The systematic degradation of gastrointestinal health is breaking down one of our most primal pathways to wellbeing. According to Dr Daniel Weber, the gut is the second organ system in evolution and is by far, the most complex, with the intestines being both the largest endocrine and the largest immunological organs in the body. The gut is the lynch pin to it all and is at the seat of most psychophysical disease presentations we know today.
Dr Weber joins us today ahead of his forthcoming key note speaking engagement at the ATMS Functional GI Symposium in Sydney in September 2019.
Covered in this episode
[00:52] Introducing Dr Daniel Weber
[02:07] The Gut: the parent of all organ systems
[04:05] The gut-brain axis
[09:24] Psychophysical disease
[10:24] The quest for single causes of disease
[14:19] The systematic breakdown of our internal environment
[21:20] To probiotic, or not to probiotic?
[26:33] "Stress impacts everything"
[28:36] Traditional Chinese medicine
[33:21] The ATMS Functional GI Symposium 2019
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Dr Daniel Weber who began his study in Oriental medicine in 1969 in Boston with further studies in Japan in Japanese-style acupuncture. He completed his Master of Science at UTS Sydney and his PhD in Chinese Herbal Medicine by writing the first English-language database on Chinese Herbal Medicine in 1992.
Over the past 40 years, he has lectured, researched, and written articles and books all the while being a clinician at heart, specialising in integrative oncology, in which he is currently completing his Doctor of Science. Daniel is a consultant and adviser to the International Consortium on Chinese Medicine and Cancer, which is co-sponsored by the National Cancer Institute in Bethesda. He is also Vice Chair of the oncology section of the World Federation of Chinese Medicine Societies and Visiting Professor at Tianjin University.
Welcome warmly to FX Medicine, Dr Daniel Weber. How are you?
Daniel: I'm well, thank you. And call me Daniel, please.
Andrew: Will do, thanks, Daniel. And thanks for making time to join us.
Daniel: My pleasure.
Andrew: Now we're talking about gut health, and you're going to be speaking at the 2019 Functional GI Symposium in September 2019, for the ATMS. Just to start off though, there's been an ever-increasing amount of research done on the GI tract and its inhabitants, why? What's happening?
Daniel: Well, I think it's just this sort of a cultural blindness on our part. You know, we always...when you talk about the heart of things, when you talk about executive decisions, you know, we always put a great deal of emphasis on the brain, the central nervous system, the cardiovascular system. You know, the lowly stomach, or even lowerly or lowlier large intestine, hardly considered...always considered culturally just a sort of thing where you put food in and it just ends up somewhere in your body.
But, you know what, look at it historically, the gut is the second organ in evolution, the first organ being skin. Did you know that sponges have skin?
Daniel: I didn't know that. No, no. But obviously any living organism has to have a membrane that is semi-permeable to separate itself from the environment and exchange appropriately the various things from inside or outside. And the gut evolved from skin. So the gut is...we're a tube, skin on the inside and skin on the outside.
But what we're now discovering is that the gut is the most complex organ, far more complex than the central nervous system, or the cardiovascular system, or the endocrine system. Because, in fact, it is the parent of all of those organ systems because it was the first organ system in animal existence.
Daniel: Well, it's beginning, again, increasingly we're recognising through the studies that there is an intrinsic relationship between the gut and the brain, the gut-brain axis. And, for example, many of the neurotransmitters that we talk about in the brain, serotonin, GABA, actually existed first in the stomach and in the intestines. They were part of the development and then, the central nervous system came along, you know, the brain is the last thing that comes along, you don't need a brain. I mean, lots of people walk around without brains at all, all day long. So yeah, I think humans value their brains too much, and then, don't pay attention to them.
So the gut actually has this tremendous impact on neurological diseases, on psychophysical disease, on emotional things, on mood, on cognition. For example, here's a question, Andrew, when is the prefrontal lobes in the brain fully myelinated?
Andrew: Ask me an easy question.
Daniel: Oh, yeah, why don't I just throw away...Yeah.
Andrew: I'd like to say Wednesday at 7 p.m.
Daniel: Well, that gives me at least 24 hours to get one. No, it's at 21 years of age.
You know, the brain is very slowly developing… and it depends on input from the body. One of the major nerves connecting the gut to the brain is the vagal nervous system. And the gut tells the brain what's going on in the world. We tend to, you know, being executive function sort of people, think that, you know, our brain is really important and we're making these decisions...no one has free will, we're just kind of traipsing around. Here's another one...
Andrew: There is a point to that.
