The Gut-Brain Axis

Presenter: Datis Kharrazian, DC

The purpose of this presentation is to convey information. It is not intended to diagnose,

treat, or cure your condition.

Donna: Hi, I’m Donna Gates, creator of Body Ecology and host of the very first online
Healthy Gut Summit. For over twenty years, I’ve been teaching people the importance
of digestive health and about eating a diet rich in healing, probiotic foods. I believe the
world is truly hungry for the simple science behind how to create a healthy gut and set
the foundation for wellness. The source of wellness and disease begins in your digestive
tract.

Whatever your goal, whether you have a chronic or serious health problem, you want to
age well, you’re planning on having a baby, or you want to be fit and manage your
weight, you must have a healthy gut. The interviews in our Healthy Gut Summit will not
only inform you, they will transform your life.

Dr. Kharrazian is the author of the bestselling books, Why Do I Still Have Thyroid
Symptoms? and Why Isn’t My Brain Working? He’s a faculty member for Bastyr
University California and the Institute for Functional Medicine. He also teaches functional
medicine at Loma Linda University School of Medicine.

Welcome, Dr. Kharrazian!

Dr. Kharrazian: Thank you for having me, Donna.

Donna: Well, it wouldn’t be a gut summit—a complete gut summit—without having you
because your information on the brain and the gut is just amazing. I know in your book,
Why Isn’t My Brain Working, you have a lot of information about the gut in there. So I’m
very grateful you’ve taken the time because I know you’re one of the busiest people I’ve
ever seen.

And the bio that I read everybody is a very short bio because if you read Dr.
Kharrazian’s books, you’ll see he has an amazing story. His life story and the degrees
that he has, I just don’t know of anybody that’s done as much as he has as far as
educating himself. So we’re very lucky to have you.

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Can you tell us—everybody likes to know who they’re listening to—so could you tell us
how you got even interested? As a little child, did you say I want to be a doctor and I
want to help people?

Dr. Kharrazian: For me, actually, I had a severe back injury when I was in high school.
And a friend of the family took me to the chiropractor and I had instant relief. And then,
I went to chiropractic school. And then after that I realized that I really needed to learn
more about nutrition. So I went and got my master’s degree in nutrition. And then after
that I realized I really needed to understand research. So I went and got my Doctorate
of Health Science degree in research.

And since then, I’ve been working part time in the lab and getting some papers
published and then teaching at some universities and having my own private practice
trying to integrate natural medicine to look at non-pharmaceutical options for people
that have chronic conditions.

Donna: That sounds good. That’s like music to people’s ears. Non-pharmaceutical
treatments, everybody’s looking for that today. What does that mean though for people
that don’t understand that?

Dr. Kharrazian: For a lot of people, when they go ahead and see a physician, they
really think that sometimes there’s a truth in the information being presented. But
everyone has their own bias. Meaning, if you go to a medical physician, you’re going to
get a pharmaceutical medication, chances are, right? You go to an acupuncturist, you’re
going to get acupuncture. If you go to an iridologist, they’re going to look at your eyes.
So, basically, there’s no real necessarily common agreed upon therapy. But there’s
different biases that people have. So it depends on what you see.

What we’re seeing today is that many people really don’t want to take pharmacology.
Many people don’t want to take drugs with the severe side effects. So they really look
for natural options. And natural options have lots of support in the literature and they
can be very, very effective to really support many chronic conditions. And,
unfortunately, we still have a system where we don’t have people learning this in
medical school. And so we really have a need for this.

And it’s very interesting because people that normally seek alternative medicine tend to
usually be very educated. And they look at all the options. And they make decisions and

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just approaches the way they look at their diet. And nutrition and lifestyle really seem to
be the way they want to really handle their case instead of just popping a pill.

Donna: So Loma Linda University where you’re teaching at, their school of medicine,
they have a program in functional medicine. Because, as you said, most doctors that go
through schools, they’re just being trained traditionally and learning the drugs and the
surgery and the radiation for a condition.

Dr. Kharrazian: At Loma Linda University, for fourth year medical students, they have
an elective option for medical students. And it’s very interesting. Teaching part of that’s
that these students are really, really excited. That they don’t even really know that
these options really exist. And they’re really quite shocked to see all the research related
to natural medicine. So for many of those students, it is the first time they’re really
getting exposed to a non-pharmaceutical approach.

And you see a lot of excitement out of that course. And really I’ve got to praise Loma
Linda for taking that step and being one of the first medical schools to really create that
option available for them because at the end of the day, we’re all after the same thing.
We’re all after an evidence-based approach looking at the best of science and then
looking at side effects, pros and cons, dangers of treatments and safety of treatments
and then trying to figure out the best option for it for patients that are suffering.

Donna: I know at the University of Miami, they have a program like that, too, in
functional medicine. It’s an elective. Well, actually, I’m not even sure it’s an elective.
They can take it besides taking their regular credits. And the first year, it wasn’t very
well attended. But now it’s getting more and more popular. I can’t imagine a doctor not
wanting to learn functional medicine because it’s really what people want from their
doctor.

Dr. Kharrazian: And I think that’s very true. But I think as students, they don’t really
know what people want or what they even want. And they don’t even know it’s out
there. So schools like Loma Linda and the University of Miami School of Medicine do
that, they’re really taking the steps into the future. And I think those programs are both
growing. And there’s a lot of excitement in those. And I think other universities will start
to implement those types of courses.

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Donna: Do you have a chance to teach much about the gut-brain relationship? Because
I’d love for you to go into that here. Why is there a relationship between the gut and
brain anyway?

Dr. Kharrazian: So one of the things that I think is a problem of how we learn about
the human body and even through either, any type of education you have on
physiology, is that we take chapters and we separate them. So we have a chapter on
the nervous system. And we have a chapter on the gastrointestinal system. And we
have these chapters on various systems of physiology like the renal system or kidney
system and so forth. And we really don’t have a chapter that tells us how they all work
together.

