Is It Just Gas? The Shocking Truth About Gut Pain, SIBO, and What Your Poop Is Telling You | Doc Paco de la Vega

Dr. Paco de la Vega: [00:00:00] The rule from digestion is you need diversity, you need colors, you need different substances, but also because our gut is a universe of these creatures, the intestinal flora, so the diversity is what really gives more things to your gut to work and to feel well. The idea of the microbiome not only breaks down food and decomposes it, but bacteria, as long as it is stuffing with energy of glucose, it transforms also into other products.

We call it postbiotics. These substances that can be pro-inflammatory for anti-inflammatory. 

Dr. Brighten: So what kinds of foods people are gonna wanna know, what kinds of foods are injuring or hurting their gut? 

Narrator: Dr. Francisco Dela Vega 

Narrator 2: is a leading surgeon and endoscopist from Mexico City, who's changing the way we think about gut health 

Narrator: certified in both general surgery and gastrointestinal endoscopy.

Narrator 2: He's a fellow of the American College of Surgeons and a firm believer that we live in a gastro centric world 

Narrator: from reflux to bloating and beyond. 

Narrator 2: Dr. Della Vega is on a [00:01:00] mission to help us break the cycle of digestive dysfunction by reconnecting how we eat with how we live. 

Dr. Paco de la Vega: We all heard of, uh, celiac disease and we do believe that it's like really coming out there and it's actually not.

'cause it's not only the part of getting the really hurt, it's having also immunological disease that manifests in your blood. The thing is 

Dr. Brighten: gas bloating. Bowel movements, what's normal and what's not normal. So what can people expect? Like day to day? We consider that normal. And what are the things that are like, it's time to see your doctor.

Dr. Paco de la Vega: First of all, digestion is, uh, 

Dr. Brighten: welcome back to the Dr. Brighten Show. I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most up-to-date information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast Get out to everyone who needs it. Alright, let's dive in. Dr. Paco, welcome to the podcast. 

Dr. Paco de la Vega: Thank you so much for this opportunity and uh, I'm very grateful to be here and have a chat with you. 

Dr. Brighten: Yeah, we met [00:03:00] in the emergency room.

That's right. So I woke up with the worst pain and you know, when you wake up with pain you're like, well, that's not a good thing if you can't sleep. But when edged on this feels about like childbirth level of pain. I was like, I have to go to the emergency room. And I immediately was like, when I went in trying to explain to them like, I need appendicitis ruled out.

I, you know, is this cholecystitis? Like I was going through everything. Amazing care, I have to say. Like that emergency room, I was like, man, they let me sleep. Like it was so great, but they wanted to gimme Cipro, which is an antibiotic, and I immediately was like, eh, you know, we don't have a culture. There's no way to know.

This is bacterial. Get me the gastroenterologist. And then you arrived. 

Dr. Paco de la Vega: Yeah, that's right. Uh, can I say where I work? Where we met? You should say anything you like. 

Dr. Brighten: Yeah, 

Dr. Paco de la Vega: so, uh, we're at the, we, uh, it's called here, the English Hospital, the American British Cal Hospital. And it's a really cool hospital. I really like working in there.

And it's not [00:04:00] like, uh, I don't work for the hospital. I have a, uh, a private office in there, and every now and then we are on call for the whole week. Like mm-hmm. You're, you're part of the gastroenterology team and for this week you're gonna take all the emergencies and never Someone asks for a, a gastroenterologist, they're gonna call you first.

Okay, that's fine. Actually, I do work for the gastroenterology work, but also, um, I, I am a surgeon, I'm a general surgeon and an endoscopist. That's why I get this in this part of, uh, of this specialty. But for many years, I mean, even in the gastroenterology specialty and in surgery, abdominal pain is always a pain in the neck.

You all are always trying to figure out, out what is it, and if it's something you have to take, you have to take out, you have to take it out. But there are a lot of things in there that actually don't [00:05:00] met the, the right criteria and they, they still get sometimes, uh, a surgery because some people just can't pin down what it is.

Mm-hmm. And there, there are so many cases like yours, like you just get up and you have the worst. Pain in your life and you're like, what is it? Yeah. And then you go to the er and this is a great hospital because you have the opportunity to actually get everything done really fast. 

Dr. Brighten: Yeah. No, they, I mean, they did the ct, they had an ultrasound, they were doing everything.

Yeah. 

Dr. Paco de la Vega: You're gonna roll out. 

Dr. Brighten: Yeah. But I have to say, so you came in and while I was like, I need to have you on the show, is because. Well, right away you started talking to me about like, there's this overgrowth that happens in the small intestine. I was like, oh God, it's sibo. I came to the ER for sibo.

We're gonna get into like what that is. But then you started asking me about my diet, talking to me about fiber daily habits, and I'm like, in what world is this? What you get in the emergency room that never happens in the United States? And this [00:06:00] often gets categorized as functional medicine or naturopathic medicine when you start talking about lifestyle and nutrition.

And yet for you that's just a given. That was something that you're like, this, of course we're gonna talk about your diet because we're talking about your gut health. 

Dr. Paco de la Vega: Exactly. The thing is the, the ER is, uh, it's a difficult place and uh, fortunately I've never been in an emergency room in, in the United States, but I.

All my friends have every now and then been there. Mm-hmm. And it's something like very, uh, different from the part we live here in Mexico, because in Mexico you, you get two types of medicine, the public medicine and the particular one. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And public medicine, it's very, very similar because there is a lot of work and there's a million people out there in the emergency room.

Oh, I, I've also worked there. In many cases. People were, were not, were not only like bought in, but they were even on the floor waiting for their turn. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Even if they. [00:07:00] Put them an iv, they just sit them on a chair and they give them their IV and let, and they just say like, uh, don't let the air get in or you will die.

Dr. Brighten: Oh gosh. It's 

Dr. Paco de la Vega: not a real thing, but people, people do believe, like, like it is going to, to happen something really bad. Um, the thing is, there's a lot of work and the thing is in emergency, in the emergency room usually get, uh, consultation from the emergency people. Mm-hmm. You know, they are a specialists in emergencies and they are also used to treating the, the things quickly.

Yeah. And that's why you usually don't get that kind of, uh. O of interview with, uh, the specialist. Mm-hmm. Because it is like, okay, if it is from a special, are you dying or not? Are you dying or not? Yeah. Get out and go to something else. Yeah. But it was a good opportunity. And then we met, and that's the thing I always need to ask people, because the thing is when they come in and they have a lot of pain and we have rule out important things like appendicitis and [00:08:00] cholecystitis on any other emergency that actually needs surgery, everybody is like, well then what is it?

Because they just, uh, gonna mail, mail me the, the bill, it's gonna be a lot of, uh, uh, of pesos and dollars. Mm-hmm. And you just want to know why. Yeah. And when I need to explain all this at the end, people just like understand like so is, was what we call it in, in Spanish. 

Dr. Brighten: What is that? 

Dr. Paco de la Vega: A stuck, uh, gas. 

Dr. Brighten: Oh, yeah.

Dr. Paco de la Vega: Uh, and they are like, I can't believe that you're gonna tell me that that pain is only gas. Yes. It's only gas. Yeah. Because all your nerves inside can be triggered just because everything is dilating. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Is getting distended, is getting bloated. And the thing that most bloats very quickly it's gas.

Yeah. So we need to treat the gas. Even my, my, my son is one of those people that comes in in the morning and he's like, dad, I feel really [00:09:00] bad. And I really, my, my tummy hurts. And of course that I also believe that I need to be sure that it's not upend side, but my first rule is you have to best a guess.

Yeah. And almost immediately, and he was like, okay. And then he just rips one off and he's feeling really, ah, it's, that's fine. Yeah. I, I feel well, 

Dr. Brighten: yeah. Well, let's talk about that. Gas, bloating, bowel movements, what's normal and what's not normal. Okay. So what can people expect, like day to day? We consider that normal.

And what are the things that are like, it's time to see your doctor? 

Dr. Paco de la Vega: Okay. Uh, first of all, digestion is a really important part of nature. Um, e every time you read about it, it is, it just doesn't end because it's always more information about it. Everything we used to, to know now, it's not that, that same information, uh, many, many years ago.

I, uh. [00:10:00] I read the book, our, uh, book that is called, uh, actually Dunno in English. It's called El Medic The Medic. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: From Noah Gordon. And it's a story about this, uh, guy in the middle ages in England that, uh, goes around with a surgeon learning how to be a surgeon that is like being a mechanic. 

Dr. Brighten: Mm-hmm.

Dr. Paco de la Vega: And then he mets a actual wise man that comes from the Middle East and that he's operating, uh, sorry, I, I, I forgot the word for Cata. The 

Dr. Brighten: cataracts. 

Dr. Paco de la Vega: Cataracts, yeah. Yeah. In the eyes. And he was like, whoa, I need to know how to do that. And he just like, it's a whole story of how he gets into the Middle East.

And then he met this great, uh, character from the, from medicine history that it's Sina or Aviana is one of the, uh, great minds in medicine in Middle East. And he just like, uh, starts being like a med student there. And I [00:11:00] remember one particular, uh, story from the book where, uh, uh, this man comes in and he's like in the emergency room of the palace and he, and he's in a lot of pain.

And they get, they get him a lot of things try to work to make him eat and he doesn't eat. And the master Sina ask, asking him, well, where is, where is he from? What does that matter? Because that matters. What does he eat? 

Dr. Brighten: Mm. 

Dr. Paco de la Vega: Because it's important. What if, if if he's from this particular region, he will not like your rice.

Yeah. You have to give them the other rice. Mm-hmm. 

Dr. Brighten: And 

Dr. Paco de la Vega: that really like got to mean like, of course you have to be like, get those details. What do you eat? Yeah. 'cause people come into the emergency room and they feel really bad. And you have to ask, what are you eating? 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: I already rule out it's not appendicitis, it's not, everything's fine.

What are you eating? And then everything starts the, the, the typical interview. No, of course I eat. Pretty well, doctor. 

Dr. Brighten: Yeah. Nobody wants to, [00:12:00] no one wants to admit it. Right. Every 

Dr. Paco de la Vega: single thing, uh, you know, from, from the dietary section in, in the supermarket. And when they start telling you everything they eat, it's like, okay, what else do you eat?

No, that's all I eat every single day. And do you have no diversity? It's important to get diversity. Mm-hmm. And then you start this real conversation because the thing is, the rule from digestion is you need diversity. Yeah. Not only because, uh, the, the food is in, in, you need colors, you need different substances, but also because.

All the, all those things you're buying from the supermarket, it comes from a refrigerator. They have conservatives. Mm-hmm. But if you get to eat, uh, what it's from, the actual season is more fresh. They have more things. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And that's part of, of that important interview with the patient. What are you eating?

And then they tell you about your gas and the movements, and you have [00:13:00] to ask how many movements you have in every single day, because some people come in with diarrhea or constipation. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: In Spanish, we actually have two different words to ask about constipation. One is when you don't feel the movement in your gut.

