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welcome back to fortitude everyone JW BP I’m pretending like we can hear the
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music I know there’s music somewhere in there yeah this is fortitude today’s guest is a is a friend of ours more
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friends there than here but definitely a good dude varat Dave uh a
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gastroenterologist um he’s got a really cool story brinton yeah as you know uh verat thank you for
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joining us my friends grateful for your time I appreciate it so a m and at the
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house but then you’re UT Longhorn so undergraduate uh Longhorn and then med
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school a m but who do we root for on Saturdays uh the team in Orange and quite um is the word vehemently I
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would say is is that the right adjective yeah so you’re a Gary Patterson fans I must be I’m just thankful that that uh
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that we have him on the side right so all roads are leading that way but CCU in Texas hopefully this this airs before
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that it may or may not but let’s pretend it does but you’re married to a gal who
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goes married to a full-blooded Aggie and then three children and how does the
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split take place so it’s interesting it’s pretty it’s it’s pretty interesting so Devin my oldest
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um will root for both equally like he wants both teams to win he wants peace in the house exactly yeah
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um Shivan the middle one almost exclusively roots for a m
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although he says he’s kind of going for UT but you can tell his heart’s not in it whatever he needs from Mom that day
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exactly the right exactly exactly and then Dylan uh the smartest of all of them uh Roots exclusively good job Dylan
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yes yeah I mean he’s a smart Dylan got some street cred right there who knows you know so then did the stud the post
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uh classroom studies Scott and White Hospital where in on Temple okay yeah so
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yeah we did um uh you know at that point even as a student we did all of our third year and fourth year rotations at
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Scott White and Temple and then I stayed on and did internal medicine and my GI Fellowship uh uh and Scott White
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override as you probably can imagine or maybe you’ve wished this this show is brought to you by cap Tech spank thank
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you Mike Thomas we know you’re out there watching every week diligently you better listen to this one Mike too
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because yeah you might you might learn something intestinal fortitude yes speaking of so so uh we’re not 50 yet
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well brinton’s a little bit over 50 right now you’re 50 55 okay those of us
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don’t know what is a gastroenterologist for at so Gastroenterology in general it’s it’s just uh the study of uh all
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things gut and related you know so any type of esophageal stomach intestinal colon
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problems but also uh liver and pancreas uh issues and then there are some folks
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that will sub-specialize into only pancreatic work and there’s a subgroup of of doctors that are hepatologists
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that only deliver but when you’re a general gastrologist you do all of those things very nice and can then ask on
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other colleagues for help if needed there’s a lot of things that that entails which we’ll delve into but before we get into that why why and how
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did you decide that that’s what you want to do with yourself so you know when I when I was uh you know starting in
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medicine um you know once you go through the rotations then you kind of get an idea
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of you know you get exposed to multiple different types of things and so I am definitely wanted to um do something
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related to Internal Medicine and it really came back kind of came down to doing gastroenterology or
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Cardiology and uh I really enjoyed both Fields um uh gastroenterology just gave me a
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slightly better lifestyle uh you know cardiologists I love them they just work
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all the time they do well because because their emergencies are you know it’s you know time is muscle right so
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they need to get there and reopen those blood vessels and revascularize and get things going and and uh and and
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everybody that has chest pain is going to get a call you know yeah get a Cardiology to you know if you power down two cookies
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before the show you might you know have some concerns possibly well verat might just say that’s just a slight case of
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diarrhea why don’t you call me in the morning I’m sleeping exactly you’re covered my place exactly so the
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lifestyle I really do enjoy GI medicine I think it’s just something that’s very fascinating I think you know
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a lot of how we feel on a day-to-day basis um can relate to how we feel
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right in here you know and how did you start realizing that because clearly you
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know there’s been this great movement of proper gut maintenance and all and like everyone oh you know you look on Insta