And we know that when we look at the brain-gut access that the brain has profound
impacts on gastrointestinal function. And that gastrointestinal function has a major
impact on the brain. And now this is called the brain-gut access or gut-brain access. And
there’s an explosion of research in this area. And what we’re learning is that many
neurodegenerative changes first start in the gastrointestinal tract. Many people don’t get
diagnosed because they’re being thought of as having digestive issue problems when, in
fact, they’re having their nervous system and their gastrointestinal tract degenerate.
They call that the enteric nervous system.

Then also we have many people that have poor gut function. And they start to get
memory decline. And they start to get more degenerative diseases. So they’re showing
relationships in the scientific literature between how brain function can impact gut, how
gut function can impact brain. And they’re also seeing that many early symptoms of
neurodegenerative diseases actually start in the gut.

Donna: So how specifically does that happen? Let’s say that somebody has leaky gut or
they have the wrong microbiome, too many of the wrong type of bacteria and yeast or
viruses in there. How is it actually affecting the brain?

Dr. Kharrazian: So when we look at the so-called gastrointestinal brain connection,

meaning the gut physiology is impacting brain, we know that there’s several
mechanisms. One mechanism is that we have changes in their probiotics. The probiotics
themselves produce what are called postbiotic saccharides-lipopolysaccharides.

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And when we look at bacteria, bacteria-producing products, too. And these are
lipopolysaccharides. And there’s many different chains of them. And lipopolysaccharides
have now been published in literature where they found leaky gut people can suffer from
depression, that probiotic changes can impact mood and cognition. So we’re seeing
some very interesting research that when we look at the gut bacteria, we kind of just
thinking of these gut bacteria as a part of the gastrointestinal environment. But, in fact,
they actually produce their own signaling compounds called lipopolysaccharides. And
they have major impacts on brain. Recently, there was a paper that showed a gut
peptide called ghrelin can actually bind to the hippocampus part of the brain and impact
memory and cognition.

So when we look at the gut, we have to realize that even though we have probiotics in
the gut and we have different immune cells in the gut that release proteins called
cytokines and we have different neurotransmitter chemicals, peptides that are released
in the gut, these peptides and neurochemicals, they actually can cross the blood-brain
barrier and have direct impacts on brain function.

This is like, for example, the easiest way to understand this is just your appetite.
Mechanisms of biology in the gastrointestinal tract of how you process foods into short-
chain fatty acids, they actually create signaling compounds that impact hypothalamic
areas in the brain, which cause you to feel hungry or not feel hungry.

So there’s a constant communication between the gastrointestinal tract in the brain. And
this is very common. And we see many people that have chronic digestive issues that
then get chronic cognitive issues or they get mood disorders. They get depression. Or
they even get neurodegenerative diseases. So we know there’s a lot of research that’s
been being published on the role of gastrointestinal health on brain function. But,
however, most people that look at people that have depression or cognitive disorders or
focus issues, they don’t really look at the health of the digestive tract, which is a big
mistake. And this is part of why we shouldn’t learn about human physiology in a
compartmentalized fashion. But that’s how people learn it.

So you have many people say, “Well, there’s no connection between what you eat and
your gut and your brain health and your brain function.” But, in fact, there really is. And
this is an area where practitioners like functional medicine people really look at health
function related to the gut as they see degeneration or lack of function in the brain.

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Donna: Well, so do you think eating disorders…Like let’s say not even ones that are
truly diagnosed as eating disorders, but somebody that can’t control their appetite or
starts to eat and then really they’re full but they just keep going on and on and on
eating, that’s because of the bacteria in their gut?

Dr. Kharrazian: There’s been some research with different bacteria strains where you
have Bacteroidetes and Firmicutes. And what they found is that certain strains actually
have an impact on how you process calories. So when you eat proteins, saturated carbs,
you produce these into glucose. But you also produce what are called long and short-
chain fatty acids. And these fatty acid ratios then determine how you process calories.

So people that have a higher ratio of Firmicutes, they tend to always be hungry. And
when they process their calories, they don’t process them efficiently into energy and
then those short-chained fatty acids go in the liver. And they promote adipose tissue
build up or, basically, the strain of bacteria that they have actually promotes fat buildup
in their body and lack of utilization of their calories for energy.

So we know that there’s some research linking obesity and eating disorders to the ratios
of Fermicutes to Bacteroidetes. But this is really interesting stuff. And they’ve done
some research where they’ve done fecal implants to different mice. And they’ve seen
changes where they take an obese mice and change the gut bacteria and they become
skinny and vice versa. So it’s really a fascinating field of the gut microbiome.

Donna: How would you suggest that people switch if they’ve got too many Firmicutes
and they wanted to have more Bacteroidetes so that they stay slender and lose weight?
How would you recommend switching them more toward the Bacteroidetes family?

Dr. Kharrazian: For the most part, what we know is that it takes several months to do
that. And it doesn’t happen quickly. And it really has to be a plant-based diet. Diets very
high in animal fat and sugar tend to promote the bacteria that processes fat. But plant-
based diets and even supplementing with butyrate—short-chained fatty acids like
butyrate—can be beneficial. But it does take quite a bit of time.

And this is why you usually see people that lose weight really make a lifestyle change.
But it’s not just the supplement that they’re taking for a period of time. They just
become, let’s say, plant-based. And when you look at the GI panel of the patients, you
see some people really have switched ratios here. And it does really take some drastic

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lifestyle change. And there are some people that have to almost be plant-based diet to
really lose some weight. And they really can’t handle much animal fat or sugar without
changing their metabolism. It’s really an interesting field of study.

Donna: Well, I’m so glad you put a time frame on that because people might…They do
this for ten days or even a whole month. And they feel like, “Gee, nothing’s happening
here. I’m putting this effort into it.” So if they have an idea that this is going to be a
three month process, they relax and settle into it and make a long term commitment.
Three months is not very long. All the wonderful things that start happening in your
body besides losing the weight is well worth the three months. And it’s really a
permanent change. It should be a forever change really because you want to keep the
Bacteroidetes predominant, right?

