February 5, 2025 • 42 mins
Are you looking for anxiety relief or sleep problem solutions? Your gut health might hold the key. Dr. Falquier is joined by Integrative Psychiatrist, Dr. Nishi Bhopal, and Clinical Nutritionist, Ailar Poonian, who work together to address mental well-being from the inside out. They chat about the powerful connection between the gut microbiome and mental health, sharing expert insights to improve your gut health and mental well-being.
In this episode you’ll hear:
2:15 – What is a whole body approach to mental health and sleep issues?
4:35 – How an integrative psychiatrist and clinical nutritionist work together.
8:15 – The gut-brain connection and the gut microbiome.
12:40 – SIBO (Small Intestinal Bacterial Overgrowth)
13:30 – Foods for gut health.
17:15 – Why are we now talking so much about the gut microbiome?
20:30 – Testing your microbiome for better mental health.
26:40 – How quickly can a person feel improvements in anxiety and sleep?
32:30 – Should microbiome testing be repeated?
34:45 – Should you eat food or take supplements for prebiotics and probiotics?
37:10 – Dr. Bhopal’s approach to supplements.
38:40 – Navigating the often confusing nutrition landscape.
Thank you to our sponsor, Auguste Escoffier School of Culinary Arts.
Guest link: https://pacificintegrativepsych.com/
CREDITS:
Host – Dr. Sabrina Falquier, MD, CCMS, DipABLM
Sound & Editing – Will Crann
Executive Producer – Esther Garfin
©2025 Alternative Food Network Inc.
In this episode you’ll hear:
2:15 – What is a whole body approach to mental health and sleep issues?
4:35 – How an integrative psychiatrist and clinical nutritionist work together.
8:15 – The gut-brain connection and the gut microbiome.
12:40 – SIBO (Small Intestinal Bacterial Overgrowth)
13:30 – Foods for gut health.
17:15 – Why are we now talking so much about the gut microbiome?
20:30 – Testing your microbiome for better mental health.
26:40 – How quickly can a person feel improvements in anxiety and sleep?
32:30 – Should microbiome testing be repeated?
34:45 – Should you eat food or take supplements for prebiotics and probiotics?
37:10 – Dr. Bhopal’s approach to supplements.
38:40 – Navigating the often confusing nutrition landscape.
Thank you to our sponsor, Auguste Escoffier School of Culinary Arts.
Guest link: https://pacificintegrativepsych.com/
CREDITS:
Host – Dr. Sabrina Falquier, MD, CCMS, DipABLM
Sound & Editing – Will Crann
Executive Producer – Esther Garfin
©2025 Alternative Food Network Inc.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Thanks to our episode sponsor Iskafia, a school of culinary Arts.
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but wonder how to make it work with your busy schedule.
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Speaker 1 (00:13):
Imagine building the skills of a professional chef right from
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Speaker 2 (00:26):
With photos and feedback.
Speaker 1 (00:27):
You'll also complete an externship in a professional kitchen, giving
you real world experience before you graduate. To take the
next step towards your dream career, download Askafia's culinary school
preparation guide to see if it's right for you. Just
head to iskafier dot edu slash culinary Medicine. That's es
c F f I E R dot d U slash
(00:48):
c U l I n A R y m E
d I c I n E.
Speaker 2 (00:53):
And now for today's episode.
Speaker 3 (00:56):
I had a patient who was struggling with a lot
of anxiety, and he was having spikes of anxiety and
panic throughout the day in conjunction with acid reflex and
loading in gas, so we just did mindful eating. We
didn't make any other changes to his nutrition, and within
the first two days of doing mindful eating, the reflex
(01:17):
went down. He started feeling less anxious, he felt more
tuned into his body, he recognized when he was hungry,
and so on, and that was within just a couple
of days.
Speaker 1 (01:30):
Welcome to culinary medicine recipe. I'm so happy you're here.
I'm your host, Doctor Sabrina Falke. I was a primary
care doctor for sixteen years and went to school for
four years to specialize in culinary medicine. In this work,
I get to combine my passionate expertise in both medicine
and food to teach people about food is medicine and
to empower them to understand what ingredients optimize health and
(01:52):
also how to cook those ingredients to.
Speaker 2 (01:54):
Make delicious meals.
Speaker 1 (01:55):
On the show, I interviewed top chefs, doctors, healthcare visionaries,
and service professionals who are making great strides in.
Speaker 2 (02:02):
The field of culinary medicine.
Speaker 1 (02:04):
Join me as we continue to explore the amazing world
of culinary medicine, where I will empower you to make
changes to your health and wellness with great food right away.
So today we're going to be talking about the impact
of diet on mental health, specifically anxiety.
Speaker 2 (02:23):
But for those of you that have.
Speaker 1 (02:24):
Sleep problems, don't worry because we're going to get into
that as well. Anxiety can feel so isolating, but it's
actually one of the most common mental health experiences. You're
definitely not alone. We're bringing in doctor Nietzsche Bopaul, who
is a triple Board certified physician in psychiatry, sleep medicine,
and integrative holistic medicine, as well as Alar Punian, who
(02:45):
is a certified clinical nutritionists. Welcome doctor Bopaul and Eilar
to today's conversation. As we get started, I'd love to
hear you guys explain what is it that you do
and how does that work happen together.
Speaker 2 (02:59):
I can start.
Speaker 3 (02:59):
So, so, I'm an integrative psychiatrist and sleep medicine physician
and I'm the founder of Pacific integrat Psychiatry. We're an
online telehealth practice seeing patients all across the state of California,
and our mission is really to provide a whole body
approach to mental health and sleep issues. So what that
means is that for people who are struggling with anxiety, depression, insomnia,
(03:23):
daytime fatigue, brain fog, those kinds of symptoms. We really
like to look at all aspects of their health and
lifestyle that could be impacting it. So in traditional psychiatry
there's a lot of focus on medications and on talk therapy,
which are incredibly helpful tools, but we go step further
where we like to look at their nutrition, which is
Elar's specialty. We look at their sleep, we look at exercise,
(03:46):
the mind body connection, gut health, which we're going to
talk about a little bit today. So that's kind of
in a nutshell what we do. And then Isler is
such an integral part of our approach.
Speaker 4 (03:56):
Yeah, So I am a certified clinical nutritionist and I'm
also a certified diabetes care and Education specialist, and I
really specialize in functional medicine or functional nutrition, which takes
a holistic approach or integrative approach, just like doctor Bopaul mentioned.
So we really work in conjunction together to guide patients
(04:19):
on how the gut and the brain are connected, how
they signal back and forth, how they communicate and talk,
and patients really start to see the connection between how
their mental health drives their eating habits, their diet and
vice versa, how their diet and the food that they
eat impacts their mood and their mental health.
Speaker 3 (04:37):
I think what's so fun about working with Elar is
that as a physician I can make some recommendations to
patients about their nutrition their diet, but there's only so
much that I can do in the span of time
that I have with patients, and also with my training,
I'm not a nutritionist by training. So to have someone
like I learn my team, I can refer patients to
her and then what she can do with them is
(05:00):
help them come up with a meal plan, help them
come up with grocery shopping lists, all the little details
where people get tripped up because everyone has kind of
heard like, Okay, you need to eat healthy, eat more
whole foods, cut down your process foods, cut down sugar.
But how do you actually implement that in your day
to day life. That's where people struggle, right, And so
(05:21):
that's really Eilar's zone a genius to help people figure
out a plan that works for them, that's personalized to
their unique needs and lifestyle.
Speaker 5 (05:28):
So how does that play out as far as say
I'm coming to you as a patient and we realize
I have anxiety and insomnia, which I'm sure is not uncommon,
and so I have a poem with you, doctor Bolpa,
how does some interplay with both of your areas of
expertise work.
Speaker 3 (05:45):
We actually have a whole set of intake forms that
people fill up before they even see anyone in the practice.
So that way, not only does it give me as
the physician, a good knowledge base to work from with
that patient to get an understanding of where they're coming from,
but it also assists the patient in understanding themselves. So
patients will sometimes say to me like, oh my gosh,
you asked so many questions on these forms and it
(06:06):
got me thinking about things that I hadn't really thought
about or I didn't know were relevant. Once the patient
sees me for that initial intake, we'll talk about their diet,
their nutrition, and what impact might be having on their health,
their physical health, mental health, and sleep. If they're motivated, right,
So like not everyone's going to be motivated to go deeper,
but if they feel ready, if they're motivated to take
(06:28):
the next step to make some changes with their nutrition
or at least just get some guidance and input that
I'll refer them to Eylar and then she'll take over
and she has a whole series of things that she
does with patients, which I'll let her share about. But
then we'll work in conjunctions, so we work inside the
same medical record system, so she can see my notes,
I can see her notes, and we collaborate. And I
(06:49):
think that's really one of the magical parts of our practice,
is that we have this ongoing communication and collaboration versus
setting someone outside the practice you kind of don't know
what's happening. So patients really appreciate that we're all working
together as a team, so they feel really contained to
have so many people supporting them.
Speaker 4 (07:11):
So, just like doctor Bob mentioned, when a patient is
referred to me by her, they're already familiar with our practice.
They're familiar with our approach. I myself really like to
use tools through the Institute of Functional Medicine, so questionnaires
or there's a nutrition and lifestyle journal which I really
like to use, and it gets patients thinking about, Okay,
(07:32):
how is the food that I'm eating related to other
aspects of my life, like my sleep, my mood, my
mental health, my relationships, my spirituality if that's a part
of your life. So we really have really customized tools
that we use, questionnaires, surveys, and it gets patients feeling
a little bit more comfortable. I know it can be
(07:52):
a little bit intimate talking about your life and especially
your diet. Some people feel judged, which can be very normal,
but we really try to get everyone to feel comfortable
and know that the more that they share with us,
the better that we can guide them.
