[00:00:00] Welcome back, everyone. This is Steve for another speaker here in the future of personalized medicine summit. Our next speaker is Dr. Matthew McNamee. I'm excited to have him. He's the chief medical officer of Tiger Medical Institute. He's been my partner now for five years. In our business just to give you a little bit of background Dr. Matt is a naturopathic physician. He spent many years in the San Francisco Bay Area working under a tremendously talented mentor. Worked with thousands of people executives, high performing type people doing what we do today at Tiger Medical, which is look at the root cause, the underlying mechanisms that are causing symptoms, and then developing a plan to help restore those at the root level for more of an ongoing solution.

[00:01:06] Dr. Matt is also ha've been trained by Dr. Dale Bredesen in the prevention of Alzheimer's and dementia. And he's got a lot of other additional training in areas like autoimmune disorder and metabolic reversal. Dr. Matt, it is a pleasure and an honor to have you on today. Oh, thanks so much for having me, Steve.

[00:01:26] Happy to be here. You bet. Today what you're going to talk about just a real summary overview is gut on fire, how gut dysfunction contributes to systemic inflammation. Before we get started, Matt, maybe you just share a couple minutes on why you became a doctor. What was it that caused you to pursue this path and choose naturopathic medicine versus Allopathic or osteopathic medicine when you were in medical school?

[00:01:57] Yeah, sure. I don't know my, my, one of my grandmothers had told me that I guess when I was like seven, I had said I want to be a doctor. I don't remember wanting to be one growing up. I love science. I've always as long as I've had a plan, there's been a big science nerd. Yeah. I had little science magazine clips from, unique species and stuff on the planets hung up on my walls.

[00:02:18] And I knew I wanted to do something around the, along the science path. I did, biology and chemistry and undergrad and as I was, getting near the tail end of it I did, an emphasis in pre medicine and biomedical and pre that I did a lot of things.

[00:02:33] Let's think about doing veterinary medicine too. And I was actually going the conventional route. I took the cats and I was going down that path and I had a study buddy who I used to do, study for exams and all that stuff with in college that we actually were both going this path.

[00:02:48] And then she had mentioned that there were accredited medical schools that that offered this type of path. And I was raised, we're 1 of the few, and actually probably the only people I know that had at least growing up, it's a lot cleaner foods.

[00:03:04] We didn't have a lot of junk foods, things like that. Or really any I used to get all that stuff in my friend's house. And we just were raised on an overall, healthy lifestyle, just raised up with that. So when I found that there was, another a path out there that would teach me more about some of the stuff with lifestyle medicine and root cause medicine. I that's really the main driver for that. Okay. That's awesome. I know a lot of patients at Tiger medical are thankful. You made that choice, including me because. I was a real mess from a health standpoint when I exited my last company, I met you and you rebuilt me from the ground up and obviously I had to had my part in it.

[00:03:47] I had to listen to what you were saying and go do it. But I was exposed to a type of medicine I'd never experienced before. And so me and you joined up in 2020 and we've been together ever since. It's been a lot of fun. So let's go ahead and get started. You want to talk about this topic and you wanted me to share my screen here.

[00:04:05] So I'm going to do that. So this is the context of gut health and how that is a. If there, if the gut health is poor, it contributes to this systemic inflammation that leads to a host of other problems, right? Yeah. So I, I found this image. It was in a respected medical journal called nature medicine, and I just thought it was fantastic because it looks at all these different components that we talk about with patients really come from like a root cause functional lens yeah, it was it's pretty cool.

[00:04:40] So it's if you look on the left here, you've got the left is basically all these things on that left outside of that left wheel there. Or gear, right? Any single 1 of those things can start getting that left gear moving, which will turn that center gear, right? That SCI stands for systemic chronic inflammation.

[00:05:04] So now we got that going. And what does that translate to? And there's a lot of, robust data that ties it into type two diabetes or insulin resistance or prediabetes, fatty liver disease, cardiovascular disease, cancer, depression. There's stuff on anxiety, autoimmune diseases, neurodegenerative diseases, things like Alzheimer's.

[00:05:22] Some of these other ones here immunosenescence that we get with aging and muscle and bone loss. But the ones that I really wanted to really talk about, I think the most, the thing I want to tie together today is this all the way far left here where it says dysbiosis. Dysbiosis is a fancy term that we use to say there's an imbalance in your gut microbiome ecology.

[00:05:49] And I want to tie that together to this systemic chronic inflammation. And you can fill in the blank afterwards once that inflammation starts, circulating. It can drive, most of the, diseases associated with chronic inflammation. There's many more that aren't even listed on here.

