Dr Pran Yoganathan: Is The Gut The Second Brain?

My guest today is Dr Pran Yoganathan, a gastroenterologist on a journey to empower his patients by using a philosophy of “food as medicine”. In our conversation we explore the role diet can play in combating co-morbidities, ask “how much protein do you actually need” for your age, discuss leaky gut syndrome, liver health, and more.

Health Podcast Highlights

Dr Pran Yoganathan: Is The Gut The Second Brain? Introduction

Today we are going to explore Digestion. Look, I often say whenever we talk about Oral Health, this is going to be of interest to anybody with a mouth, who is interested in their health but is never fully connected to the two.

Well, this is for anybody that has ever put food in their mouth and wondered what goes on and why. And the person that I am talking to today is a specialist, a Gastroenterologist but not just any Gastroenterologist, Dr Pran Yoganathan. 

He graduated from Medicine from Otago University in New Zealand. His advanced training in Gastroenterology was completed in Sydney. He’s a fellow of the Royal Australian College of Physicians (RACP) and a member of the Gastroenterology Society of Australia (GESA).

And as you will hear, he has a strong interest in the field of human nutrition. He practises an approach to health care that assesses the lifestyle of the patient to see how it impacts their gastrointestinal and metabolic health. 

Pran believes that the current-day nutritional guidelines may not be based on perfect evidence. And he passionately strives to provide the most up-to-date literature in health care and science to provide “Evidence-Based Medicine” and he does that beautifully on his Instagram post. 

He is a strong motivator and aims to empower his patients to embark on a journey of self-healing, using the philosophy of “Let food be thy medicine.” I hope you enjoy this conversation I had with Dr Pran Yoganathan.

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] I’d like to acknowledge the traditional custodians of the land on which I am recording this podcast today, the Gadigal people of the Eora Nation, and recognise the continuing connection to the lands, waters, and culture. I pay my respects to their elders of the past, present, and emerging. 

Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today we are going to explore Digestion. Look, I often say whenever we talk about Oral Health, this is going to be of interest to anybody with a mouth, who is interested in their health but is never fully connected to the two.

Well, today, this is for anybody that has ever put food in their mouth and wondered what goes on and why. And the person that I am talking to today is a specialist, a Gastroenterologist but not just any Gastroenterologist, Dr Pran Yoganathan. 

He graduated from Medicine from Otago University in New Zealand. His advanced training in Gastroenterology was completed in Sydney. He’s a fellow of the Royal Australian College of Physicians (RACP) and a member of the Gastroenterology Society of Australia (GESA)

And as you will hear, he has a strong interest in the field of human nutrition. He practises an approach to health care that assesses the lifestyle of the patient to see how it impacts their gastrointestinal and metabolic health. 

Pran believes that the current-day nutritional guidelines may not be based on perfect evidence. And he passionately strives to provide the most up-to-date literature in health care and science to provide “Evidence-Based Medicine” and he does that beautifully on his Instagram post. 

He is a strong motivator and aims to empower his patients to embark on a journey of self-healing, using the philosophy of “Let food be thy medicine.” I hope you enjoy this conversation I had with Dr Pran Yoganathan.

Dr Ron Ehrlich: [00:02:13] Welcome to the show, Pran.

Dr Pran Yoganathan: [00:02:15] Thanks a lot, Ron. Thanks for having me on.

Dr Ron Ehrlich: [00:02:17] Pran, I’ve been so looking forward to talking to you as I’ve been following you on Instagram and I heard that wonderful interview you did with Dr. Lewis Ehrlich. Just remind us, you’re a Gastroenterologist. What does the Gastroenterologist entail? What structures are we looking at?

What is Gastroenterology?

Dr Pran Yoganathan: [00:02:33] Sure, Ron. So a lot of what we do kind of crosses into what you guys do is as dentists as well, because a lot of our specialty does stuff from everything from the mouth essentially to the anal canal. And we look at the digestive tract in its entirety, everything from the oesophagus, the stomach, small intestine, and the largemouth.

In addition to that, we’ve got other things that connect onto the digestive tract, which are things like the Biliary System as well as the Pancreatic System. So our specialty kind of crosses over into all of that. Now we’re into our positions which means that we sort of practise that a lot of that long heritage of medicine made through diagnostic tests such as blood tests, clinical examination. However, with modern technology, now we use Endoscopic investigations, which are basically cameras to look into the digestive tract. So technology’s come a long way and it’s allowed us to kind of visualise pathology in real-time. And that’s kind of what drew me to the specialty, the mix of a procedural specialty in addition to the physician side of things.

Dr Ron Ehrlich: [00:03:46] So the Endoscopy, of course, is down the throat and the Colonoscopy is up the anus.

Dr Pran Yoganathan: [00:03:53] Yeah, that’s exactly right. And then we, in addition to that, do things like Endoscopic ultrasound, which essentially we attach ultrasound probes to the telescope to look beyond the stomach wherein into things like pancreas using endoscopic ultrasound. In addition, we do things like Cholangioscopy, which is to enter the biliary tract, perform intervention there. We do Enteroscopy, which is to enter the small bowel. So a Gastroenterologist sort of specialises in these procedures. I’m a General Gastroenterologist myself.