Dr. Brighten: Yeah. And 

Dr. Paco de la Vega: the other one is going to the actual bathroom. Mm-hmm. Call it. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: It's not the same thing because one people might feel like they are not going enough to the bathroom. 

Dr. Brighten: Yeah. So incomplete. Void. 

Dr. Paco de la Vega: Exactly. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: On or on the other side. They, they, you ask them are, you might be cons, could you be constipated?

No. I go every day to the bathroom. Yeah. That doesn't rule. Rule it out. Yeah. You can still get a lot of things up there in, in your stomach still trying to work their things down. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: So it's part of the thing that how much, how much is good enough that there is no like. Perfect count. Mm-hmm. Everybody would like to have like, uh, one day go to the bathroom and just feel great.

Yeah. That is in the perfect world. [00:14:00] Mm-hmm. But not many people are like that. Uh, some people go, uh, maybe one day One day, yes. One day. No. Some people actually go, many. They tend to have many days without going. Mm-hmm. And you asking, are you feeling bad? No, I'm feeling fine. Yeah. And that's the thing. If the clinic is like, you are feeling okay, then that's it.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Many years ago when I was in my honeymoon, I met this guy in the bus and we, he, and he asked me and my wife, are you newly wets? Yeah. Can I give you an advice? Yeah, sure. And he'd tell me, if it's not broken, don't fix it. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: Best advice ever. 

Dr. Brighten: I thought he was gonna say, just get comfortable going in the bathroom in front of him.

Now 

Dr. Paco de la Vega: that, that was also a thing, you know, that. It's been part of my life mantra. If it's not broken, don't fix it. Mm-hmm. If a patient tells you, I feel well, I feel fine. Okay, let's ne next thing. Mm-hmm. So that's the thing. If you are not, if you're feeling well [00:15:00] with your normal, with your movement, that's fine.

I think sometimes you even get social pressure of how many times you should go to the bathroom. Yeah. And here in Mexico, many, uh. Women community, like really get, uh, apprehensive about this. Like, you are not going every single day. And some, some women don't. 

Dr. Brighten: It's me, I'm that mom. 

Dr. Paco de la Vega: Okay. 

Dr. Brighten: I'm checking on my kids every day.

Did you go today? How was it asking the questions? Okay. Um, my oldest is almost 12 and uh, you know, I don't do it every day, but I'll just check in with them like, was it well-formed? Do you have any problems passing it? Do you see any food in there? And he is at the age now where he's like, mom. And I'm like.

I just need to check in on these things because these little things will show up and, you know, it might seem like nothing and it'll resolve itself. And sometimes it's like, you know, as I was telling you, they had a stomach virus and it's like things you were, we're showing up and we can intervene early with like, let's make sure we have electrolytes on board.

We're gonna have some broths because you're starting to have some [00:16:00] loose stools and so you might be getting sick right now. Or, you know, with kids, some, I have a toddler too, which is the age where like if it ever hurts, then they don't wanna go again. And you run into that whole cycle. So, um, it, it's me.

I'm not like Mexican mama being like, let's make sure we're going every day. Um, yeah. So I'm just gonna own that. 

Dr. Paco de la Vega: Okay. I do understand it. I mean, I. I've been that son and they're like, uh, I don't know. Yeah. 

Dr. Brighten: You're like, I've been the son to your mom. 

Dr. Paco de la Vega: I'm also that dad and, but I, I am, I never asked my, my son, his, his name is Riz.

I never ask Patricia if he's like having bad movements, but he also communicates a lot. And he comes in like, dad, I'm having diarrhea. Or that Yeah. It's, it, it something maybe like one year ago he got like a really, uh, rough time with, uh, going to the bathroom and I, and, and I was asking, we were organized like when was the last time you were eating the, your, [00:17:00] your veggies?

And he, it was a week like we were on vacation or something. He didn't have enough veggies. Mm-hmm. The good thing is he actually likes broccoli. 

Dr. Brighten: Yeah. That's what my toddler, that's his go-to vegetable. Yeah, exactly. His favorite. So it's 

Dr. Paco de la Vega: perfect. Like, okay, get some broccoli. Yeah. And after a day of broccoli, he was going to bedroom like a mister.

Yeah. So that got resolved pretty well, but I waited. Yeah. So he had to ask because. If you are trying to put an agenda on it, it's also going to, you're gonna get like anxious about it. Mm-hmm. And sometimes that's part of what just stops everything. 

Dr. Brighten: That's fair. And I think that's important for people who on social media see people, because there's people who are like, every time you eat, you should have a bowel movement.

And I'm like, firstly, how inconvenient would that be if that exactly was exactly, because 

Dr. Paco de la Vega: we're not worms. I, it's not like we're, we're indulging food and then just pooping out. 

Dr. Brighten: Right. Okay. So what's the difference between a worms, gastroenter, uh, intestinal tract and that of a human? That's another, some 

Dr. Paco de la Vega: question.

You know, because, [00:18:00] uh, it, it is not, I, I'm not a, a super science about this kind of stuff, but I've learned, uh, I've learned through, through the years. Uh, I, I remember that, uh, some, maybe in first year of medicine, when you learn about embryos and human developing, uh. You go through all the phases of all the phases of hu uh, of human development, and they tell you that every single phase is part of the, of the world's evolution, because every part of you has been part of the, of biology.

Mm-hmm. Your track could be like a worm. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: The v it's like an animal, uh, animal. Is that the an 

Dr. Brighten: an enemy. Yeah. See an enemy. And then I am like, might everyone feel 

Dr. Paco de la Vega: anini?

Dr. Brighten: It's, 

Dr. Paco de la Vega: we have everything, everything from nature lives in, lives in us. And yes, it's pretty much the same thing because worm, it's uh, uh, this living thing that in as long as [00:19:00] it's stimulating its mouth and its anus, uh, everything is indulging and move and moving. Mm-hmm. That's prosthesis. First also is the, the movement from your bowel, but it needs to be, uh, stimulated.

Mm-hmm. How it gets stimulated with movement. D dilatation. We start our digestion with the, how we, uh, drink water. Because in the moment you start like moving your throat, it, it starts every, all the engine. Mm-hmm. Now we have a really big engine, meters and meters. Well feet, feet and feet from 

Dr. Brighten: it's fair.

Insane meters. You're like, uh, people from the US with your metrics. Exactly. 

Dr. Paco de la Vega: So it starts with, uh, having your first, uh, sip of, of water. You know, every, everyone is always like, uh, telling me that. When should you go to the bathroom? Everybody goes in the morning. Why? 'cause everybody starts their day drinking stuff.

Dr. Brighten: Mm-hmm. [00:20:00] 

Dr. Paco de la Vega: And we all take our first coffee, our first, uh, glasses of water, and that just starts the movement. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Because coffee makes me go to, to the bathroom easily in the morning. It's not just the coffee. Mm-hmm. You actually, the whole movement of, uh, of drinking, everything you have on your last phase of your colon is waiting there to be moved.

So you start the engine and that's the last thing you, you're gonna start, uh, taking out. 

Dr. Brighten: And that's part of the fasting process overnight as well, that allows the migrating motor complex to sweep things through. Yes. The intestines, which is the enteric nervous system. 

Dr. Paco de la Vega: Exactly. Yeah. But it's also a problem when what you eat can't be, uh, digested correctly because you maybe you come really late from work and you eat maybe at 10, 11 in mm-hmm.

In the evening before going to bed. Then you have to get up at four or five. The, [00:21:00] the thing are still moving and you're like, I'm not going to a bathroom. Of course not. It's been only some hours. You need more. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: Why? Because we're, we are, it's still in transit. 

Dr. Brighten: Mm-hmm. I wanna, I wanna go back to the, an enemy though.

Okay. You mentioned the vii. Yeah. What are those and why do they matter? 

Dr. Paco de la Vega: It's, uh, it's a, actually, it's just like the form in how cells organ organize themselves inside the intestine. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Every VI has. Hundreds and millions of more cells that this v as, it's just like, uh, uh, the organ, like reaching out to the surface.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: All these cells are, uh, out there absorbing the, everything that comes into the intestine, water, glucose, proteins, uh, vitamins. They are there to absorb it. So it's, uh, having millions and millions on this village, just like having catapults of absorbing, uh, organs to put them in there. The thing [00:22:00] is, they are also having, uh, this, uh, interaction with the food as it is, not only with the little things they can absorb, so big things can also, uh, uh.

You know, like hurt this villa. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And they also interact with bacteria and they also interact with everything that creates a reaction. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And sometimes it villa gets, uh, gets hurt and they, instead of being like, uh, really cool grass growing, they start to, uh, be like really smooth. And there are, there are no more like.

Great surface to absorb. Why? Because of the chronic getting hurt. Mm-hmm. Getting of this, getting hurt chronically. 

Dr. Brighten: I think one of the most well known that people will relate to conditions is celiac disease. When you get exposed to gluten that there's the autoimmune issue, and now instead of having these finger-like projections to absorb everything, they're blunted, 

Dr. Paco de la Vega: it's like, okay, taking [00:23:00] that, uh, idea, like for a really cool schematic, we all known, we all heard of, uh, celiac disease and we do believe that it's like really common out there and it's actually not mm-hmm.

Not, not that common because it's not only the, part of the getting the IC hurt is having also antigen reactions is having a real immune immuno, which is the immune system immunological disease that manifests in your blood. So it's, it's a really low percentage of people actually getting celiac disease.

The thing is, there are still a lot more people getting very similar symptoms with food. Mm-hmm. Just because. It's the, the, the thing is how we are digesting those things we think is it's food. No, it's not just food. What you are eating is full of preservatives of, uh, paintings or maybe all other stuff.

They, they, they are being, you know, like they getting to the supermarket market and they. [00:24:00] Uh, they put them like for weeks and they, they never, those kind of food, they never, uh, 

Dr. Brighten: they never go bad. Never 

Dr. Paco de la Vega: go bad. Yeah, exactly. They never go bad them in the 

Dr. Brighten: cockroach surviving the nuclear fallout. 

Dr. Paco de la Vega: One of my processors used to say that, have you even noticed, have your bread is not going bad in your, in your, you know, Ana mm-hmm.

Where you put the food. Yeah. Well, it's gonna be really, really difficult for your gut to put to, to turn it down too. So that's why many of the stuff we are eating is, are so difficult to, uh, to digest because they are full of this preservatives con conservatives or 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: Dies everything, you know? 

Dr. Brighten: Yeah. So what kinds of foods people are gonna wanna know what kinds of foods are injuring or hurting their gut?

Dr. Paco de la Vega: It's not like we don't have a list of the most wanted of this shouldn't be the most wanted. I would love that. That'd make it easy. Right? It's, it's so difficult because everyone wants just like the pinned down, uh, [00:25:00] instructional. What I shouldn't eat to feel. Well, the thing is we don't know sometimes the the, you know, uh, I really like to, uh, quote the fiber fuel.