[00:06:07] So basically, inflammation works on a dimmer switch. You don't want too much or too, too little. Today we're going to be talking about, too much. Walking back to the microbiome, microbiome, is a collective kind of ecosystem in the gastrointestinal tract.

[00:06:20] We have trillions of microorganisms ideal, situation we have evolved with these and we've evolved it into this symbiotic relationship. We help them. They help us. Norm in a normal, healthy, optimal system. They help, regulate our inflammation, our immune function, our metabolic health help us help absorb nutrients and then even help produce things like vitamins and neurotransmitters.

[00:06:48] So you've said to me, like the gut, there's a pretty large percentage of our immune function is in our gut. originates in our gut. Can you elaborate on what the percentage is roughly according to the science? Yeah, it's somewhere between 70 maybe up to 80 percent somewhere around there, but you could probably safely say 70 percent or so.

[00:07:10] The reason is just think of your gastrointestinal tract like a hollow tube with like your skin. Just like your skin's on the outside. Think of it as, basically a tube that's facing all this foreign stuff. That's our 1st primary really interface with the outside world and many different microorganisms and toxins and things that can be damaging.

[00:07:33] So that's why the bulk, almost 3 quarters of our immune systems in the gastrointestinal tract because it needs to, sense and regulate. All of that stuff that's coming in contact with got it. Okay. There's a delicate balance, right? Because you've got all those collective bugs and they send information back and forth.

[00:07:51] And when they're healthy, they keep the immune response healthy when it's not immune response gets heightened or hyper reactive. And then you get downstream problems, inflammation on immunity, all kinds of things. The, there's, been a, I don't know, last couple, a couple, 2, 3 decades or so.

[00:08:09] There's been a lot of research done. It's probably 1 of the most booming fields in science, around the microbiome. And even when they've studied these these pockets of centenarian centenarians, these people that live over 100 years and the world is blue zones. 1 of the comments we find with them is they have this really robust, diverse, balanced, healthy microbiome.

[00:08:34] And that, all the other studies around the microbiome, show that when you have a healthy balanced microbiome, you've got a lower risk of, those chronic diseases like diabetes, heart disease, cancer, Alzheimer's, etc. Matt, what is it, what, how does, how do we in America, because I think you've said to me.

[00:08:53] With at least with our tiger medical customers who tend to be older, that seven, seven out of 10, six out of 10 have dysbiosis, they have this imbalance of good and bad bugs. How does that happen? What are people doing that cause that to happen? Sure. So the big drivers, there's a lot of things that can cause it probably the most common things that I see.

[00:09:18] Diets, diet, medications and stress are probably the big guns, a Western diet, you've got, higher unhealthy fats, high refined carbs are typically low in, in phytonutrients, those plant nutrients. And what that does is that stars, the good guys basically feeds the bad guys and ends up weakening the lining of the gut.

[00:09:41] And increasing inflammation medications, real common ones that people use things like acid blocking agents, nexium, protonics, pepsitums, things like that, when you shift the pH of the stomach and you lower or, or you basically, the acidity is not as as strong or the pH isn't as low.

[00:10:05] When you shift that balance, Things don't get broken down like they're supposed to. The stomach's the first line of defense, right? So that's how we get we control microbes getting in and out of our system. Change the acidity. Now you get bacteria and stuff like that can actually pass down through the stomach and live and plant, a new little home in your gastrointestinal tract.

[00:10:27] That's part, plus, when you start getting undigested food, because that's, the 1st part, or not the 1st part of digestion, but it's part of your digestion, right? One of the 1st steps is that acid component. What happens is undigested proteins and such end up, being basically.

[00:10:42] Put into the gastrointestinal tract, and it leaves like leftovers. I tell patients for other bad bugs to thrive on. So that will contribute to dysbiosis. Antibiotics. We know that even a single dose of antibiotics can disrupt the microbiome for months, maybe even up to some of them, even up to 6 months.

[00:10:59] So if you've got a 7 So a 10 day course and you take one pill, it can disrupt it for months. And then, NSAIDs, non steroidal anti inflammatories, things like Advil, ibuprofen, Aleve aspirin, Excedrin, those can directly damage the lining of the gut and increase permeability.

[00:11:18] A big one that I see all the time with people, let's say they have a fantastic Diet, all the other lifestyle habits are, dialed in, they're really balanced, except for that the lower left wheel there where it says chronic stress, that, not only can drive systemic inflammation, as you can see on this kind of simple diagram here, but that independent of everything else, right?