Dr Ron Ehrlich: [00:04:23] You know, there’s a lot of, as you say, procedures there. And I know that’s what drew me to Dentistry. I love the idea of fixing things and, boy, it’s a great mixture of technology and biology. But of course, for both of us, Nutrition should play a big role and I know it didn’t in my degree. And I know many medical doctors, it doesn’t in their degree. But I would assume that when we got to Gastroenterology, it would be a big part of your study. Your specialty was it?.

Dr Pran Yoganathan: [00:04:53] No, no, it wasn’t. It wasn’t at all. You mentioned something there which is fixing things, and that’s my personality type as well. Like, I want to fix something in its entirety. And when you apply that to medicine and to patient care, I just found as a clinician with many years of experience. In community practise, I just wasn’t fixing things. 

I think we were doing things like this endoscopy and colonoscopy and telling these patients that their normal structure we got but they still went away with symptoms and we put it down to diagnosis such as irritable bowel and reflux, which patients don’t understand. 

They don’t understand that concept. So in the end, they walk away just thinking like the problems just with their body and that this is something that they need to live with and it really is quality of life. So we never fundamentally fix the issue. 

And I think that’s kind of what drew me to the nutritional practise but I can tell you as a gastroenterologist that was never told, I cannot recall having a conversation with any of my seniors about Nutrition, a little bit of mention made with regards to the format diet and irritable bowel syndrome, which, of course, the concept of the low carbohydrate diet.

Dr Pran Yoganathan: [00:06:06] In med school. I think we spent a week on my six-year degree in New Zealand. We do a six-year degree and we spent a week on nutrition and I cannot recall it. At no point did the lecturers kind of captivate our interests and it was just boring biochemistry. Well, how does a living cause modern illness by modern living? Of course. I mean sedentary values and diet in particular.

Dr Ron Ehrlich: [00:06:34] We hear a lot about comorbidities through this COVID thing. And of course, they are another word for chronic, preventable, chronic degenerative diseases and the keyword there is preventable. And the question is why? And you touched on it. But what do you, what is it about our diet? What is it about the way we’ve been told to eat that has caused these problems? In your opinion, as a Gastroenterologist?

The Role of Diet in Combating Co-Morbidities 

Dr Pran Yoganathan: [00:06:58] Yeah, I think a lot of people level the blame at the food pyramid. I don’t do that as much. I think everyone would kind of follow it very closely, especially the younger generation. I think obesity wouldn’t be an issue. However, the issue with the food pyramid, the way I see it, is the really low protein content of it, in particular the animal-sourced protein. So therein lies the issue.

Now say we have the food pyramid, the way it is, and we had an absence of the energy that we see around us at 7-Elevens and supermarkets with these chocolates, the sweetened beverages, energy drinks, all of that type of stuff. I think obesity wouldn’t be so much an issue but when you combine a low protein diet, a low satiety diet, which is what the food pyramid will provide in addition to a campus environment, which is going to just maximise profit from these very cheap, refined energy sources, there is got an issue. 

And I think that there lies the problem. It is a fundamentally low society with an environment to make a profit from cheap energy, and that cheap energy can achieve cheaper and cheaper fats.

Dr Ron Ehrlich: [00:08:18] It’s interesting you should say you see it as low protein being the issue because I would have thought part of what we’re seeing is also this demonisation of fat. And you mentioned satiety. What do you feel, what do you think about fat?

Demonisation of Fat

Dr Pran Yoganathan: [00:08:35] That’s a really interesting one. I think if I had a few choices, my personal feeling of choice is fat because it’s so easy to consume it when you consume protein. So by consuming a protein, generally in animal-sourced protein, especially if you’re going for something that is not excessively lean like lamb or beef or salmon, whatever, the fat generally will accompany it and I think it is very difficult to over-consume fat that is not refined from these animals or marine life when you combine it with protein.

Now, take refined fat, for instance, cheese and butter. See, I’m not a huge fan of that and people that are trying to correct the metabolic issues because this is where the people like to believe it or not, it is a refined fat, very, very easy to overconsume. 

And I think this is where a lot of these low carbohydrate diets do fall over. They tend to plateau. They have this initial period of weight loss with all the glycogen that’s been depleted and the water loss. They lose a bit of weight, but then they hit a plateau and we save a life without dietitians where we’re fundamentally overconsuming fat. I think protein is the key leverant food.

Dr Pran Yoganathan: [00:09:49] Generally for consuming protein that is quality from quality sources like fish eggs, and maybe you’re going to be getting fat with it. Never really understood the concept of people eating whipping cream, butter and then putting butter in their coffee and that type of stuff. I enjoy noncooperative coffees, but my concept has always been you’ve got to earn that energy. 

Whereas with protein it’s not really an energy source. It can be used by the body as an energy source, but it is fundamentally a building block and when you consider obesity, I consider it as a form of energy toxicity. Energy has the other two macronutrients. It is carbohydrate and fat. These are the things that you can put in your body to adipose tissue, whereas protein is very difficult to convert to fat.