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or whatever and my feeds got it like all kinds of the dirt water or kavacha or whatever that
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you know all this stuff and so but you know or the kombucha yeah but there’s
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another one that’s like a mix instead of coffee it’s like um kuchaka or some I don’t know anyway it
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um but but you but back when we were in high or high school and college that wasn’t the the norm right we were eating
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you know potatoes steak and taters everything you know and I think you know but for the longest time you know everybody has said you kind of you are
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what you eat yeah you know and I think that maybe we said it but we didn’t really
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Believe it or really kind of follow through with that until you know here in the last I would say last 10 to 15 years
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I think um the conscious uh the Consciousness about nutrition and just exercise and
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and has really kind of blown up yeah and I think people are just now much more aware of of uh on a daily basis hey we
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really got to watch what we eat and take responsibility for our health because you know if we just eat a lot of things
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that you know it’s fun to eat cookies right yeah yeah it is finally Friday it’s the best thing right you know I’m
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always up for a good cookie but you know it’s just you gotta you know if you do it all the time you know then you’re
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gonna have other an appointment with you yeah exactly or or that or the endocrinologist right can you speak to
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that like you obviously you’re you’re hinting on it but what has happened in the last 15 20 years in the American
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diet that has Pro pronounced a need for people like you in the in the gut issues
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because we all know there’s issues there why is the American diet taking such a turn South seemingly you know that’s a
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hard question to answer I think one of the biggest problems as you know it’s just it’s still
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portions you know I think in general we just eat too much in America right I mean we just eat too much and it’s a
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good problem to have is the Bountiful harvests and you know we just we have but more than the productization of food
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too yeah and then so there’s processing and the money-making thing oh yeah for sure plus the processing of food you
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know we’re not really sure you know you know because you want to provide a product that’s you know tastes good but
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also economical you come I’m not saying people cut corners but you know stays on the Shelf longer exactly preservatives
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right you know all these things you know how does that affect the body long term I don’t think anybody knows the answer to that what would be the right if
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there’s a true right portion for a human being and could you generally speak to that you know it in general if I have
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somebody in the hospital and you know I can actually control what they’re going to eat or how much they’re going to eat
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we write for a 2 000 calorie uh per day diet which is really not a lot of food
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no but once your body gets used to it it’s pretty it’s pretty easy and then
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two cookies like that would make like I did that’s your daily intake that’s probably a thousand calories
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yeah I do that every couple hours you know you’re getting a little blush are you yeah
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slide down yeah yeah when I start swelling you’ll know and that’ll be nap time yeah afterwards
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but you know but I would imagine the majority of your patients that’s a stark difference than what they’re used to
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consuming correct oh yeah even if I look at you know I’ve counted my own calories yeah you’ve got to look in the mirror
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first and I’m clearly more than 2 000 calories a day yeah in on average and and so you know I think that leads to a
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lot of different issues when you carry extra weight then you know GI wise we see reflux issues uh we see fatty liver
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um problems uh and you know obesity is a known risk factor for for some you know
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different cancers colon cancer being one of them so you know it really plays a big part in
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in in my practice yeah something you told me one time was that you’ve seen patients who have never had a drop of
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alcohol in their life come in with cirrhosis correct oh yeah there’s lots of different reasons people can get
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chronic liver disease and cirrhosis so alcohol is a common one um viral hepatitis A Hepatitis B and C
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you know um and then just from uncontrolled diabetes which can lead to fatty liver
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or just fatty liver just from over consumption of just sugars and sugar and just just food in general car just over
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consumption of calories carbohydrates and sugar yes but uh I know it’s you know so we’ll see it’s overwhelming
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sometimes yeah and then there’s a lot of just different metabolic conditions that your genetic conditions that can lead to
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cirrhosis yeah yeah what are the majority of your patients I mean what’s gen what generally is the the vast