[00:11:46] So you could get everything dialed in with someone's Life lifestyle stuff, nutrition, but they're still chronically stressed. The chronic stress will lower, it suppresses the immune system. So it'll lower your secretory part of your immune cells. Immune markers in your gastrointestinal tract.

[00:12:05] We can measure for these. And then when that doesn't work as well, it doesn't control and police the microbes in the gut. And that can make it more prone for overgrowth and dysbiosis. Cortisol in itself can cause increased intestinal permeability. And then what happens is that, it's like your gastrointestinal tracts, like a coffee filter when you poke holes in it, larger grounds and things like that, and that's the same kind of principle.

[00:12:31] You get larger molecules that aren't supposed to go into the bloodstream, get in there. Things like pathogens or other microbes from the gastrointestinal tract get in there on digestive food proteins and molecules get in there and then, toxins from certain bacteria, these gram negative bacteria in the gastrointestinal tract, this stuff called lipopolysaccharide, I'll dig into that stuff a little bit more in a little bit, gets into the bloodstream, and that's one of the main things I'm going to talk about today, and it just so much.

[00:12:59] It's like gasoline when it, with respect to the body, it's really pro inflammatory, stress. It can affect the gut motility. So some people have diarrhea or constipation with stress and that can Harbor environment for dysbiosis by itself. Matt, when you say stress, nobody's going to be able to say stress is gone.

[00:13:18] It's how you get rid of the stress, how you mitigate it through. Breathwork and meditation and things like that, right? It's like having none of those practices will lead to the harmful effects of stress. Totally. I always tell people, unless they're like in a really toxic environment, whether that be at home or work or whatever I don't say we got to get rid of this and take this out of your life very often.

[00:13:41] It's what sort of practices can we do to fill your tank up so when the stress comes in, that perceived stressor goes into the brain and you have a different physiological response to it. I always use the analogy of, when you're dealing with chronic stress and your system doesn't have any resilience, it's like your system snaps like a toothpick, and just like you were talking about before, you're not going to eliminate these stressors.

[00:14:04] It's like being in a hurricane with a, as a palm tree, right? It still can go into storm and it can bend with the wind, but it doesn't break, right? And that's the we want to be able to come, become a palm tree in stressors. So it rolls right off us, right? Not to say it does, but our body has a different response and a less damaging response.

[00:14:25] Okay, let's translate the cortisol and that's literally what we're talking about that hormone. So stress hormone, that's what really impacts the stuff in the gastrointestinal tract. Okay. Yeah. Go ahead. Go ahead. Do the main part of your talk here. The nuts and bolts behind all this stuff and how it gets to it translates to chronic inflammation.

[00:14:50] Just a thing, I guess I was going to mention earlier. The father of medicine, Hippocrates said, 2400 years ago, all disease begins in the gut. There's a doctor Alessio Fasano. He's a pediatric gastroenterologist at Harvard. He's one of the leading researchers, if not the leading researcher on zonulin.

[00:15:09] It's a protein associated with increased intestinal permeability, leaky gut. He's got a paper called, All Disease Begins in the parentheses or quotes leaky gut, right? He basically has found some of the mechanisms behind this and what drives this and what pokes holes in that coffee filter.

[00:15:27] But the common denominator is, and this is just 1 pathway I'm talking about with gut health and how it drives systemic inflammation. There are. Many different pathways, but I think this 1 is unique and there's ways we can measure it as well. Anyway many times there's an imbalance in the, and just having an imbalance in the microbiome in itself, that dysbiosis, that tipped ratio between the good and bad bacteria.

[00:15:50] That can be enough to erode away at the lining or that coffee filter, you get, things into the bloodstream that shouldn't be there. And then they cause inflammation head to toe goes everywhere. So that can be 1 component of it. If I mentioned briefly the the actual mechanism behind poking the holes, if you will, in the coffee filter is, typically done by the release of something called zonulin.

[00:16:17] So cortisol will cause zonulin to be released and imbalance in those microbes that dysbiosis can cause it to be released that real inflammatory molecule. L. P. S. Like a polysaccharide that those bacteria making causes to be released. And even things like, some of the dietary stuff Western diet costs to be released and once it's released.

[00:16:39] That's what essentially opens up, it's like a gatekeeper, it opens up the gates wider, and that basically allows, it allows these large molecules to sneak into the bloodstream. And that's where it becomes problematic. So now you get, things that shouldn't be in there. Like I said, you remember if you got 70 percent of the immune system there, and then this lipopolysaccharide gets into the bloodstream, that's where it starts really stirring stuff up.