Daniel: Well, no, I never get to the point. Why would we have a conversation if we end up at the point, you get to the point, you go, "Oh..." then there's no more questions. So I'm not going to get to the point.
We have about 1.4 kilos of bacteria in our intestines. 1.4 kilos. That's about the same size as the brain, actually, in terms of weight.
Andrew: Ahh, yes.
Daniel: And this is really who we are. This gut flora uses humans as a bus to travel around in and mature so it can pass it on to the next generation. Think about it that way. Rather than that the brain is this almighty organ that dictates reality to us, that we're actually just a transporter for a lot of microbiome that needs to get passed on to the next generation.
Where I'm going with this in a meandering sort of way is that every organ system in the body, including central nervous system, endocrine system, immune system, cardiovascular system, everything started in the gut. And the gut, directly or indirectly, influences all of those secondary organs. The largest endocrine organ in the body are the intestines. The biggest immune organ in the body are the intestines.
Daniel: So we don't pay enough attention to that. And so, when I do a lot of my research in the gut-brain axis and neurological diseases, we see a tremendous... Autism for example, 15 years ago, 1 in 166 children in the United States were diagnosed with autism spectrum disorder. Last year, it was 1 in 59. That is a tremendous increase in 15 years. Now, some of it may be records, maybe diagnostic procedures, but there's something going on in terms of long-term diseases neurologically. Whether we call them psychological diseases, mood disorders, neurological functions like autism or Parkinson's disease, Alzheimer's disease, these are increasing at an accelerated rate.
Daniel: My belief and my research indicates that a lot of this is due to the breakdown of the integrity of the gut.
Andrew: Oh, absolutely. I was speaking with Dr Johan Van Den Bogaerde just recently, and apparently, I haven't seen this, there's a very new study out about autism and it's link with the gut, with the gut bacteria.
Andrew: I was very interested by something you said, and I've never heard it said this way; “psychophysical diseases.” Normally we say neurological disorders or something like that, but you're saying psychophysical, so you're linking that. I love it.
Daniel: Oh, absolutely. You know, for example, it's now pretty well-established, even in the orthodox medical community, that irritable bowel syndrome is a bi-directional disease, part of it is gut and part of it is central nervous system. And we don't know where it begins, and it doesn't matter because they reinforce each other. You have to treat both or you're not going to get any improvement. The increasing levels of depression, I think, are really not specifically psychological, in the traditional Freudian sense, but rather psychophysical depending on the breakdown of the integrity of the most critical organ in the body, which is the gut.
Daniel: Yep, yep.
Andrew: By the enterochromaffin cells.
Andrew: And yet, we're talking about a bi-directional effect and we're talking about major effects within the brain. You know, how do you prioritise the weight of therapy, if you like, to the 95% of serotonin in the gut, which is having, let's say, Y minus 5 effect, whereas in the brain… or it appears that the brain is the Y plus 50 effect? How do you sort of weight each other when you're talking about gut-brain axis and brain-gut axis? Do you give even-Steven for both or do you tend to prioritise one before the other?
Daniel: Well, I think the question is a reflection of a rationalist science. That is, that there is a hidden mechanism somewhere, you know, think Cartesian, we're going to discover it, we're going to understand, we're going to discover the underlying factor, the one thing. This has driven Western medical science for about 400 or 500 years, and it served us well, I mean, the whole idea. But when you're talking about chronic degenerative diseases, this pathway just doesn't hold water.
Daniel: There is no single one cause. When we're talking about holism, we're talking about a spectrum of things from this intracellular, the mitochondrial function, the genetic functions in there, the metabolism, protein productions all the way through to how well you get along with your children.
Daniel: That's holism. It doesn't stop at the body or the brain, it continues on. Our entire culture is sick. Clearly.
Andrew: Yeah, yeah.
Daniel: I mean, if you look at what's going on in the world... And it's the same disease that is causing people to have stomach cancer. There is only one disease. And what we keep on trying, from the rationalist's point of view, is to find the single thing so we can find the single magic bullet.
I often ask some of my students when I'm teaching. We've had a war on cancer since Nixon, and that goes back 50 years. And while there's been some major breakthroughs and certainly been some very effective treatments, particularly because of early diagnosis, and no one disputes that. You know, cancer incidences aren't changing and they may be going up. Again, that's a statistically reporting thing. But why aren't we getting a cure for cancer when billions of dollars...because there is no cause for cancer.
Now, at the same time, what was it? 40 years ago, HIV came along and, all of a sudden, there was this terrible scare, nobody knew what it was, people were dying, you know, they called it ‘the gay disease’. And they finally just said, "Okay, this is a virus," okay, HIV, they found it. How long did it take them to come up with a reasonable treatment? About 15 years. This is the difference. Acute medicine dealing with single pathogenic factors can be worked through rationally.