Dr. Brighten: Yeah. Well that was a book you brought up when I was in, I'm laying in the ER and you're like, there's this book called Fiber Fuel. And I was like, yeah, it's amazing. My friend Dr. Will Sitz wrote that 

Dr. Paco de la Vega: and I, I found that book asking Google the thing that actually will answer in this book. Mm-hmm. Because it, it was perfect.

What kind of fiber I need to show my patients. Yeah. And, uh, the, the answer is you need not just one kind of fiber, you need a whole lot of fiber. You, but the thing is you need cool fiber, you know, like, uh, from the season, not from the refrigerator. And it's not just one kind of vegetables. You need all of them.

You need colors because every color represents a different kind of, uh, vitamin, a different kind of, uh, supplement. All of them are important, and [00:26:00] the golden rule is diversity of that fiber. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: So if you want the, the list of what should I eat, everything from the veggies, it's fine, but be sure that it's fresh.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: It's cool to buy them from the farmer's market because going, they're gonna be a lot more organic. Mm-hmm. The thing is, even the organic work has gone like really far into the cap, into the capital market world. Yeah. And everything in the market now is organic and you see organic food in a tray full of, uh, plastic.

Like maybe that's not so organic now. 

Dr. Brighten: Mm-hmm. I know I always encourage people, if you can, if you have a farmer's market, actually talk to the farmers because sometimes it's too expensive and cost prohibitive, they can't use the label. But when you talk to them about what are their practices, you find that they are using organic practices or trying to use the least harmful pesticides.

I just saw recently and it just, I shuttered because broccoli was one of the ones that they're pulling, one of the pesticides used on cruciferous [00:27:00] vegetables because the, if, if the US government is like, it's bad, you know, it's bad 'cause they wait until it's like almost the worst. And seeing that. You know, people get concerned about how it impacts reproductive health, how it impacts hormones, but what you're saying right now is these things we also have to take into consideration about our gut.

Okay. Uh, you said you, you've said a few times, like, we need diversity of fiber. Why is that so important? 

Dr. Paco de la Vega: Because first of all, not all vegetables are, uh, are available every single day. Mm-hmm. Because we have seasons and those, and, you know, there are popular ones. Oranges are always popular, but oranges don't grow, uh, every single season, uh, in every single month.

You have to have a lot of oranges, and then those oranges go into a refrigerator. Yeah. And go into a laboratory where they put down some conservative to keep it shiny and, and, and cool. Mm-hmm. But then that will affect your gut also happens with all those, a lot of fruits and [00:28:00] vegetables because there, there they have, they need to be selled and since they have to be sell, they need to look cool.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And then everything starts the market. Instead of buying it from the mar, from the farmer's market, they're gonna, uh, uh, look for, uh. And another laboratory that tells them that they still look cool because they put them in a refrigerator. But that is gonna affect all the people consuming that. So do 

Dr. Brighten: you think we're doing enough research on how we're manipulating foods on the preservative process, on the pesticides we're using?

Like how the food industry is operating? Are we doing enough research to really understand the impact on our gut? 

Dr. Paco de la Vega: Totally. I do believe that there is enough research. The thing is we need regulation. Mm-hmm. We need actually, we actually need, so you 

Dr. Brighten: think there's enough research to say some of this stuff's bad and we need more regulation?

Is that what you're saying? 

Dr. Paco de la Vega: What, uh, let, let me think about it because, uh, maybe later I won't, I won't, I wanna know if that's what I'm [00:29:00] saying. But there's the thing, the thing is there is a lot of information. Mm-hmm. And there's always a lot of information around, and you can use that information to point out some ideas.

Can I, uh, let, lemme tell you, uh. One, one professor one time. Uh, we were talking about, uh, tr uh, sorry. The trauma, we were talking about accidents. Mm-hmm. And we were talking about the sta the statistics, and he was like, ah, I don't want to talk about the statistics. We were like, why, why didn't you like, uh, statistics?

Because they're statistic statistics are like, thanks. They show you a lot of stuff when they're songs. 

Dr. Brighten: Like underwear. Yeah, 

Dr. Paco de la Vega: exactly. They show you a lot of stuff, but not exactly the thing you need to know. 

Dr. Brighten: That's a good one. And that's 

Dr. Paco de la Vega: the thing with, with statistics, you get a lot of research, you get a lot of statistics.

Yeah. But it's not necessarily what you need to know. Yeah. [00:30:00] The thing is, we're not looking for truth. We're looking for what is comfortable for us. Mm-hmm. And not, especially for us, the first part that is getting comfortable are the selling parts. So yeah, the, the, those, uh, companies, they're gonna use their statistics to say, my food is fine.

Look. Yeah. And statistically it's gonna be okay. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: But the thing is, we, the consumers, we need to just like, we don't need the statistics, we need to use our common sense just to say, okay, maybe I not, I do not need this. Uh. Uh, broccoli in December because broccoli maybe was from a different season.

Mm-hmm. I need something more in the farmers market. There's, there's a lot more of vegetables that I haven't tried. Mm-hmm. Maybe you need that, those, those vegetables, because since you haven't had it, you need that di that diversity. Mm-hmm. Okay. One other example. A lot of people come, come in near the summer here in Mexico and they're like really nervous that they, [00:31:00] they're going to vacation, maybe especially to Europe, and they're like really nervous, like, I'm not going to feel well because I'm feeling bloating all the time.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And I've learned that the best advice is to tell them, just go, yeah. Enjoy it. You know what? Because the food over there is totally different. You need that diversity from there. 

Dr. Brighten: Mm-hmm. And 

Dr. Paco de la Vega: it's gonna help you. You're gonna, you're gonna feel really cool, really good about it. The problem is when you come back and you're like, nah, I'm not feeling well anymore.

Yeah, because you, you come back to your usual, the, the same foods you buy every single week at the su, at the supermarket. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: So the diversity is what really gives more things to your gut to work and to feel well. 

Dr. Brighten: And how does this impact microbial diversity? Well, let's first, what is microbial diversity?

You mentioned it before, you said it matters. So what is it? Why does it matter? And how does diversity of food impact that 

Dr. Paco de la Vega: power? Gut is a universe of these creatures that actually, like we, we've always known they're, [00:32:00] they are there. We, we always call it like the intestinal flora. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Which is actually like intestinal fauna, you know?

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: There are these, uh, bacteria, but also different kind of, uh, of leaving things from arch bacteria. Um, maybe some fungus. Not the the ones that come, come to, to your skin and creates disease, but it's what we need to pour down the, the food. Mm-hmm. Because actually your gut doesn't turn your, the, the food into poop.

You need bacteria to decompose all that food. And as we say, as we see how everything in the world decomposes inside your gut, you also need that. So we need that, that, uh, microbiome, what it's called now, it's a universe. And it's an ecosystem. And in every ecosystem there are different strengths of living things.

Some are better than others. They are trying to survive because that's what life does. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: [00:33:00] They have, uh, uh, characteristics that some strengths are, uh, tougher than the others. And they also have, uh, adaptations. These adaptations can, uh, come, come in eventually and create different, uh, clinical presentations.

One idea that I, uh, I actually try to look a lot from the fiber fuel, uh. Book is What are Postbiotics? Because you know, let's start from what you asked. What is this ecosystem? These are the bio, the biotic universe. Mm-hmm. Inside of us, 

Dr. Brighten: what people know is probiotics often, 

Dr. Paco de la Vega: well, we know, the thing is probiotics are like the, uh, item you try to bio the pharmacy or at the supermarket.

Mm-hmm. But it's actually just part of use is, is the, the ecosystem. And you need it to maintain the regularity in how you decompose the food. If you [00:34:00] just go into the pharmacy and get more pro uh, probiotics, you're actually just putting more animals in this zoo. The thing is, if your sue is already packed, you're just like putting a lot more problems.

Dr. Brighten: Mm-hmm. So you gotta feed those animals. 

Dr. Paco de la Vega: You gotta feed those animals. The thing is, you feed them with prebiotics, which is actually fiber. They're also selling prebiotics, like get your prebiotics. Like you could also get just food, you know, like regular food. And that, that, that is, that fiber is prebiotic.

It's 

Dr. Brighten: how is it in Mexico? Because in the US you know, we recommend 25 grams a day and we know that the average person's hitting about 12 grams of fiber a day, which means that many people are falling below that. In 

Dr. Paco de la Vega: Mexico, nobody. Uh, 

Dr. Brighten: yeah. Corn not the best source of fiber first. First of all, 

Dr. Paco de la Vega: nobody is counting the fiber because.

I'm 

Dr. Brighten: also counting fiber bowel movements and fiber, 

Dr. Paco de la Vega: at least around the social world where, where we work. Nobody is like, uh, I take this many grams of fiber now. Mm-hmm. They just, because in [00:35:00] Mexico, you, you, you think of food as family time. Mm-hmm. And there's the breakfast and there's lunch and there's sometimes dinner because dinner is not like in the US where you come in after work at five, six and everybody's around Now dinner here is like, I'm just stressed out and I wanna get something to eat and uh, turn down the day.

Mm-hmm. Sometimes dinner is the worst part here in Mexico because everybody's just like tired. Yeah. And what they get to dinner or Lana as we say it, quesadillas. And this, they just start packing cheese and tortilla down their throat for mm-hmm. In, in the night. And it's really difficult to process that over the night.

Yeah. Yeah. And, and the very next day they're still feeling bloated and they start having pain in the morning and they were like, ah, I'm gonna die today. 

Dr. Brighten: Yeah. You can definitely feel that way, especially if you're someone who's lactose intolerant and you overdo the cheese you brought up. Um, so, so far we've talked about like some of the habits being eat seasonally, make sure that we're getting good sources of [00:36:00] fiber and you can achieve that with eating variety of food.

But you just mentioned mealtime being like family time and that's gotta have some benefits to digestion. 

Dr. Paco de la Vega: Yes. Uh, well, if you put it romantically yes. Because, you know, everybody thinks like, yeah, family time is gonna, gonna get good vibes and feeling like really, uh, emotional and it's gonna help your gut because you're feeling well, not necessarily because, uh, not, not, not everything just translates from good fillings into good movements.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: The thing is, in families, you can always have many expectations, especially what are you eating? 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Sometimes there are families where, especially here in Mexico, like, uh, I just want something, uh, a couple towels. And your mom, your mama here is like, are you just going to eat that? No. You need to eat more.

Come on, son, have this and this and this. And then you start, start packing and maybe you are just the boyfriend in, in, in, in [00:37:00] the, in, in the table and, and they are asking you like, are you just going to eat that? And you start eating more. The thing is you start eating more than you can digest. Mm-hmm. And that can be a problem.

Sorry, I I just want to, so you're 

Dr. Brighten: like, mama, stop being food pushers. But I was more alluding to the fact that if you slow down and you actually make time to eat your meal, rather than Okay. Being in the car or, that's different because Yeah. 

Dr. Paco de la Vega: You are talking about those beautiful family moments where you slow down and not getting hassled that the thing is you slow down.