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consumption of what you’re seeing on a on a you know a typical day you know I see a lot of folks with reflux
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um some people with trouble swallowing related to reflux and getting some scarring in their esophagus um colon
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cancer screening is a big part of what we do um kind of routine Health maintenance a
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lot of fatty liver disease a lot of irritable bowel syndrome that’s another where you know everything looks normal
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just doesn’t work normal again could that be related to what we’re eating but there’s also a lot of uh
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you know psychologic overlay with the irritable bowels and anxiety and depression can kind of lead to to GI
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symptoms so there may not be a functional an actual problem here but it’s just the way you know when you’re
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when you’re when you’re not right mentally it can affect your gut function on that note what would you say the
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percentage of patients who come to you are coming at the right time or you’re like my God you’ve waited too like how
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long and then how many do you send off going I know that that’s not going to change like yeah I mean some folks come
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and um they’re just they’re not open-minded and they don’t want to you know they you
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know they’ll come and they they may listen you know and they’re all very nice yeah nobody’s really ugly but they
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you know they’re not going to follow through with what you say yeah and you know you live with that we’re all adults you know I’ve
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I will tell you what I would tell my family and and it’s in your job to kind of take it to heart if you want to uh
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the majority of people I would say you know are coming on schedule now you know we talked about colon cancer screening
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and you know you’re 55 and you know they just decrease the age for I was kidding about that no oh you’re not okay I’m
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sorry oh sorry I missed the joke yeah you guys are too I can’t play poker with you guys but uh but you know uh I didn’t
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think you were coughing up a cookie here hang on but you know they they just decrease the age for colon colonoscopies
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to age 45 instead of 50 because we’re seeing more colon Cancers and even more
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than that we’re seeing pre-cancerous polyps and younger folks um what do you think that what do you attribute that as a doctor you know
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nobody knows but I think definitely obesity of say higher rates of obesity we’re seeing why did you look at me when
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you said obesity yeah okay okay yeah and
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um the um you know the so there’s the again kind of going back to what we’re eating yeah you know could there be some
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you know some of these food additives and you know artificial colors and and flavors and preservatives is that so
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doing something to our bodies um water quality yeah I was going to ask you about that because you
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you know they call it like clustering and then there’s no proof or whatever with this kind of but but you’ve talked
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to me a little bit about just seeing like little clumps of little areas where there’s some industrial things going on
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exactly you’re just like wow I had three people and they all knew each other and lived in the same area and I diagnosed
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the first man at age 50 on his screening colonoscopy hasn’t had any symptoms had
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colon cancer a year or two later his friend comes to the ER with rectal bleeding going is
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like well it’s probably nothing let’s scope you while you’re there he was 44. the other gentleman was 50. he had
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rectal cancer then they said their friend uh you know was having some rectal bleedings like
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can you see him like oh sure I’ll see him that was about a year afterwards he had just a huge pre-cancerous polyp in
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his lower colon that I removed but but they all lived oh my gosh in a real small so what area what what did your
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was your thoughts on what’s causing you I don’t know you know you know I just I mean there’s got to be you got it makes you wonder yeah I mean water Sunday
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night dinners at somebody’s house who knows two cookies but it makes you multiple cookies I found them in your
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breaker room you’re liable for these but you know it makes you think right yeah and they have seen other clusters of
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non-gi cancers in certain areas uh you know certain bone cancers that are you
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know extremely rare and you find them in these there’s an article just recently in I think it was in Southwest Pennsylvania that there were some
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clusters of these bone cancers yeah you know and it makes you wonder is there something going on in those areas is
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something going on with the water well or like air quality Smoked Meats you know or something Smoked Meats is
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thought to be a risk factor yeah with uh you know you get these compounds built up there called nitrosamines or even
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pickled foods oh really pickles yeah so some of the you know when you see the you know the Far East so Japan and Korea
