Q&A with Gerard Mullin MD, About His New Book on the Microbiome, The Gut Balance Revolution

Today our featured guest is my friend Dr. Gerry Mullin, integrative gastroenterologist from John’s Hopkins and author of the exciting new book The Gut Balance Revolution. I recently sat down and chatted with Gerry about his new book—specifically about one of my favorite subjects, the profound influence of our gut microbes in health and weight loss. Here is what he had to say.

FL: How did you first become interested in the gut microbiome?

GM: As an integrative gastroenterologist, it has long been clear to me that the gut plays a central role in health and impacts many systems throughout the body. In fact, in other systems of medicine such as Ayurveda and Traditional Chinese Medicine, the gut is understood to be the very center of health. This may be one reason these traditional practices often use nutrition as the first step in treating illness—a concept only recently being adopted in Western medicine.

For many years I have been using nutrition as a key intervention in treating digestive ailments—especially functional bowel disorders. What I found was striking: By optimizing nutrition—specifically by eliminating FODMAPs, a class of highly fermentable fibrous foods, many digestive symptoms improved, bloating disappeared and patients often lost weight effortlessly.

The research on the gut microbiome and related issues like small bowel bacterial overgrowth (SIBO) was in its infancy at that time, but what I experienced in my clinical practice certainly caused me to wonder if gut bacteria could be a contributing factor to issues like these. Even then we knew the gut played an important role in health and impacted various systems throughout the body such as modulating the immune system, synthesizing vitamins and more. So I have long suspected that microbiota may be implicated in health issues at a far deeper level than we first knew.

Of course, the recent explosion of research in this area has not only confirmed my gut feeling, but has shown us just how deeply our symbiotic partners impact our health—influencing everything from weight to mood to cardiovascular health and more.

FL: Your new book, The Gut Balance Revolution, addresses the role of balancing gut bacteria to achieve weight loss. Please explain the science behind your book and what doctors and patients need to know.

GM: There is a revolution in motion of how the gut and its ecosystem influences the body’s physiology and many health outcomes including mood, behaviors, neurodegenerative diseases and much much more.

In my first book The Inside Tract: Your Good Gut Guide to Great Digestive Health, I was one of the first docs to promote the use of low FODMAPs foods for improving GI symptoms. The book was a self-navigation, symptom-based system which used diet to improve gut health.  Those who were overweight and on a low FODMAP diet (not calorie restricted) lost stubborn weight effortlessly while resolving their gut issues.

The research exploded in this area around that time, linking gut dysbiosis to obesity and diabetes. I mentioned my observations to my editor at Rodale, they became very interested and within months they received 4-5 proposals from other authors. Thus, I quickly drafted mine under tight time constraints and was chosen by the Rodale team to author The Gut Balance Revolution.

The rapidly evolving science synergized with my program–even on a monthly basis as I was writing. In fact, it became difficult to update the book as the science was fitting the program perfectly.  Now many studies show that overweight/obese individuals have a high prevalence of IBS-gut symptoms and dysbiosis. The tenant of the program quite simply is: “Fix the Gut to Lose the Weight for Good!”

FL: With recent news reports, and now your book, linking gut microbes and obesity, how can gastroenterologists best address the requests/concerns of patients who may come to them asking for help in balancing their gut bacteria in order to lose weight? Is this science ready for prime time (actual practice)?

GM: I have to say that so many of our patients have gut dysbiosis as a core imbalance in the body’s physiology. Look at all the studies linking gut dysbiosis to the irritable bowel syndrome, inflammatory bowel disease, non-alcoholic fatty liver disease just in the gut itself! Beyond the gut it’s mind-blowing: allergies, asthma, autoimmune disease, autism, schizophrenia, depression etc. Probiotics appear to benefit many/most of these disorders.  Yet another indicator of how powerful balancing the microbiome can be.