Dr. Kharrazian: Yes. It seems to be more efficient as far as how your energy levels
are, your function is. And, also, the Bacteroidetes produce lipopolysaccharides that are
very beneficial. For example, they produce the different species that actually dampen
inflammation. And they have an anti-inflammatory effect. So we’re seeing that diets
really high in fiber and plant-based foods tend to make it a shift in the gut microbiome,
which then influences metabolism and how we process calories and how we convert
short-chain fatty acids to either fat or calories as we look at liver bioenergetics
pathways.

So it’s really critical to consider that dietary lifestyle change over several months, maybe
even more than three months can really make the difference for people to make a
difference there. And that’s why the short ten-day fast isn’t going to be enough for some
people.

Donna: You just cleared something else up for me, as well. I’ve never read a study that
talked about LPS—lipopolysaccharides—being secreted by good bacteria. Every single
study talks about LPS related to bad bacteria. I just was about to ask you that question
when you answered it. So that’s great. So just to put that together in one thought,
explain the LPS again and the difference between the bad ones and the good ones.
They’re both secreting LPS, in other words.

Dr. Kharrazian: So gram-negative lipopolysaccharides tend to promote inflammatory

reactions. But then you have good polysaccharides. One of the most well published ones
is polysaccharide A. And polysaccharide A has been shown to literally cure autoimmunity

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in animal models and dampen inflammatory reactions and really provide immune
modulation. And this is very fascinating because you have to have your own bacteria
make it. So you can’t just take a prebiotic or a probiotic. You actually have to have a
bacterial species that’s healthy in your gut. And then you produce, for example,
polysaccharide A, which can really have profound inflammatory autoimmune modulating
properties. And this is why, again, sometimes you can’t just take a probiotic for like
three weeks and expect to see major changes in autoimmunity, right? You actually have
to change the ecology, the microbiota of the gut, to see some differences.

And in the near future, I think there’s going to be a lot of greater attention to what’s
called postbiotic. And postbiotic is the different polysaccharides that different bacteria—
good or bad bacteria—release. And this is really an area where there’s a lot of research
happening right now.

Donna: Great. That sounds really interesting. I, of course, have been promoting
fermented foods for about twenty years now. And I really never had the science in the
beginning. As much as I was looking for it, there was not science explaining how they
were working. The fermented foods have the healthy beneficial bacteria in them. And
there’s so much more science now that validates the importance of eating them more
than ever.

But getting back to the brain, everybody is concerned about their brain today because
there’s a huge number of baby boomers, seventy million baby boomers aging. They can
already see changes in their brain function. They are depressed. They don’t have the
memory they used to have. They’re really concerned, “I may live another twenty years.
If it gets worse, what am I going to do?” Then, on the other end, we’ve got children with
Alzheimer’s. So there’s Alzheimer’s that’s appeared on the scene big time. And often in
the very same families, there’s a connection with autism. And there’s so much of that.

I was just at the AutismOne conference and saw a statistic that if we keep on going, in
about ten more years, one in two children are going to become autistic. So, obviously,
this is a really important area, the study of the brain. And there’s a lot of people looking
at the brain today. But, again, because this is a gut summit, are there early signs of
brain degenerative disorders in the gut?

Dr. Kharrazian: So, actually, Parkinson’s disease starts in the gut. And it doesn’t start
with tremors. So what happens is if you look at one of the most common

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neurodegenerative diseases, which is Parkinson’s, we know that Parkinson’s takes place
not because you just lose your dopamine activity, but it’s what’s called an alpha
synucleinopathy. It’s a protein called alpha-synuclien, which is not cleared from neurons
properly. No one really understands why this happens. But this alpha-synuclein protein
accumulates in areas. And then it prevents normal neurotransmission from happening.

And from research that’s been done, they realize that this alpha-synuclein buildup
actually starts in the gastrointestinal enteric nervous system. So your gut has its own
brain. They call it the enteric nervous system. That’s what causes you to be able to
move your food and have muscle contractions and your gastrointestinal tract to move
your food along.

But most common early symptom of Parkinson’s is actually constipation and lack of
motility. Now, when you see lack of motility and constipation, the second area that it
hits is the olfactory bulbus, which is where smell comes in. People start to have reduced
smell and they start to have some stiffness and their movements are a little bit slower,
and their mental speed is slower, their chronic gastrointestinal symptom may really be
neurological, that they may actually be suffering from early Parkinsonism.

So we know that this is really important because many people that work with patients
that have gastrointestinal issues will see patients who have constipation. And they try to
give them all these different probiotics and these different types of supplements to
improve their gut health, which may be important. But what they may be really looking
at is early Parkinsonisms. And they really may want to take some strategies to support
their brain health and look at this from a neurodegenerative disease mechanism to really
make the best impact for the patient and then for the patient to really understand
what’s going on. So lack of motility and constipation are really sometimes red flags to
look at for early neurodegenerative disease, especially Parkinson’s.

Donna: And so would you then recommend they go to a certain type of specialist and
have their brain examined?

Dr. Kharrazian: Well, at this point, unfortunately in the current healthcare system,
when you look at Parkinson’s, Parkinson’s has six different stages. And stage six is when
people start to have tremors. And in the current model, no one really diagnoses it until
people get tremors. It’s getting better in the healthcare model where they’re looking at
stiffness and slow movements, but usually the early signs of Parkinson’s are pretty much

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ignored because for the most part, the therapy is L-dopa, different variations, different
drug names. But L-dopa, if you give it to people too early, it loses the effects. And they
develop another disorder called tardive dyskinesia where they just have twitches and
muscle movements and the side effects from it. So they don’t like to use it until it’s
more progressed. So in a conventional neurology model, there really isn’t anything they
do.

Now, when you look at what’s done in models of functional medicine and natural
medicine, they try to look at mechanisms that are neuro protective, whether it’s a high-
antioxidant diet, whether it’s trying to exercise to increase brain-derived nerve growth
factors, a whole list of mechanisms that we know about that can protect the
brain. And I go through each one of those in detail in my book, Why Isn’t My Brain
Working?