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they have higher rates of gastric cancer and so it’s thought to be related to some of that smoke smoking and pickling
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could that be a could that be an issue have you ever eaten a pickled egg have you ever seen those in the convenience I
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have brinton yeah you’ve eaten one like out of that jar at the counter I don’t think I’ve had many but I think I’ve had at least one was it good uh I recall it
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being decent pickle anything it tastes like a pickle so let’s have a pickled egg it tastes like a pickle more than an
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egg I recall that it’s been a while but I think so yeah what does that do to the intestinal tract when one does consume
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something that might not be good for us well there should be you know like you know we we don’t know that
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there’s a again the the there’s a it’s a theory about the the those compounds those nitrosamines is not doing
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something over time and you got to eat a lot of it over years right so if you just eat one pickled egg yeah it’s
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probably not gonna do it let’s say it was a pickled egg that had been the shelf life the shelf life so yeah so
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food poisoning so then there’s probably some type of a bacterial infection there that releases a toxin okay so that’s
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gonna cause a you know immediate effect on the GI tract to cause nausea vomiting diarrhea on the inside it’s the
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sensitive wall there exactly and then it’s like your body’s going no way that we can’t handle this exactly exactly and
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that and it’s usually it usually is going to happen within a few hours after eating the contaminated food okay and
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then it’s usually 24 hours and then your body kind of resets it yep and you’re okay but it’s that toxic it’s a toxin-mediate effect so it’s not causing
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a damage per se but that toxin is causing all these things to happen then once your body gets rid of it then you’re good and is it true that then the
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water just like surges exactly and that’s exactly so then you get the you know the GI tract the whole idea from
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the GI tract is right you’re eating all these uh and drinking eating drinking food and water and liquids extract the
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nutrients and all the water and then just get rid of a minimal amount of waste okay it’s very efficient
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system yeah you know but when you get kind of derailed and yeah then then all everything just comes out are you seeing
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more um stuff like diverticulitis like is it are we eating more harsh things that are
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in our trucks like it’s we’re ripping up our guts you have Takis oh yes the one
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chip challenge no way I have never had that have you I haven’t done it myself
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has done it and uh actually my older son actually also did something and uh and some video did a Carolina Reaper and it
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just burned his mouth and you can actually get ulcerations in the mouth and from some of these super hot peppers yeah you can you can get some issues and
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dairy is the only alternate like to bring it down or dairy and just kind of just time you know just kind of wash it
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out but the diverticulitis question yeah so I’m seeing a lot of diverticulitis even in younger people but it’s not not
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in the manner that you’re thinking that oh it’s causing you know these rough foods are causing these Pockets to form on your colon it’s just a lack fiber in
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our diet so if you don’t eat enough fiber in your diet then you can develop the pockets which is diverticulosis and then if you get bad luck it gets
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infected and you get diverticulitis is the idea because it’s like the tube is
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not getting clean sufficiently is that the kind of so the you know if you kind of go back um yeah and and the fiber is
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a natural laxative right so it’s just going to flush your system and keep you regular the the thought is if you don’t have enough fiber in your diet in in the
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in the Lumen of the color the you know through the colon is that you can increase the luminal interluminal
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pressure and then there’s certain weak points in the colonic wall where the blood vessels have to
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perforate through yeah and then the increased pressure will then create that bubble or pocket to form
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um yeah it’s like just so much pressure exactly that it starts splitting the wall or exactly yeah exactly yeah so
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you know that that’s so I see a lot of it I see it in Old you know it’s generally an issue of older folks you
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know 50 and older but you know younger people can get it and in fact if younger people get it they tend to have a more
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aggressive course because diverticulitis you know a lot of people they’ll get it you get antibiotics you know oral
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antibiotics and you’re good right some people they’ll get an abscess or even perforate their bowel like where you
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have to have an emergency surgery then get a bag right and so for the rest of your life no no true term you know and