Daniel: But when we're talking about complex diseases that involve not only the cells in our body but the way in which we love each other and care for the planet, that's the disease that is different and has no single cause. I got fairly philosophical there, didn't I?
Andrew: No, that's great. I love it I've got to say. Can we just go back though, and delve a little bit further into some of the disorders that you'll be covering at the ATMS Functional GI Symposium in September 2019?
Daniel: Yeah, we're going to look at...I mean obviously look at the gut-brain axis, we're going to look at the endocrine system in there, we'll look at the enteric nervous system, which is an entirely different nervous system, which is just fascinating.
But one of the things I want to look at, for example...and we're coming back to what you said earlier about the microbiome, you know, say Parkinson's disease, autism, Alzheimer's disease, attention deficit disorder, or ADHD, all of these diseases are apparently increasing in virulence. And I believe, and research points out, that there is a real clear connection between the degeneration of the gut function and the microbiome.
Now, I was born before penicillin so, you know, I didn't have an antibiotic until I was probably up to 9 or 10 years of age. Now, children are getting antibiotics in-utero because their mothers are eating foods, whether it's farmed, fish, or beef, that have antibiotics in it.
Andrew: Let's cover that one then because that's a really good...
Daniel: Yeah. We're destroying the internal environment of the gut.
Daniel: And with that, we're getting an increase in cancer, an increase in psychological or psychophysical diseases, we're getting an increase in neurological diseases, the ones like what I mentioned, autism spectrum. And we're getting a break down in the very capacity of systems working together.
Andrew: That's awesome. Can we expand on that?
Daniel: Well, okay. Let's look at autism spectrum disorder. Now, undoubtedly that has existed historically. Is it increasing? As I said, statistically, I mean the increase in 15 years has been massive. Now, maybe that's some of those statistics, but I do believe...what is autism? Clearly, all the research indicates it's a breakdown in gut function, the gut flora is in disregard, there is a heterogeneous population amongst this, rather than a complex earthy combination of things. And that directly impacts the brain. And children, or adults for that matter, with ASD, have difficulty communicating, have difficulty being in communication with feelings and expressing those feelings.
Come back to the vagal nervous system. The vagal nervous system is one of the primary communicators between the gut and the brain. It is 90% afferent. The gut is telling the brain what reality is. You break that down and you get degeneration of the brain. If the gut doesn't work, the brain doesn't work. The brain doesn't work... well, further back. Let's go to farming.
If we don't produce food that people find useful, helpful, and full of nutrients, with good bacteria in the soil and fermented products, then we don't have proper nutrition. The gut doesn't function, we don't get the micronutrients we need. Then we begin to have feelings of neurological-function, disorder, mood, anxiety, so forth like that. Then we have social disharmony, then we have the falling apart and the tribalisation of our culture. You see a trend here holistically. Holistically, we're looking at a breakdown in the very intrinsic values of human transformation. What is the gut? It transforms things that are without much value into something that is nutrition, and it is done by a very complex process. And we're losing that capacity, and we're not grieving, that's...
Andrew: Oh, now there's a big one.
Daniel: Yeah. Well, then...I'll go back. Okay, the development of the central nervous system. Human children are born way too early in terms of nervous system. Almost any other animal, when it's born, can at least stand up...or a chimpanzee, which is...the chimpanzee is born with the same size of braincase as a human child, 450cc, so a chimpanzee and a human infant are equally smart.
Now, a chimpanzee, on the other hand, can grab onto its mother and ride on its back, a human infant can't do anything. It can't even turn over. So the nervous system hasn't been developed very well. Someone's projected that a child would have to be in-utero for 21 months to be able to be equal in development to another kind of mammal. Now, I wouldn't put that burden on any woman to have.
Daniel: No, you know...So what we have is that children are born into a pouch and that pouch is the family, it is the culture, it is the environment. So we have an internal pouch, the gut, which incubates bacteria that we get from our mother's nipple, from her vagina, from the foods that we eat because they've got dirt on them and there's bacteria there. We're growing this internal environment, it's very complex and it takes about 16, 18 months for this to really come into some form of maturity. And at the same time, we're developing a nervous system, which is equally complex.
Now, here's something...and I don't personally want to insult raw-food fanatics...sorry, I shouldn't use the word fanatic, but those who purport that. Humans have big brains because we cook food. It takes about 5% of the nutrients of the food to transform it into something that we can utilise.