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: It has to be like a really great phrase to, for also gut that just to gut, uh, health, you can slow down. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Because you get to chew your food. Because if you chew it re really well, you're gonna be, uh, you're not gonna, uh, you know the difference between, between the indulging your food and just like chewing it because you're gonna be feel a lot better.

Yeah. [00:38:00] It's gonna help the process also because you need those, uh, that you need that food to, to, uh, mixed with your saliva and getting really, uh, easily, uh, to go down. Mm-hmm. Sometimes people just like ul the food and they're like, yeah, I'm done. Yeah. Oh, slow down. It's important. Uh, uh, taking a little step back because we talk about the probiotics and the prebiotics, I also needed to tell you what I found most important about the Fiber Fuel book.

Oh, the Postbiotics. The Postbiotics. Yeah. Because it's a really cool idea because all from all these strains of bacteria, some of these bacterias are creating postbiotics that are. Pro-inflammatory, but some of them can be anti-inflammatory. Mm-hmm. And that's what I tell the, the importance I tell to the patients are like, you need those diversity to give stimulation to the anti-inflammatory, [00:39:00] uh, pro probiotics in your gut.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Because you need to feed them. Well, if you just take the meats and the lactose and the cheese and, and the wheat, you're just, uh, feeding only one kind of probio probiotics and they can almost be always, uh, pro-inflammatory. Mm-hmm. So you need a lot more fiber. And they sometimes, like we say in Spanish, they call me crazy.

Yeah. Like, are you gonna tell me that I only need to eat more veggies? Yes. Gut health is how you eat. It's just like simple as that. Mm-hmm. You don't need more vitamins, you don't need more probiotics. Please don't go to Costco and find the 1 million probiotics, uh, flaking just in front, like, oh, they have 4 million probiotics.

Like, it doesn't matter if you, if they sell you 10 billion, 10 billion probiotics, the thing is you already have yours. Yeah. You [00:40:00] just need to feed them well. Mm-hmm. Instead of taking those probiotics from Costco. Maybe go to the veggie section. They're also concerned full of refrigerators, but at least it's better than the flask of probiotics.

Dr. Brighten: Yeah. And so I'm curious, you know, we ha you've, you've established we have to feed those critters first. If you're not feeding them, then the probiotics are waste. Are there, is there ever a time you use probiotics? 

Dr. Paco de la Vega: Yes. Uh, this, this is really like the important part of, uh, of researching about probiotics because it's so, they are so popular.

Mm-hmm. Everybody just like ask, I'm gonna get probiotics. Like, no, why not? 'cause they are not vitamins. When do you need them? When you take antibiotics? Because antibiotics that actually are substances that get absorbed in your stomach and then they go to your blood and they go into the tissue, they go to the gut tissue, they're gonna be toxic from the part where actually probiotics, uh, start to, to grow.

Mm-hmm. Uh, uh, [00:41:00] uh, at the root of them. So. Even the good and the bad, uh, probio, uh, the, the microbiome in there, they all get, uh, race down. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: But the most important is maybe the tough ones are gonna brought out first, and the, the, those are the pro-inflammatory. So you have to give more, uh, tools to the anti-inflammatory, uh, probiotics in your gut.

If you've, uh, put down the, the, the ecosystem in your gut, you need to put them a lot, uh, to put good, uh, good probiotics. Mm-hmm. And that's, uh, something I want to like pin down, uh, as one, what, which would be my advice if you could, if you, if, if you are going to take a probiotic, first of all, you need to have an indication.

That means that you need to know why you are going to take it. Mm-hmm. And. A doctor that is a specialist, not because he's a, [00:42:00] a know-it-all doctor, because he works with that. He knows what is going to happen if it, if it goes well with you. But he also know what is going to happen if it goes bad. That's the specialist part.

No, everybody, everybody can just give a, a prescription and tell you, take that because it's good. No, you should know what can go wrong. Mm-hmm. And what, how are you going to uh, to repair that? 

Dr. Brighten: Yeah. Yeah. 'cause there's some cases said you take a probiotic, so for example, small intestinal bacterial overgrowth or sibo.

Exactly. And somebody takes a lot of lactobacillus thinking that's gonna solve their problem and that can actually result in a lot more gas blowing pain. Exactly. Because you're 

Dr. Paco de la Vega: putting more animals in the zoo. 

Dr. Brighten: Yeah. I love that analogy. Exactly. More animals in the zoo. Yeah. I wanna, I wanna talk a little bit about some of the newer research that's come out in terms of the gut brain connection.

Okay. You know, people are often, they'll say things like. Oh, you know, the majority of your serotonin is made in your gut. Therefore, that serotonin is [00:43:00] influencing your brain. And as we know, that's for motility. That's not actually your gut's being stingy. It's gut serotonin. Yeah. And for its own agenda. But there is a connection between the gut and the brain.

Can you speak to that? 

Dr. Paco de la Vega: Yes. And it's like, uh, one of those like things that is, is, is really new, but not also, it's not that new because we always know it for a long time. Mm-hmm. But then this research does, like, gives a lot of people, uh, ideas to talk about. And the thing is, there are a lot of ideas, but actually no, like, practical or treatment ideas or more like ideas like, uh, steps to use them.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: First of all, the idea of the axis between gut and brain, I. This, this is the thing, because even many years ago, it was described how the gut could be communicates with the brain through our nerves, our vagus nerve. Mm-hmm. And all, all what we know of as the autonomous [00:44:00] nervous system. And then the brain tells the, the, the gut when to move, how to move.

And then the gut, uh, starts moving. And depending on what you are eating, it's also telling the brain, I need more of this. I need to slow down. And the first, that the first thing that comes to the AI is like, okay. That, that means that if I'm nervous, my gut is nervous, not necessarily. Mm-hmm. But a lot of, uh, neurotransmitters are gonna get, uh, stacked up.

Then that creates a change in the movement, but it's also a habit. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: So when people say, like, I have nervous colitis and I, my first or answer is always, that doesn't exist. Sorry. It's not, you're, you can't tell me that because you are nervous. You're, you're getting colitis because, you know, I know you're anxious.

Maybe you're fear you're, you're having bad moments in your life. But I'm pretty sure that the guy in, in, in the cave, many [00:45:00] millions, many millions years ago, they were also nervous about what they're going to eat. Or maybe if they have a saber tooth tiger around, they wearing like all bloating into the Yeah.

Dr. Brighten: Can you explain what colitis is though? So people are on the same page with you? 

Dr. Paco de la Vega: Colitis. Actually colitis is, uh, is more of a colloquial word. You know, like something we've, we've been like used to, to say like, oh, my colon is feeling in, uh, this, uh, bloating. Mm-hmm. But when I go into a colonoscopy, I go inside and I don't see the colon tissue.

Like, uh, 

Dr. Brighten: no inflammation, no, no inflamm swelling. Yeah. 

Dr. Paco de la Vega: So there is no actual colitis. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: That what we are just like trying to say like, I'm feeling bloated. Yeah. And that's a symptom, not actually a, a disease. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And that's pretty normal because it's getting filled up with gas. But we like. In, in the informal wake, we call it colitis, or if we are feeling like more, like in the upper part we call it [00:46:00] gastritis.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Maybe you get into, in that moment with an endoscopy, you see the stomach, and the stomach is feeling okay. It, it's like looking cool. Mm-hmm. I have no gastritis. No, because the, what we are calling gastritis is actually the how you feel. Mm-hmm. The, the, the problem in the upper part, like maybe you're feeling blo not bloated, but you have pain in, you know, like in, uh, so like indigestion and Yeah, like in the indigestion and you call it gastritis.

Maybe it just. At the end, you just go to the doctor and, and he's like, oh, it's just not, it's not gastritis, it's functional. Dys. Psia. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And you're like, what's that? Gastritis? It's just like a translation of your symptoms into, uh, some something more relatable word. Mm-hmm. Okay. So when people say, I have gastritis, I have colitis.

Your work as a doctor is to actually make that research through the interview and [00:47:00] ask what is he eating? What, what is happening? Mm-hmm. To say, okay, it's not just uh, colitis, it's maybe irritable bowels syndrome. And yeah, you need to make many these changes. Mm-hmm. But my colon is fine. Yeah, it's fine because this happens.

Yes. When you go, uh, maybe you're having 45 years old, 55 years old, and you're like, could it be something else? Well, it's part of the investigation. We need to see more. But I also get patients from maybe 18, 19 years. Maybe 16 years old. Mm-hmm. And they're like, do I need to get a colonoscopy? And I'm like, hell no.

Yeah. You don't need more. Uh, you don't need this kind of investigation. You're, you're just, you're just a kid. Yeah. You need to eat veggies. Mm-hmm. Maybe you have to get some, uh, I, I can fix you up with some. So something to slow down the pain, to slow down the, the bloating, and that will help. But as long as you start eating the vegetables, everything is gonna rail down.

Mm-hmm. You know, so the, the thing is, uh, when you ha when [00:48:00] you're thinking about taking, uh, probiotics, you actually need to, to think, are, am I eating well enough that I need to, what I need to. Take from the food section instead of the pharmacy section. Yeah. Actually I have a great story. The other day I was in, in my house and my kid kids don't, they don't see, uh, open table, open cable tv.

Now they see you too. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And he's watching, it's such a 

Dr. Brighten: novelty, right? Yeah. You end up in a hotel and your kid's like, what is this? Yeah. And why can't I just watch it when I wanna watch it? What's the commercial about? 

Dr. Paco de la Vega: Exactly. And then, um, we're prepar, my, me and my wife were preparing dinner and he just, uh, starts, uh, yelling, mom, can I take a probiotic?

And I was like, hell no. What are you watching, boy? Yeah. And there's between now the YouTubes, they also have the, uh, you know, we, we, we've been there. They're also getting all the ads and you can skip it. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And the kids are getting those [00:49:00] ads. Yeah. And one of those ads. It's from, uh, a brand of probiotics are putting animations and like, we're like vitamins, not you are not mm-hmm.

Like vitamins. You shouldn't be. And, and they don't re they don't get regulated. Yeah. You're in Mexico, you need a prescription to get the antibiotics. Yeah. You don't need prescription to get probiotics. Mm-hmm. And everybody's just like buying probiotics, like they are vitamins. They are not mm-hmm. They can give you sibo, they can give you more problems that you actually have.

Yeah. So you need to have, to get an antibiotic, you have to, you need an indication, you need a specialist. But also this, that specialist needs to give you exactly which, which probiotic you need. Mm-hmm. Because not all of them are the same. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: You need to take them for. Special kind of, uh, you know, for, for a special time lapse.

You just don't start like, oh, take probiotics, never call me again. No, that doesn't, that happens. And that shouldn't happen. Yeah. Because you're gonna give a probiotic. Okay. Take them for [00:50:00] one week, for two weeks tops. That's it. Never take them again unless I tell you so. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And people just, I I ask them, have you been taking probiotics?

Yeah, I started six months ago and I'm still taking them. I still feel bloated and I have a lot of diarrhea. Well, no shit. No, there's a lot of shit. 