Consider the number of people walking in your office with SIBO. Only 50%, at best, respond to an antibiotic and they universally relapse in a short period of time after they go off medication. This problem is then compounded by the fact that antibiotics have lasting effects on the gut microbiome. In fact, they may promote obesity as they are in cattle and poultry. Dr. Martin Blaser and others have published scientific articles on this issue.

I favor approaching gut dysbiosis with a dietary overhaul: Low FODMAPs in a first phase approach to eliminate triggering foods, then gently reintroducing food–favoring prebiotic foods along with probiotic fermented foods, (i.e. kefir, yogurt, kimchi, and more) to build back a biodiverse gut ecology and improve symptoms.  Losing the excess weight is a perk!

Do I think this is ready for prime time? You bet I do.

FL: What is your advice for other gastroenterologists who are interested in a more integrative approach to their practice? How can they best adopt this approach—any best practice advice or tips?

GM: First, there is a growing number of doctors who are incorporating these tools in their practice. Most of our patients in the GI –Liver disease specialty use complementary and alternative medicine (CAM) so we need to ask about their use of these modalities.

Second, patients are reluctant to be open about CAM use with their doctor for fear of being ostracized. The data has improved in the last 5-10 years but it’s still a factor to consider.

I suggest starting by being open minded and knowledgeable on CAM so you can properly advise your patients in an evidence-based, objective manner.

If you want to go deeper, there is a growing body of resources, seminars, and books to learn from. Of course, there are also review articles on the various modalities in their application to the gut and liver disease.  At Johns Hopkins there is a wonderful center devoted to Integrative Digestive Health directed by Dr. Linda Lee. I know of others in the digestive heath community who provide nutrition counseling, stress management training, and other modalities. These are all powerful methods for integrating lifestyle medicine into treatment plans.

Finally, there is another unique center here at Hopkins headed by Pankaj Pasricha: the Mind-Body Food Disorder Clinic, which is a multidisciplinary approach to gut-brain axis disorders.

If you’re interested in integrating CAM into your practice, the resources are out there. You just need to look for them a bit.

PIONEER IN FUNCTIONAL AND INTEGRATIVE MEDICINEFor Dr. Frank Lipman, health is more than just the absence of disease: it is a total state of physical, mental, emotional, spiritual and social wellbeing. Dr. Lipman is a widely recognized trailblazer and leader in functional and integrative medicine, and he is a New York Times best-selling author of five books, How To Be Well, The New Health Rules, 10 Reasons You Feel Old and Get Fat, Revive and Total Renewal.After his initial medical training in his native South Africa, Dr. Lipman spent 18 months working at clinics in the bush. He became familiar with the local traditional healers, called sangomas, which kindled his interest in non-Western healing modalities.In 1984, Dr. Lipman immigrated to the United States, where he became the chief medical resident at Lincoln Hospital in Bronx, NY. While there, he became fascinated by the hospital’s addiction clinic, which used acupuncture and Chinese medicine to treat people suffering from heroin and crack addiction. Seeing the way these patients responded so positively to acupuncture made him even more aware of the potential of implementing non- Western medicine to promote holistic wellbeing. As a medical student, he was taught to focus on the disease rather than the patient, and now as a doctor he found himself treating symptoms rather than the root causes of illness. Frustrated by the constraints of his training, and the limitations in helping his patients regain true health, he began a journey of discovery to search for the path to meaningful long-term health and wellness.He began studying nutrition, acupuncture, Chinese medicine, herbal medicine, functional medicine, biofeedback, meditation, and yoga. Dr. Lipman founded the Eleven Eleven Wellness Center in 1992, where he combines the best of Western medicine and cutting edge nutritional science with age-old healing techniques from the East. As his patient chef Seamus Mullen told The New York Times, "If antibiotics are right, he'll try it. If it's an anti-inflammatory diet, he’ll do that. He’s looking at the body as a system rather than looking at isolated things."In addition to his practice, Dr. Lipman is the creator of Be Well, an expanding lifestyle wellness brand he founded in 2010 to help people create, sustain and lead healthier lives.