93: Gut Health, Ulcerative Colitis, Crohn’s, IBD | Gastroenterologist Dr. Vanessa Mendez

Dr. Vanessa Mendez  00:00

When he had his follow up, colonoscopy for the first time in his life after you know all the medications he's been through, been on chemotherapy style medications for his inflammatory bowel disease. He was declared to be in remission for the first time ever. 

Dr. Rizwan Bukhari  00:16

Wow!

Maya Acosta  00:16

Welcome back to the Plant Based DFW Podcast weekly show with Dr. Riz and Maya. Our podcast focuses on lifestyle medicine, which is the use of evidence based lifestyle therapeutic approaches, such as a whole food, plant based diet, regular physical activity, adequate sleep and stress management to treat, reverse and prevent the lifestyle related chronic diseases that are all too prevalent. Every week, we will feature physicians, dietitians, health coaches and chefs who will share with us their knowledge on one of these lifestyle medicine modalities. Before we introduce today's podcast guests, I have a few announcements. As many of you know, I've been promoting the Physicians Committee for Responsible Medicine, nutrition class, and the website again for that as pcrm.org/nutrition class, Dr. Riz and I will be guests for the following class that's on Tuesday, February 16, at 4pm Eastern time, if you're not able to attend the live event, you will still receive an email with the recordings. So make sure you're part of that. So as many of you know, we kicked off the Grand Canyon Adventure on Saturday, February 13. This is a virtual event put together by Walk With A Doc. And because there was so much excitement about it, we're talking about resuming our monthly Walks With A Doc so stay tuned for the announcement or visit our website for more information that's plantbaseddfw.com. So let's meet Dr. Vanessa Mendez. She is a double board certified gastroenterologist and internist. She specializes in digestive disorders, which include liver disease, inflammatory bowel disease, and nutrition based disorders such as obesity and constipation. Her approach to patients and their diseases is holistic and comprehensive. Her goal is not just to treat the symptoms but to get to the root cause of the ailments and to provide lasting relief. She provides an evidence based approach to her practice and focuses on lifestyle changes first to promote wellness. Dr. Mendez attended Harvard University where she obtained her BA in Latin American Studies with a minor in pre-medicine and from there she began her medical training at ACGME Accredited University at Central Del Caribe in Puerto Rico completed her residency in internal medicine at the University of Miami Jackson Memorial Hospital, and her fellowship in gastroenterology at Tulane Medical Center in New Orleans. She has also trained in epidemiology through Florida International University and in plant based nutrition through E Cornell University. She was awarded a visiting fellowship at the Mayo Clinic through the Crohn's and Colitis Foundation, where she receive special training in inflammatory bowel diseases. She has also helped lead multiple fundraising walks to raise awareness of Crohn's and Colitis in the Miami area. She was awarded the Physician Champion at the Take Steps Walk 2019 in gastro health team. In 2020. Dr. Vanessa Mendez stayed pretty busy participating in conferences and summits, in order to spread the message about how important it is to take care of our microbiome. Dr. Mendez will talk to us about a diversity of plants that we should have in our diet on a weekly basis show we'll also talk about how certain lifestyles can impact and decrease the diversity in our gut microbiome. So she emphasizes stress management, physical activity, meditation and all that good stuff. You're going to want to listen to the entire episode because it's very full of information and very important for your gut. I hope you enjoy this episode. You can head on over to our Instagram page to tell us what you learned from Dr. Vanessa Mendez @plantbaseddfwpodcast. All the links for our guests are found in our show notes. Our episodes are also added to our YouTube channel. And you can just basically find all that at the website plantbaseddfwpodcast.com as you dive into the episodes never forget the more you implement these healthy lifestyle changes, the more you will upgrade your health. Thank you for being part of the community. Welcome, Dr. Mendez.

Dr. Vanessa Mendez  04:29

Hi, guys. Thank you so much for having me today. It's an honor to be part of your podcast.

Maya Acosta  04:34

We're very excited to have you.

Dr. Rizwan Bukhari  04:36

Thank you and well welcome. We're so happy to have you.

Maya Acosta  04:38

Dr. Mendez. Um, let's start a little bit getting to know you. I know that you're in Miami, Florida. You're Cuban American. I recently saw you in the gut summit and you since then you've done a lot of talks. You're on demand right now.

Dr. Vanessa Mendez  04:52

Thank you. Yes, absolutely. So so actually before I think before the fall of last year, I actually hadn't done any public speaking, because I was just very shy about it. You know, we kind of get that imposter syndrome very often in medicine. And I just didn't know if you know, what I had to say was worth listening to. But apparently, you know, my knowledge and expertise in this area is definitely something that people want to hear about. So I'm very grateful to have been able to do all these talks. Since then. Yeah. So since the start of the pandemic, I think I've done about 15 talks,

Maya Acosta  05:30

The pandemic has really allowed us to kind of go virtually and reach out to like a greater audience.

Dr. Rizwan Bukhari  05:35

You've become a zoom expert, haven't you? 

Dr. Vanessa Mendez  05:37

Yeah. I don't know if I can do it in person, but definitely through zoom.

Dr. Rizwan Bukhari  05:41

Yeah.

Maya Acosta  05:41

I've also heard you speak in Spanish. you're originally from Florida. Is that right? Or Cuba?

Dr. Vanessa Mendez  05:46

So I was born in Cuba, I came when I was nine, have been, you know, in the States since then. I spent those first nine years of my life in Miami, then I went to Boston for four years, then four years in Puerto Rico and med school, and then back to Miami, and then New Orleans. And I've been back here in Miami for the last three years practicing

Maya Acosta  06:09

When you were in Puerto Rico, at the university, was the content in English?

Dr. Vanessa Mendez  06:14

So you know, Puerto Rico has four medical schools that are ACGME accredited, so they're not considered international graduates were a part of the US system. And a lot of people don't know that there are so many medical schools within Puerto Rico. The content was the written content was all in English. Some of the presentations were done in Spanish. But yeah, I mean, most of the content was in English. 

Maya Acosta  06:40

And the reason I asked is because you think of all these technical terms, and to be able to process the information in both languages, is incredible. There was a time when I was in Spain, and I met a lot of Cubans who are highly skilled. I don't know if people know that, you know, Cuba produces some very intellectual people, you know, in terms of in the sciences and in medicine. 

Dr. Vanessa Mendez  07:02

Yeah, absolutely. So Cuba has been exporting, you know, physicians and healthcare providers for a very, very long time. And the medical system in Cuba, you know, it's different in Latin America. And I think in Europe, it's similar. We don't, you don't go into high school, like, there's no such thing as in high school, you go directly to, or there's, there's high school, yeah, there's high school, but you go, you don't have college, you go directly into your, into your profession. So, for example, you do your 12th grades, and then you go directly into your profession. So they don't have that four year buffer of going into college, they go straight into medicine. So the doctors graduate at a very young age, they're practicing from a very young age. And, you know, it is a, it is a difficult political system to to wrap our heads around, it's just very, very different. So now, you know, it's kind of lost that appeal for, for keeping up with the scientific community. And in medicine, at least in the last, you know, let's say in the last decade, but it was definitely very famous for exporting as physicians and scientists.