Speaker 1 (08:07):
So let's go back to some definitions, which I realize
this work may not be familiar to people. Doctor will Paul,
could you explain what the gut brain connection is.
Speaker 3 (08:16):
The gut brain connection is like a two way highway,
so there's constant communication between the brain and the gut
and they're sending messages back and forth. And what might
be surprising to people is that there's actually another nervous
system in the gut, in the gut wall. It's called
the enteric nervous system, and it's also known as the
second brain. And so when I explain that to people,
(08:38):
sometimes it clicks. They're like, Oh, that's why when I
get nervous, I get butterflies in my stomach, or I
might feel nauseous when I'm anxious because there is that
other brain that's happening in the gut, or you have
that gut feeling, right, that's where that term comes from.
Speaker 2 (08:53):
The other thing that might be surprising.
Speaker 3 (08:54):
To people is to learn that the gut nervous system
actually contains more nerve endings than the cord, and one
of the functions of the gut is to produce neurotransmitters.
So the gut contains about ninety five percent of the
body serotonin, about fifty percent of dopamine. There's four hundred
times more melatonin produced in the gut than there is
(09:15):
in the brain, in the pineal gland in the brain,
and psychiatrists have known for decades that about sixty seventy
percent of people with depression and anxiety had GI issues
like IBS or edable Bell syndrome. So it's really relevant
to mental health. Even though nutrition and diet and looking
at gut health hasn't conventionally been a part of psychiatric
(09:37):
evaluation and treatment, we do know that there is that connection.
So it's really exciting to see the research coming out
on the gut brain access and also the microbiome, which
refers to the trillions of little microbes bacteria and other
microbes that live in the gut that helped to produce
those neurotransmitters that I was talking about that send those
(09:59):
messages back to brain, so helping to foster a healthy microbiome,
which simply means you want lots of different kinds of
bugs in your gut, so you want to think about
creating like a rainforest type of environment in your gut
versus like a desert where it's all homogeneous. So eating
lots of different kinds of foods, which Ilore can talk about,
(10:19):
will help to increase the diversity of the gut microbiome.
And we know when people have a more diverse microbiome,
they're less prone to developing chronic diseases like type two diabetes,
like depression, anxiety, cardiovascular disease, Alzheimer's disease.
Speaker 2 (10:35):
Do you want to add to that, Eler, Yeah, absolutely so.
Speaker 4 (10:38):
Just like Nisch she mentioned, the microbiome really does need
to be diverse. And it's not just bacteria. I know
a lot of times we talk about bacteria, but there's fungi, protozoa, viruses,
so there's just so many different microbes that exist in there,
and we we're specifically talking about the gut microbiome. And
when we mention the word gut, people think like, oh,
(10:58):
my stomach, you know, it's all down here. But the
GI tract is huge. It starts in our mouth, right,
it runs all the way down our body. And keeping
a healthy gut microbiome involves nutrition, but it also involves
other aspects of our lives, which is why our practice
does such a great job at integrating things like sleep,
mental health, things like that that can also positively support
(11:22):
the microbiome and also help its structure and help support
keeping the good bacteria in and not allowing a lot
of the bad bacteria to get in and cause things
that really can cause digestive issues for patients, which is
most often when people start to notice, hey, something's wrong here,
Like hey, you know, I feel a little constipated, I
(11:43):
feel a little bloated, And that's your body sending signals
that there's something off with the microbiome. And I always
like to use this example. I heard a doctor talk
about it once and I apologize I forgot his name,
But it's kind of like thinking of it as a
screen door. So when your screen door has in it
bugs get in, some good stuff, maybe like fresh air
(12:04):
or purified air in your home might get out, So
it's like letting the good bugs out, letting a good
bacteria out, and letting some of that bad bacteria get in.
And they like to live in our gut, and they
like to feed on some of the unhealthier types of foods.
So some people notice like, hey, I'm craving more sugars,
you know, I'm eating more carbs, or when I eat
(12:25):
these foods, I actually get more gasy, more bloated. And
it's because these bad bacteria are actually thriving from these foods,
and they're actually asking you to eat more of these foods.
There's a condition called small intestinal bacterial overgrowth, and it
literally is what it says. So the bacteria start to
climb up your digestive tract and they start to grow
(12:46):
and thrive in the small intestine, and some of the
most common symptoms people report are things like bloating and constipation.
And it's these bacteria just really loving the food, the
unhealthier types of foods, and they're growing in your digestive
tract and you may not be aware of it until
it becomes a bit more chronic, and it does really
(13:06):
start to affect your mood and your mental health as well.
So having a healthy microbiome can definitely help protect you
from having things like that.
Speaker 1 (13:16):
When we talk about foods affecting the microbiome in either
a positive or negative way, let's go back a little bit.
If you were explaining, I'm sure this conversation comes up,
and it does for culinary medicine a lot of not
vilifying certain foods, but to have people understand, you know,
this judgment of good foods versus bad foods.
Speaker 2 (13:36):
What are broad strokes would you say of foods.
Speaker 1 (13:38):
That are commonly eaten that lead the microbiome to be
less healthy, more desert like.
Speaker 2 (13:45):
As doctor B.
Speaker 4 (13:45):
Paul mentioned, one of the main things that I always
try to make an effort to do, especially during a
first consultation, is to help patients really understand that, you know,
we need to have a healthy relationship with foods. So
if someone comes in and they're already having me here
say you know, these are the bad foods and that's
(14:06):
what their diet mostly consists of, then we're already not
able to have a conversation where they can comfortably share
with me what their diet really looks like. So they
might just leave some things out here and there, which
doesn't allow me to get a good assessment of what
their diet looks like. So what I say is just
having a healthy, well balanced diet most of the time.
(14:27):
It's just like anything you do in life, it's really
hard to do everything perfectly all the time. Like getting
eight hours of sleep every single night probably not going
to happen. So if you can have a healthy, well
balanced die most of the time, it's going to make
the most impact. So what does that look like. Well,
first we have to talk about what foods should you
try and limit or avoid as much as possible, And
(14:50):
one of the main ones I say is highly processed foods,
so not avoiding processed foods altogether, which can also be
really difficult to do. But there's highly processed foods and
then there's processed foods. So an example of a highly
processed food would be like oreos, right, things you see
with like a really long list of ingredients, things you
(15:11):
can't pronounce. There might be high fruit soose, corn syrup,
refined starches, sugars, things like that, and then there's processed foods,
which often tend to have minimal ingredients, and they have
things that you are familiar with, like let's say a
box of oatmeal, like it has oats, maybe it has cinnamon,
it has sea salt, right, other spices, things like that,
(15:33):
and it's a little bit processed, but it's not highly processed.
And then there's the healthier foods, which you're gonna find
in not boxes or packages in the grocery store. So
you're going to look in the fresh produce section, like fruits, vegetables,
protein like chicken, eggs, fish, things like that. So we
really want to have variety in our diet, thinking about
(15:55):
trying to eat the rainbow as much as possible, different
colors of fruits and veggie, these whole lean types of protein,
or even plant based types of protein if you're someone
that doesn't eat animal products, and again trying to get
all of your macros things like protein which animal sources
again fish, chicken, eggs, turkey. Plant based sources would be
(16:19):
things like beans, lentiles, nuts, and seeds, soy based types
of protein like tofu and tempepe. And then we have
our carbohydrates, which are the starchy foods things like bread, rice, potatoes.
We have complex carbs which are a bit higher in
fiber and tend to actually help the gut microbiome in
(16:40):
the structure of the gut. Those would be things like oats,
whole grain types of bread, brown rice, wild rice, sweet potatoes.
And then we have our fats or say, try to
stick with healthy fats as much as possible, and those
would be things like avocados, olive oil, and seeds and
(17:01):
wild fatty fish.
Speaker 1 (17:03):
That helps a lot to get a visual of what
what is You have this blank plate and now you're
being told that or starting to understand that all these
things are quote unquote bad.
Speaker 2 (17:11):
But what do we add? So thank you that helps
to give such a visual.
Speaker 1 (17:16):
Why why do you guys think I'll have you start
with this, doctor Bopaul, that there's so much more of
a conversation between the gut brain connection now than there
was even five ten years ago.
Speaker 3 (17:26):
Yeah, I think the science has been evolving on it
and now with I mean, I think part of it
is social media, you know, like with so much conversation
happening online, people are having discussions about nutrition. I'm seeing
this with sleep as well. I'm as sleep specialists too,
So even ten fifteen years ago, people weren't really talking
about sleep. But I think, you know, a big part
of it is just the emerging research. But what's really
(17:49):
fascinating about this is it's not these aren't necessarily new ideas, right, Like.
Speaker 2 (17:55):
We've known for millennia.
Speaker 3 (17:56):
If you look at traditional healing systems like Ayrveda from
India or traditional Chinese medicine, they knew that the gut
was so essential to health, to overall health. They knew
that the food that you eat impacts how you feel
physically and mentally. So these aren't new fangled sort of ideas.
It's just that the research and science is catching up
to it. And interestingly, when I was in medical school,
(18:19):
I went to medical school at University College Cork in Ireland,
and back then some of the researchers in psychiatry were
doing a lot of microbiome research. So they have a
center called well, I think they may have changed the
name now, but it was called the APC Microbiome Center
in Cork, and so on my way to classes, we
(18:41):
would kind of cut through the Food sciences building and
so they were doing a lot of the microbiome research there.