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then you know they can re-hook things up you know six months later like just cut the pieces yeah and then hook it back
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but if you do it when it’s infected it won’t heal so you have to cut it let it heal six months to a year later come
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back and reattach everything but younger people tend to have a more aggressive course being an internal guy is it
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harder to fix things on the inside than like a outside like inside St you know
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what I mean does the body heal faster yeah you know it I don’t know how to answer that question
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I think it heals at the same rate yeah but the thing with the GI thing you know surgery is that you if it leaks it’s a
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yeah it’s a catastrophe right because then it’s an intra-abdominal infection you know you get an infection out here on your leg it can still be very
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dangerous but if you just open it and drain it it’s good well plus you can see it and you can see exactly yeah whereas
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if you get something on the inside then you know you’re gonna have to go back in and so you know but it’s pretty amazing
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how fast the body is even after surgery is like that you know within a day or two they’re having you have liquids and bowel function returns usually in 48
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hours in most folks and and it’s I mean the body is an amazing thing it really is I never thought I’d ask this question
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and I’m asking for a friend but you mentioned before the a couple of comments before but I’m actually kind of
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curious now but what what is diarrhea why does the body have diarrhea what is
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it trying to do I think I know the answer I know but I know but is is the is the the goal to to remove the the
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stuff from the body but what is going on in the body that causes that so there’s not you know at that point
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especially for the food poisoning there’s not there’s not a goal right there’s it’s a toxin-mediate effect where it’s it’s causing these things to
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not that normally work to not work properly so you have all these things and then once the toxin is washed out of
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your system function returns right that’s not really pushing it out of your system it’s not
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like uh yeah it’s not like a cleansing function or anything it’s like it’s not like a fire hose or something like putting water on a phone no no no and
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then eventually you know it gets it gets backed and there’s lots of reasons people get diarrhea and that’s just just one I mean you can get a you know a
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viral or bacterial you know mediated diarrhea and other cancer certain cancers that cause diarrhea what is the
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best gut health measure you’ve seen as of recent fiber I would think if you could if I could say two things I would
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say everyone should drink more water every day 64
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ounces of water a day minimum is that like the milk jug or is that a little more it’s pretty
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close I mean you drinking water all the time all the time you’ve got the water bottle I didn’t see you with the water bottle yeah
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um there was a I mean I was watching there’s some days I’m not good either yeah but uh most days I’m
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pretty good yeah all the time water water and then eating 25 grams of fiber a day uh and then if I would add a third thing
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is cut your portions down to half of what we probably probably I mean if you if an average American you
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know I think I mean they’re probably eating at least 4 000 calories or more a day wow so
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don’t get the large at McDonald’s just I would suggest stay away from McDonald’s all together McDonald’s is some evil
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empire I mean there’s some there’s some bad guys sorry Mike McDonald’s sorry
20:54
McDonald’s yeah no thanks yeah uh right what’s one of the worst cases you’ve ever had a treat if you can talk some of
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the worst cases um you know they always end up being cancer kind of cases and the ones that are tragic are the young ones you know
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that are bad and and the one that I have um it’s not even a GI cancer it was a very young lady she
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was in her 30s and um she had metastatic breast cancer and her
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cancer had spread to where it had um just pretty much taken over her liver and so her liver wasn’t
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working at all and so she was jaundiced she was just yellow because it it wasn’t like a they had sent her over because
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sometimes you can get some cancers that’ll block the drainage to the liver and you can put stents and open it up it
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wasn’t that it was just so far gone and there’s really nothing I could offer that young lady you know I still remember her face I remember the room
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that I saw her in my clinic with her husband and basically just having to tell them that I really don’t have anything to offer and those are no liver
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transplant or anything like that you can’t do a transplant somebody’s got cancer yeah because the immunosuppression increases your risk
21:58
for cancer and so then it would just be kind of like fertilizer for the chaos yeah so that’s
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but that’s basically like you know she you know had to go to hospice and so it was pretty that one was a that was this was a