Dr. Rizwan Bukhari  08:15

I mean, we see it from my background, you know, the United States is, is a place where many people want to go to get a higher education. And so you see, we called it the "brain drain" from Pakistan and India, because anybody who was wanting to become a doctor or an engineer or a lawyer, they would go abroad to study. There was the idea that they might go back, but so many ended up staying. And so that's what the brain drain aspect of it was, I guess the United States has an advantage, we get to take all the smart people from all over the world and educate them. And then and then keep them to,

Dr. Vanessa Mendez  08:52

Right, absolutely. So that actually happens more in Puerto Rico, for example, Puerto Rico has a huge brain drain, because it's what you just said, you know, these aspiring positions leave either because they want to go to university, and then they stay in the United States. And that's a huge problem in Puerto Rico. And I've seen that, you know, in a lot of Latin American countries, where we differ is that, for example, Cuba and Venezuela have dictatorships, so they're not allowed to leave freely. So they retain that that knowledge that those those advanced practitioners and professionals,

Maya Acosta  09:33

So Dr. Mendez, how did you become plant based?

Dr. Vanessa Mendez  09:36

I love that question because I used to tell them that it was during, you know, I used to be asked that I used to be like, Oh, it's because you know, when I was in fellowship, and I was in GI so my patients were enjoying getting better. My husband has inflammatory bowel disease. So we knew that his medications weren't working. But actually it goes back way further than that, as I started to go through that question and ask myself where was that time when I noticed that nutrition made a huge difference in my life? It goes back to when I was 16 years old. So when I was 16 years old in high school, I suffered from acne. So, you know, it was very bad acne, I had tried antibiotics, I had tried all the different creams, and I was eventually put on Accutane. So Accutane, you know, is a very strong medication for for acne, it's actually been named in numerous lawsuits just because it can affect a whole host of things, it increases your lipid profile, it gives you you know, you have to monitor your liver enzymes to make sure that your liver is okay while you're on it. And it actually has been associated with inflammatory bowel disease. So anyway, I would take Accutane and I would get better. And then as soon as I was off of it, I would get worse again. So clearly, something wasn't working, my dermatologist wouldn't, didn't know what else to tell me really never talked to me about nutrition. So that was around the beginning of the internet and search engines per se. So I went on the internet, I searched an anti inflammatory diet. So I just put anti inflammatory diet because I just had that idea in my head. And then I think it was Dr. Will's Diet that came up. And I put myself on a no dairy, no meat or no processed food diet. And really, within a matter of weeks, my acne was gone, like something that I had suffered with for two years, and I had been on so many, many medications, I'm very, very strong. And you know, with high potential high side effect profile, and my acne was gone. So that was the first time that I really got a taste a sense of the power of nutrition in our lives. I finished high school and obviously, as a typical college student, all the bad habits that come with being away at college, I did not stick with it, but I already knew. And actually for a very long time I already you know, I stayed not eating red meat because whenever I would eat red meat, it just felt like a rock in my stomach. So I did stay not eating red meat. And then I went through my training, you know, rigorous internal medicine training, so tough. Thankfully, then, fellowship was actually a little bit lighter for me in New Orleans. And I loved it. I'm in love with New Orleans super amazing city. And, and halfway through my fellowship, my husband and I, we were eating the typical Louisiana fare, we were eating a lot of cheese. A lot of you know a lot we were I was drinking alcohol and, and a lot of seafood but a lot of fried food too. So I felt like I was you know, a really a very old person in very bad shape. And I knew something had to I had to give. My husband has had inflammatory bowel disease since he was 17 years old. His disease is moderate to severe when he was 22 years old, he required a small bowel resection part of a small bowel taken out because his disease had progressed to the point where he had narrowing in a small bowel and food couldn't go through. So he had you know, partial blockages on and off, and he had been on heavy medications even before them. So they weren't working. He progressed. And he had that. And since then he had never been in remission. So we were like, We have to change our diet. We started watching the traditional documentaries that we've all watched you know What The Health, Forks Over Knives and even before then, I don't know how I think it was because of that trial I had done on myself when I was a teenager. I kept on telling him, you know, I think that the healthiest diet is a vegan diet. I just said that, like I had no training in it. I didn't know what I was saying. But I had had that personal experience. I kept on telling him that and he's like, Oh, so why didn't go vegan and I'm like, I don't think you can ever do that. I don't think I can do that. So fast forward to then when I'm in fellowship, we're both struggling. And we watch these documentaries and I just said Look, I can't do it halfway. Like we have to do it go all in from now. So we cleaned out our pantry we donated, we gave away and from and we said from here on on, we cannot at least bringing anything into the house that is not you know, healthy plant based outside the home, we can do it a little bit more gradually. So then it took us about a year you know to go fully plant based, especially because in Louisiana, you know fish is a really big deal. But we cut out meat and dairy from the beginning. But it took us about a year so then when he had his follow up colonoscopy for the first time in his life after you know, all the medications he's been through, been on chemotherapy style medications for his inflammatory bowel disease, he was declared to be in remission for the first time ever. We continued medications that whole time, the only change we made was, you know, going plant based. And I mean, it was just such a, an astounding thing. We were just like, Is this true? Can we, you know, I was there during his colonoscopy, I watched it, because that was my training program. But it was true, you know, he has old scars, from the disease and inflammation being there so long that that your bow scars up. So that will never go away, but at least here, he'll know new information. So he was declared to be in remission. And, you know, we've continued that. And then I went on to practice that same way. He was my first patient, right, he was my guinea pig. And then I applied that to the patients that I was seeing. I continued, you know, I finished my training. I did a little bit of training in Mayo Clinic to become like an IBD specialist. Now I'm a general gastroenterologist, but also an IBD specialist. And I treat all my patients the same way with these lifestyle modifications. When we have to use medication we use them. We know medications are life saving when we need to use them. But most more often than not, especially with common GI disorders, we actually don't need medication.

Dr. Rizwan Bukhari  16:31

Yeah, lifestyle changes, food changes. So clinically, when did you notice a change in your husband when he when he went plant based? Was it? You know, did it take an entire year? Or did it take two months or three months or what?

Dr. Vanessa Mendez  16:43

I love that question. So one of the most combinations that people with digestive disorders have is food intolerances. So we'll get into the nitty gritty of why that is, and it has to do with our gut microbiome. But when it comes to patients with inflammatory bowel disease, specifically, not only do they have a microbial issue, but they also have this inflammation in their gut right, and possibly narrowing in their digestive system that doesn't allow things like high bulk foods to pass by easily. So my husband loves legumes, we're Cuban. So black beans are a staple in our family. My husband suffered so much his entire life, because he would see us eating black beans, but he couldn't even have a black bean. Like he couldn't even have the liquid from the black bean. Just, you know, strange, he couldn't have the liquid alone. And he would suffer and he would sometimes sneak it and he would eat the black beans. And then he would suffer because he would have pseudo obstructive symptoms of the of the small bowel. That was the first thing I noticed. I noticed that all of a sudden, I was making things like lentils, and he was tolerating it. And then we started progressing to the more fibrous legumes to the point that this man can eat a bowl, huge bowl of black beans and have no issues like if I eat that much, I'll be uncomfortably bloated. You know, that's a lot of black beans. But he has no issues. So that was just so amazingly liberating for him and to watch him like be able to enjoy foods and not be scared of foods was just one of the most wonderful experiences. And that was right away. Like that happened within weeks, two months, we saw that change of him being able to tolerate all fiber foods raw or not raw. The only thing he has never been able to tolerate for whatever reason. I mean, now for whatever reason we kind of know is mushrooms. So mushrooms just because they're indigestible fiber, very difficult. For some reason he can never he doesn't tolerate mushrooms, but coming from somebody who couldn't tolerate many, many plant foods, not being able to tolerate mushroom, obviously, you know, it's really sad because mushrooms are delicious. And he suffers with that. But he's come such a such a long way.