But there’s a point where you really have to look at supporting brain health. And with
things like early Parkinsonism, there’s really not many drug options. And for the most
part, for many neurodegenerative diseases, the key thing is to identify them early and
then to apply interventions through diet and nutritional lifestyle to really make a
difference because when it comes down to the pharmacology applications, they’re
usually done very end stage. That’s when they’re diagnosed. And there usually is very
little benefit from it.

Donna: Okay, so you said that the constipation is like an early sign. That’s already got a
lot of people’s ears perked up because they’re thinking, “I have constipation. Does that
mean I’m on my way to Parkinson’s?” Or more importantly, “I have constipation. What
are some of the things I can do about that?”

Dr. Kharrazian: Well, when we look at constipation, we have to look at it…Also, let’s
just continue the discussion of the brain-gut access. Constipation means the
gastrointestinal tract is decreased in motility. Motility is the concept of moving food
across your intestinal wall, right? Now, how do we have motility? Motility takes place
from inputs from the brainstem. Within the brainstem, you have the vagus. And then the
vagus nerve activates the gut nervous system called the enteric nervous system. And
this is when we start to move food and release enzymes.

So whenever we see people that have chronic constipation and they’ve had it for some
period of time—and drinking water and exercise and doing the normal things don’t make

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a difference for them—we immediately start to worry about, “Is this a brain to gut
relationship disorder? Are they having signs of neurodegeneration?” Now, here’s the
thing. We know that Parkinson’s initially starts in the gastrointestinal nervous system.
But any other neurodegenerative disorder in the brain may impact motility, as well,
because ninety percent of their brain’s output goes through the brainstem where we
have anabolic functions. And a big portion of that is where we have our vagal activity,
which causes us to have gastrointestinal motility.

So lack of gastrointestinal motility isn’t just for Parkinson’s. It’s for any
neurodegenerative disorder. So if people are having chronic constipation and they notice
their brain function has gone down, they really may have little effect of really changing
that until they can improve their brain health. And this is the concept of really
understanding if a person really has a gut problem or they have a brain-gut problem.

Donna: And so many people today do have traumatic brain injury. And it’s in the news
a lot because of the football players, for example. But I’ve talked to so many people that
have fallen off a horse or had a skiing accident or falling off a bike or something. And
they never think that it’s a big deal because they seem fine now. But can we talk about
that more because I think this is actually a big category of people. And it fits right into
what you’re saying about brain injury.

Dr. Kharrazian: So there’s papers published now that show traumatic brain injury
causes intestinal change within two to three hours. And these include changes in
immune cell activation, inflammation, what we call leaky gut, which in the journals they
call intestinal permeability. Those happen immediately after trauma to brain.

There was one study where they saw this in an animal model. And they induced brain
injury in animal models. And then they stimulated their vagus in one group. And the
group that had their vagus stimulated didn’t have any of the gastrointestinal
consequences. It was just there to confirm that the reason that the brain is causing gut
problems is because when the brain is impaired, it can’t activate the brain stem. And
then the brain stem can’t activate the vagus nerve. And then you lose gut motility. And
you lose blood flow and circulation to the gut. And then you create an inflammatory
permeable gut. And then you start to get inflammatory changes that are digestive,
which then cause a vicious cycle because they impact brain.

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Now, a lot of people have traumatic brain injuries. And what’s important to realize is
that traumatic brain injuries sometimes show up years later. That the effects of them
don’t happen immediately because, for example, the way your brain works is the
neurons stay healthy as other neurons stimulate them. But if you lose a group of
neurons from a traumatic brain injury, over a period of time, the neurons that got
destroyed are no longer activating other neurons. Then those neurons start to
degenerate. And then those neurons activated other neurons. They start to degenerate.
So many people really suffer from the consequence of head trauma and the symptoms
years later. And unfortunately this is why people get overlooked and ignored.

Donna: So just to give people more of a visual in their mind. There’s the brain. And in
the back of the brain is a brainstem. And then it is connected to the vagus nerve, which
is a big nerve that runs down to the gut. And could we just talk more about the vagus
nerve. I know it connects the brain and the gut, but it does many other important
things, too, right?

People don’t know about the vagus nerve, unfortunately. And I think it’s an important
nerve to know about. And there are things you can do to make your vagus nerve
healthier. So if we could talk about that for just a minute, that’d be great.

Dr. Kharrazian: Yeah. Well, first of all, if you’re a person who has gut symptoms or if
you’re a practitioner who has patients who have had gut presentations, gastrointestinal
problems, first thing is to see if they have motility issues. And if they have motility
issues, you immediately have to worry about, “Is there enough input through the
vagus?” And then your biggest clue is to see if their brain is working.

So the brain itself has different areas, different lobes. And the brain itself then fires
down to the brainstem and the brainstem controls your autonomic functions, your ability
to make saliva, the ability to digest, the ability to control our heart rate, the ability to
have respiration, breathing. And those are all autonomic functions.

But when the brain starts to become less efficient, then we can see changes in the
efficiency of the vagus. And for many people, one of the earlier signs is they just get
constipation. And another one is they have difficulty swallowing pills because swallowing
is also another function of the vagus, that the muscles in the back of the throat are
related to swallowing. So if someone comes in and they have a history of poor brain
function and poor memory and poor cognition and they tell you not to give them

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supplements because they don’t swallow them well and they’ve had chronic GI issues for
years and years, it may just be that they’re starting to show neurodegenerative
changes, probably both in their brain and in their gastrointestinal nervous system.

And we see this all the time in patients that have obvious brain deficits. And we see it all
the time with autistic children. And we see it all the time in people that have had
traumatic brain injuries. But the good news is that we can do a lot of things to get that
system to be more efficient.