So we even had lectures back in med school. This
is now like almost twenty years ago, talking about the
impact of the gut microbiome on mental health. Professor Ted Dinan,
he's one of the researchers. John Cryan is another one.
So if anyone wants to google their names, you'll see
lots of talks on their research on psychiatry and the microbiome.
Speaker 2 (19:05):
All of that.
Speaker 3 (19:05):
To say, back then it was cutting edge, and I
didn't realize that. I just thought, oh, like, everyone's learning
about this, But when I started working in psychiatry, no
one was talking about it, so I didn't realize how
far ahead they were in their research. But now it's
it's catching up to become more mainstream. And I think nutrition,
it's it's one of these things that it's relevant to everyone.
Speaker 2 (19:26):
Right.
Speaker 3 (19:26):
We all have to eat, and so people are really
interested in knowing what to eat and you know, how
is the how are these different types of foods affecting us?
And you know what is what's the research behind it?
And I'll just put a little caveat around that too,
because there is so much information that it can get
really confusing and overwhelming, and then people can go down
(19:47):
these rabbit holes of let me do the ketogenic diet,
or let me do a vegan diet, or let me
try carnivore or whatever it is, and you can lose
the forest through the trees. So that's where you know,
coming to basics and having this personalized approach that Eiler
provides is really important.
Speaker 1 (20:05):
That happens so frequently in this work that getting so
caught up in the details of reminding people to step
back and say, are you filling your plate with like Eiler,
how you mentioned the rainbow holds fruits and vegetables, whole
grains and well thought out proteins, and really trying to
simplify it within all the confusion that it is. Yet
we do now have this tool of testing the microbiomes,
(20:27):
So how does one do a test?
Speaker 2 (20:30):
And are they available readily?
Speaker 4 (20:33):
So microbiome testing, there's so many different tests out there
and there are new tests still being developed, so patients
can readily access a variety of tests online. But interpreting
it is a whole other step. So it's like, you know,
you get the results, but what do you do with it?
And that's where a lot of people get stuck because
(20:53):
they get kind of answers, but then they don't really
know what to do with it or how can they
modify their diet to get the results they're look looking for.
So that's why it's really important to work with a practitioner,
someone who specialized, someone knows how to interpret the results
and how to guide you or create a personalized plan
and approach to help you resolve the symptoms that you
have and really explain the answers to you or the
(21:17):
results of the test. So we use a variety of
different tests in our practice. There are a couple ones
that are my favorites to use based on some of
the common symptoms or complaints that I see in a
lot of our patients. So we have stool testing, we
have urine analysis, we have blood tests. I mentioned CIBO
(21:39):
that's done through a breath test. Some people maybe do
a saliva test, which I don't use very often. So
there's a variety of different ways to do it, and
the results that you get really depend on how the
test is done, When is the test done, did the
patient perform the test correctly, were they taking any supplement
(22:00):
right around the time of the test, or did they
stop their supplements a couple days before the test, which
we always try to let patients know that they need
to do. And then these tests look at things like
the gut microbiota, so especially things like a stool analysis
will tell us what type of bacteria are in your stool.
And again it's at that time, right, so it's like,
(22:20):
what specific part of the body or what specific time
was this stool analysis done, So these are the bacteria
that are present. They will tell us the ratios of
these bacteria. Do you have too much of certain bacteria
too little of other bacteria? And then someone like myself
will help guide you on how to balance this. So
(22:43):
stool analysis specifically indicate things like leaky gut or dysbiosis,
which again is just kind of that imbalance. Like I
explained with the screen door, some of the good bacteria
have been let out, some of the bad bacteria have
stayed in or have overgrown in your gut. So how
we can balance this through by maybe eliminating or trying
to avoid certain foods, temporarily increasing your intake of certain foods,
(23:07):
like especially high fiber foods to help support the gut.
Some people may require supplementation like pre and probiotic supplements
that can really help balance the bacteria in your gut.
So there are a variety of different ways to do
the tests, and I always explain to patients like, here's
the test that I recommend, here's what it looks like,
(23:28):
here's what it's going to tell us, And I leave
it up to them because we're not really here to
be like you have to do all these tests. Some
people maybe don't want to pay a lot of money
to have testing done, but there are a lot of
tests that give us more answers. So those are some
of the tests that we use. And again we always
give patients the option to decide.
Speaker 1 (23:47):
If somebody, how you mentioned that you asked them to
stop supplements a few days before, what if somebody had
had their lovely moment with oreos the day before, like
the whole not to the little pack, but like just
went to town with it. Can it affect the outcome
of the testing that quickly, Like you mentioned supplements, you
(24:08):
stop it two days ahead. Can it go the other
way where you have ultraprocessed food the mayhem of them
a couple days before.
Speaker 4 (24:16):
Yeah, that's a really good question. And I know a
lot of patients get hung upon this, especially when they
see a result that they don't like and they're like, wait, actually,
like right before the test, I did this, do you
think that's what caused it? So, as a certified diabetes
care and education specialist, I always tell patients like, when
they do a blood sugar test, and let's say they're
A one C, which is this average measurement of your
(24:39):
blood sugar over the past three months, but it's really
concentrated in the past month before the test, So they're like, wait,
right before the test, I had like a cake for breakfast.
Do you think that's why my A one C is high?
And I'm like, well, no, because it was like an
average over the past three months. So certain tests can
be impacted by what you did right before, like maybe
(25:00):
treglycerite test, which is a certain type of fat in
the body. But when we're looking at something like your microbiome,
this is something that is a bit more chronic. The
types of bacteria that overgrow things like that, they don't
really happen overnight, which is why a lot of patients
wait to come to us until their symptoms are becoming
(25:20):
more Bothersome it's not like, hey, I've been bloated for
three days and I decided to come see you. It's like, no,
I've been bloated for like two years, or like, oh no,
I've been like constipated for several years on and off.
So these things are a bit more chronic and it's
not like something you did the night before or the
morning of is really going to cause that result to
(25:41):
be abnormal.
Speaker 3 (25:43):
Doctor Bopaul, do you want to add Like Eyler was saying,
it's not a requirement, a lot of what we can
offer can be done without lab testing and making changes
and listening to your body is really important. So a
really crucial aspect of what we do is helping patients
connect with their intuition so that they can feel.
Speaker 2 (26:05):
What they're feeling.
Speaker 3 (26:06):
They know what they're feeling, they can keep track, they
can track their triggers, they can develop that sort of
innate intelligence or fine tune that innate intelligence to guide them.
And then a test is sort of like the cherry
on top, like we can go deeper, we can go granular,
we can look at it for a data driven people.
We have lots of people who are in tech or
(26:26):
their engineers and they want the data so great. We
can do the tests or we can do blood work,
so we really like to meet people where they are.
Speaker 1 (26:35):
If somebody fully listens to both your wisdom and expertise
and starts making these giant changes. What has been your
experience of when people start noticing changes and again focusing
on anxiety and sleep of improvement in those of symptoms.
Speaker 3 (26:55):
Yeah, I could share a little bit. I'd love to
hear Eilar's experiences too on this. So there's a few
stories that come to mind. So with one of my patients,
we really focused on mindful eating. Okay, so when we
were talking about nutrition and mental health, it's not just
about what you eat, but how you eat it has
an impact, and so sometimes we'll just start with that,
(27:16):
like we won't even make any changes to what the
patient's eating, but will recommend that they sit down when
they're eating. So we actually, I learn and I have
a video on our YouTube channel about mindful eating, so
if anyone wants to watch that and get the instructions,
I learn did a great job explaining what that is.
But essentially, in a nutshell, it's making sure you're sitting down,
making sure you're chewing your food thoroughly, that you're taking
(27:37):
a break between bites, that you take a few minutes
when you're done eating before you get up, so that
your body can fully digest. So I had a patient
who was struggling with a lot of anxiety, and he
was having spikes of anxiety and panic throughout the day
in conjunction with acid reflux and loading in gas. So
we just did mindful eating. We didn't make any other
(27:59):
changes to is nutrition, and within the first two days
of doing mindful eating, the reflex went down. He started
feeling less anxious, he felt more tuned into his body,
he recognized when he was hungry, and so on. And
that was within just a couple of days. So these
changes can be quite immediate, right pretty quick. Another patient
(28:21):
of mine that I saw just recently, she was also
struggling with sort of these spikes of anxiety throughout the day,
and we theorized that it could be related to hunger
and fluctuations in her blood sugar as well, because drops
in blood sugar can look like anxiety. The symptoms are
very similar. So we had her do mindful eating and
(28:42):
then not space at her meals as much, so just
eat a little bit more frequently throughout the day, and
again within a day or two, there was immediate relief.
So these changes can be really really quick. In terms
of sleep, it can kind of go either way. I
have had patients tell me that they sleep better if
they do have a little bit of a fast before
(29:03):
they go to bed, so you know, if they don't
eat three to four hours before going to bed, they
actually sleep better. And I have other patients who tell
me they don't sleep as well they wake up at
night if they don't eat an hour before going to bed.
So tuning into yourself and understanding what works for you
is really important here. But again you can see immediate results,
you know, within a night or a couple of nights.
(29:24):
With some of my patients who struggle with brain fog
or a lot of fatigue or low energy during the day,
or excessive daytime sleepiness what we might even call hypersomnia,
sometimes cutting out gluten can be really helpful. This is anecdotal, okay,
So like this this is sort of like cutting edge.