Dr. Brighten: Um, so with the, I'm interested though, you said that if somebody says like, I get nervous and I have digestive sym symptoms, you're, what you're saying is that you're not causing the inflammation just by being anxious, but there are people who are like, yeah, I get, you know, I definitely have colleagues who are like, I could never speak on stage or have a camera because like I get digestive upset, like just thinking about it.

Okay. 'cause I'm so anxious. It, 

Dr. Paco de la Vega: it, it's, it's a really cool, uh, um, topic, you know, because it's not like I, I will not tell you categorically anything. Like this is not like, correct. No, of course. It, it also happens. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: We all know that we, we summerize uh, when [00:51:00] you're, so your, your emotions go into something particular.

Some people get, like, they start stuttering. Maybe you get, uh, palpitations. Maybe you get just like gut feelings and you're like, I'm not feeling anything. Yeah. Because you are conditioned that way. The thing is, is not like nervous causes that mm-hmm. That will feel, that will be like saying like, in every single human being, if you get nervous, you're gonna get stomachache.

Not, no, no, not all of them. Mm-hmm. But some people get conditioned with that. Yeah. So it's normal to, if you have it, that's how you, how you are. But what I always want to, when somebody tells me I have. Nervous colitis. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: What I'm telling is we need to, uh, I I need to ask you more about what are you, uh, experiencing?

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: Because it's not like maybe you're, you, you have, uh, you are feeling nervous. Yes. But if you're feeling well, all the unwell all the time, you need some, there is something [00:52:00] more. Mm-hmm. And, and here is the other big idea I want you to give. More like, uh, emotions get into your stomach, emotions turn into habits.

Mm-hmm. Because when you get emotional, you start doing things. When people are nervous, they start eating maybe without actually getting, you know, like feeling conscious of what are you eating? Yeah. Up there in the 14th floor. I have my, uh, I work there in the clinic. The clinic, I know. In, in the clinic, you're right, 

Dr. Brighten: you're like right up there.

Exactly. Just, just a couple floors up from us. In this 

Dr. Paco de la Vega: clinic, we work a lot from eight, 8:00 AM maybe to 12 one 2:00 PM mm-hmm. We have no refrigerator for food because, you know, we, we is not like we, we have food in there, but there are cookies and you know, those beautiful cookies full of, of alite like tarts.

Mm-hmm. They're really like, when you are, uh, working and, and you haven't got a really good breakfast. It's like those are the best cookies. Yeah. [00:53:00] Suddenly if you don't control yourself, you find yourself eating maybe six, eight cookies between in the whole day because you got a, a, a, a really big day with, with procedures.

Mm-hmm. And then in the afternoon. I can feel start feeling bloated. And I was like, I haven't eaten in the, in the whole day. Oh no, I did eat and I only ate cookies. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: And that's the thing. Oh, that just 

Dr. Brighten: went from six to eight. Yeah. And that's the 

Dr. Paco de la Vega: thing with, uh, with what we call stress. Mm-hmm. The thing with stress is like you're focusing on so many thi on, on one thing with your work and your family that maybe you start eating stuff.

You haven't actually think what you are eating. Mm-hmm. You have chips around, you have cookies, maybe you have a sandwich, maybe you got something that somebody else gave you and you're like, I haven't eaten the whole day. And you start thinking back and go, okay, no, I did eat and I did this and this and that.

I had soda, I had this. Mm-hmm. And then you start, remember all the things you actually [00:54:00] ate and you are like, maybe I'm feeling bad because all the, those things that I eat and that's the thing. An anxiety maybe just gives you habits of, on how you eat, how you drink, or maybe how you keep all the, you know, that, uh, fasting mm-hmm.

Because maybe you're, it is not like I, I'm fasting because of how, how you call this, uh, intermittent fasting. Yeah. You're just fasting because you have a lot of work and then the work lays down and you're like, okay, now I have a lot of, I'm really hungry. Yeah. And you just, and you start eating a lot and a lot more of what you should have eaten.

Why? Because you didn't plan your food correctly and now you're really hungry. Mm-hmm. And maybe you don't even have the right food. What do you have? I have a sandwich. You have McDonald's. I have pizza in the fridge. You are hungry and you are craving, and you are about to eat a lot of trash food. Yeah. And on the next day, [00:55:00] you're gonna go to the doctor and you're gonna say, I'm feeling bad because I've been anxious.

No. You were anxious, you were fasting, you do, and you didn't find the right foot. Mm-hmm. And you just start packing what was really like cloning food. Yeah. That's the thing with emotions, they are not always in your mind. Mm-hmm. But they are in your habits. If you change your habits, you take care of your habits.

That's how you're gonna feel the rest of your days. Mm-hmm. Because, uh, health is not just, uh, so something, you get, something you do every day. To have health, you need to be planning your foods and seeing, okay, I want to eat well. That means you have, you, you need to buy. Good food for your refrigerator and you need to know how to prepare it.

Yeah. And when to prepare it because you know, all the veggies, salt goes into the, uh, good in, into the, in the drawer. In the drawer. Yeah. In the drawer. I call it the, uh, [00:56:00] eno. Mentos. Like, I, I really want to eat well, but I don't have the time. So you buy a lot of. They go into a drawer and they just go back in there.

Mm-hmm. Instead in your, in your gut, they go back in the drawer. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: I was like, ah, I, I can eat this. They're already, uh, decomposed. 

Dr. Brighten: My husband will testify that it's usually at least weekly I'm getting on him about You have to put things in places where people see them. Exactly. In the fridge. Exactly.

Because if we don't see it, we will, we will forget about it and we'll pass it up. And so, you know, it was, I was, we got a head of cabbage and he shoved it all the way in the back of the fridge and it was like behind all this stuff. I'm like, no one will eat that you to Exactly, to, it's bright purple too, but you have to put it where we see it in the drawer so that when you open up the fridge, it's right there.

And so sometimes it's, it's not just buying the food and knowing how to prepare it, but also being strategic and like, you know, out of sight, out of mind. We have to have it there. We have to see it. And I even encourage people, you [00:57:00] know. You can write it down in your phone, you can put it on the fridge. But if you can just have a little bit of a plan of like, I bought these things.

Let's make sure that like, I'm going to use this cabbage by this day, or broccoli or, you know, and just thinking ahead. I think there's a lot of really great, uh, resources online for meal prepping on weekends to help people be successful. You um, so you brought up IBS and we were talking about the emotional component of things, and I think often doctors will just say.

Oh, I'm gonna just throw this in the category of irritable bowel syndrome. This is IBS. What other conditions can present as IBS and what should doctors be working up looking at and, and patients be mindful about? 

Dr. Paco de la Vega: This is really important because IBS can be anything. Mm-hmm. The thing is, you start feeling bloating and you get colitis.

You get this actually just IBS 

Dr. Brighten: mm-hmm. 

Dr. Paco de la Vega: Because you're feeling distended. You're, it's, you're, you're being uncomfortable. Maybe you're calling. Your colon is not moving well. Mm-hmm. You have a lot of PO just stacking up [00:58:00] and the rest of your, uh, gut is not moving well. Yeah. So your stomach starts not, uh, uh, emptying itself well, you start having reflux and everybody's like, oh, you have reflux.

You need more of merool. Yeah. Or more. I'm pretty sure that we haven't been million of years in this planet just to find that we needed omeprazole to avoid this problem. 

Dr. Brighten: You mean we didn't evolve? And, and it's not a medication deficiency we have. Exactly. 

Dr. Paco de la Vega: Like, oh, you need more omeprazole. No, you need, you need to go to the bathroom.

You need to, to, to empty your colon. To empty your stomach. Mm-hmm. One of the, maybe having, one of the good things about the intermittent fasting that I found is that you get a lot of time to, to digest your food. Mm-hmm. So you actually get like a lot of empty space and maybe of the many of these, uh.

Symptoms can resolve just by getting more time to digest. Yeah. The thing is, we are [00:59:00] always having, like the next, we're always thinking about thinking about our ne next meal culturally around the world. We have breakfast, lunch, and dinner and on the next day and on the next day our, now it's Friday, we also have that, that cool dinner with friends.

So we get gonna get like two dinners and pizza. Mm-hmm. And on Saturday, on Saturday we're gonna get, go see a family. So we're just like eating more than we can actually go and empty our colon. Mm-hmm. So eventually we are always gonna be constipated. Yeah. We're just getting used to it, but we maybe need more time to empty stuff and give time.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And that's the first part of maybe those irr, irritable bowel symptoms are just constipation. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Uh. Accessory, irritable bowel syndrome should be like the, we, we call it, uh, d uh, sorry, not discharge, but, uh, dis [01:00:00] when a 

Dr. Brighten: throwaway Yeah. Diagnosis. 

Dr. Paco de la Vega: A throwaway diagnosis. Yeah. It should be the last thing to say, okay, we need to 

Dr. Brighten: mm-hmm.

Dr. Paco de la Vega: Like what's happened to you in the er? You had abdominal pain. Well, for, for, we first need to see that it's not, uh, appendicitis or stomach. You're not gonna die, die, don't need surgery. You're die. Die. After that, we're clear. We are cleared. Yeah. Now you get treatment. The thing is, you were on the right side of thinking, I need first to, uh, to be sure that there is no, no, there's nothing worse first.

Mm-hmm. But many people are like having a really. They work a lot and they start having these symptoms and they're like, I don't have time to feel bad. Yeah. And I don't have time to go to the doctor. I don't have money to go to the, to the doctor or buy mm-hmm. More medicines. I just need to walk it off.

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: And it doesn't walk off, 

Dr. Brighten: walk it off, rub dirt on it, you know, 

Dr. Paco de la Vega: and that's why, and then, I mean, 

Dr. Brighten: maybe eat a little dirt with your food, [01:01:00] that might be good, but don't, not like that. Exactly. But 

Dr. Paco de la Vega: the thing is, we give that, we, we, we, we don't put attention to those, uh, symptoms. And maybe those symptoms are telling us something.

It is not the same thing when you have abdominal pain with my 8-year-old son. Mm-hmm. Or, uh, with you or maybe someone with 65 years old. Each age has to take you to another different, uh, level of thinking. What could it be? Yeah. I know if an 8-year-old is having this kind of pain and it goes away when they just rip one off, it's just gas.

Yeah. Maybe it's just gas for all of them, but I have to be sure that maybe those people with 50, 60 years old, they don't have something else, and then we have to make sure we give them these recommendations. Mm-hmm. Why? Because there is also problems that we call screening. All human beings can get these things we call tumors.

Yeah. That why we get them, because we are humans. We are living tissue. Mm-hmm. [01:02:00] Our tissue can regen, regenerate, but they all can, it can break down. And some of these errors translate into growing tumors. So we do not, one of those tumors that are really important and common are colon tumors. Mm-hmm. Colon cancers.