Dr Ron Ehrlich: [00:10:37] When we talk about low carb, I think this is interesting. When you look at the science too, how you define low carb is not a story because I went on the USDA’s site recently, advice for health care professionals and put my weight and age, and activity in.

And it recommended that I eat 375- 450g of carbs a day, which is just unbelievable, and also told me to avoid fat, particularly cholesterol. This is 2021 so low carb to those people would be 200g of carbs a day. 

What does low carb mean to you? And to accompany that question, what does adequate protein mean, because that’s the other, one isn’t it? They kind of say 0.8 of a gram per kilogram. What is low carb? What is the ideal protein?

Low Carb vs. Receiving Adequate Protein

Dr Pran Yoganathan: [00:11:30] Really good questions, Ron. Actually, you’re the first one that I’ve spoken to in this podcast. Let’s put it that way and that’s a really nice way to look at it. Actually, I can answer you as — The idea kind of recommends a protein intake, a 0.6g per kilogram, 2.8 per kilogram, now that for a younger person where the sex hormones just being pumped out will help you retain muscle. But that’s thanks to the sex hormones because that’s kind of nature keeping you well equipped for reproduction, essentially. But even nature is kind of failing. It’s now, as we say, a basic right saw our kids and young adults and young people.

But the idea that recommends a 0.6-0.8g for our elderly is fundamentally putting them in a grave, far more rapid in a raft without pedals. So the latest data that I’ll be looking at sort of indicates that the elderly population with healthy kidneys, might need a huge whack of protein. 

And some of the figures that I’m looking at are potentially about 1.2-1.6g, even greater in some of these elderly individuals that are sarcopenic, which is interesting Ron because if you’re looking at 1.6g of protein per kilogram per day, that’s a lot of protein. So good luck fitting in any carbohydrate when you’ve got that much protein.

Dr Ron Ehrlich: [00:13:02] And when we talk about older people, I mean, to some people over 40 years — older people; to some over 70 years — older people. At what stage should we start to be thinking about are we getting adequate protein?

Dr Pran Yoganathan: [00:13:17] I think to me, someone where Sarcopenia starts sitting in. The data shows us that it’s about the age of 30. If this is where you start losing muscle at quite significant, right? I think it’s something like 0.8% per year. Right. But if you’re on a low protein diet, that might be five and even more. If you’ve got chronic illness, that might be a lot more. A lot of us suffer chronic illness.

So I think we really ought to start looking at the protein and at all stages of life. It’s dynamic, it shifts. But what I do know is the older you get, the more of it you need and I try to explain that to my patients. I mean, you just have to look at Alaba and know that a lot of them have very thin bone structure and 50% of the bones matrixes is a protein fundamental and it becomes a bank as these people go through life without adequate intake of essential amino acids and protein. The body has to go back to the back and keep sort of growing from things like muscle and bone.

Dr Ron Ehrlich: [00:14:19] Listen, another thing that we hear a lot about, I love lessons from the past, and I know you do, too, learning from our history and when you were asked this question, the gut is the second brain. We hear that a lot and I loved your answer to this, Pran. And I wondered if you would share this with our listeners, because, boy, if we ever had a lesson from the past, you go back so far in evolution to answer that question. Share with our listeners: Why is the gut the second brain, Pran? What do you think?

The Gut is the Second Brain Debate

Dr Pran Yoganathan: [00:14:46] I disagree, Ron and I think you might have read that. I think if you look back far enough in history where we existed, a sponge-like reaches hydra-like creatures in the ocean before there was life on planet Earth or life not in the ocean. Of course, there was no brain. These creatures which still exist to this day now, are run by something enteric nervous system. There is no central nervous system. But as life became more complex, there was a migration of these cells from the anterior plexus into a separate compartment, which eventually became the brain of these creatures.

So really, the human brain is not the first brain. It is the second brain, the initial, the original brain remains our gut and I think there’s a lot of people that feel it’s that’s cool. We got feeling they have a sense of that, that they feel that somehow that the gut is related to what goes on. There is no doubt about these things, these pathways.

Dr Pran Yoganathan: [00:15:52] There are still some very, very complicated pathways that connect the brain and the gut and probably run through the vagal nerve and so it’s such a fascinating aspect of evolutionary history. Additionally, it’s important to realise a lot of these media is made in serotonin are found in huge amounts of the garden. 

In fact, 90% of them are synthesised and made in the gut and a small percentage in the brain. So the neurotransmitters that run the brain are the same ones that run the gut.

Dr Ron Ehrlich: [00:16:25] Well, I mean, when I heard you say that, Pran, and I heard you ask that question, Lewis asked that question: What do you think of the gut as the second brain? And you said, I disagree. And I paused for a moment. Where are we going here? Oh, my God. This doesn’t make sense but I loved your answer to it because it makes so much sense. 

Listen, here’s another thing. I mentioned to you that I’d love to go on a little bit of a tour through the digestive tract. And, you know, because, as you said, it starts in the mouth and it ends in the anus and there are things that go on in between.