It's not really I mean, it's semi supported in the literature,
but it's something that we'll recommend, kind of like using
an anti inflammatory diet sort of approach. And in those cases,
(29:48):
within a few weeks I have seen people start to
have more energy, less fatigue, they feel less write and
fog during the day, more mental clarity. We're not talking like,
you know, to do this for six months straight, and yes,
the longer you do it, the more changes you're going
to see. But just doing an experiment for a week
or two you can start to see some changes. And
(30:09):
I'd love to hear Eilar's.
Speaker 2 (30:10):
Thoughts on that.
Speaker 4 (30:12):
Yes, absolutely so, just like doctor Bopaul mentioned some of
these complaints that we get, Let's say someone with heartburn,
acid reflux, you can really see changes right away, depending
on how much you really stick to the plan, right,
So it's like something that you're doing all the time,
you're more likely to see results faster versus something you're
doing some of the time, like this mindful eating approach.
(30:35):
Let's say you're practicing mindful eating every single day, every
single meal, you're more likely to see results versus if
you're doing mindful eating maybe a couple times a week.
So if someone is coming to me with chronic bloating,
chronic constipation, they do want to see results right away,
but I always explain to them, you know, this sounds
(30:55):
like it's something that's been going on for years, So
it is going to take some time to really heal
the gut, heal the microbiome. It's kind of like you're
growing a plant, right. You have to water it, you
have to watch it grow, watch it thrive, really nurture it,
take care of it. And it's same thing with your body.
So you really have to put that same type of
care and effort into your own gut, into your own microbiome.
(31:18):
So if someone is having issues like that, then I
really try to encourage them to start slow and start
where they want, just like doctor bo palm mission, meeting
the patient where they're at and saying, hey, you know,
I don't want to start with mindful eating. I want
to start with drinking more water. Right, So it's like
if that's what they want to do, that's great. That's
also something that really matters. So letting the patient know
(31:41):
that these are your options, you're in control, but here
is what's going to help the most, and then leading
it up to them because if I tell them what
to do, they're less likely to stick with it. But
if a patient decides this is what I want to do,
and they have a follow up appointment coming up like
a month later, I always hear this, it's like, hey,
I knew we had this visit coming up, so like
the last week, I've been really good about drinking more water.
(32:03):
So it's kind of like that accountability factor. And I
think having these visits, having these follow ups really allows
patients to see better results, see faster, quicker results because
they're being kind of guided a little bit more by
an expert and they're being followed more carefully.
Speaker 1 (32:21):
So my last question I have is, so you've decided
to do testing on somebody for the microbiome, you find
these changes, maybe supplements were added and the food changes.
Do you do repeat microbiome testing if their symptoms are
getting better, do you do automatically do retesting or not necessarily?
Speaker 4 (32:43):
So for a lot of patients, I often mentioned, we
really want to see did these supplements help you or
have you really been taking them consistently and do you
need to continue taking them because a lot of times
people think, you know, I just take a multi vitamin
and then I'm good and this is what I do
for the rest of my life, or same with pre
(33:03):
and probiotics. Some people think everybody needs to take this.
So I think repeating the tests are really important. Because
they give us the answers that we're looking for. And
just like doctor Bopaul mentioned, some people are really data
number driven and they want to see that.
Speaker 2 (33:18):
So a lot of our.
Speaker 4 (33:19):
Patients want to see, hey, oh my magnesium levels improved,
so that's probably why my constipation went away, you know,
and they really like to see that. And I always
recommend repeating the test, especially when we get a baseline
for it. We want to repeat it and see, you know,
did these supplements help you, did the changes in your diet.
Let's say someone had high oxidative stress levels, they've been
(33:41):
eating antioxidant rich foods for several months, did those levels
go down? And then we probably won't need to repeat
it once we get them back to their normal levels.
But again, nothing is really required. You don't have to
do tests, you don't have to repeat them, but seeing
those answers can be really helpful.
Speaker 1 (34:01):
What's the timeframe then, Like with diabetes, we often test,
you know, over three months or so, what would it
be for this situation.
Speaker 4 (34:08):
I recommend three months, and it's from the time that
they start making the changes. So often I'll see a patient,
they'll order their supplements or they're they're going to order
their testing kit. By the time they really get it
and they send those results back and we actually get
them might take a couple of weeks, so it might
actually be four months from the first time that we
(34:29):
saw each other, but I usually like to repeat that
test in about three months.
Speaker 1 (34:35):
I do have an encore question then, So you mentioned
supplements are used at times. So you mentioned probiotics, which
most people have heard in prebiotics. How do you decide
when to use food as your prebiotic with the high
fiber foods versus a supplement that's prebiotic supplement.
Speaker 4 (34:54):
Yeah, that's a really excellent question. So supplements and food
work slightly differ differently. And I always say food first approach.
So people kind of want like the quick fix. They're like, oh,
let me just take a pill instead of having to
eat the rainbow, like that sounds a lot easier. But
if you are able to incorporate a food first approach,
not for someone let's say they have like severely low
(35:16):
levels of vitamin D, I wouldn't say, you know, try
to eat vitamin D rich foods, but food first approach.
Really try to heal through diet, try to eat well
first and then we add supplements just like the word says,
it's a supplement to what you're doing, things like a
pre and probiotic. You may want to look at what
(35:37):
kind of brands there are out there, what kind of
bacteria does your body need? Do you really want to
be taking this supplement? Has it been tested clinically proven
to be effective? So I would say that for pre
and probiotics, they work in conjunction together really well, so
taking a pre and probiotic supplement in combination, but you
(35:58):
can also get it through food, and the way it
works is your body breaks down the food. So a
supplement you can take it fasting and it can really
make its way down to the gut, which is really nice.
So in the case of pre im probiotics, I really
like that about certain supplements that are clinically proven to
be effective, and I say take it fasting first thing
in the morning, because your digestive system is going to
(36:21):
break down the food a little bit more before it
makes its way down to the small test and large
intest and where it can really do the work. So
in that case a supplement might be more helpful. But
you can also get it from food because I know
these supplements can be a bit pricey, so like prebiotics,
which is the fiber food that the probiotic bacteria feed on.
(36:42):
Prebiotics you can find in things like artichoke, plantain, garlic, onion,
probiotics fermented foods like kimchi, sauerkraut, tempey miso, so again
you can't get it from food. Supplements can be a
little bit more helpful in the case of pre im probiotic,
but again not necessary.
Speaker 2 (37:02):
So as we're finishing up, I'll start with doctor will
Paul in this one.
Speaker 1 (37:05):
Is there anything that wasn't said today that you want
to make sure that our listeners here.
Speaker 3 (37:12):
There's sort of three categories that I think about when
it comes to supplements for like three million buckets. So
are we using them for prevention? So for example, using
full light during pregnancy, are we using it for repletions?
Or are we trying to repleate a vitamin D deficiency
or an iron deficiency, which we'll see a lot in
patients with anxiety and sleep issues. Or are we using
(37:32):
it as a therapeutic So are we using it maybe
for its calming effects or something like that in anxiety
and so I think just having that framework in your
mind can can give people just a little bit of
structure instead of feeling like, oh my gosh, there's like
twenty different supplements I need to take and you don't
really know what they're for or why you're taking them,
so just thinking about them. Okay, So just for prevention,
am I repeating a deficiency? Am I using it for
(37:54):
its therapeutic effects? And then just having an end date.
So whether we're prescribing a medication for support or for
prescribing or recommending a supplement, it's a good idea to
have an end date on it. So talk to your
healthcare practitioner about what would be appropriate. You know, even
if we're supplementing for a deficiency, we might recheck their
vitamin D or iron in three months time to see
(38:16):
if they still needed if they still need that dose,
and that'll help kind of cut down on what people
are taking because sometimes we'll see people who have been
on a supplement regimen for a decade and they just
didn't know that, you know, they didn't need to take
it anymore, or that there should be an end date.
So I think those are just some general guidelines for
people to think about.
Speaker 2 (38:34):
How about you, Eilira, any last.
Speaker 4 (38:36):
Thoughts, especially when it comes to the topic of nutrition.
Just like doctor Bopa mentioned, there's just so much information
out there nowadays, and a lot of people are looking
at things on the internet, things being promoted like carnivore diet,
ketogenic diet, so it can be really confusing. Just keeping
in mind that everyone is different, your body is different,
(38:58):
your lifestyle is different. Just because ketogenic diet work for
someone else doesn't necessarily mean it will work for you.
So really understanding what your goals are and how nutrition
or talking to an expert like doctor bopam mental health
can help you. So what is your purpose behind it?
What is your end goal? Just like she said, you know,
(39:19):
having like an end date like in the next three months,
I really want to be able to do X, Y
and z. So really just keeping that in mind and
then trying to create a personalized approach for it, knowing
that things can take time. Someone might see results in
a week, someone might see results in a month. And
that's why I think having a functional medicine or a
holistic an integrative approach is really important, so you can
(39:42):
really look at all aspects of your life versus putting
all your focus on one thing and just really trying
to see results by focusing on that one thing versus
knowing that there are other areas and other things that
can be impacting what you're going through or the symptoms
that you're experiencing, and that you're not alone, like everyone
goes through similar things and talking about it, especially talking
(40:05):
about it to an expert, can be really helpful.
Speaker 1 (40:08):
This conversation has been really fantastic to really look at
whole person health and not fragmenting somebody into these silos
that often happens in healthcare. So I really really appreciate
both your not only your own insight and your own
area of expertise, but even in this conversation that can
see how well you work together. So if people are
interested in working with you both, how would people reach you?