So, for the most part, what we like to do is when we see poor vagal function is one of
the things we do is we have people gargle. So if they can gargle with several large
glasses of water a day, as they gargle very deeply and intensely, they make the muscles
in the back of their throat work. That’s where the gargling comes in. And those muscles
are ennervated by the vagus. As the vagus gets activated, you also start to activate the
vagal responses in the gastrointestinal tract.

Donna: Well, in your book, Why Isn’t My Brain Working?, you really…It’s an
extraordinary book. It really is. And you were the first. I’ve never seen anybody with
this much information, certainly about the vagus nerve and therapies to get it working
again. So it’s so interesting because people are treating their constipation by taking
laxatives, for example, when they should be gargling and doing some of the other things
you mention in the book. Coffee enemas was another thing you mentioned. Wasn’t it
connected to the vagus nerve, if I remember correctly?

Dr. Kharrazian: Yes. So one of the other things we do is we do coffee enemas. But the
goal of really making the coffee enema would be more of a brain-vagal therapy. It isn’t
that you just do it so you can void. You want to do it and then suppress bowel urgency.
So what we have patients do is we have them, basically, make a coffee enema. And they
can figure out how much coffee they can saturate it with.

What coffee does is coffee has caffeine in there. And the caffeine stimulates what are
called nicotinic receptors and they cause you to have bowel movement and bowel
activity. But to really get the biggest changes, you have to feel those urgencies. And you
want to try to hold the content of the coffee enema for as long as you can. And as a
person actively suppresses a bowel urgent response, they actually stimulate their frontal
cortex brainstem feedback.

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And if they can do that over and over and over again, then they can start to rebuild
plasticity in that area. And we see that their brain-gut access over a period of time can
start to function better. Just like if someone had weak biceps and they started to do
biceps curls, the same type of concept. As you activate that area, you strengthen it. And
then you get better function in that feedback system.

Donna: I’m sure everybody’s grabbing their computes and their IPads right now and
downloading the book on Kindle. It’s amazing! I’ve never, ever heard anyone say that
before. Oh, what about coffee, though? I’m sure many people think, “Well, I drink
coffee. Is that doing the same thing?

Dr. Kharrazian: Well, yeah, coffee has similar effects. And most people that drink
coffee sometimes they do it as an attempt to get their bowel activity going. But that’s
usually, again, for people that are constipated. And they drink the coffee. And they get
the same nicotinic receptors. But the goal with the coffee enema is that when you
actually do the enema and you get that fluid into the colon, you actually cause colon
distention. That actually feeds the vagal pathways from the gut to the vagus. And as you
actively suppress it, it has a greater effect.

So if we’re trying to reestablish the brain-gut access, we don’t want people just to drink
coffee. We want their gastrointestinal tract to be distended and their gut pressure fibers
to be stretched. And then they’re actively trying to inhibit that bowel urgency. And that’s
when you really get the brain to get that pathway of activation between the brain-gut
access. These are frontopontine types of integrations as far as pathogens are concerned.

Donna: Would you recommend that for a child even?

Dr. Kharrazian: Well, for children, we have to be more cautious. We don’t necessarily
do that unless they can actually have some…They’d have to be old enough and mature
enough to do things like that. With children, we can do little gag reflex of the tongue.
They can gargle. They can sing loudly and really use their muscles at the back of the
throat. Those all activate the vagus. So it really depends on the child to see if that’s
appropriate. But it’s not something we routinely do unless the children are ready for it.
It’s kind of traumatic for some kids to do that.

Donna: I’ve always heard that they just do deep breathing also activates the vagus.

© 2014 Body Ecology, Inc. All rights reserved. 14

Dr. Kharrazian: Deep breathing has some activation in the pontine pneumotaxic
centers. But we really want to really be more specific. But yeah, deep breathing does
create a parasympathetic response. And at the end of the day, as you activate one
parasympathetic, then you activate others. So you can see changes in gut functioning
with that, as well. It just depends on how specific you want to do the activation.

Donna: We’ve mentioned the autism word a couple of times. And I know people think,
“Well, I don’t have an autistic child and this doesn’t refer to me. But I think when you
study autism, people can learn so much about being associated with the autism
community because there’s so much research going on right now helping these kids
recover. It’s one of the areas in functional medicine where they’ve really looked at the
brain and the gut, of course, and diet. And they’re trying to find the cause.

They’re doing a great job of identifying so many things that are wrong with the kids.
They have yeast infections. They have mercury in their body and other heavy metals.
But they definitely have a gut…The brain has to be treated with autism. And I believe
we’ll have many people listening who are interested in autism. So could we talk about
that a little bit, the autism gut-brain connection?

Dr. Kharrazian: And even if you don’t have kids, if you ever plan on having kids,
there’s a high risk now that you may have an autistic child. And if you have kids and you
expect grandchildren one day, it’s very likely that they may have kids or you may have
grandchildren that are autistic. So this is a real threat to everyone in society.

But when you look at autism, what we know is we see such a focus on everything
besides the brain. And people just assume that if you give them probiotics and you get
them off gluten and dairy, get rid of mercury or do all these things that you’re going to
do, you’re going to change the brain. But sometimes you really need to specifically
approach the brain, itself.

And when you look at autistic kids, here’s what we know. And there’s a lot of research
on this. There’s actually quite a lot of understanding of what’s happening with an autistic
child, as far as which pathways are involved and the things that are not working. We
just don’t know if there’s any one single cause or mechanism for autism. And then
apparently, there’s multiple causes. So we definitely know that with autistic children,
their gray matter and white matter are different. We know that they’re not connecting
different pathways in their brain. The overall research that’s been published, we know

© 2014 Body Ecology, Inc. All rights reserved. 15

that there’s different changes in their cell structures.

And the interesting thing is that there’s some papers now that are identifying autism
during the third trimester, that they can actually see in pregnant women that in the third
trimester that these mothers have fetal brain antibodies that during their pregnancy
they can actually see antibodies against the child’s brain being developed and measured
in blood.