And they don't tell you I have a tumor. Yeah. They're just growing and maybe they are causing symptoms. Maybe they are not cussing symptoms, but if someone comes in into the office and tells you, doc, I'm feeling bad and I'm feeling bloating and I have diarrhea, maybe it's just IBS. Mm-hmm. Maybe it is something they ate.

Maybe they're not eating enough vegetables, but you have to be sure that they are also getting their screening. Why? Because it can be that, it can be something else, but what. Uh, which people should go through this? Well, the recommendation right now is if you go, whenever you turn 45 years old, you're on the way to, to get a colonoscopy.

Why? Because you're human. Mm-hmm. You can [01:03:00] get that. And we see all those stories around the tb, you know, the, the actors that got, uh, that, that were diagnosed with colon cancer and like, oh, he was so young. Yes. He was very young. Yeah. Very young. And all of us can get that problem. That's why we need to start screening.

Dr. Brighten: There's been concerns being raised though, that people are getting colon cancer at a higher rate and younger. Before. What do you think is going on with that? 

Dr. Paco de la Vega: Because we are exploring more. Maybe they're mm-hmm. Maybe it's always been like that. Yeah. But people are getting more screening. We have more colonoscopies.

People are like getting into it, like, okay, I need my colonoscopy. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And they find this, and they get in, they get the diagnosis and it can be treated. That's the miraculous part, because colon tumors can be treated with surgery, with, uh, immunotherapy, with chemotherapy, and you can just like get it resolved.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Get it solved. [01:04:00] It's something you can actually find and treat and get cured. That's the, that's the important part. Yeah. But it starts like. If you are feeling, uh, you're, you're feeling bad in your stomach, okay. Start thinking, what are you eating? Mm-hmm. And if it keeps up with the, with, with this, you need to get checked.

Yeah. And you need to get checked with some, uh, with a specialist. The thing is, that's the d difficult, the difficult part. Not many people can get to the specialist. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: When here in, in, in public medicine, to get the specialist, you first need to get to the, uh, to the general practitioner. Mm-hmm. Also in the states, you first need to note of the doctor and then they will tell you to go to the specialist.

But that depends on the, uh, how, how many spaces you have. And that's the difficult part because people should get screen, should get screened, should get interviewed. They should be like, okay, I talked to the specialist and he tells me this. But the difficult part is reaching that [01:05:00] specialist. There are not so many specialists about this and.

That's the most difficult part because then everybody ends up with Dr. Google. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And the bad thing about Dr. Google is that he can give you a special, uh, advice. Now we have the ais that actually have like more, uh, they can give you more information. 

Dr. Brighten: Yeah. But it's not necessarily individualized. No, exactly.

Dr. Paco de la Vega: That's, but, but it gives you the idea 

Dr. Brighten: that it does. And I will say I do encourage people, like, use Google, look at all of that, but also understand that if you don't know what to ask, if you don't know the right thing to search beyond that. So if someone sees you, you have a whole list of questions you're gonna go through, you're gonna ask them all of these details.

And maybe somebody might not know how to piece all that information together. Um, you know, when we're talking about IBS, we know that endometriosis okay, which is a chronic reproductive condition, but really. That's how it gets categorized to be fair, [01:06:00] is a systemic condition. Mm-hmm. So where there's, are you familiar with it?

Yeah. Okay, good. Just making sure. But we know that it can present with symptoms of IBS and often that can be the early symptoms and women will be told you have IBS and not be worked up for that. But you brought up SIBO as well, so I just wanted to mention that for people especially, 'cause if you're having painful, heavy periods, um, pain with ovulation, your doctor says IBS, it may be time to see the gastroenterologist and really investigate further with that.

Sibo, small intestinal bacterial overgrowth. We've mentioned it a few times. Okay. I had it. You're diagnosed me with it. We treated it. Let's tell people like, what is that and how often, you know, are you seeing that, you know, the, the bucket of IBS was really a case of sibo. 

Dr. Paco de la Vega: Okay. Uh, first of all, you, you said it.

Well, SEBO stands for small bacterial, uh, small intestinal bacterial overgrowth. And it's not just a [01:07:00] diagnosis, it's like the idea of what actually causes irritable bowel syndrome or dyspepsia, dysmotility. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: The idea of the, uh, microbiome. Is like this, uh, feature of us not only breaks down food and decomposes it, but we all know that bacteria, as long as it is stuffing with energy of glucose, it transforms also into other products.

We call it, we, we talked about postbiotics, these substances that can be pro-inflammatory, inflamm or anti-inflammatory. Uh, it, they're part of the, the communication between the gut and the brain. All these substances are, are, are in communication, but they're, but this bacteria is also producing. Gas. Mm-hmm.

Because that's what, uh, bacterias do when that's how we uh, ha we know natural gas that is, uh, fuel and it's part of nature. 

Dr. Brighten: And when you pass gas, it's not you who made that. It's your bacteria. Exactly. It's your [01:08:00] bacteria. Yeah. So if somebody says that smells, you say, that's my bacteria. That's so sorry.

Yeah. Like blame. I'm just the 

Dr. Paco de la Vega: co I'm just the host. 

Dr. Brighten: Yeah. I'm just the vehicle. Yeah. They're hanging out. 

Dr. Paco de la Vega: The thing is they are the machine that it's creating the gas. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Whenever you feed them, which depending on what are you feeding them, that, that's why with the phrase, what are you feeding them? Yeah.

Your bacteria. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: They will create more or less gas, but if, uh, as long as they're also this living feature of yourself, living things tend to grow and Yeah. If you give them a lot of energy, it's not like they're gonna start doing a city in there. Mm-hmm. If you give them more energy, they're gonna pu to continue to reproduce.

And the tougher strengths are gonna reproduce faster than others. But maybe the other ones that are not that tough, that maybe they are the good ones. Mm-hmm. So you need to be like. Giving enough food for all of them. But if you are just [01:09:00] giving a lot, some kind of energy, maybe just, uh, lactose, uh, dairy products and meats, maybe you are just giving energy to one strength of, of bacteria that is overgrowing.

And as, as long as it's overgrowing, it's creating more gas. We are not gonna get into your gut and start counting. How many of you are in there? No. We just have to ask, which is the clinical manifestation? This person has a lot of gas. Well, maybe he's creating a lot of gas. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: We need to give it time to, uh, uh, to help him to, uh, clear it out.

He always have gas. Well, we, we know of treatments, we know of medications that can affect the creation of gas. One of my favorites is called Symone. Mm-hmm. I'm always like, uh, prescribing it because it's like, really, it's a safe medication. You can buy it over the counter in the States. Here in Mexico, in Europe, [01:10:00] whenever you start, start feeling well, uh, feeling bad in the stomach, you can ask for Symone.

It's something that you don't absorb. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And it's a substance that's going into your gut, just like cleaning for the gas, it disintegrates the bubbles of mucus and gas. Mm-hmm. So you start, you start feeling, uh, well really fast and as long as you treat the gas, people are, start feeling better. And that's the, like the clinical manifestation that you are treating.

Uh uh, so, um, overproduction of gas 

Dr. Brighten: mm-hmm. 

Dr. Paco de la Vega: Which can introduce into the, this the idea of sibo mm-hmm. Of over, uh, of. Overgrowth. 

Dr. Brighten: Yeah. So those, those organisms of placebo, they're not bad organisms. 

Dr. Paco de la Vega: No. 

Dr. Brighten: But they should be predominantly in your large intestine. So what are they doing in your small intestine?

Like how are they getting there? I. What's happening? 

Dr. Paco de la Vega: First of all, we don't have a rule, um, in like, it shouldn't be in there. They can be in there. Why? Mm-hmm. Because it's a gut, but we have an 

Dr. Brighten: overgrowth. You have a is which is the name. [01:11:00] 

Dr. Paco de la Vega: Yes. But it's actually like we, it's just the idea. Mm-hmm. What we are seeing is gas, and you are treating gas, and that the idea that you are treating those, uh, those bacteria and if the, the, the patient gets, gets better, then you're, you're positive like, yeah, I'm doing the right thing.

Not because you have a culture, not because you have, uh, a test, uh, uh, a positive test. Mm-hmm. For example, in, in America, to diagnose sibo, you need this test of, of lactose, uh, 

Dr. Brighten: lactose breath test. Yeah. Lactose 

Dr. Paco de la Vega: breath test. Exactly. And then you get the diagnosis, and then you get the treatment. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Here in Mexico, we don't have it.

Yeah. And then you just like give direct the, the treatment, which is, if it is positive, then you are, you know, it's, it's okay because, uh, the patient is getting better. 

Dr. Brighten: The thing 

Dr. Paco de la Vega: is, well, 

Dr. Brighten: oh, I just wanna say too, when we talked about the testing, yeah. I was like, I don't want the testing because if you've got it, it's gonna make it worse.

It's, yeah, you're gonna feel worse, provocative, and you're gonna [01:12:00] feel worse. And also it delays the tie before you can start treatment, but Exactly. Yeah. And you, so, well, let me, I'll just ask you, what do you use for the treatment of sibo? How do you approach it? 

Dr. Paco de la Vega: I use, uh, a substance called rifaximin. Mm-hmm.

Which is an, uh, more like, like an antibiotic, but it's it's an antiseptic. Yeah. So the difference is an antibiotic, as I told you before. Uh, it's a substance that is gonna get absorbed in your stomach, get into your bloodstream. Mm-hmm. Then go to the tissues 

Dr. Brighten: and wipe out anything it can, and wipe and 

Dr. Paco de la Vega: wipe out everything.

That's why if you get a prescription of Cipro fluxes in or any other antibiotic mm-hmm. It is gonna affect the good and the bad, uh, uh, cultures in your gut. Plus the 

Dr. Brighten: impact on mitochondria. The side effect profile and ax. Exactly. I think people right away think rifaximin antibiotic bad. But you're saying it's antiseptic, but it's not.

It's an 

Dr. Paco de la Vega: antiseptic. Yeah. So instead of getting absorbed, it just gets, uh, it, it just goes, uh, flowing into, into the, into the, in, [01:13:00] into the gut. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: It doesn't get absorbed. So it, the, the, the interaction between the rifaximin and the bacteria is directly 

Dr. Brighten: mm-hmm. 

Dr. Paco de la Vega: It will. Uh, affect more the part that is over like the, the lining of the mucosa.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: So the part that is, you know, is, is, is, is still intact. The, the part in the bottom where they are all, uh, where, where is the roots of, of the, of the microbiome. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: So it's a, a little more safer to use the rifaximin to treat the overgrowth because it's actually on the surface and it will give you space.

The thing is, it gives you space, not, it's not gonna black out your, your intestinal flora. The thing is not to black it out. Mm-hmm. Just to give it space. If you slow down the production of gas, you start feeling a lot more space. And then miraculously you get, like, you, you start feeling like, oh, I want more food.

And I tell the patients, [01:14:00] you have to be like really careful because with this treatment you're gonna feel well. Mm-hmm. You're gonna get hungry and you're like, what are you going to eat? Yeah. And this hungry. Is something you have to invest, not to just buy something and say, oh, I want chips. No, you have more space, then eat more veggies because those veggies is gonna be the part of you not go coming to see me every single week.