Daniel: You eat raw food, it takes 25% of the energy. That's why apes have big guts and flared ribs because their guts need to be so long to be able to break down the vegetable material. Humans have very efficient guts because we've been cooking. So where does the extra 20% of energy go? It goes into developing the central nervous system.
Daniel: Our gut and our brain need each other. When one of them fails, the other will fail.
Andrew: So Daniel, you know, we've spoken about how we really need to be thinking far more broadly than even just the condition that's presenting us if we're going to be treating them holistically. Practitioners love probiotics and we love that, you know, they're part of our good healthy gut bacteria, and so, therefore, we'll use that as a tool. But, you know, there's a lot of questions regarding probiotics and just how good they are with regards to...or I should say in comparison to, or contrasting to foods, and fibres, and things like that. So again, when we're looking at practitioners and what they want from you and for their patients, what have you got to say to them about the usefulness of probiotics?
Daniel: Most of the studies I've seen suggest that probiotics are of really no value after 30 days. If there's an issue, an antibiotic or chemotherapy or such, where they destroy many of the flora, then bringing that back in with some probiotics is really appropriate.
Now, remember that most formulations of probiotics have, you know, 10, 12 in there, and we're talking about over 1,000 different kinds of flora in the gut, and perhaps more that we can't even culture outside the body. So food would obviously be much more important, fermented foods of all kind would be much more important.
Surprisingly, also how you eat. Sitting down with family, cooking your own food, eating, speaking socially, having relationships, sharing meals, these also have an impact on the gut, and the gut environment, and the gut flora.
Now, supplementing with probiotics is really important. I personally favour prebiotics because I believe that we should feed the appropriate biotics and create the diversity of flora, that is really an important thing. Now, that all occurs before we address whatever the specific issue is, maybe there's a mood disorder? People who have mood disorders don't necessarily eat very well, you know, they're depressed, or they're anxious, or they're not sleeping well, they're self-medicating. So they're not eating well. So telling somebody, "You should eat well and eat sauerkraut every meal," is not going to go there.
We come back to it, "What is the person wanting and how can we build on that particular need?" And it all comes down to nutrition, whether it's food we eat or the relationships we have. Those things are important to develop. There is an absolute 100% connection between how we think, the moods that we have, and the function of our gut. So when we're looking at changing any one of those aspects, we need to actually address all of them.
Andrew: So, therefore, you know, do we have to look at a physiological level here and just target what's happening physically first, and get things moving, and then, slowly hand over the responsibility of care to the patient?
Daniel: Oh, of course, it has to be a partnership. I mean, to prescribe to somebody without talking them through the understanding of why we're doing something like that, I think is just shoddy medicine. So we have to bring them on to, you know, understanding rather than just say, "Oh, yeah, yeah. I'm going to eat well. I'll exercise every day." Sure, sure you will. No, you won't.
How can I engage the patient in this process? You're mentioning SIBO. SIBO often occurs because of hypochlorhydria, low stomach acid, which is increasingly common in people who age, people my age have very low levels of hydrochloric acid. If you have low hydrochloric acid, you're not getting the kinds of bacterial function, you're also not creating the peristalsis, and therefore that, people who take PPIs, for example…
Daniel: Have much higher levels of SIBO than the general public. So again, pharmaceutical drugs are actually an exacerbating conditions, solving one small problem like gastric reflux and creating a much more severe condition like SIBO.
So the question is, "How do I treat the person?" I treat them by finding those things that help them move. What is it that is not moving, in simple terms?
Andrew: You mentioned earlier that even these microbiota-driven disorders are increasing in their sort of severity over time. I mean that's a really big thing to notice because you've got a heck of a lot of years of practice under your belt.
So are you finding that it's all diseases, like including the amount of stress that we suffer from in our modern convenience-driven societies? Do you find that there's, you know, a whole hodgepodge of culprits there like the farming practices as well? Or can you put your finger on like one or two real meanies that, you know, you can really change for patients?
Daniel: Oh, look, yes. I mean obviously, you know, all of those things are critical. You know, and I think we should be looking at farming practices and the use of antibiotics in animal feed and so forth like that. I mean those are...you know, medicine has to be a political function, you know, it can't be separate from that. Same with climate change.
But coming back to that, stress is one of the most important factors I think. Stress impacts everything from the mitochondria to the microbiome, it creates inflammatory markers because of the axis, the activisation of the HPA axis, high levels of Interleukin 1 and 6, tumour necrosis factor, these all are small enough to get through the blood-brain barrier and lodge in the brain. So the brain experiences it...it's sick. Sickness behaviour happens because of these inflammatory cytokines. So yeah, I would start with stress.