Speaker 3 (40:31):
Yeah, so the best way is to go to our
website Pacific integrativepsych dot com. Our practice is called Pacific
Integrative Psychiatry. You can book a free call with our
team via our website. It's a free twenty minute call
and they'll talk to you and just make sure our
services are the right fit for you. We do see
patients across the State of California virtually, and we occasionally
(40:53):
offer workshops and other programs that are open to anyone anywhere,
So even if you're not in California, you may be
able to ten some of those and you can join
our email list. We have a supplements for anxiety free
download on our website, so if you choose to opt
into that, you'll get on our email list and then
you'll get more information about our other upcoming events.
Speaker 2 (41:13):
Y mensas social media also what is the handle for that?
Speaker 3 (41:18):
So we're at Pacific Integrative psych on Instagram, LinkedIn and Facebook.
Speaker 2 (41:26):
Wonderful. Thank you both, truly so much, thank you, thank you.
Speaker 1 (41:33):
I hope you feel motivated by this episode. Please leave
us a rating and a review and mention our show
to others who you think could use this information. That
could be your doctor, it could be somebody who works
in the food service industry who's interested in the health components.
It could be a friend that is working on their
health journey. If you want to hear more, please remember
to follow Culinary Medicine Recipe on your favorite podcast listening platform.
(41:57):
Until next time, Salu and Bona Petti. All content provided
or opinions expressed in this episode. Are for informational purposes
only and are not a substitute for professional medical advice.
Please take advice from your doctor or other qualified healthcare professional.
Thanks to our episode sponsor Iskafia, a school of culinary Arts.
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Speaker 2 (00:53):
And now for today's episode.
Speaker 3 (00:56):
I had a patient who was struggling with a lot
of anxiety, and he was having spikes of anxiety and
panic throughout the day in conjunction with acid reflex and
loading in gas, so we just did mindful eating. We
didn't make any other changes to his nutrition, and within
the first two days of doing mindful eating, the reflex
(01:17):
went down. He started feeling less anxious, he felt more
tuned into his body, he recognized when he was hungry,
and so on, and that was within just a couple
of days.
Speaker 1 (01:30):
Welcome to culinary medicine recipe. I'm so happy you're here.
I'm your host, Doctor Sabrina Falke. I was a primary
care doctor for sixteen years and went to school for
four years to specialize in culinary medicine. In this work,
I get to combine my passionate expertise in both medicine
and food to teach people about food is medicine and
to empower them to understand what ingredients optimize health and
(01:52):
also how to cook those ingredients to.
Speaker 2 (01:54):
Make delicious meals.
Speaker 1 (01:55):
On the show, I interviewed top chefs, doctors, healthcare visionaries,
and service professionals who are making great strides in.
Speaker 2 (02:02):
The field of culinary medicine.
Speaker 1 (02:04):
Join me as we continue to explore the amazing world
of culinary medicine, where I will empower you to make
changes to your health and wellness with great food right away.
So today we're going to be talking about the impact
of diet on mental health, specifically anxiety.
Speaker 2 (02:23):
But for those of you that have.
Speaker 1 (02:24):
Sleep problems, don't worry because we're going to get into
that as well. Anxiety can feel so isolating, but it's
actually one of the most common mental health experiences. You're
definitely not alone. We're bringing in doctor Nietzsche Bopaul, who
is a triple Board certified physician in psychiatry, sleep medicine,
and integrative holistic medicine, as well as Alar Punian, who
(02:45):
is a certified clinical nutritionists. Welcome doctor Bopaul and Eilar
to today's conversation. As we get started, I'd love to
hear you guys explain what is it that you do
and how does that work happen together.
Speaker 2 (02:59):
I can start.
Speaker 3 (02:59):
So, so, I'm an integrative psychiatrist and sleep medicine physician
and I'm the founder of Pacific integrat Psychiatry. We're an
online telehealth practice seeing patients all across the state of California,
and our mission is really to provide a whole body
approach to mental health and sleep issues. So what that
means is that for people who are struggling with anxiety, depression, insomnia,
(03:23):
daytime fatigue, brain fog, those kinds of symptoms. We really
like to look at all aspects of their health and
lifestyle that could be impacting it. So in traditional psychiatry
there's a lot of focus on medications and on talk therapy,
which are incredibly helpful tools, but we go step further
where we like to look at their nutrition, which is
Elar's specialty. We look at their sleep, we look at exercise,
(03:46):
the mind body connection, gut health, which we're going to
talk about a little bit today. So that's kind of
in a nutshell what we do. And then Isler is
such an integral part of our approach.
Speaker 4 (03:56):
Yeah, So I am a certified clinical nutritionist and I'm
also a certified diabetes care and Education specialist, and I
really specialize in functional medicine or functional nutrition, which takes
a holistic approach or integrative approach, just like doctor Bopaul mentioned.
So we really work in conjunction together to guide patients
(04:19):
on how the gut and the brain are connected, how
they signal back and forth, how they communicate and talk,
and patients really start to see the connection between how
their mental health drives their eating habits, their diet and
vice versa, how their diet and the food that they
eat impacts their mood and their mental health.
Speaker 3 (04:37):
I think what's so fun about working with Elar is
that as a physician I can make some recommendations to
patients about their nutrition their diet, but there's only so
much that I can do in the span of time
that I have with patients, and also with my training,
I'm not a nutritionist by training. So to have someone
like I learn my team, I can refer patients to
her and then what she can do with them is
(05:00):
help them come up with a meal plan, help them
come up with grocery shopping lists, all the little details
where people get tripped up because everyone has kind of
heard like, Okay, you need to eat healthy, eat more
whole foods, cut down your process foods, cut down sugar.
But how do you actually implement that in your day
to day life. That's where people struggle, right, And so
(05:21):
that's really Eilar's zone a genius to help people figure
out a plan that works for them, that's personalized to
their unique needs and lifestyle.
Speaker 5 (05:28):
So how does that play out as far as say
I'm coming to you as a patient and we realize
I have anxiety and insomnia, which I'm sure is not uncommon,
and so I have a poem with you, doctor Bolpa,
how does some interplay with both of your areas of
expertise work.
Speaker 3 (05:45):
We actually have a whole set of intake forms that
people fill up before they even see anyone in the practice.
So that way, not only does it give me as
the physician, a good knowledge base to work from with
that patient to get an understanding of where they're coming from,
but it also assists the patient in understanding themselves. So
patients will sometimes say to me like, oh my gosh,
you asked so many questions on these forms and it
(06:06):
got me thinking about things that I hadn't really thought
about or I didn't know were relevant. Once the patient
sees me for that initial intake, we'll talk about their diet,
their nutrition, and what impact might be having on their health,
their physical health, mental health, and sleep. If they're motivated, right,
So like not everyone's going to be motivated to go deeper,
but if they feel ready, if they're motivated to take
(06:28):
the next step to make some changes with their nutrition
or at least just get some guidance and input that
I'll refer them to Eylar and then she'll take over
and she has a whole series of things that she
does with patients, which I'll let her share about. But
then we'll work in conjunctions, so we work inside the
same medical record system, so she can see my notes,
I can see her notes, and we collaborate. And I
(06:49):
think that's really one of the magical parts of our practice,
is that we have this ongoing communication and collaboration versus
setting someone outside the practice you kind of don't know
what's happening. So patients really appreciate that we're all working
together as a team, so they feel really contained to
have so many people supporting them.
Speaker 4 (07:11):
So, just like doctor Bob mentioned, when a patient is
referred to me by her, they're already familiar with our practice.
They're familiar with our approach. I myself really like to
use tools through the Institute of Functional Medicine, so questionnaires
or there's a nutrition and lifestyle journal which I really
like to use, and it gets patients thinking about, Okay,
(07:32):
how is the food that I'm eating related to other
aspects of my life, like my sleep, my mood, my
mental health, my relationships, my spirituality if that's a part
of your life. So we really have really customized tools
that we use, questionnaires, surveys, and it gets patients feeling
a little bit more comfortable. I know it can be
(07:52):
a little bit intimate talking about your life and especially
your diet. Some people feel judged, which can be very normal,
but we really try to get everyone to feel comfortable
and know that the more that they share with us,
the better that we can guide them.
Speaker 1 (08:07):
So let's go back to some definitions, which I realize
this work may not be familiar to people. Doctor will Paul,
could you explain what the gut brain connection is.
Speaker 3 (08:16):
The gut brain connection is like a two way highway,
so there's constant communication between the brain and the gut
and they're sending messages back and forth. And what might
be surprising to people is that there's actually another nervous
system in the gut, in the gut wall. It's called
the enteric nervous system, and it's also known as the
second brain. And so when I explain that to people,
(08:38):
sometimes it clicks. They're like, Oh, that's why when I
get nervous, I get butterflies in my stomach, or I
might feel nauseous when I'm anxious because there is that
other brain that's happening in the gut, or you have
that gut feeling, right, that's where that term comes from.
Speaker 2 (08:53):
The other thing that might be surprising.
Speaker 3 (08:54):
To people is to learn that the gut nervous system
actually contains more nerve endings than the cord, and one
of the functions of the gut is to produce neurotransmitters.
So the gut contains about ninety five percent of the
body serotonin, about fifty percent of dopamine. There's four hundred
times more melatonin produced in the gut than there is
(09:15):
in the brain, in the pineal gland in the brain,
and psychiatrists have known for decades that about sixty seventy
percent of people with depression and anxiety had GI issues
like IBS or edable Bell syndrome. So it's really relevant
to mental health. Even though nutrition and diet and looking
at gut health hasn't conventionally been a part of psychiatric
(09:37):
evaluation and treatment, we do know that there is that connection.
