busy schedule to
join us today.
So, laura, if you don't mind,give our listeners a little bit
about.
Tell them about yourself.
Speaker 2 (00:51):
Thank you so much and thanks again for having me and
this opportunity to talk aboutwhat I think is a pretty
important topic.
So my background is in pharmacy.
I come from several years doingretail pharmacy.
I've done everything fromcorporate retail to independent
pharmacy, pharmacy managementand I transitioned over to doing
(01:17):
functional medicineconsultations and I do nutrition
counseling.
I actually also have abackground as a certified
nutrition specialist.
So basically I'm boardcertified in nutrition and that
really evolved out of myexperiences listening and
talking to my patients over theyears in the community setting.
(01:37):
Pharmacists who are in thatsetting have such a powerful
impact because we are not onlyaccessible but we are typically
the most approachable healthcarepractitioner that our patients
have, and in my experience, alot of those patients are
frustrated because they'reexperiencing symptoms that seem
disconnected.
They might even intuitivelyknow that there's a relationship
(01:59):
or a connection between them,but they seldom have the
opportunity to really have anexpert help them put together
those connections Exactly, andso I'm motivated by helping
other clinicians, otherpharmacists, learn about the
nutrition side of things, learnabout functional medicine and
(02:20):
whole person care in a way thatthey can then make it accessible
for their patients, and I thinkthat's a huge community impact
that we can have together.
Speaker 1 (02:28):
Yeah, for sure.
And you know some would jump onthe bandwagon and be like, oh,
this is a trend, this is the newtrend, like the holistic
approach and supplements andwhatever nutrition.
But I mean it shouldn't be atrend, it should have been a
thing all along.
Speaker 2 (02:43):
Yeah absolutely, and I'm here to ensure that it's not
a passing trend that we make itapproachable, sustainable and
something that really has animpact on our healthcare
outcomes.
Speaker 1 (02:53):
Yeah, that's great, that's great.
Well, one of the things that welove to do with our podcast is
show how we can impact thecommunity and how we can impact
more than just the one patientand whatnot.
So, yeah, this is great.
Well, thanks again, it's greatto have you and we're super
excited for you to to share allof your knowledge with us today,
and all of 30 minutes You'regoing to, you're going to impart
(03:14):
all your wisdom.
Speaker 2 (03:15):
We're going to pack it in, that's right.
Speaker 1 (03:18):
Well, on that note, let's jump right into our first
thing we touched on in the titleof the episode as well, as gut
brain, so we're talking aboutthat connection.
So let's let's touch on thatfirst remind our listeners how
the gut and the braincommunicate, like how do they
talk to each other and why isthat a thing you know, like
what's going on?
Speaker 2 (03:36):
Absolutely so.
One of the most establishedconnections actually in the
literature is the gut brainconnection.
There is multiple points ofinnervation between the brain
and the gut and largely it'srelated to the ANS autonomic
nervous system.
So, one of the most famous, thatprobably has caught most of the
(03:58):
trends that we hear about onsocial media or might be hearing
a lot about, is the vagus nerve.
Vagal nerve and the way thatthat connects from the brain to
the gut, and that's just oneexample of the various
mechanisms that the brain andthe gut are talking to each
other, and it's important toalso remember this is what's
called a bi-directionalrelationship.
This is a two-way highway.
(04:19):
This is not some one-way backcountry road, right?
Speaker 1 (04:23):
So these are long-time, they, these are all
each other.
Speaker 2 (04:26):
They call each other up.
They are on the phoneconstantly.
There are those people.
So back in the day, when I usedto work at CBS, my best friend
worked at another CBS and wewould be constantly on the phone
with each other, sometimesbecause we had to call each
other to say, hey, did you haveXYZ in stock, and sometimes
because we just wanted to talkhey how's your day going?
(04:46):
what's going on?
How's it going right?
We were the gut brainconnection, right, that bestie
that you are calling to makesure that they are on the same
page as you.
So when we talk about like kindof um, colloquial terms, like
uh, I had a gut feeling aboutthis, that is a legitimate brain
(05:07):
interpreting what the gut isfeeling and sending messages
back to the gut.
That is part of that two-wayconnection.
Speaker 1 (05:14):
I've really never even thought about that before
and how that actually like thefear of your stomach dropping
and whatever, and that'sactually talking.
Speaker 2 (05:23):
That's actually your stomach in that moment let's use
that the butterfly effect.
Or when your gut just drops,when something feels really
intense, that is actually yourbrain perceiving a situation and
sending the message back to thegut.
And if you think about it from asurvival mechanism we know
sympathetic, parasympathetic,fight or flight, rest and digest
(05:45):
.
When you think about it inthose terms, it makes sense,
because the last thing I needwhen I'm running away from a
saber-toothed tiger is to beslowed down because my stomach's
like um, excuse me, I need asnack.
Speaker 1 (05:55):
I'm well hungry.
I need to go to the bathroomright now, can we?
Speaker 2 (05:58):
just take a little pizza, like we don't need those
messages, right?
Because we're in the middle oftrying to make sure that we
don't get eaten by that sabertooth tiger.
So that back and forthcommunication is kind of
critical.
And in this modern life,translate saber tooth tiger to
constant stressors.
Emails dinging, going off, themessages on your phone are
(06:19):
constantly going off.
Your boss is breathing downyour neck, whatever that looks
like for you.
That is constantly telling yourbrain we are not in a safe
environment and that's sendingmessages back down to the gut to
then dictate what the gut isgoing to do with the microbiome
environment, with the acidity ofthe stomach, with the motility
(06:40):
of the stool and with how it'sgoing to handle and digest the
food that it's introducedInteresting.
Speaker 1 (06:47):
So I'm learning just already that my brain always
says eat, just go eat.