[00:17:04] That stuff, basically, it binds to these receptors called tolec, tolec receptor four which are like danger sensors. We have them on our immune cells. We have them on the lining of our blood vessels. We have them on our blood brain barrier. And that's like another coffee filter to protect the brain.

[00:17:21] And what binds it, it goes down this pathway, right? Where it stimulates NF kappa B, which ultimately, stimulates these other inflammatory cytokines TNF alpha and interleukin six. And those basically are chemical messengers between your immune system to stimulate. More inflammation, fight infections and sound the alarm.

[00:17:47] So it just perpetuates this cycle. Yeah, does it contribute to autoimmune eventually if this isn't? Oh, 100%. So Alessa Fasano has done some outstanding work on basically the, one of the etiologies or causes of a foundational work that lead towards autoimmunity. Yeah. Anybody that I see with an autoimmune condition, this is one of the first places that I look is their gut health, just because it's, it lays the foundation for autoimmunity.

[00:18:16] Most people have a genetic component where, you know, somewhere in their family where they have an autoimmune disease, but typically it starts with an imbalance in the microbes, this dysbiosis, this increased permeability, And then there's other triggers and such that can contribute to that. But that's that's a great point.

[00:18:32] 100 percent it can autoimmunity for sure. And that's why you can see it over here on the right autoimmunity. Sure. And then, if you think about this stuff, this real inflammatory stuff. Floating around the bloodstream it can erode away that protective lining called the endothelial glycocalyx, and that's up that protects the blood vessels from all the stuff that's floating around the bloodstream.

[00:18:54] When that erodes away now, you get the vessels are more prone to get inflammatory things lodged in there and that can ultimately down the road translate to plaques or atherosclerosis. For the brain, when you damage the blood brain barrier Then, those inflammatory molecules, the LPS and some of those other inflammatory cytokines in that cascade actually cross into the blood brain, or into the brain, excuse me, LPS in itself, that lipopolysaccharide and that TNF alpha and that interleukin 6 are all extremely neuroinflammatory, like they are very, they like basically like the brain on fire, right?

[00:19:33] So you've got just we're talking about right now that can create and perpetuate that not only brain inflammation can translate later to neurogenic diseases like in that lower right there. And what does that mean? Some people have anxiety, depression or irritability or brain fog or, cognitive changes or insomnia.

[00:19:53] You know what, Matt, what's incredible to me is that the dysbiosis, the leaky gut is like this gateway to all of these second, third, fourth order effects that can happen downstream. And your, what your picture is showing here is if you just do the opposite. Fix the sleep, fix the stress, fix what you eat, fix your gut, get your weight inbounds, get your activity up, address any chronic infections.

[00:20:20] You're basically reverse engineering the problem. A hundred percent. And that's almost, it's interesting. I've never really looked at it this way before, but in, in functional medicine, we have a, it's called a five R approach. To basically addressing gut health and healing the gut and basically the lifestyle stuff and the things that you remove as part of that program, a lot of them are over on the left.

[00:20:49] It's actually and this thing over here, just for people, Xenobiotics right here that I'm highlighting. That's basically, for simplicity, that's, chemical toxins, so yeah, but let me camp on that. Just a second. How can chemical toxins if left unaddressed?

[00:21:06] Lead to metabolic disorder, cardiovascular disease, because aren't toxins highly oxidative, Matt? Yeah, and that translates to inflammation, right? So anything that will drive, I always use the analogy of like oxidative stress is like rust in the body and I say inflammation is like fire, and yeah, so anything that causes that oxidative stress, which causes damage to your tissues will create an inflammatory process. A hundred percent, and that's. And this is just getting a little bit more into the weeds with it. And I was talking to a colleague of mine over the weekend.

[00:21:40] We were at a conference and I was just telling her about some of these, most people have probably heard of BPA, the stuff that probably was in a lot of plastics that they pulled out, what just getting that in your system. Sure. It can be harmful in itself, but it has an affinity for the thyroid gland.

[00:21:56] And attaches the thyroid gland that little plastic piece looks. abnormal, never seen it before, the immune system says, right? And it's attached to part of the thyroid, it starts attacking it because it's never seen it. And it basically makes a new antigen, we call it, which is like this new foreign molecule, right?

[00:22:15] So that's one mechanism behind autoimmunity just right there with, xenobiotics or not or toxins in general, Yeah, but so what you were talking about before. How do you unwind this process, Matt? That's what I want to close with is just your approach to medicine so that you can bring somebody back into a state of good health.