So we know for the most part that this was most likely a neurological autoimmune
disorder. And what happens with these kids is that there’s different parts of their brain
that don’t connect and work. And part of it is integration to their vagus. There’s another
part of the brain called the insular cortex. And this is where you have the map of your
gut. So your brain has to know where your small intestine is and where your bowels are
and where your large intestine is. In this area, the brain does not work well.

So literally these kids don’t know where their gastrointestinal tract is. They don’t know.
Their brain doesn’t know where their intestinal bowels are and how to turn them on and
turn them off. So when you look at that, you have to realize that you can’t just go on
there and just give kids dietary change and see a big change in autistic activity. I mean,
some people will change their diet and have some changes. But there has to be some
component to really supporting the brain and doing some things for that.

There’s a good friend of mine who wrote a great book called Disconnected Kids. His
name is Robert Melillo. And he does a great job of talking about different therapies and
treatments they do to activate the brain. And it’s something to look at if you have a child
with a learning disorder or autism. But sometimes you just need to do activation itself
for the brain to really get those systems to function more properly.

Donna: So Disconnected Kids is the name of the book. That sounds fantastic! And what
therapies would you recommend for recovering the brain?

Dr. Kharrazian: So you have to look at the child, specifically. There’s a list of
symptoms that are involved, right? Is there a frontal cortex involved? Do they have
issues with planning, memory, focus, concentration? Is their temporal lobe involved?
They have auditory discrimination issues where they can’t distinguish different sounds?
Can they not pick up on pitch? Do they have a monotone voice? Is their parietal lobe
involved where they can’t feel things on one side of their body? So it really depends on

© 2014 Body Ecology, Inc. All rights reserved. 16

what part of the brain is not really developing. So it’s not one thing that they do. It’s
just understanding how to identify areas of the brain that aren’t working and then
providing specific exercises for them, right. So if your frontal lobe is involved on the left
versus the parietal lobe on the right, those are all different types of therapies based on
which is specific to the child.

Donna: You know ten years ago, I started working with autism. And I knew they had
different issues. Like they have yeast infections, all of them. And they have digestive
problems. They do have heavy metals. And all the parents I’ve worked with, we’ve had
thousands go through our Bedrock group, actually. We said, “You have to fix the gut.
Here’s how you do that. They’ve got to be on our gluten-free, casein-free diet. We feel
very strongly they’ve got to be on the probiotic foods.”

They respond beautifully to that, got to bring your yeast infection under control, and so
on. But there’s another problem going on. That’s the brain. And there was very, very
little help for the brain. And today, though, I noticed, just having come back from that
conference, that it is the major focus these days. And so, it’s really encouraging.

I heard Dr. Bradstreet—Jeffrey Bradstreet—who is one of the experts on our gut summit
here, he actually made the statement that we feel like we’re getting very, very close to
being able to help these kids recover. And I’ve always held that intention, also, is that
we’re going to get every single one of these kids well. But I don’t think it will happen
until there’s some type of treatment for the brain. And what you’re saying, basically, is
it has to be individually unique for each child.

Dr. Kharrazian: Yes. And also, we have to realize that this really starts with pregnancy
itself and development in the fetal stage. That there has to be some effort also put on
the mother’s health. And prenatal health isn’t just taking a prenatal vitamin. That we
know that mothers that have chronic stress or mothers that live next to a freeway have
increased risk of autism. We know that if mothers have infections, they have increased
risk of autism. If they have any underlying autoimmune diseases, they’re at increased
risk. If there’s any type of genetic methylation disorders or a combination of different
things that these risks all go up.

So there has to be a point where we also kind of look at this and go, “What are we really
doing to assess the mother’s health? What are we really doing to value in all the

© 2014 Body Ecology, Inc. All rights reserved. 17

variables that are involved with risk factors for pregnancy because even a multivitamin
as a prenatal isn’t enough.”

So there’s another level of this where we have to really look at how we look at mother’s
health and prenatal health and looking at those factors before we even have the
potential to have a child with autism. Now, once the child has autism, then we have to
look at all the other factors and functions. But many times, you’ll see kids where the
family has multiple children with autism. It’s not just one child. Or they’re on different
spectrums of the autism scale. So it’s a big area of just investigation here. But there’s
really a lot of new information in the past five years that really show there’s an
environmental autoimmune mechanism where autistic changes are happening during
development.

Donna: And so this is where the fetal brain antibodies are coming from in the fetus?

Dr. Kharrazian: Well, some papers have shown fetal brain antibodies. But other papers
have shown other mechanisms. So it may be not the only one. But we know that just
the fact you live a mile from the freeway dramatically increases your risk for having
autistic child. So those are more of a chemical component.

And when we look at the fetal brain antibodies, obviously with anything autoimmune,
there’s multiple tissue protein antibodies that can show up. And I don’t know if they’ve
tested all of them at this point. They’ve only tested a few of them. But that’s one of the
emerging models of why this is such an epidemic and what the mechanisms may be.

Donna: Your other book, Why Do I Still Have Thyroid Symptoms? clearly you are an
expert in the thyroid, as well. And the thyroid is such an important organ during
pregnancy. And Hashimoto’s, which is an autoimmune condition that so many women
have today probably before they get pregnant, is there a relationship between that,
between Hashimoto’s and problems with the thyroid and autism, do you think?

Dr. Kharrazian: Not published, but working with Hashimoto’s patients myself and other
practitioners, they communicate. We see that many Hashimoto’s patients do have
autistic children. But we’ve never really studied this in an accurate way to see if there’s
any statistical significance. My only guess is that there probably is some connection for
all autoimmunity. Hypothyroidism, most commonly, is Hashimoto’s. And Hashimoto’s an

© 2014 Body Ecology, Inc. All rights reserved. 18

Autoimmune. But autoimmunity is linked to autistic risk. So I think there is some of
those connections that may be there. But we still don’t have that published.

Donna: And would you say that autoimmune issues are also a gut problem?

