Intro 0:03
Welcome to Maximal Being, a podcast devoted to ditching fad diets and using real science to get you healthy and feeling great. I’m Doc Mok, a GI and functional medicine doctor who harnesses the power of gut health to get you achieving your goals. And I'm Jacky P, a well-informed layman who challenges the experts and ask the questions that you want. Don't forget to hit the subscribe button or leave a comment, and now onto the show.
Doc Mok 0:32
What's going on Maximal Beings, Doc Mok here with maximalbeing.com. Don't forget to hit the subscribe button. Leave us a comment, it does help us to get the word out. If you have any questions, you can email us at [email protected]. Enjoy the episode.
What's going on Maximal Beings. Doc Mok here, beaming in today is just the solo episode. I figured I'd take a moment to talk to all of you about some really important articles that I identified and some really exciting research that we're uncovering at my pancreas program at my job. Unfortunately, Jacky P has been super busy improving the financial health of America, and so you are stuck with me today, but hopefully I'll give you a lot of important information. For those of you that are tuning in for the first time, I'm Doc Mok. I'm a therapeutic endoscopist, which is a fancy type of GI doctor that treats, palliates, and removes GI cancers. I'm also bored in functional medicine, and I'm coming to you from sunny Florida.
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So jumping right in, I wanted to talk about a really exciting advancement in terms of the shuttling of micro plastics across bodies of living organisms. This particular study, which was published just now in 2024 Environmental Health Perspectives, that's Volume 132, issue 2 highlights the shuttling of microplastics that are ingested through the GI tract of different mice. So in this study, they gave polystyrene and various other sort of compounds that are available, say in products that line our food here in America, to these mice, and what they found is that after ingesting these micro plastics in the GI tract, by measuring them in their stool, they found that these micro plastics actually shuttle through the GI tract and end up in the brain, liver, and kidneys of these mice. Super interesting in that we know that micro plastics are here in our environment. It has to do with the way that we treat our garbage, the frequency at which we use micro plastics in treating our food products and storing our food products. And so it's interesting to see that the impact of these compounds may not just remain within the gut, but also exist throughout our GI tract and other organs, really. And it also alludes to the importance of the GI tract in filtering these sorts of compounds as well. You know, anything that you put in the human body will go across your GI tract and be absorbed, with the exception of things like dietary fibers, which interact with our gut microbiome and give us other byproducts that are important, but it's not actually absorbed, and it's a little bit scary to think about a plastic compound that you're eating, you know, something that's wrapped in cellophane making its way into your brain. And we really just don't know the detrimental effects of these things, but it's an important proof of concept. There was a study that was published several years ago in our GI literature, which showed evidence of microplastics, and people in Siberia in their stool, even though there was a very limited exposure there in their environment. And so, you know, not only are we finding that this sort of, you know, chemical compound can be found throughout the world despite limited exposure, but it also clearly gets into our body some way. And so with that in mind, there may be help along the way, I wanted to highlight another really interesting article that was published just now as well, in ACS Nano. And this highlights a magnetic micro robot that was able to swarm different bacteria and water that exists within the cellular sort of research environment, and was actually able to clean the water and the bacteria that existed within this water of these micro plastics. So despite the fact that these microplastics exist in our environment, it's scary the potential effects throughout our organisms. At least, scientists are beginning to develop interesting ways using nanotechnology to be able to remove these microplastics from our body. Another interesting thing in the GI space. I just wanted to highlight so this is a actually a study that we did out of our lab, and this is yet to be published. This is undergoing review through the Scientific Review Board, but what we did is test the urine of different people for environmental and fungal toxins. And we took healthy control groups that were based here in Florida, and we matched them up with people that had developed pancreatic cancer. And in this study, we actually, the group of people with pancreatic cancer had no identifiable risk factors. So taking a step back, you know, pancreatic cancer is becoming one of the lead causes of cancer in America, the survival is increasing, but it is still a very low 12.5% common risk factors include things like tobacco exposure, excess alcohol exposure, obesity, insulin resistance, and acute and chronic pancreatitis, and there's also a number of genetic conditions, including things like braca, which we often think of associated with breast cancer. But what we found in this study is that this group of pancreas cancer