So it's really exciting to see the research coming out
on the gut brain access and also the microbiome, which
refers to the trillions of little microbes bacteria and other
microbes that live in the gut that helped to produce
those neurotransmitters that I was talking about that send those
(09:59):
messages back to brain, so helping to foster a healthy microbiome,
which simply means you want lots of different kinds of
bugs in your gut, so you want to think about
creating like a rainforest type of environment in your gut
versus like a desert where it's all homogeneous. So eating
lots of different kinds of foods, which Ilore can talk about,
(10:19):
will help to increase the diversity of the gut microbiome.
And we know when people have a more diverse microbiome,
they're less prone to developing chronic diseases like type two diabetes,
like depression, anxiety, cardiovascular disease, Alzheimer's disease.
Speaker 2 (10:35):
Do you want to add to that, Eler, Yeah, absolutely so.
Speaker 4 (10:38):
Just like Nisch she mentioned, the microbiome really does need
to be diverse. And it's not just bacteria. I know
a lot of times we talk about bacteria, but there's fungi, protozoa, viruses,
so there's just so many different microbes that exist in there,
and we we're specifically talking about the gut microbiome. And
when we mention the word gut, people think like, oh,
(10:58):
my stomach, you know, it's all down here. But the
GI tract is huge. It starts in our mouth, right,
it runs all the way down our body. And keeping
a healthy gut microbiome involves nutrition, but it also involves
other aspects of our lives, which is why our practice
does such a great job at integrating things like sleep,
mental health, things like that that can also positively support
(11:22):
the microbiome and also help its structure and help support
keeping the good bacteria in and not allowing a lot
of the bad bacteria to get in and cause things
that really can cause digestive issues for patients, which is
most often when people start to notice, hey, something's wrong here,
Like hey, you know, I feel a little constipated, I
(11:43):
feel a little bloated, And that's your body sending signals
that there's something off with the microbiome. And I always
like to use this example. I heard a doctor talk
about it once and I apologize I forgot his name,
But it's kind of like thinking of it as a
screen door. So when your screen door has in it
bugs get in, some good stuff, maybe like fresh air
(12:04):
or purified air in your home might get out, So
it's like letting the good bugs out, letting a good
bacteria out, and letting some of that bad bacteria get in.
And they like to live in our gut, and they
like to feed on some of the unhealthier types of foods.
So some people notice like, hey, I'm craving more sugars,
you know, I'm eating more carbs, or when I eat
(12:25):
these foods, I actually get more gasy, more bloated. And
it's because these bad bacteria are actually thriving from these foods,
and they're actually asking you to eat more of these foods.
There's a condition called small intestinal bacterial overgrowth, and it
literally is what it says. So the bacteria start to
climb up your digestive tract and they start to grow
(12:46):
and thrive in the small intestine, and some of the
most common symptoms people report are things like bloating and constipation.
And it's these bacteria just really loving the food, the
unhealthier types of foods, and they're growing in your digestive
tract and you may not be aware of it until
it becomes a bit more chronic, and it does really
(13:06):
start to affect your mood and your mental health as well.
So having a healthy microbiome can definitely help protect you
from having things like that.
Speaker 1 (13:16):
When we talk about foods affecting the microbiome in either
a positive or negative way, let's go back a little bit.
If you were explaining, I'm sure this conversation comes up,
and it does for culinary medicine a lot of not
vilifying certain foods, but to have people understand, you know,
this judgment of good foods versus bad foods.
Speaker 2 (13:36):
What are broad strokes would you say of foods.
Speaker 1 (13:38):
That are commonly eaten that lead the microbiome to be
less healthy, more desert like.
Speaker 2 (13:45):
As doctor B.
Speaker 4 (13:45):
Paul mentioned, one of the main things that I always
try to make an effort to do, especially during a
first consultation, is to help patients really understand that, you know,
we need to have a healthy relationship with foods. So
if someone comes in and they're already having me here
say you know, these are the bad foods and that's
(14:06):
what their diet mostly consists of, then we're already not
able to have a conversation where they can comfortably share
with me what their diet really looks like. So they
might just leave some things out here and there, which
doesn't allow me to get a good assessment of what
their diet looks like. So what I say is just
having a healthy, well balanced diet most of the time.
(14:27):
It's just like anything you do in life, it's really
hard to do everything perfectly all the time. Like getting
eight hours of sleep every single night probably not going
to happen. So if you can have a healthy, well
balanced die most of the time, it's going to make
the most impact. So what does that look like. Well,
first we have to talk about what foods should you
try and limit or avoid as much as possible, And
(14:50):
one of the main ones I say is highly processed foods,
so not avoiding processed foods altogether, which can also be
really difficult to do. But there's highly processed foods and
then there's processed foods. So an example of a highly
processed food would be like oreos, right, things you see
with like a really long list of ingredients, things you
(15:11):
can't pronounce. There might be high fruit soose, corn syrup,
refined starches, sugars, things like that, and then there's processed foods,
which often tend to have minimal ingredients, and they have
things that you are familiar with, like let's say a
box of oatmeal, like it has oats, maybe it has cinnamon,
it has sea salt, right, other spices, things like that,
(15:33):
and it's a little bit processed, but it's not highly processed.
And then there's the healthier foods, which you're gonna find
in not boxes or packages in the grocery store. So
you're going to look in the fresh produce section, like fruits, vegetables,
protein like chicken, eggs, fish, things like that. So we
really want to have variety in our diet, thinking about
(15:55):
trying to eat the rainbow as much as possible, different
colors of fruits and veggie, these whole lean types of protein,
or even plant based types of protein if you're someone
that doesn't eat animal products, and again trying to get
all of your macros things like protein which animal sources
again fish, chicken, eggs, turkey. Plant based sources would be
(16:19):
things like beans, lentiles, nuts, and seeds, soy based types
of protein like tofu and tempepe. And then we have
our carbohydrates, which are the starchy foods things like bread, rice, potatoes.
We have complex carbs which are a bit higher in
fiber and tend to actually help the gut microbiome in
(16:40):
the structure of the gut. Those would be things like oats,
whole grain types of bread, brown rice, wild rice, sweet potatoes.
And then we have our fats or say, try to
stick with healthy fats as much as possible, and those
would be things like avocados, olive oil, and seeds and
(17:01):
wild fatty fish.
Speaker 1 (17:03):
That helps a lot to get a visual of what
what is You have this blank plate and now you're
being told that or starting to understand that all these
things are quote unquote bad.
Speaker 2 (17:11):
But what do we add? So thank you that helps
to give such a visual.
Speaker 1 (17:16):
Why why do you guys think I'll have you start
with this, doctor Bopaul, that there's so much more of
a conversation between the gut brain connection now than there
was even five ten years ago.
Speaker 3 (17:26):
Yeah, I think the science has been evolving on it
and now with I mean, I think part of it
is social media, you know, like with so much conversation
happening online, people are having discussions about nutrition. I'm seeing
this with sleep as well. I'm as sleep specialists too,
So even ten fifteen years ago, people weren't really talking
about sleep. But I think, you know, a big part
of it is just the emerging research. But what's really
(17:49):
fascinating about this is it's not these aren't necessarily new ideas, right, Like.
Speaker 2 (17:55):
We've known for millennia.
Speaker 3 (17:56):
If you look at traditional healing systems like Ayrveda from
India or traditional Chinese medicine, they knew that the gut
was so essential to health, to overall health. They knew
that the food that you eat impacts how you feel
physically and mentally. So these aren't new fangled sort of ideas.
It's just that the research and science is catching up
to it. And interestingly, when I was in medical school,
(18:19):
I went to medical school at University College Cork in Ireland,
and back then some of the researchers in psychiatry were
doing a lot of microbiome research. So they have a
center called well, I think they may have changed the
name now, but it was called the APC Microbiome Center
in Cork, and so on my way to classes, we
(18:41):
would kind of cut through the Food sciences building and
so they were doing a lot of the microbiome research there.
So we even had lectures back in med school. This
is now like almost twenty years ago, talking about the
impact of the gut microbiome on mental health. Professor Ted Dinan,
he's one of the researchers. John Cryan is another one.
So if anyone wants to google their names, you'll see
lots of talks on their research on psychiatry and the microbiome.
Speaker 2 (19:05):
All of that.
Speaker 3 (19:05):
To say, back then it was cutting edge, and I
didn't realize that. I just thought, oh, like, everyone's learning
about this, But when I started working in psychiatry, no
one was talking about it, so I didn't realize how
far ahead they were in their research. But now it's
it's catching up to become more mainstream. And I think nutrition,
it's it's one of these things that it's relevant to everyone.
Speaker 2 (19:26):
Right.
Speaker 3 (19:26):
We all have to eat, and so people are really
interested in knowing what to eat and you know, how
is the how are these different types of foods affecting us?
And you know what is what's the research behind it?
And I'll just put a little caveat around that too,
because there is so much information that it can get
really confusing and overwhelming, and then people can go down
(19:47):
these rabbit holes of let me do the ketogenic diet,
or let me do a vegan diet, or let me
try carnivore or whatever it is, and you can lose
the forest through the trees. So that's where you know,
coming to basics and having this personalized approach that Eiler
provides is really important.