Speaker 2 (06:55):
That means you're feeling safe.
I guess, that literally meansthat your brain is basically
saying it's totally safe, josh,go ahead and have that snack,
because we're not running awayfrom anything anytime soon.
Speaker 1 (07:05):
Just eat that.
Speaker 2 (07:07):
Eat that ice cream and you'll be fine, yeah but you
know how some people, whenthey're under a lot of stress,
they don't want to eat mmm right, some of us stress eat for sure
, I'm right.
I'm blessed to be one of thosepeople that when I'm under
stress, I want to eat but thereare definitely there are some
people that when they'restressed or certain kinds of
stress will lead them to nothave an appetite anymore.
(07:27):
Right Now the way that yourespond to stress.
There's a lot of reasons forthat.
Right, there is.
You know how you manage stress,how you perceive stress, what,
what access you have toresources to help you cope with
that stress, the kind of foodthat you like.
There's a lot of differentfactors, are different factors
that are going to dictate that.
But at the end of the day,what's happening is that,
(07:49):
depending on the microbiomeenvironment, on the hormones and
what's sort of driving thatconversation.
And then, of course, we knowhunger cues are based on things
like, yes, insulin, yes, leptin,but also cortisol, serotonin,
dopamine.
So all of these hormones andthese neurotransmitters, the way
that they're talking to eachother, is going to then send
(08:11):
messages back to the brain.
That's going to say stressfulsituation we can eat or
stressful situation we can't eat.
Obviously, that's verysimplified, but you kind of get
where I'm going with.
The hormonal response isdictated by what's happening in
your microbiome and in your gutenvironment.
Speaker 1 (08:28):
So so much going on there, but I think the real take
home is that they are inconstant communication together,
the gut and the brain, andthey're doing it via multiple
different pathways, basically soyeah, so you mentioned
microbiome and I think that's agreat jump point off to that.
So let's, let's jump intomicrobiome.
What, what, what is it, what?
(08:50):
What is the role you know?
Like?
Let's just let's really breakit down, okay.
Speaker 2 (08:55):
I'm going to first tell you what it's not because,
I remember being taught you know, whoever y'all out there,
you're probably going to be fromdifferent generations of
pharmacy.
So for my older pharmaciststhat have been doing this for a
minute, you might remember beingtold that the microbiome is
just a few different kinds oforganisms that live in the gut
(09:20):
and that when we take anantibiotic it's going to kill
some of them and that's going toincrease the risk of candida
for some of our patients andwe're just going to go ahead and
prescribe some lactobacillus orprescribe some probiotic and
that's just going to clear it up.
Speaker 1 (09:32):
I was going to say it's the good bacteria.
Speaker 2 (09:34):
It's the good bacteria, right, and there's
some stuff in there we don'treally know what it does.
That's what I remember sodistinctly hearing.
We don't know what it does.
This was before you know.
This was like at the I'm datingmyself now, but like early
2000s, where we were saying,like, okay, just like these wide
spectrum antibiotics werehitting the market, we were
(09:55):
using them more and morefrequently.
We're starting to see moreantibiotic resistance and, as a
result of that, we were tryingto figure out is there more to
the situation than just somediarrhea and some yeast
infections, right?
Like?
Is that it?
Like, do we just give aDiflucan and call it a day?
Speaker 1 (10:12):
Right.
Speaker 2 (10:13):
And what we've learned since in the last few
decades is that, yes, it is trueit's the good bacteria, but
it's actually so much morecomplicated than that.
There's actually trillions oflittle bugs and, yes, there's
bacteria, but there's alsoviruses and there's candida
species and there are commensalparasites as well, so it's truly
(10:35):
a just mishmash of all thesedifferent types of species.
Now, yeah we focus a lot on thebacteria, because the bacteria
seem to be at the interface ofthe conversation between the
environment, the food that weput inside our gut and what gets
communicated then to our DNAand what dictates some of our
(10:58):
metabolomics.
In other words, when thebacteria in our gut perceive
something in the gut or getmessages from the brain, they
release certainneurotransmitters and certain
byproducts that then pick up thephone and they call different
parts of our body.
So this is why you're hearing alot more about the microbiome,
(11:20):
because in the last couple ofdecades we've started to realize
that the microbiome mightactually be yet another almost
endocrine system that'scommunicating, it is dictating
transcription in our DNA, it'sdictating how our DNA might
express, it's sending messagesto different organs.
(11:40):
It's also communicating to ourbrain and telling our brain then
how to respond to thosetriggers and those signals.
So it's kind of like those oldfashioned phone operators.
Speaker 1 (11:51):
Oh my gosh.
Yeah, I was just actuallyenvisioning that, where it's
like taking that and putting inand yeah, exactly.
Speaker 2 (11:56):
And when it's in balance.
So when we say good bacteria,the good bacteria has to be in
the right balance.
There has to be the rightspecies.
The species have to be in theright part of the digestive
tract, so meaning it also has tobe in the right neighborhood.
I call it so.
When you don't have enough ofthem, you're missing certain
(12:19):
neighborhoods or you just havean overgrowth of things that
aren't supposed to be there.
That's when we have what wecall dysbiosis, or bacterial
imbalances, or an over,potentially an overgrowth of
bacteria that then causes someof these.
That's where we have theproblem Exactly.
Speaker 1 (12:40):
The problem ensues from that.
Speaker 2 (12:42):
Exactly, exactly.
Speaker 1 (12:44):
Okay, so that's super helpful as, again, to kind of
lay the foundation.
And you've talked about howmicrobiome is involved in a lot
of that and it's involved inmood and cognition and
neurological and hormonal andall that kind of stuff.
So let's talk about medicationsand or foods, even if we wanted
to go down that path that we'reintroducing, the system that's
(13:07):
also affecting I won't even saydisrupting, because maybe it's
affecting in a good way,absolutely.
