The Coalition with Dr. Shani Belgrave: Gut Health and The Microbiome with Dr. Shani Clay

Introduction and Guest Background 0:00

Welcome to The Coalition. This is a talk show dedicated to discussing health, wellness, and inspiration. I'm your host, Dr. Shani Belgrade. Hello, everybody. Welcome to the coalition. I'm your host, Dr. Shani Belgrave. I am a bariatric and general surgeon in Atlanta, Georgia. You can learn more about me and get connected at www.DrShaniBelgrave.com. I am super excited to welcome to the show today Dr. Shani Clay. Dr. Shani Clay is an accomplished gastroenterologist that works with WellStar Health.

She has graciously agreed to join the coalition for an amazing conversation on the gut microbiome and its impact on our health. Dr. Shani Clay, thank you for joining the coalition. Good morning. Good morning. Before I have you tell us a little bit about who you are. I have to give the viewers some context. So Dr. Shani Clay is also from Maryland. So shout out to the DMV area code 301. You already know what it is. And also, I know Dr. Shani Clay from when she was a medical student at the University of Maryland.

So this is really a full circle moment. So again, thank you so much for joining the show. Please tell us who you are and what you do. Sure, sure, sure. So again, my name is Dr. Shani Clay, it's so weird seeing both of our names on the same names on the screen. I rarely meet any other Shani, so I'm super excited to be here. So I went to medical school at University of Maryland, and then I did my residency in internal medicine at UAB, University of Alabama, Birmingham. And then I did my fellowship, gastroenterology fellowship at Emory University here in Atlanta.

So lots of training. I've lost count of how many years I've been training for. but it is all very, very well worth it. I have been in practice now for almost seven years, and I've loved every minute of it. I really enjoy the combination between clinic as a gastroenterologist as well as doing procedures, and it's a great lifestyle. lifestyle balance. So I'm enjoying my time here as a gastroenterologist in Atlanta. Awesome. So Dr. Shani Clay, please, let's get started. I'm really excited about this topic of the microbiome and gut health.

So can you please start off by letting us know what is the microbiome and how does it relate to gut health? Sure. So the microbiome is a collection of various microorganisms in your gut. So we have naturally good bacteria and good viruses and fungi that live in our gut that help with digestion, that help with building up immune responses.

What the Microbiome Is and Why It Matters 2:53

It's gotten a lot of, um, there's been a lot more research in the past couple of decades on the microbiome. So 40, 50 years ago, we really didn't know much about it. Now there's been a lot of research just kind of delving into what makes up the microbiome, what bacteria are good bacteria, what bacteria aren't good bacteria for you. It's interesting because we don't really, we haven't fully mapped out the microbiome. So hopefully, you know, in the coming years in the future, we'll be able to do that.

But we haven't mapped out the entire microbiome yet, right? And everyone's microbiome is also different. So there is a lot we know, but there's a whole lot more that we don't know in summary about the microbiome. So what do we know? So we do know that there's specific types of bacteria and specific types of fungi that are good for us that live in the gut. We do know that it helps with immunity. So our immune cells, it's almost as if the immune cells use the microbiome to see, hey, what bad guys are out there, what bad guys are in your gut.

And based on the bad guys that it sees, it's able to develop antibodies against those bad guys to help to prevent infection. The microbiome also helps to digest various things like carbohydrates and digest nutrients. So it helps with nutrient resorption. It's very interesting because it's also been implicated in various disease states, so things like inflammatory bowel disease can be associated with dysbiosis or disruption of the microbiome. Um, certain types of cancer, definitely colon cancer and even mental health disorders.

So things like depression and anxiety, the large majority, 80 to 90% of serotonin, which is kind of the happy hormone is producing the gut. Right. And so we know that when people that have depression or anxiety, ADHD has been linked. to dysbiosis or dysregulation of the microbiome. So we know that so much stuff happens down in the gut and can affect us outside of the intestines, our various forms of physical and mental health. But we don't know exactly how to regulate that as of yet. But there is lots of studies being done now on what the best way is to normalize our microbiome.

and hopefully prevent other disease states down the line. I really find this to be fascinating. I was reading an article with a connection between the microbiome and Parkinson. And the article was speaking about kind of like the epithelial barrier and certain things crossing that that then are kind of contributing to inflammation and things like that in the body. The next thing I would ask you is, I understand that it's not entirely clear how we can fully treat those conditions as it relates to the regulation of the microbiome, but can you speak to prebiotics, probiotics, and the potential role that those things play?

Sure. So many patients come into my office saying, hey doc, which probiotics should I take? Hey doc, which prebiotics should I take? Um, in summary, a lot of those things are just money-making scams. So for various reasons, right? When it comes to probiotic pills. So the difference between a prebiotic and a probiotic, a probiotic pill is supposed to replace the healthy bacteria in your stomach. A prebiotic is the nutrition for probiotics.

Probiotics, Prebiotics, and Who Should Use Them 6:38

So there's lots of things out on the market. Now you go down Publix, Kroger, wherever you see various probiotics on the market. But a lot of those things haven't been proven to help with the microbiome because we don't know enough about it. Number two, they're also not FDA regulated. So you may see it says there's X, Y, and Z in the ingredients in the box, but you really don't know what's there because it's not regulated by the Food and Drug Administration. So I always tell my patients, you have to be careful with taking these things that aren't regulated and that we don't know exactly what's in them.

Thirdly, they can be harmful to a small subset of patients. So specifically patients that have cancer, that are going through chemotherapy, your immune system is already weakened. And so introducing other bacteria that we don't really know what it is into that can cause you to be sick. And our guidelines in the literature and the gastroenterology literature don't really strongly recommend probiotics in general. I never say, oh, you don't feel well here, take a probiotic. Oh, you have a gas, take a probiotic.