Speaker 1 (20:05):
That happens so frequently in this work that getting so
caught up in the details of reminding people to step
back and say, are you filling your plate with like Eiler,
how you mentioned the rainbow holds fruits and vegetables, whole
grains and well thought out proteins, and really trying to
simplify it within all the confusion that it is. Yet
we do now have this tool of testing the microbiomes,
(20:27):
So how does one do a test?
Speaker 2 (20:30):
And are they available readily?
Speaker 4 (20:33):
So microbiome testing, there's so many different tests out there
and there are new tests still being developed, so patients
can readily access a variety of tests online. But interpreting
it is a whole other step. So it's like, you know,
you get the results, but what do you do with it?
And that's where a lot of people get stuck because
(20:53):
they get kind of answers, but then they don't really
know what to do with it or how can they
modify their diet to get the results they're look looking for.
So that's why it's really important to work with a practitioner,
someone who specialized, someone knows how to interpret the results
and how to guide you or create a personalized plan
and approach to help you resolve the symptoms that you
have and really explain the answers to you or the
(21:17):
results of the test. So we use a variety of
different tests in our practice. There are a couple ones
that are my favorites to use based on some of
the common symptoms or complaints that I see in a
lot of our patients. So we have stool testing, we
have urine analysis, we have blood tests. I mentioned CIBO
(21:39):
that's done through a breath test. Some people maybe do
a saliva test, which I don't use very often. So
there's a variety of different ways to do it, and
the results that you get really depend on how the
test is done, When is the test done, did the
patient perform the test correctly, were they taking any supplement
(22:00):
right around the time of the test, or did they
stop their supplements a couple days before the test, which
we always try to let patients know that they need
to do. And then these tests look at things like
the gut microbiota, so especially things like a stool analysis
will tell us what type of bacteria are in your stool.
And again it's at that time, right, so it's like,
(22:20):
what specific part of the body or what specific time
was this stool analysis done, So these are the bacteria
that are present. They will tell us the ratios of
these bacteria. Do you have too much of certain bacteria
too little of other bacteria? And then someone like myself
will help guide you on how to balance this. So
(22:43):
stool analysis specifically indicate things like leaky gut or dysbiosis,
which again is just kind of that imbalance. Like I
explained with the screen door, some of the good bacteria
have been let out, some of the bad bacteria have
stayed in or have overgrown in your gut. So how
we can balance this through by maybe eliminating or trying
to avoid certain foods, temporarily increasing your intake of certain foods,
(23:07):
like especially high fiber foods to help support the gut.
Some people may require supplementation like pre and probiotic supplements
that can really help balance the bacteria in your gut.
So there are a variety of different ways to do
the tests, and I always explain to patients like, here's
the test that I recommend, here's what it looks like,
(23:28):
here's what it's going to tell us, And I leave
it up to them because we're not really here to
be like you have to do all these tests. Some
people maybe don't want to pay a lot of money
to have testing done, but there are a lot of
tests that give us more answers. So those are some
of the tests that we use. And again we always
give patients the option to decide.
Speaker 1 (23:47):
If somebody, how you mentioned that you asked them to
stop supplements a few days before, what if somebody had
had their lovely moment with oreos the day before, like
the whole not to the little pack, but like just
went to town with it. Can it affect the outcome
of the testing that quickly, Like you mentioned supplements, you
(24:08):
stop it two days ahead. Can it go the other
way where you have ultraprocessed food the mayhem of them
a couple days before.
Speaker 4 (24:16):
Yeah, that's a really good question. And I know a
lot of patients get hung upon this, especially when they
see a result that they don't like and they're like, wait, actually,
like right before the test, I did this, do you
think that's what caused it? So, as a certified diabetes
care and education specialist, I always tell patients like, when
they do a blood sugar test, and let's say they're
A one C, which is this average measurement of your
(24:39):
blood sugar over the past three months, but it's really
concentrated in the past month before the test, So they're like, wait,
right before the test, I had like a cake for breakfast.
Do you think that's why my A one C is high?
And I'm like, well, no, because it was like an
average over the past three months. So certain tests can
be impacted by what you did right before, like maybe
(25:00):
treglycerite test, which is a certain type of fat in
the body. But when we're looking at something like your microbiome,
this is something that is a bit more chronic. The
types of bacteria that overgrow things like that, they don't
really happen overnight, which is why a lot of patients
wait to come to us until their symptoms are becoming
(25:20):
more Bothersome it's not like, hey, I've been bloated for
three days and I decided to come see you. It's like, no,
I've been bloated for like two years, or like, oh no,
I've been like constipated for several years on and off.
So these things are a bit more chronic and it's
not like something you did the night before or the
morning of is really going to cause that result to
(25:41):
be abnormal.
Speaker 3 (25:43):
Doctor Bopaul, do you want to add Like Eyler was saying,
it's not a requirement, a lot of what we can
offer can be done without lab testing and making changes
and listening to your body is really important. So a
really crucial aspect of what we do is helping patients
connect with their intuition so that they can feel.
Speaker 2 (26:05):
What they're feeling.
Speaker 3 (26:06):
They know what they're feeling, they can keep track, they
can track their triggers, they can develop that sort of
innate intelligence or fine tune that innate intelligence to guide them.
And then a test is sort of like the cherry
on top, like we can go deeper, we can go granular,
we can look at it for a data driven people.
We have lots of people who are in tech or
(26:26):
their engineers and they want the data so great. We
can do the tests or we can do blood work,
so we really like to meet people where they are.
Speaker 1 (26:35):
If somebody fully listens to both your wisdom and expertise
and starts making these giant changes. What has been your
experience of when people start noticing changes and again focusing
on anxiety and sleep of improvement in those of symptoms.
Speaker 3 (26:55):
Yeah, I could share a little bit. I'd love to
hear Eilar's experiences too on this. So there's a few
stories that come to mind. So with one of my patients,
we really focused on mindful eating. Okay, so when we
were talking about nutrition and mental health, it's not just
about what you eat, but how you eat it has
an impact, and so sometimes we'll just start with that,
(27:16):
like we won't even make any changes to what the
patient's eating, but will recommend that they sit down when
they're eating. So we actually, I learn and I have
a video on our YouTube channel about mindful eating, so
if anyone wants to watch that and get the instructions,
I learn did a great job explaining what that is.
But essentially, in a nutshell, it's making sure you're sitting down,
making sure you're chewing your food thoroughly, that you're taking
(27:37):
a break between bites, that you take a few minutes
when you're done eating before you get up, so that
your body can fully digest. So I had a patient
who was struggling with a lot of anxiety, and he
was having spikes of anxiety and panic throughout the day
in conjunction with acid reflux and loading in gas. So
we just did mindful eating. We didn't make any other
(27:59):
changes to is nutrition, and within the first two days
of doing mindful eating, the reflex went down. He started
feeling less anxious, he felt more tuned into his body,
he recognized when he was hungry, and so on. And
that was within just a couple of days. So these
changes can be quite immediate, right pretty quick. Another patient
(28:21):
of mine that I saw just recently, she was also
struggling with sort of these spikes of anxiety throughout the day,
and we theorized that it could be related to hunger
and fluctuations in her blood sugar as well, because drops
in blood sugar can look like anxiety. The symptoms are
very similar. So we had her do mindful eating and
(28:42):
then not space at her meals as much, so just
eat a little bit more frequently throughout the day, and
again within a day or two, there was immediate relief.
So these changes can be really really quick. In terms
of sleep, it can kind of go either way. I
have had patients tell me that they sleep better if
they do have a little bit of a fast before
(29:03):
they go to bed, so you know, if they don't
eat three to four hours before going to bed, they
actually sleep better. And I have other patients who tell
me they don't sleep as well they wake up at
night if they don't eat an hour before going to bed.
So tuning into yourself and understanding what works for you
is really important here. But again you can see immediate results,
you know, within a night or a couple of nights.
(29:24):
With some of my patients who struggle with brain fog
or a lot of fatigue or low energy during the day,
or excessive daytime sleepiness what we might even call hypersomnia,
sometimes cutting out gluten can be really helpful. This is anecdotal, okay,
So like this this is sort of like cutting edge.
It's not really I mean, it's semi supported in the literature,
but it's something that we'll recommend, kind of like using
an anti inflammatory diet sort of approach. And in those cases,
(29:48):
within a few weeks I have seen people start to
have more energy, less fatigue, they feel less write and
fog during the day, more mental clarity. We're not talking like,
you know, to do this for six months straight, and yes,
the longer you do it, the more changes you're going
to see. But just doing an experiment for a week
or two you can start to see some changes. And
(30:09):
I'd love to hear Eilar's.
Speaker 2 (30:10):
Thoughts on that.
Speaker 4 (30:12):
Yes, absolutely so, just like doctor Bopaul mentioned some of
these complaints that we get, Let's say someone with heartburn,
acid reflux, you can really see changes right away, depending
on how much you really stick to the plan, right,
So it's like something that you're doing all the time,
you're more likely to see results faster versus something you're
doing some of the time, like this mindful eating approach.
(30:35):
Let's say you're practicing mindful eating every single day, every
single meal, you're more likely to see results versus if
you're doing mindful eating maybe a couple times a week.
So if someone is coming to me with chronic bloating,
chronic constipation, they do want to see results right away,
but I always explain to them, you know, this sounds
(30:55):
like it's something that's been going on for years, So
it is going to take some time to really heal
the gut, heal the microbiome. It's kind of like you're
growing a plant, right. You have to water it, you
have to watch it grow, watch it thrive, really nurture it,
take care of it. And it's same thing with your body.
So you really have to put that same type of
care and effort into your own gut, into your own microbiome.