Speaker 2 (13:13):
In fact, let's start with a positive right.
Let's start with SSRIs.
Standard of care when it comesto depression is the use of
antidepressants or SSRIs.
What's the mechanism there?
Spot check right.
They're going to inhibit thebreakdown of serotonin.
This is operating on thepremise that there's an issue
with the production and orbreakdown of serotonin and that
(13:36):
by preventing that breakdown,we're gonna increase the amount
of serotonin.
More serotonin is going toengage with the serotonin
receptor and that's going toenhance mood.
Now, real quick, what's one ofthe side effects like the first
thing that you could think of ofserotonin, of SSRI rather?
Speaker 1 (13:54):
Oh goodness, first thing, well, I always think of
weight gain, but I don't know ifthat's it's not for all of them
, so I don't know Right,absolutely Weight gain.
Speaker 2 (14:03):
Exactly GI upset.
Speaker 1 (14:05):
Oh yeah.
Speaker 2 (14:06):
Diarrhea.
Right, because a large majorityof our serotonin receptors
actually reside in our gut,because our bacteria actually is
part of what's responsible forturning on and making more
serotonin, and so to a certainextent we can actually use SSRIs
, as it's used sometimes for IBSconstipation, because of that
(14:31):
improvement in the motility as aresult of increasing the
concentration of serotonin inthe gut.
But when you really go upstream, there's something going on in
the way that the microbiome iscommunicating with the
innervation signaling from thebrain.
That's then changing theconcentration of the serotonin
or changing the way the receptoris engaging with that serotonin
, and that's all changing theconcentration of the serotonin
or changing the way the receptoris engaging with that serotonin
(14:52):
.
And that's all on thatmicrobiome level right.
So one mechanism to enhance thisto think about is if you've got
somebody who's not doing wellon an SSRI, who is potentially
still experiencing symptoms ofdepression and in fact I believe
there's a statistic thatapproximately 40% of patients
(15:13):
don't feel 100% better on theirSSRI and their depression
symptoms continue.
So that's a large number ofpatients that we would never
ignore that statistic right.
So what else can we do toenhance that?
And to me, the obvious nextstep is to address things that
are going to impact themicrobiome.
And then we're going tointroduce the idea that
inflammation is one of thosedrivers of both the disruption
(15:36):
in the microbiome as well as thedisruption in the communication
and the signaling between thegut and the brain that's
impacting the outcome of thatSSRI intervention.
Speaker 1 (15:46):
Wow, wow, yeah, and all that's just an SSRI.
Speaker 2 (15:50):
And that's just an SSRI, and that's just the SSRI.
So how many?
Speaker 1 (15:52):
other medications affect this?
No, but what are some of theother common ones that we should
look out for as far like?
What are we seeing commonlythat we know there's evidence
that they do affect microbiomeor they are affected by
microbiome?
Speaker 2 (16:08):
Absolutely the number one thing is going to be
anything that changes the gutenvironment.
So already you know we canthink of a bunch of different
things right.
Top top contenders for me wouldbe PPIs and NSAIDs.
Right, but literally anythingthat is going to alter or have
an impact, have an increasedrisk of bleed as a side effect,
(16:29):
anything that has an increasedrisk of diarrhea or constipation
as a side effect is going toimpact not only the motility of
the gut environment but the pHbalance in different parts of
the GI, or it's going to have adirect impact on the microflora
like antibiotics.
Speaker 1 (16:47):
I'm also thinking GLP I mean right.
Speaker 2 (16:51):
Josh, you nailing it Exactly, Exactly.
One of the side effects of GLPones, and why actually it's part
of its mechanism, is the changein motility of the GI tract
right.
So we should be constantlythinking about once we have got
somebody on a GLP one, forwhatever reason they're on it,
we need to be thinking abouttheir gut motility, the
(17:16):
environment of the gut and again, what are the alterations?
Because we're impactingdirectly the communication
channel to the brain by changingthe way the hormones
responsible for satiety andhunger are operating.
So that's an even moresignificant impact on their
mental health.
So, whether they're at risk forit or they come back and they
tell you hey, I've lost weight,but I don't seem to have the
(17:37):
same.
Like you know, my mood isdifferent or I'm not feeling as
motivated.
We should be diving a little bitdeeper and talking to them
about their bowel movements,what their gut health looks like
.
Has their diet changed?
Like?
That's a really important pointactually, because I find,
because we're removing thenatural hunger cues now we've
sort of altered the way somebodythinks about food and the way
(17:59):
that they're motivated by foodchoices.
I find a lot of folks, becausethey're not as driven by that
decision, they sort of eatwhatever is convenient and they
stop thinking about eating interms of health or even paying
attention to the nutrientdensity.
They're just sort of eatingbecause it's convenient, because
it's there, because they haveto.
(18:21):
I've had one patient describe itto me as like, yeah, my husband
kind of is worried about me, sohe puts down a plate in front
of me and I sort of eat itbecause I don't want him to
worry.
And that is because the GLP isdoing its job.
It's really communicating tothat person that hey, you don't
really need this, you're good,and she's experiencing the
(18:42):
weight loss that she's after.
But now I'm worried that she'snot feeding her microbiome
environment with fiberadequately.
That tends to be the firstthing that falls off of the
plate, right, because she feelsfull.
She does.
She really doesn't want to eata whole big salad.
She doesn't really have thespace for it right so she ends
up eating more processed foodand as a result of that, she's
really not getting as muchnutrient density.
(19:04):
She's probably not getting agood variety of different colors
and anti-inflammatory foods inher diet anymore.
She's not getting a lot ofprotein because again she's
feeling satiated and full, andthen all of that is going to
contribute to some nutrientdepletions and it's going to
alter her microbiome environmentand because her GI has slowed
(19:24):
down, that might also impact notonly her microbiome her
motility.