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normal healthy normal lady just got just a really bad breast cancer you know uh
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like was it uh like too late you know we’re always looking for somebody if like oh you drank too much you ate too
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much you didn’t get checked out early enough but it was that one was not her because she was younger than even when mammograms would have started you know
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and and so it was just a bad one and you know I’ve got I’ve got a lot of other you know see a lot of sad things in
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medicine and there’s some of the you know the ones that are also uh sad are the ones that could have been preventable like the alcoholics you know
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that this drink themselves into into the grave you know yeah and they know they need to stop
22:45
but it’s an addiction and they just can’t stop and you see them and you’re you watch them leave and you’re like
22:51
there’s no way you’re coming out yeah I mean there’s really high functioning people I mean I’ve had Executives and
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you know yeah wonderful families and all the opportunities in the world that have to do anything they want and
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they’re just in a cage yeah how often would you see somebody like that the alcoholics that can’t stop
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um you know I’ve is it a weekly thing not no I would say it’s actually less now and I think part
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of that is um I’ve been doing this for 16 years when I first started there weren’t a lot of uh liver just pure
23:22
liver specialist the hepatologists you know they weren’t as many as there are now and so I think a lot of those folks
23:28
are getting shuttled that direction so I’m just not seeing as many right yeah I don’t think the numbers have gone down I
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think the the general practitioners are starting to talk about fatty liver disease like raised liver levels too
23:39
which may pull people away exactly I think I think that’s a great point I think the primary care doctors are doing
23:45
a great job and trying to hit it at the beginning yeah early on and maybe kind of you know get people to to to realize
23:52
that hey they’re really doing a lot of damage yeah how many what percentage of the American public would you say is
23:58
overweight is there a general stat on that I’m sure they’re always all overweight no and I want to say at one
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point it was 50 because I think it was 50 or more but it’s you know because you
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know you base it on BMI right so normal BMI is less than 25 25 to 30 is
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overweight and then over 30 is obese over 40 is morbidly obese but they
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lowered the levels right um I think that was a couple years ago pretty constant yeah I think okay I
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could be wrong yeah yeah I’m sorry but um you know now that the problem is that you know I’ll see somebody that has a
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BMI of 30. it’s almost just like normal you get a little desensitized yeah but you know it’s not normal yeah to have a
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BMI of 30 you know that’s that’s you know putting you at risk for high blood pressure diabetes heart disease all those things covid take things one way
24:45
or the other on like some of those uh yeah everybody gain weight that’s what everybody talks about I’ve got that
24:51
covet 20 or the covid-19 yeah you know you know yeah they’ve all gained weight yeah and so I think it in that regard it
24:57
is uh the majority of people have gained weight even the people who bought the pelotons during those folks yeah they
25:03
never used them worse slice worse thing you can put in your body before we get to the fecal transplant question worse
25:10
things um yeah I mean alcohol right alcohol I mean in
25:17
excess is definitely an issue and just too much of anything yeah I mean I think I’m being so generic I know but really
25:23
it’s just I think if you do everything in moderation small point you know small portions of look it’s fun to eat yeah
25:29
it’s fun to have a drink every now and then right you know it’s just when you do it to to excess that’s where we kind
25:35
of I once heard that nacho cheese is one molecule away from Pure plastic is there
25:41
anything sure what that’s in there I don’t eat it because yeah you know and I’m not going to say I’ve never had it yeah but uh you know at the UT football
25:48
game perhaps maybe so but I’ve taken it off the list yeah I’ll just celebrate in
25:53
another way a marshmallow we were talking about Marshall what exactly is marshmallow I’m not sure what the I don’t even like so the marshmallows I I
26:00
don’t I try to avoid gelatin why uh because I just feel bad of where it
26:06
comes from comes comes from you know like what is it from uh
26:11
like collagen and the devil yeah yeah basically it’s an animal yeah it’s a
26:16
kind of animal byproduct gelatin is I had no idea so I’m a vegetarian so in general it’s gonna stop the marshmallow
26:22
consumption in my house so they have non they have marshmallows without gelatin they’re not as they’re not as free ice
26:28
cream there’s one um I don’t know if I can mention specific stores but uh
26:34
Trader Joe’s has a good one that doesn’t have gelatin and it’s pretty darn good and it melts like a regular one for a
26:40
s’more so fluff you know the popular sandwich maybe it’s like some kind of collagen
26:46
from an animal it’s just gelatin and sugar right I mean yeah I did not know gelatin was a thing yeah Gilton and
26:53
gelatin’s animal byproduct well first off why is a 55 year old man eating marshmallows at home anyway that’s the
26:58
room fluff sandwich I just tried to relive the old days man ask him the fecal questions okay yes so fecal
27:05
transplant you know it was something that we talked about when I was a a fellow back you know a GI fellow from
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2003 to 2006 but it was not readily available it was a treatment for a particular colon infection
27:17
um called C difficile or clostridium difficile which is um an infection that
27:23
you see in folks that have received antibiotics the antibiotics sort of kill off the good bacteria in our system and
27:29