I wonder if we might go on a little bit of a tour together and just sort of say what goes on and what can go wrong. I know the mouth is the beginning of the digestive tract, and I’m very familiar with the mechanics of it. Tell me about what goes on digestion wise in the mouth?

A Tour of the Digestive System

Dr Pran Yoganathan: [00:17:14] Yeah, I mean, it’s a great question. Let’s start at a very basic fundamental level. I think what separates us, humans, from any other species on the planet is the fact that we pre-digested our food and this is what’s contributed to this massive surge in brain growth for us. So we used techniques such as cooking, which started about 1.9 million years ago when people think fire was being regularly used.

800,000 years ago before we’re talking of groups like Homo Erectus and the offshoots of that. But the data shows us that the fire was being used really 1.9 million years ago. So Homo Erectus was able to utilize fire and when you utilise fire and your cooking foods like tubers and meat, you unblocking nutrients immediately. 

So all food is very, very difficult for the body to extract energy from. And people with a raw-food diet tune with that very well. That can be more meat and vegetables and fruit or whatever. But when you utilise them cooking is predigested. So fire is one such way.

Dr Pran Yoganathan: [00:18:25] But being humans where we’re absolutely frags in the animal world because of this level of intelligence, not only do we use cooking with fire, but we preferment, we try we do all sorts of things to that. So we essentially break these foods down before we even put them into our mouth, utilising things like fermentation dairy to make an yoghurt, which is easily digestible or easy to digest and milk is where we’re doing things like making sourdough bread, which is basically pre-digesting this food, utilising bacteria before we put it into our mouth. Things like kimchi with sauerkraut and so forth were pre-digestive.

So you hear this argument that we can’t be carnivorous species because we don’t have sharp teeth like the lions and so forth. Our weapon is our brain and that is what makes us this apex predator that we’ve been for the last two and a half million years. 

Now, before it gets out, we predigested them. We put it in our mouths. It’s sort of masticating. That’s why our team, as you were Ron, didn’t necessarily need to be all that efficient at breaking these down with the oesophagus. Is this conduit that is a beautiful super movement which contracts and delivers it to our stomach and within the stomach. Now you’ve got this highly acidic environment which essentially is there to clean protein. So we’ve got PH level of something like one. It’s something we can draw under one. 

The most acidic starts on the planet with bits of carrion that face off scavenger’s rotting meat. So it shows you the lunchroom past that. We also spent time being a scavenger, which is quite evident that when you look at creatures like the Australopithecus and Homo Habilis and so on, that we were scavengers for a long period so and it’s not helpful in that regard. And even up until one hundred years ago, before refrigeration became a common theme, we would have been consuming so much contaminated food because we would live through that environment, but the acidic stomach would have been protected in that context.

Dr Ron Ehrlich: [00:20:47] One of the things that amaze me about that is to hear you say the PH of one because I have a chart up in my office about different PH levels. And of course, PH is a measure of acidity alkalinity and it’s not linear, it’s exponential. So PH of one or less is just like placeable mods. How come we don’t burn a hole in our stomach?

Dr Pran Yoganathan: [00:21:12] Yeah. It’s amazing. And so we’ve got this very muscular system that’s deeply muscular. In addition, we’ve got this layer of mucus is pumped out by the cells lining the stomach. And so this is the thing we’ve got this ability to not quite neutralise, but to protect the lining of the stomach against that. 

But in saying that, I think with the modern world, we do see a lot of peptic also disease, although it’s less common in the era of the proton pump inhibitors but that’s another issue in itself. But I think when you utilise it’s not the way it’s supposed to be utilised. I can’t imagine ancestors would have died of Pictou cattle disease, let’s put it that way.

Dr Ron Ehrlich: [00:21:59] And what’s your view when you hear someone talk about, oh, we have to make the body more alkaline, let’s drink alkaline water?

Dr Pran Yoganathan: [00:22:07] Yeah, that’s bullshit.

Dr Ron Ehrlich: [00:22:11] Nicely put, Pran. I always use that is a little bit of, you know, hey, what do you think when you get doctors promoting alkaline water? I have serious concerns for their advice nutritionally, but let’s just leave that because that is just so, it’s like one step thinking like I need to be more alkaline. I’ll drink alkaline water. Yeah, but it’s not as simple as that, is it? 

Dr Pran Yoganathan: [00:22:35] No, no, no. And that’s right. And I have a very sarcastic view that is terribly sarcastic humour sometimes, which is presenting to adopt the same saying I’ve got a really sick stomach. And the doctor replied, yeah, that’s cool. You’ve got it, it’s just this beautifully evolved system. Right, and I think we’re spending in the face of evolution when we try and combine that with alcohol. And I think that’s —

Dr Ron Ehrlich: [00:23:06] Now another thing that I heard you say that just blew me away and I want you to share that because we hear so much about heartburn, reflux, indigestion. We know it’s a huge industry. But you said, well, you felt it wasn’t necessarily an acid problem. Tell us more.