She might experienceconstipation as a result, and
that's going to have its owndomino effect of issues.
Speaker 1 (19:34):
Yeah, you were going to say cascade effect.
Yep, exactly, exactly.
Well said, yeah.
So you also mentioned.
You mentioned PPIs, which Ithink are super common, also
over the counter.
So I mean, those are somethingpeople can grab.
You don't have to see them on aprescription screen.
That could be somethingsomeone's taking that you don't
realize.
Same with NSAIDs.
I mean, very few NSAIDs areprescribed these days, you know,
(19:56):
unless they're super high doses, which we'd be worried about as
well.
But yeah, so anything else thatpharmacists can really keep an
eye out for as far as if I see apatient on this, I need to
trigger the whole idea of youknow, let's talk about deeper
things, let's see if thecommunication is there, anything
else you?
Speaker 2 (20:15):
can think of.
Yes, one of the most commonlyprescribed medications is oral
contraceptives.
Oral contraceptives alter theGI environment.
They also can lead to certainnutrient depletions.
I'm going to mention that aswell.
Right, Particularly B vitamins,but there's also some studies
that suggest that things likezinc and magnesium can also be
(20:36):
depleted in women who are takingoral contraceptives for an
extended period of time.
So, definitely something tomonitor.
But alterations in themicrobiome as a result of any
HRT, whether that comes from anoral contraceptive or
traditional hormone replacementtherapy estrogen in particular
could alter the microbiomeenvironment because we require
(20:59):
the microbiome to actuallydetoxify and remove those
estrogens, otherwise we get aninterhepatic recirculation
effect.
So first it goes through theliver, the liver goes through
its phase one, phase twodetoxification, then it moves it
into the gut, where in the gutwe require beta glucuronidation
to or beta glucuronidase, theenzyme to perform beta
(21:21):
glucuronidation, which is partof that detoxification effect
and then puts it in the stool,packages it and sends it out.
Right, if you experienceconstipation or you increase the
amount of estrogen net or thestress on removing that estrogen
or there are othercomplications that are impacting
the ability of the liver tothen do its job to detoxify,
(21:43):
that's going to add added burden, added stress.
That is going to thenessentially speed up that
conveyor belt through betaglucuronidase and that is going
to also impact the up thatconveyor belt through
beta-glucuronidase and that isgoing to also impact the
environment in the gut.
In fact, we can measurebeta-glucuronidase in stool and
we can see the impact of theincrease of that
beta-glucuronidase.
That's usually a good signalthat there is added
(22:04):
detoxification pressure, thatthere's an altered microbiome
environment and likely thatthere is potentially a
recirculation of that estrogenand some estrogen dominance
occurring in that case.
Speaker 1 (22:15):
Interesting.
Wow, and again, what else isover the counter now?
Birth control pills, right?
Speaker 2 (22:22):
Those happen to be progestin only.
So there's less of an impact,right, so great call out right
Less of an impact, that doesn'tmean that they're not going to
cause their own set of sideeffects.
So still worth the counselingpoint for sure, but we don't
have the estrogen.
The estrogen detoxificationpoint is not related there.
(22:44):
That said definitely.
I mean, it goes back to yourpoint earlier about so many of
these things are now over thecounter.
It only restresses to me theimportance of that pharmacist
consultation opportunity to popin and say, hey, what else are
you taking?
So they're coming in.
They're telling you they'refilling their SSRI medication.
(23:05):
They're telling you they're notfeeling well, they're not sure
if they should start it.
They're hesitant because of X,Y, Z reason.
We we have to start asking themwhat else are you taking over
the counter?
How often do you take an nsaid?
Do you ever take a ppi?
Do you have issues withconstipation?
Are you, are you taking xyz inorder to deal with ibs symptoms?
Uh, are you on an oralcontraceptive right?
(23:27):
All of these questions arerelevant because not only do
they directly impact themicrobiome, directly impact
motility, directly impact guthealth and could potentially
alter the way they'reexperiencing inflammation in
their gut, which thenpotentially has the direct
effect on theirneurotransmitters, on their
(23:47):
hormone function and on theirbrain chemistry and their brain
health.
Speaker 1 (23:52):
Wow, wow, yeah, that's so much.
I mean, again, we've onlytipped the iceberg of the common
ones.
We're not even talking aboutthe ones that are maybe not
super common but are stillaffecting the microbiome and the
gut in a specific way.
So, yeah, Well, let's jump intosome of the opportunities for
(24:13):
our pharmacists.
So tell us what we could bedoing to be better clinicians in
this space.
What should we be doing?
Should we be asking certainquestions?
You're the expert.
I'll let you tell us what weshould be doing, because there's
so much information here and Ifeel like we could go in a lot
of different directions, but Iwant to give the listeners you
(24:36):
know.
Here are a few things you cando and I'll let you go.
Speaker 2 (24:40):
Yeah, I think I'm going to put it into three
categories for us.
Speaker 1 (24:45):
And Laura, that's a great place for us to stop for
today's episode.
You've given us some greatinformation to look forward to
in part two of the Gut-BrainConnection episode, so,
listeners, please be sure totune in next week for part two.
We will learn the specificsabout those buckets that Laura
mentioned and you'll be able totake some actionable items back
(25:07):
to your practice sites.
If you're a CE Plan subscriber,be sure to claim your CE credit
for this week's episode of GameChangers by logging in at
ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all again next week.
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm super excited
about our conversation today.
The gut and the brain are inconstant communication,
influencing everything from moodand cognition to neurological
health, mood and cognition toneurological health.
In this episode, we'll explorethe science behind the gut-brain
(00:27):
connection, the role ofmicrobiome and how pharmacists
can help patients optimize bothdigestive and mental well-being.