then this bad bacteria can kind of overtake um although is that yeast does yeast come into play here or no not in the
27:35
colon okay can in other antibiotics can cause yeast infections in other areas okay okay in general not in the colon
27:42
but can it in the gut in the esophagus okay you can get it yeah you can get esophageal fungal infections and and
27:47
that yeah but so this um uh but now even with C diff C diff has changed and to where even folks that have not received
27:54
antibiotics can get C diff if you’ve been in the hospital or a nursing home those are high-risk settings where you
27:59
can get this infection so the treatment is go figure antibiotics uh different antibiotics and that usually will work
28:07
but sometimes you have to treat multiple times so they’ve now developed different antibiotics that will treat this
28:13
particular infection they were getting to a point where some people were just basically they
28:18
were losing their colons because they couldn’t fix it and they were just having massive amounts of diarrhea and
28:23
just not getting any better and so they would they would you could lose your colon which you can live without a colon It’s not a great way to live but but you
28:29
can’t wait you can you you can just overuse your colon like it’s just well it was just yeah well it was just it was
28:35
infected and it was just infected and some people then they’ll get dilated and and just they’ll stop working increased
28:41
risk for just overwhelming infection or sepsis so they just have to come out because otherwise they were going to die
28:46
if you get the colon out you got to do the bag uh for a short time probably and then
28:52
they can sometimes then do some other things to make a little pouch or you know make it to where it’s another
28:57
cookie buddy yeah yeah but so so what happened was some really smart folks said you know well what if
29:04
we could just reintroduce normal bacteria and so they started this idea of if
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healthy donors could donate stool and then if you would just instill that
29:16
stool in the colon would that get that person to repopulate a healthy
29:23
population of bacteria and get rid of the C diff on itself without any further antibiotics and darned it works oh wow I
29:31
mean who like who’s the first this boggles my mind like where does the idea come from then is it like at the the
29:38
school where it’s like my husband’s working on a very uh very Advanced Grant of you know fecal transplantation you
29:46
know like who says like I don’t get this and then it’s like an astronaut you know like
29:51
first man like I’d like to volunteer for the trend like you know I don’t know I’m I don’t know the history of it uh you
29:58
know and and uh I can I can tell you later I don’t know the history of it but the the crazy so that is since evolved
30:04
to where now um they’ve found that you can actually if you do a long do an upper endoscopy
30:11
longer one where you go into the small intestine you can instill it that way and it works
30:17
why you would want to do it I mean seems like the other way seems better yeah but anyway and also now that the
30:24
newest thing is they have like capsules like stool capsules that if you can that’s what
30:29
they’re working on right I’ve not seen that it’s actually been out I’ve not that sounds reasonable yeah you probably
30:35
take it from the people smuggling heroin through uh swallowing contacts
30:40
yeah could that potentially get rid of these you know uh receipt of infection
30:45
so that’s really where the fecal transplant came about interesting but this interest is the whole gut biome uh
30:50
is a very um fertile ground for research right now because they’re saying could that be
30:56
our you know our natural population of bacteria could that right determine if we’re obese or not
31:03
oh really so that’s that’s really kind of Cutting Edge physiological yeah because there’s something yeah there’s
31:08
something else going on that could be contributing to to obesity in some folks right and then you know do you do a
31:14
transplant to a healthy donor from say I want Michael Phelps to stool yeah right
31:21
you too that’s weird yeah I know you know is kombucha good for you I mean it
31:26
I I mean it’s fermented I mean if it has probiotics that you know that there’s a thought that probiotics you know are
31:31
they good you know they can help some people especially with irritable bowel type symptoms you know gas bloating
31:37
cramping and it does help some people some people it doesn’t really do much of for them uh it doesn’t hurt anybody yeah
31:43
in general yeah you know it’s going to help you or not do much yeah what about expiration dates for that you see if food expiration hits all the time how
31:51
how real should we pay attention to this stuff um I I do uh just because it makes I would
31:59
just think about it right I don’t know is that just is that is that a silly question because
32:04
take them seriously yeah I usually do but you know I think that you know I’m sure it like you know folk you know food
32:09
banks and things I think they you know I’m sure that there’s a built-in window exactly yeah you know to where
32:16
they could still be used and say folks that just really need you know I can give you a little first world uh
32:22
experience with that at one time I was at my grandmother’s and chumped into a bag of uh cheese Buffs and when those
32:29
disintegrate begin to disintegrate in your hand but then very quickly in your mouth yeah it would be it would have
32:35
been smarter to look at the expiration what about so uh I am you’re a
32:41
vegetarian you said I’m a I’m a pescetarian so I don’t eat meat uh what
32:46
are your thoughts on meat chicken things of that nature I think it’s I think you know I think it’s um
32:52
I will say I think for the planet the best way is is vegetarian just because raising livestock and poultry and now
33:01
even you know fish farms and all it’s harder on the environment takes more water you know takes more resources right
33:07
right um in terms of on a more just individual basis I think it’s fine to eat meat
33:13
um I think red and processed meat should be the smallest portion or part of your diet um the World Health Health Organization
33:20
probably it’s I want to say five to ten years ago came out with a pretty explosive statement that’s saying that
33:26
you know eating red meat causes cancer and usually these kind of organizations they don’t put out such definitive type
33:33
papers but man they did it and it made a lot of people mad that had a lot of
33:40
monetary interests uh uh sure sure you know with with meat production right and um
33:47
and they actually spelled out how much you should be eating and I don’t know the numbers off the top of my head but I would just say it should be the smallest
33:53
portion of your diet we should all be eating more fruits and vegetables more vegetables than fruit