Dr. Rizwan Bukhari  19:01

And the reason I ask is because even in my profession, vascular surgery, the you know, we sit there and we manage these diseases manage with medications, but we're not really curing them. We're not fixing them. We're not going for the root causes, you say, but then you change your diet, and they're not managed. They're gone in just a matter of weeks to months. And that's just what's amazing to me.

Maya Acosta  19:24

You know, Dr. Mendez, I'm so glad we're speaking about this topic for two reasons. First of all, I had no idea how many people in this population I don't know suffer from digestive disorders, but also the other topic that is very important, and I've heard you address is SIBO. And I've heard other influencers, people that moved away from the plant based diet, blaming it on SIBO, and now everyone is gluten intolerant. So can we start by talking about what is the gut microbiome? How important is that to immunity and all so what are some of the common conditions that you see? 

Dr. Vanessa Mendez  20:02

Yeah, absolutely. So let's start with the gut microbiome. So basically, we all have different microbiomes within our body, we have a microbiome in our mouth, that's our oral microbiome, we have one on our skin, we do actually have one in our airways, we have one in our private parts, and the largest microbiome exists in our digestive system. So in our gut, we have about 39 to 100 trillion microbes. That's a huge difference, because actually, it's constantly changing. And we can your microbiome is different from his and mine. So everybody has a different number, right? So trillions of microbes live in our digestive system. And more so over the last decade, we science has been able to figure out that they're involved in so many different pathways in our body that we previously did not even know, this is not something that was emphasized just like nutrition in our medical schools, because one for that one, specifically, the science wasn't there yet. Or if it was, there wasn't enough, you know, knowledge from our teachers, right, our educators. So the gut microbiome is involved in things such as the immune system, inflammation, fat deposition, and maintaining the integrity of the colonic wall. Those are just the preliminary functions that we know that gut microbiome is involved in. But that's just the beginning. That's just scratching the surface of the of the knowledge that we have so far. We think that that's just going to explode over the next decade. But just with that alone, their their function is huge. They're involved in our immune system. So how do they do that? Basically, in our gut, we have good bugs and bad bugs, we all have the bad ones, okay, there's no way to get rid of the bad ones. If you got rid of the bad ones, let's say with a lot of antibiotics, you would get rid of the good ones, too, we wouldn't want to do that. What we want to do is empower the good ones to be able to be fruitful at their function. So we know based on the scientific studies, that the more diverse the your gut microbiome is, the more chances you have that you're going to have all the good ones doing their jobs, right. So we want a lot of the good ones. But we also want them to be diverse have, we want a lot of different species in our gut microbiome. So the good ones are in charge of these essential functions in our body. One of them, one of the functions is that they create short chain fatty acids. But how do they do that they need some kind of energy source to be able to create short chain fatty acids. They take fiber, so when we eat whole plant foods, it goes into our digestive system, and that is the energy that they use as their food source. So just like its food source, for us, it's food source, it's their main food source for the good ones, okay, they in turn ferment them. And that's where you feel the gas and the bloating, which is normal, but it shouldn't be uncomfortable, and it shouldn't last forever. But they ferment, they break down these fiber products. And in turn, they create these byproducts called short chain fatty acids. So what a lot of people don't know is that us we as humans, we can't digest a lot of fiber, we ourselves rely on the gut microbiome, to do most of the fiber breakdown. Because we have our human body has certain enzymes to help digest carbohydrates. But the microbes have many, many more enzymes to digest these fiber rich foods. So therein lies the issue with you, these people with pre existing GI conditions, they eat fiber, they feel uncomfortable, so then they avoid it, but then they're never going to get better. So it's a revolving doors of cycle they're never going to get out of so we'll talk about the specific issues of why a lot of these influencers leave, right. So these short chain fatty acids that were produced by the good gut microbes, when they ingested the fiber, we fed them certainly through our body. And in fact, we know for example, something is the blood brain barrier. We know that very few products cross the blood brain barrier. But short chain fatty acids are one of these products. So we've actually seen the link between basically an unhealthy gut microbiome and things like dementia, things like Alzheimer's and even Parkinson's disease. And now we see that connection is because they're able to cross the blood brain barrier. So I mean, this is just amazingly, you know, eye opening, because we knew nutrition was important, right? We've known that, but now we actually get to the nitty gritty of how this is actually functioning. So I think it's more exciting than ever to To be in our plant based field, because we're really seeing the mechanisms of action through the microbiota through the creation of short chain fatty acids circulating throughout the body. So going back to the microbiome, when we have an imbalance in our gut microbiome, meaning our good microbes are not doing very well, or they're lacking diversity, or there's not enough of them, then that allows the bad ones to take over. When the bad ones take over, just like the good ones created a byproduct called short chain fatty acid. The bad ones create a product called trimethylamine oxide. So what do the bad bugs feed on, just like the good ones feed on fiber, the bad ones have to feed on something, they feed on things like red meat, processed foods, refined sugars, energy drinks, and they use those products. And they create trimethylamine oxide trimethylamine oxide has been associated with cardiovascular issues, inflammation throughout the body, and in many diseases actually. So that imbalance in the gut microbiome, we don't have a lot, you know, the good ones or do not, we don't have a lot of the different species, the bad ones take over that's called dysbiosis. Okay. And dysbiosis really has been associated with so many disorders, not only the ones we just mentioned, in terms of dementia, Parkinson's, Alzheimer's, but also cardiovascular disease, acne, eczema, you name it, like there are so many, many disorders associated. And again, this is really exciting, because we're just scratching the surface of what's really going on here. And let's talk about immunity now. Okay. So the good microbes in the creation of short chain fatty acids, the short chain fatty acids is the energy used by the colonic cell walls, to stay together to maintain their structural integrity, that barrier function, our colonic wall serves as the first line system, the first line of defense when it comes to invaders in our body. So hence the immune system 70% of our immune system 70 to 80% of our immune system resides in our gut, not only through the colonic wall, but through something called gut associated lymphoid tissue, which is on the other side of the colonic wall, on the side of the of the body, right. So if you think about it, the microbiota is in the lining of the gut, then there's a colonic wall, so microbiota, colonic wall, and then the immune system, and they're in constant communication, and they're separated by a very, like, nanometers, or millimeters in, in in, in diameter. They're in constant communication, because as I mentioned, the short chain fatty acids and TMAO can crossover and, and affect the body in positive or negative ways. So when we have that dysbiosis, that imbalance in our gut microbiome, then what's going to happen is that that colonic wall barrier function is broken toxins and pathogens cross into the body, our immune system is right there waiting for them. And the immune system mounter response, the response, if it's, if it's something that stays broken, if that system is broken, if that chronic wall stays kind of broken and separated, then that response is maintained. The longer we maintain that response, then the body's responding in a very, in a in a large way,

Dr. Rizwan Bukhari  28:45

It becomes a chronic issue

Dr. Vanessa Mendez  28:47

becomes a chronic issue, but it also takes it to the point of autoimmunity. And this is where things like inflammatory bowel disease, rheumatoid arthritis, and a lot of other autoimmune conditions are associated with this breaking down of this very tightly connected system.

Maya Acosta  29:04

Well, this is very interesting that you should mention autoimmune, and I don't know if it's like appropriate to bring it up right now. But just recently, you were talking about some studies that came out as to what makes the difference between a person getting severely sick with COVID. And then people who can whose body can fight that and I think you said that it become it becomes an autoimmune issue, doesn't it? 