patients didn't have these risk factors, so we screen their genetics for risk factors. We talked to them about their lifestyle habits. None of these people had tobacco exposure throughout their lives. They were had very limited, if no, alcohol exposure. They had a plant based diet. They were all of normal body mass index. They all exercise at least 150 minutes weekly, pretty much average throughout their entire life. And what we found in this study was a high level of different environmental toxins, as well as fungal toxins. I wanted to highlight a few of the important aspects of these environmental exposures. So number one is that there was a very high level of something called ochratoxin. And ochratoxin despite our healthy attempts at practicing, you know, plant based diets, ochratoxin can be present both in buildings that have water damage, very relevant here in Florida as well as. People that ingest foods like grains and nuts that are not stored properly or stored in kind of wet environments. And so these people may have experienced this exposure, and there is a tie between ochratoxin and various cancers, but nobody is yet to link it to pancreatic cancer. So I can't tell you that this is an exact cause of pancreatic cancer, but there's at least some sort of interesting correlation there. Right. The way to determine cause in studies is to do what we did in these first two articles that we highlighted, and that is, give it to something, an organism in a controlled environment, and look at the effects of that organism by getting rid of those tissues, removing those tissues from the organism's body. Obviously, you cannot do that with people right that there's no ethical way that scientific review board would allow us to give okra toxin to people and track whether or not they got pancreatic cancer, nor, nor would any reasonable scientist that is not a psychotic want to do that? So it's an association, right? It's an associative relationship, but it's an interesting one at that. Now that wasn't the only relevant finding. So we found citrinin, which is a toxin that can actually have some neurologic effects. And in this population, there actually was a subset of people with pancreatic cancer that had very rare spinal cord and neurologic metastases. And citrinin has a way of poking its way through the protective lining of our brain and our nerves in a spinal cord. And so that is also a very interesting finding in this study, additionally, talking about some of the environmental toxins. So organic phosphates were in much higher levels. Benzene compounds were also in higher levels. A lot of these compounds that we found in the urine of these people with pancreatic cancer, as opposed to healthy controls, exists either in water that has not been treated properly or also through the inhalation of different exhausts. And that could be either through people's jobs or through, you know, sitting in traffic on various highways. And so these are controllable factors. You know that I think that that is that the both the good thing and, you know, although these are scary findings, this gives us hope, right? It gives us the ability to control these potential risk factors. And again, I'm not saying that these things will cause cancer, but it has at least the potential. You know, you can purify your water, you can attach a system to your home for $1,000 or so, and this system can actually extract a lot of these very harmful compounds from your water, potentially decreasing the potential effects of these things. Again, again. I'm not saying that this is the cause of pancreatic cancer, but it's at least an interesting finding in a group of people that otherwise we deem healthy.
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Switching gears in terms of association, not causality. I wanted to highlight an interesting article that came out just now, again in neurology clinical practice, that associated acid suppression therapy with an increased risk of migraine headaches, and this is through the National Health and Nutrition Examination Survey. So this is a survey that's given to Americans every year. It has actually a pretty wide usage. This particular data set was from 1999 through 2004 so older data, and what they found in this group is that people that were on acid suppression therapy, things like acid blockers, like omeprazole, pantoprosa,l and other generic antacids at about a 70% higher risk of having migraines. And the correlation that these authors make is through magnesium. You know, if you go on Instagram and look at different influencers, a lot of people will tell you to take magnesium. And I do think that there's a lot of useful ways to to utilize this mineral, but you know, one thing to be aware of is just that there are a lot of side effects to magnesium as well. In particular, it can cause pretty profound diarrhea. So when we're setting people up for colonoscopy, one of the things that we use is actually magnesium citrate to actually get rid of all of that waste from the GI tract so we can see we're doing fine. Find colon polyps prevent colon cancer. But in the case of the rest of the body, magnesium has a lot of great effects. So it can cause relaxation, it can cause a sense of calm in terms of your neurologic system and your muscles. And so, you know, there are effects of magnesium using these medications. And so the thought is that these medicines interfere with your ability to signal magnesium through the body, in particular the brain, and therefore