And to do that, we have afantastic guest expert with us
today, laura Zacharia.
How are you?
Speaker 2 (00:39):
I'm great.
Thank you so much for having me.
Speaker 1 (00:41):
Yeah, thanks for being here.
We appreciate you taking timeout of your busy schedule to
join us today.
So, laura, if you don't mind,give our listeners a little bit
about.
Tell them about yourself.
Speaker 2 (00:51):
Thank you so much and thanks again for having me and
this opportunity to talk aboutwhat I think is a pretty
important topic.
So my background is in pharmacy.
I come from several years doingretail pharmacy.
I've done everything fromcorporate retail to independent
pharmacy, pharmacy managementand I transitioned over to doing
(01:17):
functional medicineconsultations and I do nutrition
counseling.
I actually also have abackground as a certified
nutrition specialist.
So basically I'm boardcertified in nutrition and that
really evolved out of myexperiences listening and
talking to my patients over theyears in the community setting.
(01:37):
Pharmacists who are in thatsetting have such a powerful
impact because we are not onlyaccessible but we are typically
the most approachable healthcarepractitioner that our patients
have, and in my experience, alot of those patients are
frustrated because they'reexperiencing symptoms that seem
disconnected.
They might even intuitivelyknow that there's a relationship
(01:59):
or a connection between them,but they seldom have the
opportunity to really have anexpert help them put together
those connections Exactly, andso I'm motivated by helping
other clinicians, otherpharmacists, learn about the
nutrition side of things, learnabout functional medicine and
(02:20):
whole person care in a way thatthey can then make it accessible
for their patients, and I thinkthat's a huge community impact
that we can have together.
Speaker 1 (02:28):
Yeah, for sure.
And you know some would jump onthe bandwagon and be like, oh,
this is a trend, this is the newtrend, like the holistic
approach and supplements andwhatever nutrition.
But I mean it shouldn't be atrend, it should have been a
thing all along.
Speaker 2 (02:43):
Yeah absolutely, and I'm here to ensure that it's not
a passing trend that we make itapproachable, sustainable and
something that really has animpact on our healthcare
outcomes.
Speaker 1 (02:53):
Yeah, that's great, that's great.
Well, one of the things that welove to do with our podcast is
show how we can impact thecommunity and how we can impact
more than just the one patientand whatnot.
So, yeah, this is great.
Well, thanks again, it's greatto have you and we're super
excited for you to to share allof your knowledge with us today,
and all of 30 minutes You'regoing to, you're going to impart
(03:14):
all your wisdom.
Speaker 2 (03:15):
We're going to pack it in, that's right.
Speaker 1 (03:18):
Well, on that note, let's jump right into our first
thing we touched on in the titleof the episode as well, as gut
brain, so we're talking aboutthat connection.
So let's let's touch on thatfirst remind our listeners how
the gut and the braincommunicate, like how do they
talk to each other and why isthat a thing you know, like
what's going on?
Speaker 2 (03:36):
Absolutely so.
One of the most establishedconnections actually in the
literature is the gut brainconnection.
There is multiple points ofinnervation between the brain
and the gut and largely it'srelated to the ANS autonomic
nervous system.
So, one of the most famous, thatprobably has caught most of the
(03:58):
trends that we hear about onsocial media or might be hearing
a lot about, is the vagus nerve.
Vagal nerve and the way thatthat connects from the brain to
the gut, and that's just oneexample of the various
mechanisms that the brain andthe gut are talking to each
other, and it's important toalso remember this is what's
called a bi-directionalrelationship.
This is a two-way highway.
(04:19):
This is not some one-way backcountry road, right?
Speaker 1 (04:23):
So these are long-time, they, these are all
each other.
Speaker 2 (04:26):
They call each other up.
They are on the phoneconstantly.
There are those people.
So back in the day, when I usedto work at CBS, my best friend
worked at another CBS and wewould be constantly on the phone
with each other, sometimesbecause we had to call each
other to say, hey, did you haveXYZ in stock, and sometimes
because we just wanted to talkhey how's your day going?
(04:46):
what's going on?
How's it going right?
We were the gut brainconnection, right, that bestie
that you are calling to makesure that they are on the same
page as you.
So when we talk about like kindof um, colloquial terms, like
uh, I had a gut feeling aboutthis, that is a legitimate brain
(05:07):
interpreting what the gut isfeeling and sending messages
back to the gut.
That is part of that two-wayconnection.
Speaker 1 (05:14):
I've really never even thought about that before
and how that actually like thefear of your stomach dropping
and whatever, and that'sactually talking.
Speaker 2 (05:23):
That's actually your stomach in that moment let's use
that the butterfly effect.
Or when your gut just drops,when something feels really
intense, that is actually yourbrain perceiving a situation and
sending the message back to thegut.
And if you think about it from asurvival mechanism we know
sympathetic, parasympathetic,fight or flight, rest and digest
(05:45):
.
When you think about it inthose terms, it makes sense,
because the last thing I needwhen I'm running away from a
saber-toothed tiger is to beslowed down because my stomach's
like um, excuse me, I need asnack.
Speaker 1 (05:55):
I'm well hungry.
I need to go to the bathroomright now, can we?
Speaker 2 (05:58):
just take a little pizza, like we don't need those
messages, right?
Because we're in the middle oftrying to make sure that we
don't get eaten by that sabertooth tiger.
So that back and forthcommunication is kind of
critical.
And in this modern life,translate saber tooth tiger to
constant stressors.
Emails dinging, going off, themessages on your phone are
(06:19):
constantly going off.
Your boss is breathing downyour neck, whatever that looks
like for you.