(31:18):
So if someone is having issues like that, then I
really try to encourage them to start slow and start
where they want, just like doctor bo palm mission, meeting
the patient where they're at and saying, hey, you know,
I don't want to start with mindful eating. I want
to start with drinking more water. Right, So it's like
if that's what they want to do, that's great. That's
also something that really matters. So letting the patient know
(31:41):
that these are your options, you're in control, but here
is what's going to help the most, and then leading
it up to them because if I tell them what
to do, they're less likely to stick with it. But
if a patient decides this is what I want to do,
and they have a follow up appointment coming up like
a month later, I always hear this, it's like, hey,
I knew we had this visit coming up, so like
the last week, I've been really good about drinking more water.
(32:03):
So it's kind of like that accountability factor. And I
think having these visits, having these follow ups really allows
patients to see better results, see faster, quicker results because
they're being kind of guided a little bit more by
an expert and they're being followed more carefully.
Speaker 1 (32:21):
So my last question I have is, so you've decided
to do testing on somebody for the microbiome, you find
these changes, maybe supplements were added and the food changes.
Do you do repeat microbiome testing if their symptoms are
getting better, do you do automatically do retesting or not necessarily?
Speaker 4 (32:43):
So for a lot of patients, I often mentioned, we
really want to see did these supplements help you or
have you really been taking them consistently and do you
need to continue taking them because a lot of times
people think, you know, I just take a multi vitamin
and then I'm good and this is what I do
for the rest of my life, or same with pre
(33:03):
and probiotics. Some people think everybody needs to take this.
So I think repeating the tests are really important. Because
they give us the answers that we're looking for. And
just like doctor Bopaul mentioned, some people are really data
number driven and they want to see that.
Speaker 2 (33:18):
So a lot of our.
Speaker 4 (33:19):
Patients want to see, hey, oh my magnesium levels improved,
so that's probably why my constipation went away, you know,
and they really like to see that. And I always
recommend repeating the test, especially when we get a baseline
for it. We want to repeat it and see, you know,
did these supplements help you, did the changes in your diet.
Let's say someone had high oxidative stress levels, they've been
(33:41):
eating antioxidant rich foods for several months, did those levels
go down? And then we probably won't need to repeat
it once we get them back to their normal levels.
But again, nothing is really required. You don't have to
do tests, you don't have to repeat them, but seeing
those answers can be really helpful.
Speaker 1 (34:01):
What's the timeframe then, Like with diabetes, we often test,
you know, over three months or so, what would it
be for this situation.
Speaker 4 (34:08):
I recommend three months, and it's from the time that
they start making the changes. So often I'll see a patient,
they'll order their supplements or they're they're going to order
their testing kit. By the time they really get it
and they send those results back and we actually get
them might take a couple of weeks, so it might
actually be four months from the first time that we
(34:29):
saw each other, but I usually like to repeat that
test in about three months.
Speaker 1 (34:35):
I do have an encore question then, So you mentioned
supplements are used at times. So you mentioned probiotics, which
most people have heard in prebiotics. How do you decide
when to use food as your prebiotic with the high
fiber foods versus a supplement that's prebiotic supplement.
Speaker 4 (34:54):
Yeah, that's a really excellent question. So supplements and food
work slightly differ differently. And I always say food first approach.
So people kind of want like the quick fix. They're like, oh,
let me just take a pill instead of having to
eat the rainbow, like that sounds a lot easier. But
if you are able to incorporate a food first approach,
not for someone let's say they have like severely low
(35:16):
levels of vitamin D, I wouldn't say, you know, try
to eat vitamin D rich foods, but food first approach.
Really try to heal through diet, try to eat well
first and then we add supplements just like the word says,
it's a supplement to what you're doing, things like a
pre and probiotic. You may want to look at what
(35:37):
kind of brands there are out there, what kind of
bacteria does your body need? Do you really want to
be taking this supplement? Has it been tested clinically proven
to be effective? So I would say that for pre
and probiotics, they work in conjunction together really well, so
taking a pre and probiotic supplement in combination, but you
(35:58):
can also get it through food, and the way it
works is your body breaks down the food. So a
supplement you can take it fasting and it can really
make its way down to the gut, which is really nice.
So in the case of pre im probiotics, I really
like that about certain supplements that are clinically proven to
be effective, and I say take it fasting first thing
in the morning, because your digestive system is going to
(36:21):
break down the food a little bit more before it
makes its way down to the small test and large
intest and where it can really do the work. So
in that case a supplement might be more helpful. But
you can also get it from food because I know
these supplements can be a bit pricey, so like prebiotics,
which is the fiber food that the probiotic bacteria feed on.
(36:42):
Prebiotics you can find in things like artichoke, plantain, garlic, onion,
probiotics fermented foods like kimchi, sauerkraut, tempey miso, so again
you can't get it from food. Supplements can be a
little bit more helpful in the case of pre im probiotic,
but again not necessary.
Speaker 2 (37:02):
So as we're finishing up, I'll start with doctor will
Paul in this one.
Speaker 1 (37:05):
Is there anything that wasn't said today that you want
to make sure that our listeners here.
Speaker 3 (37:12):
There's sort of three categories that I think about when
it comes to supplements for like three million buckets. So
are we using them for prevention? So for example, using
full light during pregnancy, are we using it for repletions?
Or are we trying to repleate a vitamin D deficiency
or an iron deficiency, which we'll see a lot in
patients with anxiety and sleep issues. Or are we using
(37:32):
it as a therapeutic So are we using it maybe
for its calming effects or something like that in anxiety
and so I think just having that framework in your
mind can can give people just a little bit of
structure instead of feeling like, oh my gosh, there's like
twenty different supplements I need to take and you don't
really know what they're for or why you're taking them,
so just thinking about them. Okay, So just for prevention,
am I repeating a deficiency? Am I using it for
(37:54):
its therapeutic effects? And then just having an end date.
So whether we're prescribing a medication for support or for
prescribing or recommending a supplement, it's a good idea to
have an end date on it. So talk to your
healthcare practitioner about what would be appropriate. You know, even
if we're supplementing for a deficiency, we might recheck their
vitamin D or iron in three months time to see
(38:16):
if they still needed if they still need that dose,
and that'll help kind of cut down on what people
are taking because sometimes we'll see people who have been
on a supplement regimen for a decade and they just
didn't know that, you know, they didn't need to take
it anymore, or that there should be an end date.
So I think those are just some general guidelines for
people to think about.
Speaker 2 (38:34):
How about you, Eilira, any last.
Speaker 4 (38:36):
Thoughts, especially when it comes to the topic of nutrition.
Just like doctor Bopa mentioned, there's just so much information
out there nowadays, and a lot of people are looking
at things on the internet, things being promoted like carnivore diet,
ketogenic diet, so it can be really confusing. Just keeping
in mind that everyone is different, your body is different,
(38:58):
your lifestyle is different. Just because ketogenic diet work for
someone else doesn't necessarily mean it will work for you.
So really understanding what your goals are and how nutrition
or talking to an expert like doctor bopam mental health
can help you. So what is your purpose behind it?
What is your end goal? Just like she said, you know,
(39:19):
having like an end date like in the next three months,
I really want to be able to do X, Y
and z. So really just keeping that in mind and
then trying to create a personalized approach for it, knowing
that things can take time. Someone might see results in
a week, someone might see results in a month. And
that's why I think having a functional medicine or a
holistic an integrative approach is really important, so you can
(39:42):
really look at all aspects of your life versus putting
all your focus on one thing and just really trying
to see results by focusing on that one thing versus
knowing that there are other areas and other things that
can be impacting what you're going through or the symptoms
that you're experiencing, and that you're not alone, like everyone
goes through similar things and talking about it, especially talking
(40:05):
about it to an expert, can be really helpful.
Speaker 1 (40:08):
This conversation has been really fantastic to really look at
whole person health and not fragmenting somebody into these silos
that often happens in healthcare. So I really really appreciate
both your not only your own insight and your own
area of expertise, but even in this conversation that can
see how well you work together. So if people are
interested in working with you both, how would people reach you?
Speaker 3 (40:31):
Yeah, so the best way is to go to our
website Pacific integrativepsych dot com. Our practice is called Pacific
Integrative Psychiatry. You can book a free call with our
team via our website. It's a free twenty minute call
and they'll talk to you and just make sure our
services are the right fit for you. We do see
patients across the State of California virtually, and we occasionally
(40:53):
offer workshops and other programs that are open to anyone anywhere,
So even if you're not in California, you may be
able to ten some of those and you can join
our email list. We have a supplements for anxiety free
download on our website, so if you choose to opt
into that, you'll get on our email list and then
you'll get more information about our other upcoming events.
Speaker 2 (41:13):
Y mensas social media also what is the handle for that?
Speaker 3 (41:18):
So we're at Pacific Integrative psych on Instagram, LinkedIn and Facebook.
Speaker 2 (41:26):
Wonderful. Thank you both, truly so much, thank you, thank you.
Speaker 1 (41:33):
I hope you feel motivated by this episode. Please leave
us a rating and a review and mention our show
to others who you think could use this information. That
could be your doctor, it could be somebody who works
in the food service industry who's interested in the health components.
It could be a friend that is working on their
health journey. If you want to hear more, please remember
to follow Culinary Medicine Recipe on your favorite podcast listening platform.
(41:57):
Until next time, Salu and Bona Petti. All content provided
or opinions expressed in this episode. Are for informational purposes
only and are not a substitute for professional medical advice.
Please take advice from your doctor or other qualified healthcare professional.
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