Dr. Kharrazian: Well, there’s lots of research in animal models where they’ve shown
that is they induce intestinal permeability with zonulin that they can induce
autoimmunity, especially pancreatic type I diabetes. There’s several papers on that.
And, of course, we know that. But we also have to realize this that papers are now
showing that just having autoimmunity of any kind creates an inflammatory cascade
that then causes leaky gut. So the tight junction proteins can also be broken down just
from the inflammation of autoimmunity unrelated to their digestive tract.

And this is why you see many people that have autoimmunity and they’re on a perfect
diet and they eat really well and they eat plant-based and fermented foods and take
probiotics and take digestive enzymes and do all the right things they want to do. And
their gut function is very bad despite doing all the right things. So we know that
autoimmunity inflammatory reactions that can be triggered by stress or lack of sleep,
they can also cause breakdown of intestinal tight junctions and get a leaky gut.

So it’s kind of like a vicious cycle that when most people develop an autoimmunity, the
inflammatory consequence breaks down their tight junctures in their intestines. And
they get this leaky gut syndrome. And then, as they get a leaky gut syndrome, their
proteins that are not digested, then trigger their immune overzealousness. And they get
into this vicious cycle. So it’s important to make sure that they support their gut health,
but at the same time, they also want to realize that the autoimmunity, itself, is the
factor involved so they don’t totally get frustrated that their diet’s not working, right?

Donna: And so how do you test for that? How do you know if you have a disturbed
brain-gut access?

Dr. Kharrazian: There’s two ways we test for that. I use Cyrex labs for both of them.
One is Array 2, which is a blood test where it looks at zonulin occludin antibodies. And if
the person has their tight junctions break down, their proteins get broken down in the
bloodstream and the immune cells in the gut start to make antibodies and you get this
high elevation of zonulin occludin antibodies.

© 2014 Body Ecology, Inc. All rights reserved. 19

The other thing we always look at is we look at blood-brain barrier protein antibodies.
Cyrex has a blood-brain barrier protein antibody panel, too. And if we see—for many
people—we see is when they get a leaky gut, they also get a leaky blood-brain barrier.
And there’s some research in the celiac disease journals where they show that celiac
disease people release this compound called zonulin that not only opens up their
intestinal tight junctions, but it also opens up their blood-brain barrier.

So, in fact, we may see many people that really have poor gut and brain permeability at
the same time. And this is a devastating mechanism before anyone does any kind of
heavy metal chelation treatments, because if someone’s blood-brain barrier is breached
and their gut barriers breached, it can absolutely be dangerous and inflammatory and
reactive to do any kind of chelation type of therapies.

Donna: So you’re saying fix the gut and then do the chelation therapy?

Dr. Kharrazian: I’m saying fix the gut. Fix the blood-brain barrier. Make sure they
don’t have chemical antibody reactions, meaning that they don’t have chemical
tolerance issues. And then consider doing it. Just today, I saw a physician. She was a
prep physician in the Los Angeles area. And she started to have muscle fasciculations
throughout her body. And she had a polyneuropathy type of pattern. And it all started
after she started doing chelation.

So we look at chelation as being the best thing in the world for everyone. But it’s not.
And we know there’s papers published now in EDTA and DMPS and DMSA—and I list
these in my brain book—that it shows that it can redistribute in other tissues. And the
key reason if this is going to be redistributed or not is if the blood-brain barrier and gut
brain-barrier’s intact. So when many people have leaky guts, it’s maybe not the best
idea to do chelation. And this is what we see in the autistic population a lot of the time,
too. That you have to look at these variables very carefully and just make sure
everything’s okay.

So another panel that we check is what Cyrex calls Array 11. It’s a chemical antibody
panel. So it checks mercury bound to human protein antibodies. And that means is that
the person has lost their tolerance to environmental compounds. And if you start to
redistribute metals and they’ve lost that tolerance, you can definitely trigger an
autoimmune disease.

© 2014 Body Ecology, Inc. All rights reserved. 20

Donna: That’s amazing! This is definitely one of those interviews that people are going
to need to listen to two or three times because every single thing you say is just packed
with amazing information here. I think there are many doctors that are going to be
listening to The Gut Summit. And they don’t know this either. So this is amazing that
you’re sharing this with us.

Now, just to make sure we understood you, right…So there’s the gut barrier, the
intestinal barrier. And the brain has its barrier. Many people think that the brain barrier
is pretty safe. But you’re saying that when the gut barrier’s inflamed, the brain barrier’s
in trouble, too, right?

Dr. Kharrazian: Yeah. The blood-brain barrier is definitely vulnerable. We know that
chronic inflammation breaks down the blood-brain barrier. High homocysteine breaks
down the blood-brain barrier. Chronic cortisol and stress break down the blood-brain
barrier. Chronic infections break down the blood-brain barrier. There’s multiple
mechanisms where the blood-brain barrier can be breached.

Donna: Well, when it is breached, what’s happening in the brain?

Dr. Kharrazian: So what’s happening in the brain is you have two types of cells in the
brain. You have neurons, which are what we know as the cells that cause synapse to
happen and then we communicate brain activity. But then, there’s another cell in the
brain called the glial cell. And the glial cell is more than half of the weight of the brain.
And these are our immune cells. And they call them glial cells because they used to
think they were glue cells. And glial in Latin means glue.

There’s twenty glial cells to every neuron. And like I said, more than half the mass of
the brain is our glial cells. These glial cells, once they get activated, they don’t turn off.
And they don’t get activated unless the blood-brain barrier is breached. So if you have
someone who’s lost their blood-brain barrier, now particles and chemicals and
messenger peptides and proteins can turn on these glial cells and you promote a neuro-
inflammatory cascade.

And the most devastating part of this is something that they call PANDAS. PANDAS is a
pediatric autoimmune neuropsychiatric disorder from streptococcus. And what happens
is these kids that have breached blood-brain barriers, they get the typical streptococcus
infection, strep infection. But since their blood-brain barrier is breached, the strep

© 2014 Body Ecology, Inc. All rights reserved. 21

antibodies cross the blood-brain barrier because it is permeable and it actually binds to a
part of their brain that’s very similar to strep proteins called the basal ganglia. And they
develop neuropsychiatric disorders where some of these kids jump out of moving cars
and they mutilate themselves and they become different children. So this is the key
concept that the blood-brain barrier has to be intact. And if you’re not, your brain is
vulnerable.