Heartburn and Acid Reflux

Dr Pran Yoganathan: [00:23:25] No, I don’t think it’s a massive problem. I think it is a regurgitation of the contents of the stomach problem, which is the oesophagus. The oesophagus, as I said, is a beautifully evolved conduit that carries with it from the stomach to the gut. It’s basically a pot is not there to deal with acid. It’s not there to receive the same content. 

However, when you have the failure or the mechanisms, such as the lower oesophagus, also the diaphragm or the muscle which helps hold these contacts in this stuff, regurgitate, well, this is what you can get symptoms because the acid itself is regurgitated by utilising proton pump as we drop the acidity of that regurgitated content.

Dr Pran Yoganathan: [00:24:09] So the symptoms diminish and there’s no doubt about the efficiency of proton pump if it is in that context. But it doesn’t solve the issue of the regurgitation, which is the fundamental problem, which is called automatic transient relaxations, or the low oesophageal sphincter, which are often driven by for motility downstream in the colon. That makes sense, that we find in our research indicates that when you’ve got food fermenting away in the colon, which is in the large now, which is very far fetched, you wouldn’t think it’s connected to the three to six metre long tube.

We know that that especially gas methane, which is a by-product of fermentation, that the bacteria live right, that’s the time to get people to get a lot of digestion symptoms which dyspepsia. Additionally, the regurgitation. If you ask a person who’s got reflux, do they have bloating, gas belching flatulence, often they will. The two go hand in hand.

Dr Ron Ehrlich: [00:25:11] And when you said Diaphragmatic Sarcopenia, I just thought, wow, you know, the more I learn about the diaphragm, the more incredible it is. There’s just I had a men’s health specialist, Dr. Rob King, and he talked about the importance of the diaphragmatic activity to pelvic floor muscle activity. There’s a whole other story there. But as we leave the stomach, we move into the duodenum, the small intestine. What goes on in there?

Dr Pran Yoganathan: [00:25:40] Yeah, and this is what we are, Ron. We are primarily small bowel based on the digestive system. This is where all the magic happens. We’ve got this beautiful bowel system, which in this series of projections to the small bowel to the biliary which increases absorption on the surface area, quality absorption. 

So this is where we absorb only protein, quality protein, quality fat, and quality cataloguer. This is where all the magic is in this mobile. And ask us about four metres, which is enormous compared to the most prominent so when built for this quality method of absorption.

Dr Pran Yoganathan: [00:26:17] So here is where we use enzymes to break it down, break down through. We don’t utilise bacteria to break down food very, very, that’s a common misconception. In the small amounts or enzymatic starvation of these enzymes from the interior site, which since the size of them and delivered it to the belong to the enzymes attempts of the building right down the pre-digestive food, which is being cleaned by cooking, by chewing, and then write down what the stomach makes it easier for the small bowel to digest.

A lot of times, this is an interesting concept. There is this phenomenon that is Borborygmi, which is essentially after meals you get this forceful contraction of gas and liquid into the bowels, that this is the problem, that people get off the rails. If you’re getting that after meals, you essentially digest —

Dr Ron Ehrlich: [00:27:14] What was the word you just used? I didn’t get that.

Dr Pran Yoganathan: [00:27:18] So it is B, I don’t want to go to the spelling. B-O-R-B-O-R-Y-G-M-I. It is essentially when your small bowel counterassault, what you mean that forcefully contracts and people often describe it at night watching TV after dinner is the stomach growling away. It’s not going to talk about it’s more it’s just moving things little quickly. 

A lot of that tends to be non-absorbable carbohydrates. The breads in the past, it’s in the sweetness and the sugar in the nuts and so forth so but I digress. But the small bowel itself, it’s what humans eats one billion according to worldwide by lengthening the school quality foodstuffs which allow for brain expansion and it’s not a bacterial digestion is an enzymatic ordering on by starvation.

Dr Ron Ehrlich: [00:28:13] And then when you said that, I thought, well, we’ve done another programme on SIBO (Small Intestinal Bacterial Overgrowth). What’s your thought on that? 

Dr Pran Yoganathan: [00:28:23] I think that concepts kind of thrown around a lot, Ron. I think they respect your right, but my perspective is that it’s occurring in the colon and I think that’s and we can talk about it when we get to the call. A lot of things but I think the issues coming from the colon, I don’t think it’s coming from the small bowel. Of course, it’s one track and if you’re getting over the right colon, that’s going to translate into the small intestine. But see, in itself, I think is overused.

Dr Ron Ehrlich: [00:28:54] Now, while we were in the small intestine, of course, autoimmune conditions are a huge and growing problem and would leaky gut has been bandied around for many years. It’s gained popularity in the medical profession ever since it’s been called intestinal permeability. But essentially it’s the same thing. Is it? I mean, it’s leaky gut and intestinal permeability. What do you think of leaky gut? Tell us about leaky gut. Or intestinal permeability. 

Leaky Gut

Dr Pran Yoganathan: [00:29:22] Yeah, sure. It’s a very real phenomenon, Ron and I think one that we need to study in great detail to understand more. And I think it’s one of the drivers of the disease, of course, or any disease is complex and simple insights better. But I think there is a huge role that the gut plays in the epidemic the way we’re seeing. 