Dr. Rizwan Bukhari  29:27

The same things that we do to to protect ourselves from hypertension, diabetes, obesity, and chronic disorders, which is to eat a plant based diet is the same thing we can do to boost our immunity. That's what I love about plant based nutrition. It's not like we have one diet for cardiovascular disease, one diet for the brain, one diet for the gut. It's the same diet and it's works well for all all aspects of the body.

Dr. Vanessa Mendez  29:51

I'm actually really glad you mentioned that because I just had a patient two days ago who is a COVID, long hauler, and I saw him virtually, he's in New York, he got COVID in April. And he his whole food plant based, and he was athletic, very athletic, very active then. And he actually, he was his body responded completely adequately. At first, he actually didn't even get sick, very minimal, mild symptoms, stayed at home, everything was going great. Then two to four weeks afterwards, he felt he wasn't getting better, like in terms of he had some malaise. So we went to his herbalist, okay, was, over the course of months prescribed 20 different supplements, his body had reacted appropriately. Now, you come into contact with all the supplements that we don't know what the effect of that is going to be in the body. I, I suspect and my diagnosis of him is that he actually prolonged that low lying inflammation from COVID made it a chronic inflammation because he actually ramped up his immune system. By taking these supplements, which we know happens, we know that there are studies out there of actually things like akinesia causing autoimmunity, right? So he ramped up his immune system didn't allow the body to actually heal and properly, you know, deal with the chronic inflammation, and now has developed this chronic condition. So we want COVID, your body's immune system to fight COVID hard at the beginning, like say no, don't come in, don't multiply, right, we want a sturdy immune response, not an over response, and under an under response, a steady response. But then afterwards, when it's just dealing with that low lying inflammation that we know is there, we want the immune system to lay back, let it go not ignore it, don't don't even do anything about it, don't recognize it as something in the body. So that's where we see you know, it's it's fascinating. I mean, what we're seeing with COVID is, frankly, fascinating, but there comes the you know, there comes like, you know, if we had seen me, then then I would have put your let's optimize your nutrition, let's optimize, you know, the diversity of plants that you're eating, we'll optimize your lifestyle, and then we'll put you on, and then we're gonna watch you, we're gonna watch you. But I mean, now he has a chronic inflammatory response that resembles an autoimmune response, including thyroiditis, like inflammation of his thyroid, and loss of hair and all these different issues. So, um, so yeah, I mean, we're working together, and I think he's gonna, he's gonna do really well, but it's just we don't have that long term data. Yeah. And we don't really know how to treat it other than optimize the body from the beginning, so that it can deal properly with the virus.

Dr. Rizwan Bukhari  32:51

Well, just like everything else, that's certainly one of the first things we should do is always optimize the body's health, you know, then, of course, use our standard Western medicine, things to help when they're necessary, just as you said earlier, it seems to me so much of the things that go wrong with our chronic processes is a hyper exaggerated immune response. You know, that's what atherosclerosis is. And so it becomes a chronic, chronic inflammatory response to a stimulus that from the outside, and that's where the disease arises from, we can stop that by optimizing our body's health weight, the way I look at it is, you know, do you do you see it the same way is that the relationship between our, our microbiomes, all of them, but our gut microbiome and us is a symbiotic relationship?

Dr. Vanessa Mendez  33:40

Yeah, absolutely. So we know that the gut microbiome has been with us through time, it's evolved with us, we actually can find the microbiota in the feces, of like fossilized feces, petrified feces. So it's been there throughout time, and it's evolved with us in times of famine and times of richness. And it, it modulates itself a changes according to the conditions. I mean, the studies that we have showed that, you know, there's a gatherer populations who, depending on the region, that there are, depending on the season, right on the season, their gut microbiome changes drastically. So. So yeah, I mean, I think that they respond to everything that we are surrounded by, by our environment and everything that we're putting in our bodies, and they adjust right? And if we're not doing you know, we're not putting we're not surrounding ourselves with relaxation or focus or healthy nutrients, healthy sleep, then it definitely is going to respond in a way, right? I always say if you're not feeding the good guys, you're feeding the bad guys. And that's very true of the gut microbiome. We know that things like exercise, sleep, chronic stress trauma, affect our gut microbiome, our gut microbiome. So to go back, it starts developing in utero when the baby is in the mother's womb, before we thought that babies were born with sterile guts. And now we know that's not true. In fact, they are already born colonized, there is translocation of microbes through the placenta. So mommy's health is really where we need to start, right, mommy before she gets pregnant. That's the health we should be targeting. Yeah, carry it out through mommy and baby's life,

Dr. Rizwan Bukhari  35:28

that meconium should be proof that there's something going on in the baby's gut. Right, you know, already when they're born. Yeah,

Maya Acosta  35:35

been that you touched a little bit on COVID-19 and I know that is still fairly new in terms of treating the disease when a person is going through it. But do you have some recommendations like what you did with your patient for individuals who maybe are not gravely ill and do not have to be hospitalized? What's the best thing that they can do as they're going through that period? 

Dr. Vanessa Mendez  35:58

Yeah, I mean, I think that um, so just to, to take it to more scientific, we know that the gut has crazy amounts of ACE inhibitor to receptors. So we know that the buyers colonizes the gut in a very deep level. I think that our gut is one of the places that we should be targeting that we should be looking at for targeted therapy. And there are things like the American gut project are right now doing their collecting, storing COVID patience. So you know, the same, the same. The same system that told us 30 plus plants is really where we're health is our when it comes to diversity of plants equals healthy and robust microbiome to to be able to maintain your immune system and your overall health, that same system, the American gut project is now taking stool studies from from patients who have had COVID, and really the regular population to see if actually, you know, this patient got had no symptoms, but we find COVID in their gut, or SARS, COV 2, you know, so I think we're gonna have that data in terms of really how to modulate the microbiome in the coming years. And I think it's going to be really fascinating. Right now, what we know the database on the gut microbiome, though we already have says that, in order to optimize your microbiome, that equals as I explained to you guys, the immune system, and then overall health is with diversity, a variety of whole plant foods, because that is where the gut microbes, the good ones thrive, they eat fiber, that's their only source of food. So and, and each of each of the species digests a different component, a different fiber. So we simplify and say oh, there's, you know, two types of fiber, but no actually eat. For example, an Apple has many different types of fiber. So each of the species is involved in digesting a specific component in the apple. And then as a group, they actually work together different species, to digest the whole apple. So the more different foods we can give our body in the form of whole plant foods, that's the most energy, you're going to be giving these gut microbes so that they can multiply so that they can thrive. People don't know that in one day, 24 hours, we actually have 50 generations of microbes. Why? Because bacteria multiply, for example, equally multiplies every 20 minutes, right? So in 24 hours, you have 50 generations of microbes. So in one day's food you've affected or once they one, one day's lifestyle, you've affected 50 generation of microbes. So potentially, you can have a huge impact on the gut microbiome in a matter of days. And the studies do support that. And I think there's a study from nature's in 2014, where actually showed, you know, they put somebody on, they put a group of people on a whole food plant based diet. They tested their stool microbiome before they did that. And afterwards, they saw was very diverse. It was full of the healthy gut microbes and then the vaccine group, they put them on a completely like process and red meat diet. And in like, three days to a week, the same like the opposite shift happen. The their gut microbiome, which was one healthy now is colonized by all these different microbes that are pro inflammatory, pro disease causing associated with inflammatory bowel disease. So what happened, they were there, they were there before. It's not like they came out of nowhere. It just that you fed them and now they multiplied. So it's astounding, you know, like the data that we have is just it's it's mind blowing. It really reaffirms that whole food plan days are planned for diets are the way to maintain health.