can potentially cause migraine headaches. I would also hypothesize that there's a potential for these proton pump vinegars to interfere with the way that we digest certain foods, and there's a known association with certain foods, particularly alcohol and chocolate and different aged cheeses and migraine headaches. And so it's an interesting thing, the impact of these medications, I feel like we continue to discover a lot more and, but I think for it, in order for it to gain a lot of national press, often there's this kind of association, not causality study that comes out. So when I was going through training, there was an assertion that these medications cause heart attacks. And in fact, we've subsequently done randomized trials that kind of debunk that fact. And then presently, you know, before this study came out, there was a potential impact on stroke and dementia risk. I think the jury's still out on that one. But what are the real effects of these acid blocking medications? So acid blocking medications, namely proton pump inhibitors, block the the main last stop of our acid pumps in our stomach. The acid pumps have different inputs, so acetylcholine, which is a neurotransmitter, inputs into this pump to cause acid production, a hormone that we make called gastrin also does the same thing. And then hydrogen atoms, or histamine, both of these things can also input into this acid pump. And so before we created proton pump inhibitors, which block that hydrogen atom potassium pump, we were blocking things like histamine, but obviously you're leaving the other main gateways still open, so the body can often figure out a way around these sorts of things. So as a result, when I have people come in and they're on medicines that block histamine receptors like famotidine, they often will report breakthrough symptoms, or if they're having additional effects or benefits this these effects may actually be placebo induced, because inevitably, your body will find a way around this blockade. But if you block the end state the proton pump, that actually will theoretically block acid and of course, the human body can adapt over time, but it it's much better at controlling symptoms, and there's tremendous amounts of great quality evidence, randomized data, systematic reviews that show these proton pump inhibitors are better at improving symptoms than h2 receptor antagonists, but there are also greater potential effects and long lasting effects. And so I'm a member of you know, the NCI neuroendocrine tumor board, where we create guidelines and neuroendocrine tumors are this kind of weird tumor that exists in the GI tract. It makes hormones. Your GI tract makes a lot of hormones, things like gastrin, like we just talked about, things like insulin, things like somatostatin and secretin that make our pancreas move and shake, make our GI tract move and shake. So can cause all these kinds of interesting symptoms, and the main link between these is usually serotonin. So in the stomach, we're noted there are actually previously three different types of stomach neuroendocrine tumors, and one tends to be relatively indolent. In its course, people have generally have a pretty good prognosis. Two is associated with genetic conditions and ulcers, so it's called Dollinger Ellison syndrome. And three tends to have a worse prognosis. But now we're actually uncovering type four, and the belief is that type four may be related to these acid blocking medications. And before you get scared and call your doctor or call me if you are one of my patients, I just wanted to tell you that you know these data are still evolving, but the association is becoming way more evident, and so you know, we need these medicines to improve our symptoms, there are associations with other conditions that are a little bit scary. Now these more causal relationships are becoming more concerning. So how do we as a society get off of these medications? You know you have to be real with yourself, right? So your cause of your is number one, is your heartburn, really heartburn? Is it true, acid reflux disease, or non Ulcerative dyspepsia, where you have a burning in your belly, or is this something else, and you're on a proton pump inhibitor for really no reason? So that's number one. Number two is, you know how to get off of these if you actually are on them. And number three is what is causing your acid reflux disease if you do, in fact, have it. So the best way to determine if you truly have acid reflux disease is to start this medication and see if your symptoms improve objectively, or you can also give acid to somebody and see if it reproduces them. And then the most objective sort of testing are pH monitoring tests, which we can do by little capsules that are inserted into your esophagus or via catheters that go through your nose and measure the fall and rise of ions over time. So that's the most objective way to determine it. The rest is really just surrogate markers, including what your ear nose and throat doctor may do by sticking a camera in your nose and saying your cords are red, the data on that shows that your nose and throat doctors actually aren't very good. And when they're blinded and look at the same pictures, they can't predict that, and those predictions actually don't match up with true acid reflux disease as measured by the methods that I talked about. The first determining, do you have that diagnosis? Second, if you have that diagnosis, and you're interested in getting off of this, think