Dr. Brighten: Yeah. There's a lot of people who, once they get a SIBO diagnosis thrown under the impression they need to be on a low FODMAP diet indefinitely. What do you think about that? 

Dr. Paco de la Vega: Low FODMAP is not it, it is not a diet, it's a str it, it's a strategy. Mm-hmm. When you go with a, a, a specialist in nutrition and tells you what are you gonna do?

We're gonna go through low fodmap, which is we gonna start low, and then going back to those, uh, same foods spot. W with, uh, with steps, 

Dr. Brighten: how long, how long would you keep someone on low FODMAP and then start the reintroduction? Actually, 

Dr. Paco de la Vega: the thing is, [01:15:00] uh, this is a really like, difficult part with the patient because it's like an, it's a horrible way to eat too.

It's not fun, 

Dr. Brighten: right? 

Dr. Paco de la Vega: No. And people shouldn't stay. Like, I, I'm gonna eat like this forever. No, you're gonna get, you know, you start low and then you get, you start, uh, getting your food back, but mm-hmm. In steps to see what actually is triggering these things. Yeah. So it maybe can take maybe a month, maybe two months.

But the thing is, I do work this part with, uh, specialist in, in nutrition. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Because. Uh, as long as I get the, the, the opportunity of getting to work with consults and procedures and endoscopy and colonoscopy and surgery, I don't always have the time to assess the diets. Mm-hmm. So I do work with nutrition in this part, and they have this strategy of, if I tell them this is a patient with sibo, this is a patient with, uh, colitis, they know they need a, uh, start with a low flat map and then go back to their regular food bot, uh, [01:16:00] taking, you know, notes of what they need.

Mm-hmm. 

Dr. Brighten: The 

Dr. Paco de la Vega: thing is, they shouldn't go back to the regular diet because their regular diet is the thing that started the problem. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: You need to. Introduce new foods. Uh, maybe these people are not getting enough vegetables or the right vegetables. Yeah. Or they just need more kind of vegetables because they always getting the same side salad.

I love that. The, you know, uh, when you ask people are you feel, uh, do you eat eat vegetables? Yeah. Eat salad every single day. You know, there are more vegetables than just salad. Yeah. And the thing is, salad can be a good thing. They have you with lettuce. With spinach you can have, uh, you, you can get a lot of, of iron and good things, but if you eat it every single day, the thing is, we are not everybo.

Mm-hmm. We do not have more than one stomach. Yeah. 

Dr. Brighten: And 

Dr. Paco de la Vega: we can't create, you know, we can break down leaves as every before. 

Dr. Brighten: So you're saying also get cooked vegetables in 

Dr. Paco de la Vega: We need cooked vegetables. Yeah. The thing is, the, if you get us a whole week of salad, you'll also get [01:17:00] constipated because all those leaves, they're gonna get into your colon and they're gonna be like really difficult to move.

Because we are not every horse. Mm-hmm. We need more, more kind of vegetables. 

Dr. Brighten: Do you use fasting with your patients who have sibo? 

Dr. Paco de la Vega: Not directly. I, I, the thing is not like you have sibo, you need intermittent fasting. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Because some people could, could, can depend. It depends on their, uh, lifestyles. Yeah.

So I also ask nutritionist to evaluate mm-hmm. If that, that patient maybe can, uh, maybe he would like to use intermittent fasting. Yeah. But I do give them, uh, the, I ask the nutritionist to assess that part. Mm-hmm. Because the thing is you can't also get in, you know, get in charge of everything. Yeah. Here, uh, in my work, I'm, first I'm a surgeon, then I'm endoscopist.

And now because all the things I've treated, I get into the specialty [01:18:00] part of evaluating the clinical part. I also still need to do the procedures. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: You need to, to be aware that you can't do everything by yourself. Absolutely. So you need a team. You need to know where to look for, uh, advice and with people that also know a lot of how to treat people just by asking what are you eating?

Mm-hmm. When are you eating? How are you eating? Are you eating by yourself? Are you eating with your family? Are you chewing it? Mm-hmm. Are you just indulging because you have to go to work in 10 minutes? Yeah. That, those, those, uh, questions are important and it is part of how to assess the pe those people, and that's why I treat, I work with this nutritionist.

Dr. Brighten: I also work with a nutritionist, so I wanna just echo, I, you know, I have a nutrition degree. And so people will often say like, why don't, why don't you handle all this? Well, because. You know, my brain is thinking about like, what labs do you need and are you going to die? And like, what are all of these other things?

And I need someone who can [01:19:00] solely focus on it because it's so important. Lowfat is a lot of handholding to get, to get it dialed in, to get it right, to understand is it actually causing these, uh, symptoms for you or are you afraid of food? Uh, why I brought up the fasting is because when intermittent fasting, I think it's just in the last like three years, it became like, yeah, very hot topic.

And when it came up and there were people that were like very against it and I'm like, I've been using this. I will say they have had so many patients with SIBO who you get into it and they, they've got a good diet and they're eating the right things. And then when you start asking 'em about timing, they're eating at 8:00 PM waking up at 5:00 AM eating before their workout and, and they're so often just not enough time for digestion.

And I love that you highlighted that before because when people said intermittent fasting, I'm like, that's just. Closing the kitchen at a certain time and opening like you can in 12 hours support your gut health with that. It doesn't have to be, but you know, there's men in the [01:20:00] biohacking space who took it to extreme and who were like, you know, you gotta fast for like, it, it has to be like you only eat in a four hour window.

And as you were saying, that can lend people to binging. Last thing we wanna talk about today, coffee, good or bad for gut health, where do you stand on that? 

Dr. Paco de la Vega: I do stand on. It's good. 

Dr. Brighten: No. Why is it good? But it depends. Oh, yeah, it does. You know, 

Dr. Paco de la Vega: the, the perfect word for that doctor is it depends. Yeah. Because for example, uh, I, here in Mexico, besides the gastroenterology Association, besides the Endoscopy Association, uh, there is also the neuro, uh, neuro gastro association.

Mm-hmm. And it's like the hot topic right now, because in neuro gastro, you actually look for all this, you have this, this talk with the specialist. What is going into the world between the gut brainin axis, what is going on with the IBS? Mm-hmm. What is going on with, and there was the, on the last, uh, con, uh, conference, like, uh, two or three months ago, there was [01:21:00] this awesome, uh, you know, like, uh, talk about which are the, the, the, the, which recommendations do we have about different kind of foods?

And they just like, uh, putting down the list of which were, which were evaluated. We all know that coffee can be good for gut, uh, for, for guts. Why? Because it starts moving. The caffeine can actually stimulate the, the movement, and that helps with constipation. But people do know like, oh, coffee's bad for your stomach.

Yeah. But we are not all stomach. You know, we have esophagus, we have a stomach, we have small bowel, we have large bowel. The taking coffee starts with drinking something in the, uh, in the morning. Mm-hmm. So you start the movement and that will help you. The caffeine will help you to move a little more. The colon, it, it will help move everything around Actually.

The problem with coffee is that [01:22:00] usually, uh, after the first coffee, it comes maybe the second coffee mm-hmm. Or maybe the third coffee. And you are not taking an espresso. You're taking the venti super size coffee and after three sizes of those coffee, you're realize you haven't taken anything but coffee.

Yeah. And not water. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: The thing is, coffee and any other thing we drink is just like cons, something concentrated. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And that can irritate the, the lining, the mucosa. And that creates, uh, overgrowth and that creates, uh, irritation of, of, of the lining. And the thing is, it's not the problem that you're taking coffee, it's that you're not taking water.

Mm-hmm. You need to pour it down. You need to delight it in your gut. Yeah. You take a coffee, take a normal cup coffee, and then take a glass of water. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Don't take the venti coffee. And then the second venti coffee take. Just a regular coffee and then they take water. You want the second coffee. Okay.

But after water, the same thing with drinking alcohol. [01:23:00] Is it good to take, to take a glass of wine? Yes. And after this, the first glass of wine, take water. Not the second glass of wine. Yeah. And or the third wine, you know, here in Mexico and maybe every, in, everyone in Latin er, America get the same advice.

When you grow. You start going to parties after, if you're, if you're getting a drink, take water. Mm-hmm. It's gonna help to avoid getting drunk real fast. Yeah. But it's a good advice because with coffee, with soda, with drinking alcohol, take water, everything that can actually stress your gut, you just need to alert it to move it.

Dr. Brighten: Mm-hmm. So 

Dr. Paco de la Vega: what we actually need is more water. If you're having dinner, it's gonna help down. But definitely I. Coffee can be a good thing in our life is, is, uh, stimulating us. It's good. 

Dr. Brighten: How much water should people be drinking 

Dr. Paco de la Vega: there? You know, the, it's in the boxes on the internet. We all know two liter.

Sorry if I don't call it in ounces, but 

Dr. Brighten: No, no, you're fine. Two 

Dr. Paco de la Vega: liters a day [01:24:00] is the regular recommendation, but it's, I, I don't like when they ask me that, uh, it is like, oh, how many water should I take? What you should do is have a bottle of yourself, you know, take a one of those. Cool water bottles when you buy it in whenever you want.

Target, Disney, whatever, Disney 

Dr. Brighten: get Disney water bottle. 

Dr. Paco de la Vega: Get the bottle of water you want and carry it around. Yeah. So you need one bottle. When you, uh, from when you go up, when you start your day and then you go lunch, you should already finish one bottle. Mm-hmm. One liter bottle. And then from lunch to when you go to sleep, you should already take another bottle.

Those are two liters. Mm-hmm. The thing is, you need the habit of carry your, your, your water around. The problem is not always, uh, drinking water, but instead of carrying around water bottles, people carry around, uh, soda cans and soda bottles mm-hmm. And maybe other kind of, [01:25:00] of things that are not water. And they still irritate the gut because they're not water.

The best thing is water. So you want coffee? Take your coffee, but take a normal amount of coffee and then get water. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: You want soda? Take a normal amount of soda and then get water. 

Dr. Brighten: You, when we were talking before this, you said often the coffee isn't the problem, it's what people put in it. 

Dr. Paco de la Vega: Exactly.

When we were talking about, you know, when you go into Starbucks, what coffee do you want? We have super duper frappuccino with banana flavor and like it's, I just wanted coffee. 

Dr. Brighten: I know. I don't go to Starbucks for that reason many years. One, their coffee's not very good, which is why I think they have to put all that stuff in it.

But also I'm like, I'm overwhelmed. I'm like, I don't want all of this. Yeah, yeah. Like, just gimme some good coffee. 

Dr. Paco de la Vega: I always like, I just want coffee. Well, but we have this coffee in the dark oven and I just wanted a, and then they know you 

Dr. Brighten: have to say, they're like vent data and it doesn't make sense when they say grande.

And I'm like, that doesn't, with the size, I can't with you [01:26:00] people, just let me say what I need to say. 