[00:22:37] You want a general approach or what we talked? Specifically on the topic today. I think both talk about the gut health, how you restore that and then just how you bring people back overall. Yep. And we have about five minutes left. So I can get a real simplistic overview. Generally, for most people, very superficial overview is take out the bad and add the good.

[00:23:00] So what do we need? You need to take out that's a very superficial kind of overview for the gut stuff. We'd seed and feed. It's a simple way of looking at it. If you think of your gut, like a garden, right? And it's out of balance and all the weeds are overgrown and there's not enough sunlight for the plants that you want to grow.

[00:23:18] So we go in there. We weed those. We plant some new seats for the good bugs that we want. Get rid of the bad bugs, weed them out. Okay. With good bugs and then feed them with, nutrients prebiotics and such. That's a general overview, but the 5 program basically remove the offending, factors, whether it's foods, medications, stress, we talked about.

[00:23:39] As you mentioned before connections the 2nd R would be replaced. So that's replacing basically, components of the digestive tract that they might be, not have enough, whether it's, stomach acid or digestive enzymes. The 3rd ones re, inoculate. So that's the seed portion of it where you would add probiotics and, the 4th is repair, right? So you want to heal lining of the gut, lower that intestinal permeability. And then the 5th and the most commonly, maybe not addressed or missed is the components on the left here that are, it's the diet the movement practice, the physical activity component sleep and stress, right?

[00:24:15] And stress as I mentioned earlier, many times. People can do everything else, and they really won't get well if the stress is still a role. An overview of what I do, generally it's the same way I got into looking into just even gut health. It was like, I was always trying to figure out, I've always been a Y person since I've been on the planet.

[00:24:34] Like my, I was probably And I'm always trying to figure out why something is going on with someone that I'm working with. I try to take the pieces apart, look at everything and try to put the puzzle together with someone when I'm working with them. And then that's how a lot of times this has led me to gut health.

[00:24:55] Why is this inflammatory marker higher? Why is this still high? We've done all these other things, right? And that's why a lot of people start looking at the gut and then, in the beginning. But overall, I do, focused and sometimes quite comprehensive testing, depending on the individual depends on what for we do all kinds of different, specialized tests from head to toe.

[00:25:18] Basically, go through that go through the test results with them when they come in and after their 2nd visit or so, and then we formulate a roadmap to their health journey. And many times, almost I would say 95 percent of the times we're needing to optimize the things on the left here physical activity levels.

[00:25:41] Sometimes I have to look for hidden infections with chronic infections. Sometimes we're looking at, toxins. Many times we're looking at sleep, in fact, that's one of the critical pieces. I almost always start with because if someone's not sleeping well, they're going to wake up with higher cortisol levels, which is the one on the left there and stress.

[00:25:56] And it just a vicious cycle, so nutrition. These are all things on the left that it's nice to see in a very, reputable conventional medical journal, but it's eating all these things. And that's why it's part of the reason. It's why it's important. Why we do these things, we want.

[00:26:12] Okay. Inflammation because, they call chronic, low grade inflammation basically for laymen. It's like inflammation. It drives the aging process and it contributes to many of these chronic diseases that people are susceptible to, especially as we age. Anyway, yeah, it's the lifestyle stuff and it's just, we retest, depending on what we're looking for the needle on.

[00:26:33] And it's, just keep gathering data and, doing basically serial testing to see, what's working, what's not and keep. If you're watching this, I've worked with Dr. Matt for five years and excuse me,

[00:26:54] it is rare. that a person doesn't get better because of this approach. If you want to know more about how to work with Dr. Matt we're going to, we're going to have a special offer during this summit where you can get a test. And we find that it's a great way for people to get started because we can give them data right up front about where they are with their health before they make the decision to sign up with Tiger Medical to work with Dr. Matt. But if you like what you heard today look for the special offer. It's a test that we have. We're going to offer a special pricing for people. It's very reasonable and affordable. It has excellent information. And when the results come in, we ship it right to your home. And when we get that information back, you'll meet with a tiger professional who will go through that information with you.

[00:27:50] And then you'll be, then you'll have a good understanding of how, what you're seeing in your labs can be improved upon using this process that Dr. Matt has created at Tiger Medical. So Matt, we just really thank you for all the work you've done the last five years and for this really informative session and we just appreciate it very much.

[00:28:11] Thanks so much for having me, Steve. It's been a pleasure.