Dr. Rizwan Bukhari  40:04

It just takes a few days. What they want to know is okay, I've been on antibiotics for a week or something else that's upset my gut microbiome, how do I correct my microbiome? And how quickly can that happen? And what you're saying is just a matter of a few days of a good plant forward diet, can readjust and rebalance your your gut microbiome.

Dr. Vanessa Mendez  40:24

So when it comes to antibiotics, we know that, you know, if you take one antibiotic, it's gonna, let's say, the studies show that it gets rid of about 20% of your microbes. But if you expand that to broad spectrum antibiotics that say to antibiotics, then you're going to be getting rid of more microbes. That was the what we've thought, you know, for a while. And that is true. However, what is also true is that there's something called the risk system. So there is genetic material in the gut microbiota in the gut microbiome, right, their genetic material that actually brings us brings them back for system meaning resistance, their resistance to erratic being eradicated. So obviously, that works for the bottom ones, too, but at least the good ones have that as part of their genetic component. So now, that actually gives us a little bit of relief when it says, you know, okay, yeah, I have to take antibiotics, we know they're life saving, when we have something that requires that we need to take them, and it kind of gives us a little bit of relief, knowing that they're going to come back, we just actually have to feed them the appropriate foods. And therein lie, people ask me all the time, you know, I have to take antibiotics, you know, can you give me a consultation so that I know how to optimize my gut microbiome? And I'm like, absolutely, you know, there is tons that you can do before, during, and after taking antibiotics to fortify that microbial comeback. And one of them is feed the body, the right foods, that's the main thing. And we know that the good the good bugs thrive. And their energy source is that whole plant food. So we just do it. And we do it in a way that's very targeted with more diversity of plans. Versus, you know, I'm just going to be relaxed and eat like mashed potatoes and a salad, no, no, I'm gonna have a smoothie that's gonna have a lot of diversity and which ones and combining it in a way that's really going to feed that whole host of species that we want to maintain. A lot of people ask me about probiotics. So that is a huge topic. We know, it's a huge industry. You know, we attended the gut microbiome World Congress last year, which I happen to attend to buy chins, because my friend and colleague will is like, hey, it's gonna be in Miami. Oh, are we gonna meet up? I'm like, What? I had no idea. So then we all met up all the plant based GI doctors, and it was amazing. And we learned so much. But the funny thing is that this Congress was sponsored by probiotic companies mostly. Yeah, and we're like, oh, my gosh, it's gonna be you know, you know, it's gonna be biased or whatever. But actually, the scientists, they presented these meta analyses that showed that really, we don't have enough data to recommend probiotics. So that's what the meta analyses show. And then they went on to present these two really, really interesting studies. One of them was basically how when we test the microbiome, you know, before and after probiotics, we test the stool. We're not actually going in depth to the colon, we're not doing a colonoscopy and then extracting microbial cultures. So we're just looking at a stool. So if you think about it, if you take a probiotic, and it goes right through you, it doesn't bind to your colon. So it's not really having a turn effect. It comes out in your stool, does that mean it's doing its job? No, we don't have the data saying that probiotics are actually beneficial for most conditions, especially in gi. Okay. The other study, their microbiome was tested, then all groups were given antibiotics, one group was given probiotics, one group was left to recover on their own and meaning no intervention, and one group received a fecal microbiota transplant from themselves. So they extracted the stool and after receiving antibiotics, they were, you know, recolonized with their own stool through through deposition through a colonoscopy. The results were mind blowing like a jaw dropped our jaws all of us physicians attending the conference, because what it showed is no surprise that the fecal microbiota transplant population was the fastest to recover, right. If you inject me with my own microbiota after receiving antibiotics, I'm going to recover the quickest. There was no surprise there. The huge surprise was that the group that was left to recover on their own actually recovered faster than the group that received probiotics. And that was just mind blowing for us because we thought, we think that one of the main functions of probiotics is to help recover after antibiotics. And it the data was just frankly, not there. Again, it's one study, but there hasn't been other data suggesting that the response is any better. So that was in March of 2019. Now, fast forward to August of 2020, when our gi guidelines come out on probiotics, I don't think they had ever done this. All the societies got together and basically released these guidelines regarding probiotics, because they know that there's so much misinformation, people are just consuming this without any physician recommendations off, you know, out in the grocery stores, anybody can buy and have access to it. So their recommendations for digestive disorders were very clear. They said, if you are a patient suffering with a digestive disorder, such as IBD, inflammatory bowel disease, or IBS, irritable bowel syndrome, or anything else, you we don't recommend probiotics.

Dr. Rizwan Bukhari  46:07

You mentioned there's 40 to 100 trillion bacteria in our gut. And those must be 1000s and 1000s of different types of bacteria. And how are we going to take a probiotic that has four or five or 20 different bacteria in it, and hope that that's what's going to actually recolonize in an appropriate balance, you know, and then and so we don't know what reads right now what we're taking, and how is that really going to help? So that's why it gets for me, it gets back to, you know, that they they they're still there, Let's feed them and help them grow back?

Dr. Vanessa Mendez  46:43

Absolutely. So the three instances that they do recommend probiotics, and I'll talk about which, you know, the first one, the strongest recommendation is in preterm or low birth weight, premature babies, they do recommend probiotics to prevent necrotizing enterocolitis. Okay, so that was a solid recommendation. Then the second recommendation was in patients with inflammatory bowel disease who have had surgery and now have a pouch and they have inflammation from the pouch. So a condition called pouch itis very specific right pouch itis, then the benefits may outweigh the risks, and they said it may be of benefit to take probiotics. The last recommendation was not based on good evidence, it was not a strong recommendation, it was a weak recommendation was in the setting of antibiotics. And in that setting, if you read the fine print, they actually say patients who are immunosuppressed. They don't recommend probiotics, because there could be potential translocation of the microbes that you're ingesting why were physicians recommending probiotics in the first place in the setting on robotics, and it was to prevent c diff.

Dr. Rizwan Bukhari  47:53

C diff being C. difficile, which is a bacteria that causes diarrhea,

Dr. Vanessa Mendez  47:58

20% of us have it, that doesn't mean that we 20% of us will develop diseases, and the good ones are suppressing it. So if you're a high risk of contracting c diff, meaning you've had it before, you're a nursing home resident, you're a long term facility resident, then the benefits of taking probiotics while on antibiotics may outweigh the risks. But in the general population, they say, we don't see that the benefits are going to outweigh the risk, really consult with your physician to see if it's the right one for you.

Dr. Rizwan Bukhari  48:27

Except our physicians don't really know the answer.

Maya Acosta  48:29

If I have to take antibiotics. And this is just a general question for our listeners, if you have to for whatever reason, and you're saying foods what you do before, during and after is very important to help restore that gut bacteria. What do you think about kimchi, miso, kombucha

Dr. Rizwan Bukhari  48:45

Fermented foods?