Dr. Paco de la Vega: When many years ago, uh, me and my wife were. Coffee lovers. We've always loved coffee. And, uh, when we were younger, she always liked this, the Starbucks, you know, like, uh, flavoring things. Mm-hmm. And when I, I start remembering, let me know if I, lemme see if I still remember.

Then you go into the counter and you're like, yeah, I would like, uh, venti vanilla latte with, uh, this decaffeinated and d lactose. And I was like, suddenly realizing like, so you want a coffee with no coffee? Yeah. With milk, with no milk and sugar. With no sugar. What are we eating? What, what are we drinking?

What is it? Because it, it has no, none of those things. 

Dr. Brighten: Well, and as you were saying, coffee, having benefits, uh, you know, there's been research. We know it has polyphenols. There's possibly prebiotics depending on your coffee, anti-inflammatory components. You're not getting that. If you're, if you're going in and you're, you're filling it with all of these other [01:27:00] things and there's like no actual coffee happening, we, we 

Dr. Paco de la Vega: shouldn't see like always like, uh, I'm getting all these vitamins from this.

Eh, it's just coffee. I mean, it is, is not a miraculous thing. Oh, I will 

Dr. Brighten: defend coffee. Okay. Okay. It's from a time day. I wouldn't put it 

Dr. Paco de la Vega: on a pedestal, you know, like it's coffee. Yeah. I also like some teas every now and then. I don't 

Dr. Brighten: think you've been to Portland, Oregon, sir. If you've been the Pacific Northwest, like we are very serious about our coffee there.

Okay. I spent over a decade there and it's not just coffee. It is the wonderful warm hug that creeped you in the morning and lets, you know your day's gonna be just right. I totally 

Dr. Paco de la Vega: understand that and I love that feeling too. But it's also like, uh. You know, I'm, I'm, I really, I hope this ist out of line, but I do love memes.

You know, it, it, it, I just, I 

Dr. Brighten: don't know how that's out of line, but just go with it. 'cause Yeah, it 

Dr. Paco de la Vega: is like, is the doctor talking about mems? Yeah. Memes. Yeah. Why not? Is the way we connect with the whole world and it gives the best ideas. And there's this meme I, I've seen where it's actually from a [01:28:00] cartoon I haven't seen before.

It's like a, a grownups cartoon from superheroes that are like fighting like this super dad against his super son. And they're just like fighting each other. And then they're having this discussion and through the discussion a pair of, uh. Airplanes go by, you know, one of those military planes. Mm-hmm. And then the dad tells the son, you know, and the original line, he's like, look what they have to do to I ameliorate something we do.

Like we are, we can fly. So they have to imitate us. Mm-hmm. And then the meme goes when the guy is like, the, some idea is looking at the plane and he realized that the plane is, uh, is imitating what he can do. And this meme is about toddlers. And the toddlers are looking at the planes. And the planes are coffee.

Mm. And they, and they, and they're, and they're discussing, see what adults have to do to imitate our energy. And he's like, exactly. Because we do depend on coffee. Like we, I, I know I [01:29:00] need coffee. Yes. But my son doesn't. 

Dr. Brighten: Yeah. 

Dr. Paco de la Vega: And because I, I wouldn't recommend my son take coffee. 

Dr. Brighten: Okay. That's a good point. And I'm glad you're making that distinction.

'cause while I am praising coffee. Yes. Just because it's good doesn't mean it's good for everybody. No. Like it has benefits, but maybe that's not true for you and it's certainly not true. Don't give your children coffee please. Because actually. 

Dr. Paco de la Vega: When we leave around coffee now, all the kid with, uh, when you go to Starbucks and Starbucks is like the new Disneyland, the new McDonald's.

Everyone's Yeah. Goes around Starbucks. What do kids want? Oh, my kid was the chocolate shake. Mm-hmm. Maybe some kid is gonna start asking for that. Super duper Frappucino. Yeah. And they start getting coffee at really early age and they're already hyperstimulated. 

Dr. Brighten: Yeah. So I had a 13-year-old patient and her mom brought her to me for anxiety.

And when I went through like, okay, tell me let's go through your day and when does your anxiety occur? And her telling, she was drinking more coffee. Than I do in the morning, not eating breakfast, having a full, like, like we're talking like [01:30:00] 20 ounces of coffee and then having another one. She went to school and I'm like, I don't think you have anxiety.

I think you have a normal physiological response to not eating and then drinking a ton of caffeine. So I, I always say to people like, you know, when it comes to coffee and people talk about energy and the problems like, oh, coffee's draining. It's the sleep you're not getting, that's the problem and that you need coffee.

It's not that coffee's the problem, it's that we're, we're skipping sleep and then depending on coffee. 

Dr. Paco de la Vega: Yeah, and that's the thing when. If when they go to the gastroenterologist and say, doc, can I still drink coffee? Yes you can. But how are you drinking it? Yeah. Because if you're telling me that you are drink, you are a binge drinking coffee from the morning to the night, of course you shouldn't drink it like that.

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Doc, can I eat? Uh, you know, we love chilla. We, we love spicy food here and it's a really same Yeah. And it's a good thing for God because it also stimulates the movement. Mm-hmm. But it depends on what, how are you preparing it? If you [01:31:00] are asking me can I take spicy stuff, yes, you can prepare it, but if you are telling me that you're putting, uh, your salsa on three, four quesadillas in the night, maybe you shouldn't be taking those quesadillas in the night.

The problem is not the salsa. Mm-hmm. Or the quesadillas. So everything depends. You need to ask patient, is this good or bad? Well, it depends. How are you using it? Mm-hmm. 

Dr. Brighten: Everything 

Dr. Paco de la Vega: should. Maintain in control. Yeah, it is. Uh, food can be good, but you need to diversity it. You shouldn't take the same food every single day.

So, you know, like when you're a kid and you just want to eat, uh, Cheerios with ham in the morning? Ham. Yeah. You know, with I'm like, you're eating Cheerios 

Dr. Brighten: and Ham. Like, if you were just gonna say Cheerios, wait. When 

Dr. Paco de la Vega: kids start, like having those kind of weird, uh, weird, weird meals. Like was I only want that?

Yeah. Like for the next three weeks. 

Dr. Brighten: You were calling me out though. In my childhood, I did have my Cheerios binging face. Okay. Not ham, though. I [01:32:00] do 

Dr. Paco de la Vega: know some, uh, you know, kids that they, what do you want for reakfast? I want bread with beans. And that's, that was their breakfast for like two months. Mm-hmm. Uh, like, you need something more now.

Just want that. You need more. And then, because that's what you actually need. And that is like, okay, he's a kid. Yeah. Also no aisles that only get the same thing every single day. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: You want to feel good with your gut health. You need to get diversity. And that's another bottom line I want to share to take care of your foot is not about restriction.

It's not about saying, doc, I don't take, uh, irritations, I don't get, I don't get coffee, I don't get, uh, spicy food, and I'm still feeling bad in my gut. Mm-hmm. Why? 'cause you need to take care of your food. I do take care of my food. I eat the same thing. Yeah. You need to start planning your food. Mm-hmm. 

Dr. Brighten: You 

Dr. Paco de la Vega: need, you want that diversity.

It will not come by itself. You need to buy it. You need to put it in front [01:33:00] of yourself. You know, like you said, instead of putting it in the back of the refrigerator, you have to put it like, maybe prepare it. When you go, you get to, from the market, to the house, you prepare it and then you have it for yourself.

That is about taking care, is planning, having your strate, your strategy. It won't, it won't get by your, by itself. So you want to have, you need to, you need to do it smart. So. Planet, put it and prepare it. If you are still feeling, not feeling well, uh, maybe about, uh, two, three weeks with having, uh, a good diet, you need to talk to a specialist about it and get and see may, maybe it's sibo, maybe is extension, maybe you need some, uh, medication for a moment.

And then it will help you to go through it and then you restart the planning, the planning part. But the thing is, you need to plan it. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: Everything comes by any the good [01:34:00] thing, you need to do it by yourself. Yeah. 

Dr. Brighten: So, 

Dr. Paco de la Vega: uh, stop thinking that going to a gastric, he's gonna restrain everything I eat. Now, my advice is plan your food.

You want something you like. Okay. But don't eat it every single day or every single night. You like pizza. Okay. Eat it on the week, one day on the weekend, but not every single night. Mm-hmm. No. And you get pizza. The, the best part of getting pizza in the night is you get pizza on the breakfast. Yeah. Pizza on the next lunch.

And then you're like, oh, maybe I I shouldn't have that lot, uh, pizza last night. Yeah. Because you eaten it for three meals now. Yeah. So you, you need to plan that, that kind of things. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: You wanna go at health, you gotta plan it and just, you get to get rid of all those bottles of probiotics, uh, from Costco and recommendation like you need.

You don't need more. Uh, the problem is you don't need the probiotics or the omeprazole or all those medicines. [01:35:00] Maybe you just need to plant your food. 

Dr. Brighten: Mm-hmm. 

Dr. Paco de la Vega: And get a good advice and just like help someone that directs you on the right path. 

Dr. Brighten: I love that. This has been a fantastic conversation. I'm gonna build all the links to where people can find you, but share with people where can they find you if they wanna learn more, follow your, follow, your expertise, your advice, okay?

And your memes. 

Dr. Paco de la Vega: Thank you so much. I actually, I'm not that, uh, of a publisher on, on social media. Uh, I do have an Instagram that helps within when someone googles it, it's, uh, Doug Paco de la Vega. You know, Doug, like DOC Paco is the short name from Francisco here in Mex, uh, well in, in Spanish speaking countries.

PACO De la Vega. Uh, you can reach me there. Uh, my, uh, email is de Vega md at iCloud com and, uh. Then I, I do not publish a lot because I am, like, I, I don't get someone in charge of that. So I, I put [01:36:00] something every now and then. Do you describe what your 

Dr. Brighten: memes out there? Just get your memes out there? Yeah, I 

Dr. Paco de la Vega: used to do it, but I then I just got a lot of work and I, I, I didn't do that anymore, but, and whenever, uh, whenever someone reaches me and they have these questions and they want, uh, like, oh, can I get a consulta, uh, a video consult or something?

If you want to chat, you can chat through the Instagram. It's fine. You have a question? I will answer it. Uh, maybe we can chat in, in a video call. That's fine. It is not like, uh, do I need to make an appointment? No, I do, uh, take care of my Instagram account and my emails. I, I don't have assistance for that.

Everyone has questions. I know. And if a anyone wants to, uh, take their particular cases, I, I will always, uh, be sure to give them those answers. Okay. 

Dr. Brighten: Okay. Well, Dr. Della Vega, thank you so much. Thank you so much. 

Dr. Paco de la Vega: Have a, a great day. And thank you so much. It was really fun. Uh, [01:37:00] hope that, that my, the way I talk in English is not like really confusing or something like that.

No, 

Dr. Brighten: you are great. You were fantastic. Okay. 

Dr. Paco de la Vega: Thank you so much. Yeah. 

 

Dr. Brighten: I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out this.