So this is the gut small bowel historically saying our ancestors would have been an impermeable barrier. So we digest food and we extract whatever is within the gut, within the small bowel, throughout the body and we don’t let anything else through basically. But these tight junctions between these small, small bowel, sides are now loosened because of issues related to the proteins that bind them together. And what drives these?

Dr Pran Yoganathan: [00:30:17] It’s still speculated as to what might be driving it, but some of the factors that are linked to things like wheat-based proteins gluten they feel increasing to stop immobility, even in those with not celiacs. In fact, that’s been demonstrated in lab-based studies in humans. 

We know that excessive consumption of fructose, which is a very common sugar that we find in our foods, is potentially contributing to what we find. Things like most suppliers as soy, like things like these, are some of the things that are being treated for it. I myself am also very suspicious of roundup or glyphosate, which is not huge amounts. Two hundred fold increase in glyphosate in our food supply in the last five years. I have a strong suspicion that that might potentially be driving. It is not particularly amongst all the factors that we will probably have for a long time.

Dr Pran Yoganathan: [00:31:14] So the problem with opening up the style barrier is that we did open up the body to the rest of the world. All right, and now we get free transfer of bacterial antigens, broccoli saccharides through based antigens foods that historically we want to be able to tolerate with a normal permeable might cause issues in someone with a permeable gut. And I think these are the nuances that we have to realise. So I think it is a very real phenomenon and is something that fascinates me and I think we need to understand it better and studying better in the future.

Dr Ron Ehrlich: [00:31:59] You said something there, which I think while we’re in the small intestine, it’s worth reminding our listener that you said it opens us up to the world. And that’s something about the digestive system that people don’t fully appreciate. Is that from the mouth to the anus is still part of the outside world? It’s our connection with the outside world, isn’t it?

Dr Pran Yoganathan: [00:32:19] It is. It really is. I mean, when you look at the respiratory tract, the respiratory tract, you know, it’s such a masterpiece of evolution with breathing strategies for the body to filter out these microorganisms. We’ve got a lung that is very hostile to pathogens, especially nonfit people. 

It’s very hostile to any pathogens that enter and this is why the elderly historically used to die of things like pneumonia because as they get older, their immune system weakens. So that the respiratory tract is another system that is open to the outside world. Yet there are strategies in place to filter things out of mucus and so forth.

Dr Pran Yoganathan: [00:33:01] The gut is the second barrier, the second entrance into the world. It’s how we communicate with the world. The problem is the atmosphere has changed and so we make things worse and this is why I think people suffer chronic inflammation like the respiratory tract, which is not sinusitis and so forth, but the food environment. 

Well, that that’s changed hugely dramatic and I think, the environment, and this is a concept that I’ll always put out to my patients. Their bodies are beautifully built and evolved. However, it’s the environment around you, that stuff, whether that be the atmosphere or the food.

Dr Ron Ehrlich: [00:33:38] Well, while we were down there in the small intestine, you mentioned a part of your specialty is the biliary system, the bile duct, and the liver, I guess. What role at this point, what is the liver doing? What’s the bile doing? What’s going on? 

The Liver and Bile Duct

Dr Pran Yoganathan: [00:33:55] Yeah. The liver is interesting. Are all simplifying the liver as a way of us saying you go right down to the small bowel and the nutrient is essentially absorbed into the liver. But this is what liver is such a very, if you can see in the liver of animals, it’s a very nutrient, this source of food because it’s storage for a lot of these vitamins. It’s still glycogen schools, fat stores.

 All sorts of things are the portal vein, which then takes all that into circulation where absorption of a small amount into the liver. And the liver distributes energy essentially through fat and sugar and storage, things like blockage, which is sugar.

But that’s the function of the liver also simple supports things like alcohol and the functioning end of the reasons. It’s very interesting but that I think is built for fact. I think it’s a way of bile, essentially as a way of encapsulating fat and being able to basically absorb fat. So I think the gallbladder is a storage spot for bile and in response to the gall bladder contract, of course, put out the bile, which then encapsulates the fat. We absorb it downstream in the (inaudible) which is into the small bowel. So that’s the bile duct.

Dr Pran Yoganathan: [00:35:27] And then the pancreas is critical. It’s a lot of enzymes that break down protein any particular enzymes and fat-based enzymes and they rely pierces the pretty proteases and normalises as well in carbohydrate as well. So these are two very, very important things. The enzymes that made the brush for life. Additionally, the pancreas secretes enzymes as well. They sound very connected, very high up to the small amount.

Dr Ron Ehrlich: [00:35:59] And then we’re into the large intestine, which you mentioned, small intestine digestion is enzymatic and you’ve given us where the pancreas and the bile and all of this is happening. We’re now in the large intestine. What goes on there?