Dr. Vanessa Mendez  48:46

Yeah, I think that the you know that the probiotic foods are really good, and they should be part of our weekly meal planning. I think more important than anything is prebiotics. So really all the fiber rich foods. Why? Because the probiotic foods we know they're healthy, and they also act as prebiotics. So they're amazing foods, and I always incorporate them in all the meal plans for my patients. I think the bigger focus is focusing on that variety of whole plant foods. The research shows 30 plus plant foods per week. And again, you don't have to get that in a day. But if you think about it in a smoothie, you're getting like five different plants. So 30 plus plant foods per week, is really what's going to create that diversity of microbes because you're feeding all the different types. So 30 plus plant foods, including probiotic foods, miso and tempeh are the easiest to digest for patients suffering with digestive disorders. They're the easiest for them to tolerate. Remember that patients with digestive disorders have a lot of food intolerances because they're lacking their microbial army working for them and digesting these foods. So we have to do a very carefully very measured very Gradually, we do things like if you're intolerant to oats, or if you have IBD. And we know oats kind of like scrape at the bow, we give you old water, we include old water, like we literally drain old, we include that old water in your smoothie. And that has some prebiotics in it so that you can feed those microbes, but not overwhelmed, overwhelmed them, and then gradually, we will do growth, which is ground oats. So we'll cook the will soak the oats for at least 24 hours, we'll cook them but then we'll blend them. So that's growth, and then just to just a tablespoon, one day, and then progressively until we get you eating normally. These are patients who are incredibly, you know, they're incredibly challenged and what they're eating often they're very limited. And they've gone through all the different diets of traditional doctors telling them you don't tolerate that. So avoid forever, that is not the answer, because it's just a revolving door. So So yeah, so my first one would be diversity of plants, the ones that you can tolerate the ones that you can't, we can work with you. But 30 plus plant foods plus the probiotic foods, then we move on to lifestyle, right? We know that if you're very stressed out, that's actually going to decrease the diversity of your microbiome. Chronic stress and trauma is actually, especially in children is one of the determining factors for the diversity of your microbiome, how sturdy it's going to be for the rest of your life. We didn't mention, but in terms of my microbiome development, we achieved maturity of the gut microbiome by the time we're two to three years old. So our microbiome resembles that of adult by the time we're two to three years old. So imagine how crucial those first years are. So I love working with parents, because the more information you give them upfront, really the you know, the better outcomes we're gonna have. But let's talk about lifestyle in general. So, you know, if you're chronically stressed, that's going to decrease the diversity of your gut microbiome. So part of my treatment strategy is I send my patients home with deep breathing, diaphragmatic, breathing, belly breathing exercises, to train them to control their breath to something that they can, you know, tangibly do on an everyday basis. And then I encourage them, obviously, to see a therapist and all these things, but I incorporate breath work into my treatment strategy, then come Sleep, sleep is one of these, we know that we need that rest, the microbes are still working, but the body needs to rest to be able to regenerate, right and, and if we don't get enough sleep, our sleep is not restorative, then actually, that's chronic stress, right? So that's not going to be helpful either. So that sleep and that sleep regimen, a lot of people especially now, you know, we're more on our phones and our on our tech devices now than ever, it's important to educate them on that sleep regimen, right? before they go to bed a couple hours before they go to bed, you meet patients where they're at, right?

Dr. Rizwan Bukhari  53:05

Obviously, sleep affects our stress hormones tremendously.

Dr. Vanessa Mendez  53:07

Absolutely. And then, you know, one of my favorite aspects of, of talking to patients is encouraging them to go outside, right. So I, again, we meet patients where they're at, if you are living in New York City, and you cannot, you're afraid of going outside, a lot of people have developed very bad phobias from the pandemic. And I get them working with a plant, I actually hadn't get them working and growing a plant. So I, I have them getting organic soil and doing their little pot, and then you know, getting dirty in that little pot, and then watching that little thing grow. It's incredibly therapeutic, and it helps the gut microbiome. So you're, you know, you're killing two birds with one stone. It's a it's, it's one of my favorite things. But also, you know, I encourage them look, go out into nature, go drive to a park if you if you have access to it, keep driving until you find a secluded field where you feel comfortable, especially during the pandemic and then and then just sit there. You can just sit there, if you don't want to walk, you don't have to walk, if you want to walk even better, but then sit and just like be one with nature. I think we lose sight of the big picture when we are in front of our computers in our homes. We bought these things we feel like we have control over them. And actually in reality, we don't so we can control certain things, but not but not everything that's happening to ours in nature per week is actually that, you know, we're we're seeing the that that good effect on our health.

Dr. Rizwan Bukhari  54:43

Something that I heard during what you were just saying and I think is important for our audience to hear is that there are people who have problems with certain foods. It may be an intolerance, that's due to our gut microbiome, and it can be fixed so it's not really a true food. allergy, which means you have to avoid that food forever. But it's a food intolerance that can be remedied.

Maya Acosta  55:05

Riz was growing his microgreens. And then we started sprouting, are those also very good for the gut? 

Dr. Vanessa Mendez  55:10

Absolutely. So you know, sprout sprouting and germinating. If you think about it, it's like it's a baby, right. So all the nutrients are very, very concentrating, very, very concentrated in this tiny little particle food. So they're incredibly healthy in terms of antioxidants and phytochemicals. And they're, you know, they're also prebiotics. So we definitely need to incorporate them in in our meals.

Maya Acosta  55:36

What are the most common digestive issues that you see? And how quickly are they resolved with a diet and lifestyle metaphoric modifications? And also, what do you think about colonics?

Dr. Vanessa Mendez  55:48

Let's start with the last one colonic. So basically, based on the studies that we've done, when we prep patients for colonoscopy, it's you know, it's a form of a colonic, because we give them a laxative, they take it with large amounts of water or liquids, and then they clean out their colon so that we can see inside it. So it's the same thing as a colonic, we've done. We've tested the microbiome before and after we know that there's a transient shift in the microbiome. Again, because of the system and the genetic material, they do come back, but there is a shift. I have patients, you know, not many, but once in a while, you'll get a patient that after prepping for a colonoscopy, they'll get like worsening constipation until you get those, you know, get that microbiome back and their motility back to functioning. So imagine we do colonoscopies because we want to one diagnose or prevent a cancer, you know? So these are crucial tasks that we need to do to save lives or diagnose people with certain conditions. So when we need to do them, we do them. Why would we want to cause this shift in the microbiome otherwise? So I think that colonics are one of these fad, I guess, diets, you know, fad products that are out in the market. And it's because people are living with chronic constipation and gut issues. And they transiently feel better when they clean out their gut, and they lose weight. Yeah, because we hold X number of pounds of stool in all of us. And when you're cleaning out your gut, you feel great. There's nothing worse than the feeling of being constipated. And a lot of people don't even know that they're constipated. It'll reflect us a migraine, it'll reflect as brain fogginess. And when you clean out your gut, yeah, you feel better transiently. But you've also disrupted your gut microbiome. So why not clean out your gut the best way possible. And that's with lifestyle, write with lots of water, fiber, fibers, foods, and you will become regular. And you'll be cleaning out all those toxins in your body. Right, not only the ones that we ingest, but also the ones that are byproducts of the things that the mechanisms that are happening in our body, we release a lot of toxins through our bowel movements. So why not do it naturally, there's no risk of damage. If you do colonics in preparation for the colonoscopy, then what do we eat after very simple, it simply said, right, but all these patients have food intolerances. So that's where you have to work with them, but it's the same. Try to optimize your nutrition if you were eating a lot of processed foods or refined sugars, or even if you were eating them once in a while, just right before your colonoscopy or right before you take antibiotics. Start not doing that. No sodas, no artificial sweeteners. Really just stick to what we recognize this fall was what your grandmother would recognize as the real food. do that before, during and after to to really get that microbiome just focusing on on re energizing itself and repopulating itself

Maya Acosta  58:52

And how important are colonoscopies? When should we start doing them and what conditions can you discover as a result of the the procedure?