about the causes. So in America, probably the most the most common cause is related to the foods that we eat, so different environmental sensitivities to foods or being overweight. If you're overweight, you need to lose weight to get to these greater these symptoms. But there are a lot of other factors too, so things like having a hernia inside of your stomach kind of going above the natural acid barrier, which is the diaphragm. It also has some internal barriers, but the diaphragm is a huge part. So strengthening your diaphragm muscles may have some help. Are you coming home from work and eating too late? So separating your last meal from bedtime by four hours or greater actually has a very high likelihood of getting rid of acid reflux symptoms. The highest one is weight loss. Also being real with you know what sort of exercise is best for you? So for some people, I've found that running tends to upset it. For some people, it's cycling. Experiment with different types of exercise that may strengthen and really the core strengthening is important. In terms of environmental sensitizing foods. You know, they're very common culprits, things like lactose or dairy and gluten probably being the most prevalent, but there are many other ones, like soy and sesame and peanuts. You can get these things tested. If you're interested in getting these things tested, reach out to me at team at maximalbeing.com or you can take our free course that's available at maximalbeing.com and we can run these tests, and you can determine what foods are best for you. Or you can do something called the elimination diet, where you remove the common food culprits and you reintroduce one variable at a time and test yourself at home, and all that does is cost, the amount of time and, you know, and the cost of food. And so we can, we can help you out with those things as well. If you have no risk factors that you can see the the other thing to think about is stress. So there's a direct effect on our psychological state, on different neuro hormones on the acid pump. And so we already talked about the input of hormones like acetylcholine and like gastrin on the acid pump. Acetylcholine is directly affected by stress levels. And so working on stress, you know, I'm talking to all of you out there, I know that I am is super duper important for improving acid reflux symptoms and digestive issues. And so that can be in different ways. It can be through community. It can be through religious practices, if that's your thing. It can be through mindfulness meditation. And there are also exercises that you can do to kind of relax the vagal nerve, which is one of the main inputs into that rest and digest system, the parasympathetic nervous system, which makes acetylcholine. So all those things really important for acid reflux disease. And then we can get into a lot of other less common causes, but you know, those are the the high yield fruit. If you are able to improve those, you're on your acid blocker, and your doctor tells you to stop. Inevitably, you will have rebound symptoms, because those pumps are used to being blocked, so they kind of get bigger, and when you remove that blockage, they're going to make a lot of acid. And so we kind of recommend a tapering regimen of getting off of your acid blocker if you want to know more information about that, or if you need help guiding your doctor again, email me at [email protected]
So a lot of really interesting stuff today, guys, you know, I just wanted to go through some some interesting environmental sort of research, which has a great sort of interaction between the gut as well as functional medicine through environmental toxin exposure, highlight some really exciting evidence that we're uncovering and in the process of publishing through my lab. And then I also just wanted to briefly touch on an important subject which is near and dear to my heart, some may say, burning with the heart, but and that's acid reflux disease or heartburn. If you want a deeper dive into this, we interview my pal, Dr Jeff Costanzo in an earlier episode. Go ahead and listen to that on your favorite neighborhood podcast listening software. We're looking forward to doubling back with Jacky P when he gets back from a much needed break, and he's really been hustling at work. But I'm looking forward to doing a lot more of these solo talks with all of you. If you have any questions for me, email me at [email protected] and head over to maximalbeing.com to download our new free gut health tips course, lot of great tips on there on how to improve your gut health that are very high yield, very succinct and sponsored by yours truly. If you haven't done so already, go ahead and hit the subscribe button. Leave us a comment. We love getting the word out there, and that is the best way to do it. And as always, I'm Doc Mok, and I am here to maximize your health.
The content included is not intended to be used as medical advice and viewers should consult their physician or health care provider should they have additional questions. The viewers should not rely on information contained in these presentation for immediate or urgent medical needs. Additionally, if you think you have a medical emergency, call your physician or go to the emergency department or call 911 immediately. Never disregard professional medical advice or rely on seeking medical care or delay medical care due to information contained in this presentation.
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