And this is why I was trying to point out that if someone has high amounts of blood-
brain barrier antibodies in their serum, which we can measure it now, and if they have
those, you may want to be very careful with doing things like chelation. And you really
want to really help that blood-brain barrier heal. The blood-brain barrier can’t heal as
stress is removed, as homocysteine is reduced, as people have more glutathione in their
system and higher antioxidants. And that can be measured objectively with follow-up
testing. So it is a major area that is a concern for us, especially with gut dysfunction
because we see many times in parallel as we see leaky gut, we see leaky blood-brain
barriers, too.

Donna: You know, again, working with the children, many of them have, about eighty
percent of them actually have a problem with their MTHFR SNP, one of the genetic
variations. And so they are going to have high homocysteine levels. And they do have
PANDAS. It’s a big problem in many of them. So this is quite fascinating that we’re
talking about this.

What’s the fix? I mean, obviously many people don’t fit into the category of doing things
like jumping off a bridge, really bizarre symptoms of brain behavior. But what about
people that just are going through life on an everyday basis, but they do have a leaky
gut? What would you recommend they do? Excuse me, not just a leaky gut, I mean a
leaky brain, too, both.

Dr. Kharrazian: Sure. The example I give you is just the most extreme. And in a more
everyday level, if your blood-brain barrier is breached, you’re going to have greater
brain inflammation. The more brain inflammation you have, the more neurodegenerative
changes you get. And you know, one of the most common symptoms of brain
inflammation is brain fog because as neurons become inflamed, they lower their
conduction speed. So many times as people start to have inflammatory reactions in their
brain, they really notice that they can’t find words, that their mental speed comes down.
The most common thing is they have the foggy brain.

© 2014 Body Ecology, Inc. All rights reserved. 22

Now, we know that gastrointestinal inflammation and things like leaky gut and things
like lipopolysaccharide breaches and things like cytokine elevations from gut reactions
can turn on glial cells in the brain and cause a neuroinflammatory cascade. And in the
brain book I wrote, I also referenced a lot of studies where they find multiple papers
now that are showing people that have an inflammatory bowel disease have
characteristic white matter lesions in the brain.

And now there’s a whole growing and continued growing list of papers where they’re
finding that one of the consequences of chronic inflammatory bowel disease is
inflammatory white matter and demyelination changes in the brain that when the gut’s
on fire, the brain’s on fire. This is even more of an issue if the blood-brain barrier is
breached because then you can turn on the glial cells much more actively because you
don’t have that barrier to protect these inflammatory reactions.

Donna: Obviously, this is a huge subject and one that people really have a need to
know a lot about. And they need to be very conscientious of taking care of their gut and
taking care of their brain. It’s exciting in many ways because we’ve never had this focus
on the brain before. I’m excited for people because there’s help. There are people like
you teaching us all what to do.

And you have this great book. The beautiful thing about this book, Dr. Kharrazian, is
that it’s easy to read. A lot of times you think a brain book is going to be over your
head. But Why Isn’t My Brain Working is very simple and very easy to read. And I
definitely think it should be a textbook in high school and all the colleges because it’s
just such…You know, if you fix the brain, I think many other things in the body get fixed,
too. So are there any last minute points that you would like to leave with us or tips that
you wish to share with people?

Dr. Kharrazian: Well, since this is a gut summit, the only thing I would like to say is
that there needs to be a focus that there is a brain-gut axis. We obviously know that the
gut can impact the brain because any one of us that has either had gut
inflammatory reactions or a patient with gut inflammation, we realize that brain function
is impacted and mood is impacted.

But the other side of this is the brain to gut axis, which most people don’t really think
about. And the biggest clue is that if a person has constipation or slow motility or can’t
swallow and you also see poor brain function, that you really want to investigate the

© 2014 Body Ecology, Inc. All rights reserved. 23

health of the brain. And by doing so, you really may change the ability to get the gut to
function better. That at the end of the day, the brain fires the vagus only when it’s
healthy.

And efficient vagal activity causes blood flow to gut so the gut can heal. Vagal activity
causes enzyme release. Vagal activity causes you to have bowel control so you don’t get
things like small intestinal bacterial overgrowth. Vagal activity causes you to be able to
have smooth muscles and your gallbladder contracts so you can have proper bowel
release. And this is a key aspect of healthy gut function.

So if we see people that lose motility and can’t produce enzymes and they’re seeing any
type of brain decline symptoms, there should be some emphasis on looking at some of
the brain-gut axis exercises we talked about in the book and also just strategies to
improve brain health. So that’s the key thing I would like to close with, as far as, my
contribution to the summit.

Donna: So I’m sure in many people’s minds right now, there’s a big question, “Do I
need to run off and find a functional medicine doctor that can examine my brain and
help me with my gut problem?” Or do you think reading the book, we can begin to get
ideas to start helping our brain and our gut heal?

Dr. Kharrazian: I think right now the most efficient way is for the patient themselves
to educate themselves and read about it, understand it. Then they can—as they become
empowered with the information—they can find the right practitioners to work with
because quite honestly, not every functional medicine practitioner works on the brain.
And not everyone looks at early signs of neurodegeneration.

But as you can start to see the links together as you get the information and empower
yourself, you’ll be able to create the right team you need to really get your brain and gut
health back on track.

Donna: Where will people go to reach you, get more information, find your website?

Dr. Kharrazian: Well, my website is BrainHealthBook.com. And the name of my book is

Why Isn’t My Brain Working? And that’s where we list articles and newsletters and have
more information if people have interest.

© 2014 Body Ecology, Inc. All rights reserved. 24

Donna: Thank you so much. This has been an amazing interview.

Dr. Kharrazian: Thank you, Donna.

© 2014 Body Ecology, Inc. All rights reserved. 25