Large Intestine

Dr Pran Yoganathan: [00:36:13] Yeah, in the large intestine, I think is very, very interesting. And I think this is where a lot of the damage has come from with regards to conditions like irritable bowel, gastroesophageal reflux, bloating. So because we lead a diet, like if you look at the modern diet, the modern human diet, the standard is 70 percent of our food comes from processed grain. That’s just flat-out fat.

Dr Ron Ehrlich: [00:36:37] Processed grain.

Dr Pran Yoganathan: [00:36:39] Processed grain. We can consume unprocessed grain because it will just go straight through us but that process is grains where most of the food comes from. Now, when you consider that a lot of that is not absorbable sugar so processed grain needs to contain things like fruit, danzon and which we simply can’t absorb very efficiently. 

But there are many sugars in nature that were in our food supply that we can say, well, these are what we call the fallback sugars such fructose, the lactose, the polysaccharide huge amounts. And so this is why I feel that this carbohydrate predominant diet 80 percent of our energy comes from carbohydrates.

Dr Pran Yoganathan: [00:37:29] I think with overwhelming the capacity of our small bowel about to absorb this kind of a full-scale contraction, we’ve got to do it with it, dumps it into the small bowel now the bacteria get to work right. This is the hind gap is the richest area in the digestive tract of bacteria and the second spot will be the mouth, what we will done. But the colon contains a huge amount of bacteria, trillions, and so is where the bacteria get to work. 

They work on these nondigestible cataloguers to prevent by-products of this fermentation shortening acid, which is a few but then they give you a partial with that, give you a little bit of the short-term fatty acids which at lost, that’s the primary fuel for our colon. So the colon takes that up but the bacterial by-product of all this is methane, hydrogen nitrogen sulphide gases. 

So mole gas in general, excessive amounts of gas and all about all this stunt will stun the rest of the gut, and motility drops off so that we get all of these issues related to the topic that I think is coming from carbohydrate (inaudible) ducts.

Dr Ron Ehrlich: [00:38:39] I mean, when we’re in the gut.. Well, let me just ask you this. When we take antibiotics and this is where the bacteria made most of the bacteria are in the large intestine, when we take antibiotics, what do you think we should be doing to pay respect to those bacteria in the large intestine or should we be doing anything? Probiotics? What do you think?

Dr Pran Yoganathan: [00:39:03] I don’t think there’s evidence for appropriate in any respect. I think there’s only a very limited spectrum of uses that irritable bowel and antibiotic use haven’t been conclusively proven to be of any benefit. So that’s the American General Gastroenterology based on the latest guidelines and I tend to agree with that. I think the vast majority of people’s probiotics make a difference. 

I think things like the transplant where you’re delivering a higher load of some of these bacterial species from a healthy donor probably make some difference. But again, you know, like the quality of the donor is something that cannot be controlled if it’s not a commonly done procedure and not something like this.

So probiotics prebiotics. I don’t think we can do much about it. I think with regard to antibiotics, the IBD, I don’t think anyone can disagree with that. That could be used at primary care level, at the hospital level. We’ve got a massive issue with that in saying that antibiotics are one of the biggest drivers for increasing human lifespan since they’ve been around for the last 100 years, that huge. And so this is what allows us to live to some of these ages, because as you get older, of course, the immune system becomes compromised as your younger immune system is compromised. These are the two extremes of age where antibiotics can be lifesaving and so I accept that. However, can we alter what antibiotics do to the microbiome? I don’t think you can do it with something external. I think it’s just to go back to really healthy eating and exercising and waiting for the gut to go back to its normal stage.

Dr Ron Ehrlich: [00:40:51] This has been fantastic. It’s been such a great chat with you. I wonder if we might just finish up now, taking a step back from your role as a gastroenterologist. And because we’re all on a health journey through life, I wondered if you might share with us what you thought the biggest challenge was for individuals on their health journey in this modern world.

The Biggest Health Challenge

Dr Pran Yoganathan: [00:41:15] It’s a difficult question to answer. I think we have a state of confusion in the general public. I’m not talking about people like yourself and me, and because we’ve obviously kind of been on a journey but I think a lot of people are busy. They lead busy lives. They’ve got families, they got mortgages. They’ve got… It’s becoming increasingly more complex. Additionally, they’ve got knowledge at their fingertips in terms of the Internet. 

So I think fundamentally there’s just a lot of bad advice going around and this should easy guidelines and guidelines that kind of promoting something and politically is this push as well? I think people are genuinely confused. Not only are they confused at times, not only are they time poll, but they’ve also got knowledge in the form of these findings at their fingertips and there’s just an excess of really bad information. 

So I think we’ve got in a situation where it really is a hostile environment to people if they’re trying to go on a health journey to their doctors, some altitude diets or even low carb diets, which aren’t very, very supportive of a lot of ways in which you could stop carbohydrate diet, which is the refined fats and bodies and bacon and cream.

Dr Pran Yoganathan: [00:42:43] So it’s just it’s become all and I think it’s interesting that people once they get into a cycle of ill health, it’s very difficult to pull yourself out of it. It’s a very depressing thing and I think people, they turn to food as a source. So it becomes a vicious cycle and once you’re in that, there’s no energy exercise. And so it’s a really, really strange environment. I think we find ourselves in this and you combine it with things like testosterone in young men and I think people just have less drive to want to try to improve their health. It’s quite a depressing picture of their own, but it’s it is a complex world.