That is constantly telling yourbrain we are not in a safe
environment and that's sendingmessages back down to the gut to
then dictate what the gut isgoing to do with the microbiome
environment, with the acidity ofthe stomach, with the motility
(06:40):
of the stool and with how it'sgoing to handle and digest the
food that it's introducedInteresting.
Speaker 1 (06:47):
So I'm learning just already that my brain always
says eat, just go eat.
Speaker 2 (06:55):
That means you're feeling safe.
I guess, that literally meansthat your brain is basically
saying it's totally safe, josh,go ahead and have that snack,
because we're not running awayfrom anything anytime soon.
Speaker 1 (07:05):
Just eat that.
Speaker 2 (07:07):
Eat that ice cream and you'll be fine, yeah but you
know how some people, whenthey're under a lot of stress,
they don't want to eat mmm right, some of us stress eat for sure
, I'm right.
I'm blessed to be one of thosepeople that when I'm under
stress, I want to eat but thereare definitely there are some
people that when they'restressed or certain kinds of
stress will lead them to nothave an appetite anymore.
(07:27):
Right Now the way that yourespond to stress.
There's a lot of reasons forthat.
Right, there is.
You know how you manage stress,how you perceive stress, what,
what access you have toresources to help you cope with
that stress, the kind of foodthat you like.
There's a lot of differentfactors, are different factors
that are going to dictate that.
But at the end of the day,what's happening is that,
(07:49):
depending on the microbiomeenvironment, on the hormones and
what's sort of driving thatconversation.
And then, of course, we knowhunger cues are based on things
like, yes, insulin, yes, leptin,but also cortisol, serotonin,
dopamine.
So all of these hormones andthese neurotransmitters, the way
that they're talking to eachother, is going to then send
(08:11):
messages back to the brain.
That's going to say stressfulsituation we can eat or
stressful situation we can't eat.
Obviously, that's verysimplified, but you kind of get
where I'm going with.
The hormonal response isdictated by what's happening in
your microbiome and in your gutenvironment.
Speaker 1 (08:28):
So so much going on there, but I think the real take
home is that they are inconstant communication together,
the gut and the brain, andthey're doing it via multiple
different pathways, basically soyeah, so you mentioned
microbiome and I think that's agreat jump point off to that.
So let's, let's jump intomicrobiome.
What, what, what is it, what?
(08:50):
What is the role you know?
Like?
Let's just let's really breakit down, okay.
Speaker 2 (08:55):
I'm going to first tell you what it's not because,
I remember being taught you know, whoever y'all out there,
you're probably going to be fromdifferent generations of
pharmacy.
So for my older pharmaciststhat have been doing this for a
minute, you might remember beingtold that the microbiome is
just a few different kinds oforganisms that live in the gut
(09:20):
and that when we take anantibiotic it's going to kill
some of them and that's going toincrease the risk of candida
for some of our patients andwe're just going to go ahead and
prescribe some lactobacillus orprescribe some probiotic and
that's just going to clear it up.
Speaker 1 (09:32):
I was going to say it's the good bacteria.
Speaker 2 (09:34):
It's the good bacteria, right, and there's
some stuff in there we don'treally know what it does.
That's what I remember sodistinctly hearing.
We don't know what it does.
This was before you know.
This was like at the I'm datingmyself now, but like early
2000s, where we were saying,like, okay, just like these wide
spectrum antibiotics werehitting the market, we were
(09:55):
using them more and morefrequently.
We're starting to see moreantibiotic resistance and, as a
result of that, we were tryingto figure out is there more to
the situation than just somediarrhea and some yeast
infections, right?
Like?
Is that it?
Like, do we just give aDiflucan and call it a day?
Speaker 1 (10:12):
Right.
Speaker 2 (10:13):
And what we've learned since in the last few
decades is that, yes, it is trueit's the good bacteria, but
it's actually so much morecomplicated than that.
There's actually trillions oflittle bugs and, yes, there's
bacteria, but there's alsoviruses and there's candida
species and there are commensalparasites as well, so it's truly
(10:35):
a just mishmash of all thesedifferent types of species.
Now, yeah we focus a lot on thebacteria, because the bacteria
seem to be at the interface ofthe conversation between the
environment, the food that weput inside our gut and what gets
communicated then to our DNAand what dictates some of our
(10:58):
metabolomics.
In other words, when thebacteria in our gut perceive
something in the gut or getmessages from the brain, they
release certainneurotransmitters and certain
byproducts that then pick up thephone and they call different
parts of our body.
So this is why you're hearing alot more about the microbiome,
(11:20):
because in the last couple ofdecades we've started to realize
that the microbiome mightactually be yet another almost
endocrine system that'scommunicating, it is dictating
transcription in our DNA, it'sdictating how our DNA might
express, it's sending messagesto different organs.
(11:40):
It's also communicating to ourbrain and telling our brain then
how to respond to thosetriggers and those signals.
So it's kind of like those oldfashioned phone operators.
Speaker 1 (11:51):
Oh my gosh.
Yeah, I was just actuallyenvisioning that, where it's
like taking that and putting inand yeah, exactly.
Speaker 2 (11:56):
And when it's in balance.
So when we say good bacteria,the good bacteria has to be in
the right balance.
There has to be the rightspecies.
The species have to be in theright part of the digestive
tract, so meaning it also has tobe in the right neighborhood.
I call it so.
When you don't have enough ofthem, you're missing certain
(12:19):
neighborhoods or you just havean overgrowth of things that
aren't supposed to be there.
That's when we have what wecall dysbiosis, or bacterial
imbalances, or an over,potentially an overgrowth of
bacteria that then causes someof these.
That's where we have theproblem Exactly.
Speaker 1 (12:40):
The problem ensues from that.
Speaker 2 (12:42):
Exactly, exactly.
Speaker 1 (12:44):
Okay, so that's super helpful as, again, to kind of
lay the foundation.