Daniel: What is it, what are you doing to manage stress? And some of these are such large cultural issues that it's very difficult, I think, for us as practitioners, to actually address directly.
Andrew: Yeah, ubiquitous and wholesale. I'm also really interested in how you marry TCM-aspects of treatment with the Western viewpoint. I mean, you work, as I said in your bio, with the International Consortium on Chinese Medicine and Cancer, co-sponsored by the NCI, the National Cancer Institute, in Bethesda. So you've got a hardcore Western approach there with, you know, an Eastern-medicine approach. Do you find that there's more of an acceptance of gelling of the system of medicine embedded in Chinese medicine and Japanese medicine?
Daniel: Well, here I may tread on some toes here. I mean, Chinese medicine, there's no such thing as singular Chinese medicine. Unschuld, who's one of the great authors on that said, "Chinese medicine doesn't exist," it's just a hodgepodge of various kinds of traditional medicines, you know, thumbed together by Mao in the '50s and they called it traditional Chinese medicine.
Part of it is that and also part of it is Western people don't understand that Chinese language, because it's based on pictograms, is much more metaphorical. So when they talk about Qi...and I've been thrown out of conferences of Chinese medicine by people who think I'm a heretic, I said, "There's no such thing as Qi. Qi is not some mystical, invisible, unmeasurable energy that is circulating in the universe, that's just nonsense." Is there something called...If we analyse what is Qi, yes then...but to claim it is some invisible energy is just medieval, you know? You know, and Chinese language as it is, particularly when it's taught in the West, just disabuses the whole real intention of Chinese medicine, which is scientific.
Daniel: You know, it is. I mean Chinese medicine is very driven by science, not rational science but empirical science. And the basis of it is just extraordinarily insightful because they understood polymorphisms long before we even understood the concept of genetics. However, how it's been taught in the West and how it is often embraced is, I think, really cheats people of the real advantage of it.
Chinese medicine, in its basis, is scientific. When I go to China and I teach there, and I do people, you know, doing Master's degrees, they have full bench facilities, they have full-spec, they have Western blot, they have everything, they just...full bench. This is not some concept, philosophical, this is medicine. They're testing it, they're doing trials.
Andrew: Yeah. I was speaking with Dr Caroline Ee about this.
Andrew: And we were discussing acupuncture for...I think it was pain, endometriosis. And when she was going through a few of the descriptions in an "energetic fashion."
Andrew: What was conjuring up in my mind was actually a Western picture of pain with endometriosis. You could actually make that analogy straight across.
Daniel: Sure, sure, sure. Look, if you look at the character of Qi, you'll see that it is made of three different parts. One is steam, which is the thing on the top, it's steam.
The second thing is a container of some kind and the third is a pictogram of a grain of rice. So if you read it, you say, "Qi is the transformation of a substance into something different.” It is taking raw grain, which you cannot eat, and turning it into a nutrient. Qi is the capacity to transform.
Daniel: That's what it is. In the West, we call that allostasis. So Qi and allostasis are the same thing. Does Qi exist? Yes, it's not some mysterious invisible energy...
Daniel: It is the capacity of the individual to renew themselves, to reinvent themselves, to recreate. That's Qi.
Andrew: So, constitution, resilience?
Daniel: Yeah, absolutely. And it may be constitutive, it may be psychological, it may be genetic. You know, who knows why some people are very capable of reinvention and why some people aren't?
I have to ask though, you'll be speaking, as I said before, at the ATMS Functional GI Symposium. What other things will you be covering there? What other pearls of information can we glean from you so that we can incorporate them into our practices the following week?
Daniel: Okay. There's two parts. One that everything that I put out and will lecture on is referenced. Everything is referenced. It is all backed by some kind of research. So that's number one.
Daniel: Number two, I say, "There's the information. Don't worry about it. You can have copies of the slides, you can do your own research. What you need to do is find out who that patient is and what they need. You are not a technician," and this is where we've lost medicine. We've turned it into some kind of technical skill, and medicine is a human skill. If I may.
Andrew: Oh, such an important statement.
Daniel: What's the difference between pure science and relational science? Pure science is physics, mathematics. Relational things are like architecture, you need to know the balance of being or egress but the beauty of a building is something different. And that's medicine, real medicine is inspired, based on knowledge, based on wisdom, based on acuity, but it is delivered to the person's need.
Andrew: We could learn so much more from you. Thank you so much for joining us on FX Medicine today, Daniel. It's been an absolute pleasure.
Daniel: You know, any opportunity for me to rant is always a good time.
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.