33:58
because even fruit has natural sugar it’s still sugar right yeah um so it should be more more of that regard and
34:05
whole grains and and uh and um you can get you know as a vegetarian it
34:11
is difficult getting protein uh you got to think about it I eat eggs so I’m not you know I don’t I mean I do dairy
34:19
um uh not so much Dairy but I do I do do some and and um
34:24
you can do it and there’s a lot of plant-based protein powders now so if you really had right right you can you
34:29
can get it in other ways yeah but I think eating you know I think that eating meat and fish is is fine it just
34:35
like I said should just be the smallest part of your diet sure you’re a father of three as you told us uh is is a as a
34:41
parent three of us are obviously but what’s good advice just generally speaking for kids these days you said
34:47
enough things already is urged a general statement you know with the kids is always just trying to get them to eat a balanced diet right because they you
34:53
know when they’re younger they may just want to eat one or two things and yeah you know and and then you know you get
34:59
tires like oh just eat it you know we all do that how much how many times we’ve done just he’s hungry and he’s
35:04
gonna eat this and then we’re good so even as being vegetarians I think that
35:09
that we had that we were eating too many carbs you know we were not eating enough just green leafy vegetables so that’s
35:16
still the I would just say if we’re gonna push something green leafy vegetables um and uh and eating less sugar for the
35:23
kids there yeah eating you know they didn’t have a sugar recommended you know daily allowance for sugar until the last
35:28
five years and I think they said it should be less than 30 grams a day a standard you know Coke as 35 grams of
35:37
sugar how much do you think that cookie had oh the ones you had yeah I had two twice that yeah so I just had 4X
35:44
probably standard sugar yeah being as they were sugar cookies yeah yeah they
35:49
were delicious yeah so what would you say that the the green leafy vegetable is probably best thing you could put in
35:54
your gut like yeah if you had to choose one well let’s do this if you guys had to choose one food to live off of the
36:01
rest of your life wine red wine it would yeah red wine for sure that might be a little high on the sugar intake uh what
36:08
about you Varan if one’s the question is one food to live off of to live I mean I would just if I would say one you know
36:14
more vegetables yeah yeah definitely nice I choose Pizza Pizza yeah we
36:20
thought you might but I don’t I would probably die before both of you you think I would die first if I ate pizza or 55. you’re expected to die before
36:27
probably probably the wine the wine would kill them yes thank you bye Jada
36:32
all right well super 10 thanks for being here again we did have some technical
36:37
difficulties first run but uh we can’t appreciate it enough and um you know this is super important do
36:43
you ever get I was thinking about it as we were asking you all these questions do you ever get tired of being this kind of doctor in the sense that everywhere
36:49
you go I’m sure someone’s like oh you know I ate this or I did you know they’re all probably talking about their
36:55
stomach where it’s like geez Louise you know no I I love it I really I can’t imagine doing anything else yeah you
37:01
know really for me it doesn’t feel like work uh I get to meet just wonderful people uh the people of Fort Worth are
37:07
just the best salt of the earth very appreciative of Health Care and their doctors
37:13
um I have a wonderful staff we just take care of people but we have fun all day long we laugh and we joke
37:19
and uh that’s in my office at the Endo centers even at the hospitals I mean they’re just the best people and
37:25
I don’t feel like I work at all and it doesn’t bother when people ask people do ask me things yeah um in general it
37:31
doesn’t bother me there are some uh you know maybe a little bit just not the right time you know but but uh no it
37:38
doesn’t bother me and it’s I feel it’s better than a dermatologist yeah dermatologist like hey can you look at this and yeah nobody’s asking me to you
37:46
know look at anything per se you might step in the men’s room we’ve enjoyed the time this is
37:52
fascinating stuff how can people find you for us so we um uh we are my group is called a Texas Digestive Disease
37:58
Consultants uh we’re part of the GI Alliance which is a nationwide organization now so GI Alliance has an
38:05
Instagram page um tddc also has a local website that you can look into and right and uh we
38:12
have uh just a wonderful group of doctors and nurse practitioners um um and um at the ready to take care of
38:19
anybody what kind of photos might people find on the GI Alliance Instagram page just uh just uh just headshots okay
38:25
well we ask our guests before they go aside from family and kids and all the
38:30
familial Affairs do you have a best day of your whole life shoot and uh what I can’t remember what I said last time
38:36
what do you mean last time I feel like I’ve been here before that’s all yeah yeah uh best day of my life that’s not
38:43
related to kids or family correct you came through some heavy times remember I maybe it was like
38:49
that we didn’t get into that yeah I mean I answered for himself sorry I’m just getting a hint you know I um
38:57
on a personal note I mean yeah I mean getting into med school was a was a it
39:02
was a big deal you know because I wasn’t you know it’s really hard to get in that’s cool yeah and I didn’t think I was going to get in I got in so that was
39:09
a big deal personally you know that it was uh because then at that point I felt like my adult life was
39:16
um the path was now concrete like okay now I know I’m here and I just have to
39:21
work hard and I can get to where I want to be yeah and and it really did work out
39:26
um that would be the number one the family one you know there’s too many family wants to mention sure I mean the boys
39:33
are amazing uh they are just uh you know that’s what I look forward to my wife is amazing and you know
39:40
uh she’s had some her own battles so you know beating her beating cancer was a big one I know you said not family
39:45
related yeah um and then um uh the Longhorns winning the National
39:51
Championship uh I had a feeling that might come up there it is there it is
39:57
yeah it was a nice football in football right and uh it’s been a long time ago now some might consider that a fecal
40:04
transplant of its own so I’m ready for another one we’re at thank you for the time we’ve enjoyed it
40:09
thanks for joining fortitude thank you cap Tech spank we appreciate you you next time yeah thanks thank you
40:15
thanks thanks Rod thanks guys appreciate it [Music]