And you've talked about howmicrobiome is involved in a lot
of that and it's involved inmood and cognition and
neurological and hormonal andall that kind of stuff.
So let's talk about medicationsand or foods, even if we wanted
to go down that path that we'reintroducing, the system that's
(13:07):
also affecting I won't even saydisrupting, because maybe it's
affecting in a good way,absolutely.
Speaker 2 (13:13):
In fact, let's start with a positive right.
Let's start with SSRIs.
Standard of care when it comesto depression is the use of
antidepressants or SSRIs.
What's the mechanism there?
Spot check right.
They're going to inhibit thebreakdown of serotonin.
This is operating on thepremise that there's an issue
with the production and orbreakdown of serotonin and that
(13:36):
by preventing that breakdown,we're gonna increase the amount
of serotonin.
More serotonin is going toengage with the serotonin
receptor and that's going toenhance mood.
Now, real quick, what's one ofthe side effects like the first
thing that you could think of ofserotonin, of SSRI rather?
Speaker 1 (13:54):
Oh goodness, first thing, well, I always think of
weight gain, but I don't know ifthat's it's not for all of them
, so I don't know Right,absolutely Weight gain.
Speaker 2 (14:03):
Exactly GI upset.
Speaker 1 (14:05):
Oh yeah.
Speaker 2 (14:06):
Diarrhea.
Right, because a large majorityof our serotonin receptors
actually reside in our gut,because our bacteria actually is
part of what's responsible forturning on and making more
serotonin, and so to a certainextent we can actually use SSRIs
, as it's used sometimes for IBSconstipation, because of that
(14:31):
improvement in the motility as aresult of increasing the
concentration of serotonin inthe gut.
But when you really go upstream, there's something going on in
the way that the microbiome iscommunicating with the
innervation signaling from thebrain.
That's then changing theconcentration of the serotonin
or changing the way the receptoris engaging with that serotonin
, and that's all changing theconcentration of the serotonin
or changing the way the receptoris engaging with that serotonin
(14:52):
.
And that's all on thatmicrobiome level right.
So one mechanism to enhance thisto think about is if you've got
somebody who's not doing wellon an SSRI, who is potentially
still experiencing symptoms ofdepression and in fact I believe
there's a statistic thatapproximately 40% of patients
(15:13):
don't feel 100% better on theirSSRI and their depression
symptoms continue.
So that's a large number ofpatients that we would never
ignore that statistic right.
So what else can we do toenhance that?
And to me, the obvious nextstep is to address things that
are going to impact themicrobiome.
And then we're going tointroduce the idea that
inflammation is one of thosedrivers of both the disruption
(15:36):
in the microbiome as well as thedisruption in the communication
and the signaling between thegut and the brain that's
impacting the outcome of thatSSRI intervention.
Speaker 1 (15:46):
Wow, wow, yeah, and all that's just an SSRI.
Speaker 2 (15:50):
And that's just an SSRI, and that's just the SSRI.
So how many?
Speaker 1 (15:52):
other medications affect this?
No, but what are some of theother common ones that we should
look out for as far like?
What are we seeing commonlythat we know there's evidence
that they do affect microbiomeor they are affected by
microbiome?
Speaker 2 (16:08):
Absolutely the number one thing is going to be
anything that changes the gutenvironment.
So already you know we canthink of a bunch of different
things right.
Top top contenders for me wouldbe PPIs and NSAIDs.
Right, but literally anythingthat is going to alter or have
an impact, have an increasedrisk of bleed as a side effect,
(16:29):
anything that has an increasedrisk of diarrhea or constipation
as a side effect is going toimpact not only the motility of
the gut environment but the pHbalance in different parts of
the GI, or it's going to have adirect impact on the microflora
like antibiotics.
Speaker 1 (16:47):
I'm also thinking GLP I mean right.
Speaker 2 (16:51):
Josh, you nailing it Exactly, Exactly.
One of the side effects of GLPones, and why actually it's part
of its mechanism, is the changein motility of the GI tract
right.
So we should be constantlythinking about once we have got
somebody on a GLP one, forwhatever reason they're on it,
we need to be thinking abouttheir gut motility, the
(17:16):
environment of the gut and again, what are the alterations?
Because we're impactingdirectly the communication
channel to the brain by changingthe way the hormones
responsible for satiety andhunger are operating.
So that's an even moresignificant impact on their
mental health.
So, whether they're at risk forit or they come back and they
tell you hey, I've lost weight,but I don't seem to have the
(17:37):
same.
Like you know, my mood isdifferent or I'm not feeling as
motivated.
We should be diving a little bitdeeper and talking to them
about their bowel movements,what their gut health looks like
.
Has their diet changed?
Like?
That's a really important pointactually, because I find,
because we're removing thenatural hunger cues now we've
sort of altered the way somebodythinks about food and the way
(17:59):
that they're motivated by foodchoices.
I find a lot of folks, becausethey're not as driven by that
decision, they sort of eatwhatever is convenient and they
stop thinking about eating interms of health or even paying
attention to the nutrientdensity.
They're just sort of eatingbecause it's convenient, because
it's there, because they haveto.
(18:21):
I've had one patient describe itto me as like, yeah, my husband
kind of is worried about me, sohe puts down a plate in front
of me and I sort of eat itbecause I don't want him to
worry.
And that is because the GLP isdoing its job.
It's really communicating tothat person that hey, you don't
really need this, you're good,and she's experiencing the
(18:42):
weight loss that she's after.
But now I'm worried that she'snot feeding her microbiome
environment with fiberadequately.
That tends to be the firstthing that falls off of the
plate, right, because she feelsfull.
She does.
She really doesn't want to eata whole big salad.
She doesn't really have thespace for it right so she ends
up eating more processed foodand as a result of that, she's
really not getting as muchnutrient density.