Dr. Vanessa Mendez  59:01

Yeah, so as gastroenterologist, we do endoscopy and colonoscopy that means that we give you some medication to make you sleepy and then we take a camera and look inside your stomach with an endoscopy, an upper endoscopy, and with a colonoscopy. We go through your rectum and we look at your colon. So the older recommendations on where to start preventative screening for colon cancer at age 54, regular population 45 for African Americans, and if you have a family history, then you really have to talk to your doctor because your screening protocol can start way earlier. Now there's been a huge shift and even since last year, some of the guidelines you know we have a lot of gi guide a lot of GI societies, some of the societies and american cancer, the USPF taskforce came out with a recommendation that everybody should be screened at 45. The reason is because My american cancer had said that last year Alrighty, so now the rest of the societies just have to catch up the payers, the insurance has to cover it. That's all based on the fact that we're seeing colon cancer at much earlier years than we were before and more much more aggressive cancers, right? How many different celebrities have already died of colon cancer of very young ages? It's incredibly, you know, and that those are the ones that make the news. But what about all the other ones that are all the other people that are dying from these very advanced cancers at younger ages than ever before? And we think has a lot to do with lifestyle and diet.

Dr. Rizwan Bukhari  1:00:40

Well, there you go. I was gonna say, do you have a hypothesis as to why we're seeing more aggressive disease at an earlier age? It's our standard American diet.

Dr. Vanessa Mendez  1:00:48

Yeah. And you know, the World Health Organization in 2015, declared, you know, process needs to be cancer causing just like cigarettes type one carcinogen, for processed meats. So one hot dog a day, or four bacon strips a day is the same as smoking, you know, a pack of cigarettes per day, it's a type one carcinogen and a probable carcinogen for red meat. Why would anybody consume these foods? Why is there no label on them? Why would any doctor ever say it's okay to eat them is beyond me. But we know that diet has a huge has a huge effect on specifically colon cancer and all digestive cancers.

Dr. Rizwan Bukhari  1:01:32

As important as nutrition is, in gastroenterology. What do you see your colleagues? level of acceptance? And how much do they preach about nutrition? And how much do they stress it?

Dr. Vanessa Mendez  1:01:45

Oh,

Dr. Rizwan Bukhari  1:01:48

it's a loaded question, isn't it is

Dr. Vanessa Mendez  1:01:49

I already loaded question because I think of all the fields, obviously, I'm so I'm biased, because I'm a GI doctor. But of all the fields. I think gastroenterology is the one field that should and does have a completely direct connection with the foods that we're eating, and the drinks that we're drinking. And the fact that we don't get any further training than yours, you yourself. You know, anybody any other doctor is just, it's baffling. And in terms of my what my call my colleagues, I different days, I feel differently. Some days, I feel very discouraged and frustrated. Other days, I consider myself lucky that at least I can, you know, I can teach them the right things to my patients. But it's very, very discouraging, it's very, very sad, they still get put on low fiber diets. They're still proposing low low fiber diets for patients with inflammatory bowel disease without any really knowledge of what, you know what the body needs, why IBD came about in the first place. You know, when physicians don't know something, they have defense mechanisms, they can deny it. They can they they can deny that it's important, they can get defensive. Right. And which often happens, too. So the healthy defense mechanism should be you know, I don't know enough about this. But how do they say that?

Dr. Rizwan Bukhari  1:03:25

Well, very often we are taught to act like we're an expert on something even when we're not, you know, give an answer and act like you really know what you're talking about, you know, so so I experience the same frustrations in my field. But I I imagined you do too. I just was curious to know if there's a trend or a change, or you see that more and more gastroenterologists are understanding how important nutrition is in our overall health.

Dr. Vanessa Mendez  1:03:49

So I am seeing a little change at least in the social media world because a lot of the plant based I guess, because I'm in gi I recognize them and I know them, but I think I feel like there's a lot of plant based, or least plant forward doctors out now in, in, in social media, educating the public, more so than other specialties. But again, I'm biased because I, I am a GI and I attract others, you guys, so I'm not sure do you see a lot, a lot of your colleagues,

Dr. Rizwan Bukhari  1:04:17

I know exactly one vascular surgeon in the entire country who's plant based, that would be me. When I became plant based, I was known as the crazy doctor. That was about four or five years ago. And now over time, they now know me as the healthy doctor. So you know, you know, it's it's been a change, and there's some acceptance and some changes. And I think that there is a change in consciousness that is occurring. It's subtle, but people are beginning to understand how important it is. And we're probably in our infancy and hopefully, it'll continue to evolve.

Maya Acosta  1:04:51

So Dr. Mendez, I've also in a in another lecture that you gave, I heard you mentioned that you were developing a protocol for IBD I think It was with your registered dietitian, do you have that established already?

Dr. Vanessa Mendez  1:05:03

Thank you so much for asking. So we are treating our patients with our IBD protocol, we are planning to launch it like for anybody who can, you know, who wants to join to the public, you know, I can't see all patients because of state guidelines, unless you're licensed in a state unless COVID is allowing it, I don't have access to see patients in every state. So we developed this protocol to be able to help people, you know, outside of our stay and help a lot more people. So the protocol is a six week protocol, involves all lifestyle. So we will have, you know, a yoga teacher actually come and teach these belly breathing exercises. In terms of the nutrition aspect of it, I teach them the, the, the root cause of what you know, what may have happened, why they got this inflammatory bowel disease and what's actually happening in their body right now, which is two prong. There is a dysbiosis, that imbalance in your gut microbiome that created that, that cascade to inflammation and autoimmunity. So the medications are attacking the inflammation, the auto immunity, that immune response, right, but nothing is helping that dysbiosis. So unless we actually attack that, from a nutrition standpoint, you're not doing anything. So our drugs are biologic drugs, which are chemotherapy style drugs for IBD. They, they only get about 60% of patients into remission,

Dr. Rizwan Bukhari  1:06:35

they're managing the symptoms, not the cause.

Dr. Vanessa Mendez  1:06:37

Correct. And that's clinical remission that is not actual remission, that when we look and we take biopsies, there's no inflammation, that's clinical remission, so and it's only 60% of patients. So what about all these other patients and if you fail the first biologic, you go on to the second one, those remission rates actually decrease every time. So we're not actually being able to help a lot of patients, those drugs, I think they're still placed for them. And they're incredibly important, but we don't get to that root cause of that dysbiosis that imbalance in your gut microbiome, that process will continue. And you know, what we're, that's the protocol. I, you know, we continue them, they continue with their medical therapy, but we're teaching them from a lifestyle perspective, how to eat especially dealing with their food intolerances, how to incorporate these foods to the point. And so we don't do an elimination diet, we do an incorporation diet, to optimize their gut microbiome to getting eat, getting them eating 30 plus plant foods per week, and get their gut healing. So you know, we'll have a questionnaire now that I'm joining the Indiana group, I do plan to put this to the test in a trial. So we're really, really excited about that. There's nothing like it. There's a UMass a IBT. Diet, that is not a plan based protocol. And I believe it's a little bit more restrictive. It's a good one. But you know, so we're learning from that. My colleague, Ari Levine in Israel is doing wonderful things with the pediatric population. He's a pediatric gastroenterologist over there. He has multiple trials going on. And we you know, we recently had a meeting with him. And we're learning a little bit from each and just doing the first like, IBD gut healing, like plant based IBD eco healing diet. We haven't come up with a name yet. But yeah, we're planning to launch it in January,

Dr. Rizwan Bukhari  1:08:33

you're gonna have to come up with a nice acronym. So we can just say,

Maya Acosta  1:08:36

I was wondering about the sort of the research that you can gather along the way since you are treating these patients and probably seeing these incredible reversals and improvement on the microbiome was sort of conditions do you have you seen can be treated within those six weeks.