Dr Ron Ehrlich: [00:43:29] Well, Pran, today’s talk and this podcast actually are very much about correcting that confusion to clarity, information to knowledge. So thank you so much for joining us today. It’s been terrific. Thank you.

Dr Pran Yoganathan: [00:43:44] Thanks, Ron. I appreciate you having me on the show and your vastly brilliant questions, and I’ve really enjoyed it. Thank you.


Dr Ron Ehrlich: [00:43:54] Well, to have a Gastroenterologist on the show of Pran’s not only qualification, but his interest in nutrition, honestly, I just can’t tell you. Well, let me tell you, about 30 years ago, I was at dinner with the professor of Gastroenterologist socially, just socially and I’ve been interested in nutrition for over 35 years now. I did my first nutrition course in 1981, so that is actually 40 years. 

Anyway, I asked him, what does nutrition play a big role in your practise? This is to the gastroenterologist. His answer was, No, not really. It’s not a lot of evidence to show that nutrition has very much to do with it. That is breathtaking. That is breathtaking. But it gives you a clue as to how the medical profession and the dental profession too, we’re not different approach disease.

Dr Ron Ehrlich: [00:44:55] When you go to a dental conference, the trade exhibition that is on is all about technology and materials and all about practise management and how to improve products and profits and all of that. And look, we live in a real-world and there’s nothing wrong with that. There’s absolutely nothing wrong with that and I’ve done I’ve lived my professional life like that.

But looking at the cause of disease is not a focus for many qualified health practitioners, like medical practitioners, like dental surgeries, like any specialty you want to name. And that is perhaps a sobering thing to hear, particularly coming from a health practitioner. But Pran confirmed that himself, and that is why I have been so looking forward to talking to this guy.

And honestly, if you follow him on Instagram and if you are a health professional, you must follow him on Instagram because of the research that he shares and the level of analysis that he gives to is amazing. I thought his comments about we’re not eating enough protein were really interesting. And the fact that he put those levels there, which I think you should go back and have a listen to because those levels are a little bit higher than what we are being told. And those levels are point six to point eight of a gram of protein per kilogram of white. So if I’m 80 kg, which I am, that would equate to about 60 to 66 grams of protein a day. 

Dr Ron Ehrlich: [00:46:39] Look, I’m not going to confuse you. You’ve got to sit down with a piece of paper and do that. But the point being that he feels that we need to be eating more protein, but not lean protein and that’s important, too, because we’re being pushed to eat lean protein. And that’s not what we should be eating. And we should be eating fat in its natural form, which is as it is attached to a well managed, ethically grown, grass-fed, and finished animal. 

And, you know, this whole story of plant-based vegan food, I’m sorry, but I just think that people who are espousing the vegan approach are doing this with the best of intentions in mind. Most people, the vast majority of people who are vegans are hands on their heart, doing the best for the planet and the best for their health. But in my opinion, they are unwittingly becoming the foot soldiers of the processed food industry. 

Vegans are becoming the foot soldiers of the processed food industry because plant-based is the 21st century what low fat was to the 20th century and I believe the outcomes, health, and environmentally will be equally disastrous. Animals are an important part of our human journey. They are an important part of our nutritional journey. 

They are an important part of our environmental journey and we need to be managing correctly. As one of my all-time favourite guests on this programme, Allan Savory, said It is not the resource that it’s the problem, it’s the way the resources are managed, and that resources resource needs to be managed in a holistic context. So that is important.

Dr Ron Ehrlich: [00:48:32] What about pre-digesting our food? I mean, I was so looking forward to going on a journey through our digestive tract and I really wasn’t expecting, I was expecting Pran to be talking about some of what goes on in the mouth. But his point about pre digestion is another equally important one and our weapon is our brain, I love that. 

And I’ve done a healthy bite on that as well and go back and have a listen to that because I talked about the Australopithecus brain, which we are on our evolutionary journey. We went Australopithecus, Homo habilis, Homo erectus, and there are other ones along the way, Neanderthal and Homo sapiens.

And when you look at the jump from Australopithecus to Homo habilis, our brain size increased, or certainly, when we got to Homo erectus, our brain size almost doubled and two big things happened. One, we harnessed fire, and two, we started to eat nutrient-dense foods, which are animal products, because the animals were a way of packaging up all those nutrients that they spent twenty-four hours a day grazing on the bank. 

We ate an animal that did that for us. So I just thought there was so much in that programme. You can tell them that excited about it. And I was certainly excited to have on. I will have links to his clinic, his website, his Instagram.

Dr Ron Ehrlich: [00:50:11] I would encourage you to join us on our online wellness programme. It’s exciting. It’s evolving, and to become part of that community where we’re going to be having ongoing live Q&As and meetings and we’re going to change the world. So join us. I hope this finds you well until next time. This is Dr Ron Ehrlich. Be well.


This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.