(19:04):
She's probably not getting agood variety of different colors
and anti-inflammatory foods inher diet anymore.
She's not getting a lot ofprotein because again she's
feeling satiated and full, andthen all of that is going to
contribute to some nutrientdepletions and it's going to
alter her microbiome environmentand because her GI has slowed
(19:24):
down, that might also impact notonly her microbiome her
motility.
She might experienceconstipation as a result, and
that's going to have its owndomino effect of issues.
Speaker 1 (19:34):
Yeah, you were going to say cascade effect.
Yep, exactly, exactly.
Well said, yeah.
So you also mentioned.
You mentioned PPIs, which Ithink are super common, also
over the counter.
So I mean, those are somethingpeople can grab.
You don't have to see them on aprescription screen.
That could be somethingsomeone's taking that you don't
realize.
Same with NSAIDs.
I mean, very few NSAIDs areprescribed these days, you know,
(19:56):
unless they're super high doses, which we'd be worried about as
well.
But yeah, so anything else thatpharmacists can really keep an
eye out for as far as if I see apatient on this, I need to
trigger the whole idea of youknow, let's talk about deeper
things, let's see if thecommunication is there, anything
else you?
Speaker 2 (20:15):
can think of.
Yes, one of the most commonlyprescribed medications is oral
contraceptives.
Oral contraceptives alter theGI environment.
They also can lead to certainnutrient depletions.
I'm going to mention that aswell.
Right, Particularly B vitamins,but there's also some studies
that suggest that things likezinc and magnesium can also be
(20:36):
depleted in women who are takingoral contraceptives for an
extended period of time.
So, definitely something tomonitor.
But alterations in themicrobiome as a result of any
HRT, whether that comes from anoral contraceptive or
traditional hormone replacementtherapy estrogen in particular
could alter the microbiomeenvironment because we require
(20:59):
the microbiome to actuallydetoxify and remove those
estrogens, otherwise we get aninterhepatic recirculation
effect.
So first it goes through theliver, the liver goes through
its phase one, phase twodetoxification, then it moves it
into the gut, where in the gutwe require beta glucuronidation
to or beta glucuronidase, theenzyme to perform beta
(21:21):
glucuronidation, which is partof that detoxification effect
and then puts it in the stool,packages it and sends it out.
Right, if you experienceconstipation or you increase the
amount of estrogen net or thestress on removing that estrogen
or there are othercomplications that are impacting
the ability of the liver tothen do its job to detoxify,
(21:43):
that's going to add added burden, added stress.
That is going to thenessentially speed up that
conveyor belt through betaglucuronidase and that is going
to also impact the up thatconveyor belt through
beta-glucuronidase and that isgoing to also impact the
environment in the gut.
In fact, we can measurebeta-glucuronidase in stool and
we can see the impact of theincrease of that
beta-glucuronidase.
That's usually a good signalthat there is added
(22:04):
detoxification pressure, thatthere's an altered microbiome
environment and likely thatthere is potentially a
recirculation of that estrogenand some estrogen dominance
occurring in that case.
Speaker 1 (22:15):
Interesting.
Wow, and again, what else isover the counter now?
Birth control pills, right?
Speaker 2 (22:22):
Those happen to be progestin only.
So there's less of an impact,right, so great call out right
Less of an impact, that doesn'tmean that they're not going to
cause their own set of sideeffects.
So still worth the counselingpoint for sure, but we don't
have the estrogen.
The estrogen detoxificationpoint is not related there.
(22:44):
That said definitely.
I mean, it goes back to yourpoint earlier about so many of
these things are now over thecounter.
It only restresses to me theimportance of that pharmacist
consultation opportunity to popin and say, hey, what else are
you taking?
So they're coming in.
They're telling you they'refilling their SSRI medication.
(23:05):
They're telling you they're notfeeling well, they're not sure
if they should start it.
They're hesitant because of X,Y, Z reason.
We we have to start asking themwhat else are you taking over
the counter?
How often do you take an nsaid?
Do you ever take a ppi?
Do you have issues withconstipation?
Are you, are you taking xyz inorder to deal with ibs symptoms?
Uh, are you on an oralcontraceptive right?
(23:27):
All of these questions arerelevant because not only do
they directly impact themicrobiome, directly impact
motility, directly impact guthealth and could potentially
alter the way they'reexperiencing inflammation in
their gut, which thenpotentially has the direct
effect on theirneurotransmitters, on their
(23:47):
hormone function and on theirbrain chemistry and their brain
health.
Speaker 1 (23:52):
Wow, wow, yeah, that's so much.
I mean, again, we've onlytipped the iceberg of the common
ones.
We're not even talking aboutthe ones that are maybe not
super common but are stillaffecting the microbiome and the
gut in a specific way.
So, yeah, Well, let's jump intosome of the opportunities for
(24:13):
our pharmacists.
So tell us what we could bedoing to be better clinicians in
this space.
What should we be doing?
Should we be asking certainquestions?
You're the expert.
I'll let you tell us what weshould be doing, because there's
so much information here and Ifeel like we could go in a lot
of different directions, but Iwant to give the listeners you
(24:36):
know.
Here are a few things you cando and I'll let you go.
Speaker 2 (24:40):
Yeah, I think I'm going to put it into three
categories for us.
Speaker 1 (24:45):
And Laura, that's a great place for us to stop for
today's episode.
You've given us some greatinformation to look forward to
in part two of the Gut-BrainConnection episode, so,
listeners, please be sure totune in next week for part two.
We will learn the specificsabout those buckets that Laura
mentioned and you'll be able totake some actionable items back
(25:07):
to your practice sites.
If you're a CE Plan subscriber,be sure to claim your CE credit
for this week's episode of GameChangers by logging in at
ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all again next week.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.