Dr. Vanessa Mendez  1:08:52

So this one specifically is for inflammatory bowel disease. But one of the most common conditions that I get now is food intolerances. And you know, people feel like oh, they'll eat this food and they feel terrible. Anything from bloating, gas, headaches, fatigue and malaise. And it's food intolerance. Right. So you had been, Dr. Riz, you had mentioned the idea of a food allergy or food allergies, very different rights are more of an immediate response. You can get hives, you can get a chain, you can get scratchy throw your you can have trouble breathing, it's a very acute and dramatic response that you have to food. And if you do have that you need to see your doctor. They're going to do some allergy testing, but that's a I have, like two patients with food allergy with a food allergy or two, the rest are food intolerances, and it's this more delayed response. It could be a cube, but it's more usually a more delayed response where they don't feel well. And again, it's because that microbiome is not sturdy enough to

Dr. Rizwan Bukhari  1:10:01

It's interesting, you should bring that up because I had a nurse come up to me the other day, and she's been having some food intolerance issues. And she went to a chiropractor who did some testing on her, and came up with about 30 or 40 different foods that she was intolerant to. So their answer for her was to avoid those foods, I had to sit down and talk with her about, you know, there's no, there's a different approach. These are food intolerances, not allergies. And if you correct your baseline issues, you can begin to probably eat most of these foods again.

Dr. Vanessa Mendez  1:10:34

And you want to hear that even the crazier part of that these food allergy, or these food intolerance tests are now validated.

Dr. Rizwan Bukhari  1:10:41

No, I know. In fact, she showed me the pamphlet for the test that she took. And it was clearly not some sort of approved testing, nothing validated, no science behind it.

Dr. Vanessa Mendez  1:10:53

Food intolerance, testing is not validated. And it has not been recognized by any of our gi societies. It hasn't been put through the appropriate testing and research to be for us to be able to say, Hey, this is actually accurate, and we're gonna be able to use it. And we'll be the first ones to say when it's validated, because we want to be able to use these, it'll make my life a lot easier. There's

Maya Acosta  1:11:14

so glad that you brought that up. Because a lot of times that's one of the things when people have different panels, and and studies or tests done, they're looking to see what what do I need to eliminate? But what do you think about nightshade foods? I wonder if that's a common question.

Dr. Vanessa Mendez  1:11:30

So it is a common question. I think lectins is another common question. I think these are all and going along with the food intolerance test. They're all these stem from somebody. trying too often more often than not, I'm not gonna say like, for example, fodmap diet was a legit diet and elimination diet with a quick reincorporation of these foods little by little after six weeks. So that's legit, it was developed in Australia. And you know, there is a place to use that I don't personally use it, because I think that it's very broad, and everybody is completely different. I believe in more of an individual approach to patients, obviously, that takes a lot longer, but I think it's more effective, and less discouraging to patients. But a lot of these other you know, fads came about or ideas or myths came about or somebody's trying to make money off of you. And the idea is that they we don't have the evidence to support things like my shell shades being bad lectins being bad, or you know, whole grains being bad or gluten being bad in specific populations. We do avoid things like wheat, you know, like in celiac disease, but also now we have new evidence saying that inflammatory bowel disease, wheat can be one of the triggers to so we avoid it in these populations. But other than that, by eliminating a whole food blindly for the rest of your life, you're actually, you know, robbing your body have that opportunity to get to the next level of healing.

Maya Acosta  1:13:04

What are the four states where you're licensed to practice telehealth,

Dr. Vanessa Mendez  1:13:07

I am licensed in Florida, Maine. I am I have the COVID license for California. New York is allowing me to practice and actually like 15 other states are allowing us to practice right now without a license. And then about 17. Other ones have an emergency license. So really, I can see patients in most states at this time. We hope that that will continue in, you know, in the coming year and beyond. But I am applying for my Texas license My New York license and full California license as well. But yeah, I can see patients in most states, and I also see them internationally. I was thinking we need you in Texas. We know we don't have anyone like yourself here that I know of right?

Dr. Rizwan Bukhari  1:13:59

I don't know. I don't think so. No.

Maya Acosta  1:14:01

There are some people that still continue to have digestive issues. You know, I mentioned that we have a friend who has Crohn's disease, we know someone else with all sorts of all sort of colitis, and who eat plant based. I know that one of them. The condition is triggered with stress, those kind of conditions along with SIBO, how long do they take to resolve and have you ever seen any of these reversals with your own patience?

Dr. Vanessa Mendez  1:14:27

Yeah, absolutely. So after, you know, using my husband as a guinea pig, I actually have done this in countless patients. We're all actually induce them with the standard medical therapy standard medications, and I'll induce them with a plant based diet and I've seen a complete and utter healing from huge ulcers to no ulcers at all in three months and this is something that the patients had been dealing with for several years and three months is actually very quick and that is just in the ulceration. their symptoms actually improve dramatically right away because they are on medical therapy plus this diet, they improve a lot quicker, really usually in a matter of a couple of weeks. You know, there's always patients that have had the disease longer, remember inflammatory bowel disease very complex, they can have narrowing in their bowels. So that, you know, they may not they may not feel better for a long time, sometimes they require surgery. So everybody is independent, you know, everybody is completely different. But usually we see the response very quickly with most conditions.

Dr. Rizwan Bukhari  1:15:39

Do you see a concurrent drop in inflammatory markers like C reactive protein and sed? Right?

Dr. Vanessa Mendez  1:15:45

Yeah, so the one we actually use even more so is fecal calprotectin. So we've used this as a gold standard for a couple of years for ileocolic, alien colonic disease. Because it, it's actually been shown to predict a flare by up to four months. So it starts to increase before the patient actually experiences a flare. So we track these biomarkers now proactively, which is one of the gold standards in our IBD care to not do reactive, but to proactive monitoring to make sure these patients are doing well. But yeah, the biomarkers actually come down really quickly. Because that inflammation is decreased. Now the ulcers take a little bit longer. That's why we do the colonoscopy at three month mark after three to six months after starting a new therapy. But yeah, but biomarkers respond really, really quickly.

Maya Acosta  1:16:38

Well as we wrap things up a couple of things. So we like to end our podcast by asking our experts, if you have a tip that our listeners can implement to upgrade their life. And then what's the best way to get ahold of you if they want to learn more from you?

Dr. Vanessa Mendez  1:16:54

Yeah, so I think the tip would be focus on real food and try to get yourself to eating different foods, variety of foods as tolerated obviously. And the other thing would be you know, really taking that downtime, either through meditation either through going into nature or both to really get yourself centered because we know that you know, we didn't talk about this but we know that the gut and and the brain are intimately tied we talked about that. It may be through the short chain fatty acids but definitely what we're feeling in our mind we're gonna feel in our gut so really optimizing that relationship you have with yourself with your body and with with nature is going to get you healing quicker. And the you can contact me I have a website Dr. Dr. Drvanessamendez.com. I'm also on social media, on Instagram through plantbasedgutdoc and I'm on Facebook has been a tremendous honor. Dr. Vanessa members.

Dr. Rizwan Bukhari  1:18:03

Well, Dr. Mendez thank you very much. We've enjoyed it. I've learned a lot today. You do present the information in a very understandable way. And I think that's, that's great. And I look forward to you, learning more from you in the future. Thank you so much, guys,

Dr. Vanessa Mendez  1:18:18

and thank you for this opportunity. It's

Maya Acosta  1:18:20

been a pleasure for me as well been listening to the plant based DFW podcast show. If you like our content, please like, share and leave a review. Our goal is to provide quality episodes to help support the community.