I never do that with my patients. Only in very specific conditions is probiotics recommended. But in general, for the average patient that just says, hey, doc, I got bloating, I got some constipation or some diarrhea, my first go-to is not probiotics. So I say take those with caution. Most people, it's not going to harm you. We don't really know how much it will actually help you. But in some folks, it can harm you. So I wouldn't get all caught up in spending hundreds of dollars on probiotics or figuring out what's best at the CVS.

I would just really focus on eating a healthy, well-balanced diet, which is much cheaper as well and healthy. Yes. And so you mentioned that there is a subset of patients who you do recommend them for. Who are those patients? Some patients that, for example, might have a disease or an infection called C. diff, claustridium difficile, and if they're on antibiotics, then we oftentimes will recommend, okay, especially if they have severe C. diff or if they're hospitalized with it, then we start probiotics because we know that the antibodies that they're on for the C.

diff has wiped out certain gut flora, right? or gut bacteria, and so we will prescribe, or we will give probiotics to help replenish that. But in general, outside of those, you know, that specific, I typically do not recommend probiotics. Okie doke. So you're saying that it's not really necessarily recommended and that for many, it's not harmful, but you do have to be careful because depending on the patient, if they have cancer, if they're undergoing chemo, it could actually be harmful. Exactly.

Exactly. So save your money and go to the farmer's market instead. Fresh produce is that we know that for a fact that's very good for you. Lots of fiber. Lots of fiber. We could talk definitely. I'm a huge proponent of, you know, increasing your fiber intake. I typically recommend for my men and women between 25 to 30 grams of fiber a day. There is a website, you can go to the Mayo Clinic website. I like to recommend because if you Google Mayo Clinic high fiber diet, it has a list of foods and their fiber contents and fruits and veggies and bran, things like that.

So that's the best thing that you can do for your gut is to eat a well-balanced diet not full of saturated fats, not full of highly processed foods, just focus on things that come straight from the earth, right? So your fruits, your veggies, your apples, your raspberries are a great source of fiber, things that are high in antioxidants as well. Those can help to naturally replenish your gut flora. Thank you so much for that insight. So why is fiber so good? What does fiber do for our gut?

Fiber, Constipation, and Gut-Friendly Habits 10:40

Yeah. So most of the things. So fiber oftentimes helps a lot. So there's a condition that I see quite often in my clinic called irritable bowel syndrome, or IBS. And it can kind of come in three different flavors, I like to call it. IBS constipation predominant. IBS diarrhea predominant or mixed where people have a combination of both. And we often recommend fiber for that condition as well as for kind of your general constipation. It helps to really bulk up things in your gut and helps to pass.

So when you have fiber in your gut, water is absorbed into the gut lumen, so the center of the gut, and it helps things to move more quickly down your digestive system and out. So that's mainly the reasons that I typically recommend fiber. It's very good to use. Sometimes it can cause bloating in some people. And again, that's for those same reasons, right? The water moves into your gut and can cause you to have a gassy and bloating feeling. If that's the case, you know, you can reduce it a little bit.

But in general, I'm a big fan of various forms of fiber, of insoluble fiber. So that's a perfect segue to something that I wanted to make sure I asked you about as a gastroenterologist, which is constipation. Because with doing a lot of weight loss surgery, some patients will say within the first few weeks, I'm constipated. And so I normally feel like it could be related to just not drinking enough fluid. So the first thing I do is make sure you're staying hydrated. But do you have any other things that you recommend for constipation?

That's a common question. How can I treat constipation? Sure. Yeah. So outside of, you know, 64 ounces of water a day, at least fiber, I do like Miralex. So I'll typically recommend fiber like a Metamucil three times a day. And then Miralex can also be taken three times a day as well. Miralex works in a similar way as to Metamucil in terms of it pulls, it's what we call an osmotic active. So it pulls water into the gut. and makes the contents in the gut more mushy, for lack of a better word, and allows you to pass.

So I'll do Metamucil, I'll do Mirlax Stool Softener, so things like Docosate, Colace are really healthy. And then there are other stronger laxatives that we can prescribe that can help, even if it's just in the short term. For instance, after you've had a surgery, Um, whether it be weight loss or, you know, an ACL repair or whatever that you might be on, you know, narcotics. So there's things that we can prescribe just to kind of temporarily help with passing, um, the passage of stool and to help to relieve that constipation.

Thank you so much, Dr. Clay. I had to give you a thumbs up because I was so excited that your regimen is what I've been doing. We're on the same page with the gastroenterologist. Yes. Yes. Yes. Good job. You know, I love me some Miralax and Metamucil three times a day. And if you have too many bowel movements, go down to twice a day or once a day. You can just kind of play around with it. But in general, you know, Metamucil, Merilax, Colace, even Senna is going to be very, you know, it's going to really help with your constipation in most patients and it's not going to be harmful.

Perfect. There were a couple other topics that I wanted to see what you thought about. One is fermented foods. like kiffer and kimchi. U other thing is kombucha. I to get the perspective fro Yeah, so again, we don't know a lot.

Fermented Foods and SIBO 14:16

So typically, when patients come into my office and say, hey, I'm taking this or I'm taking that supplement, in general, they're probably OK. Do I specifically recommend definitely take kombucha? I typically don't. If the patients feel as though it helps them, I'm OK with that. I'm perfectly fine with that. But because we're learning, still learning a lot, There aren't any firm recommendations on those kind of specific or exotic, if you will, supplements. I think that there, I'm sure there are patients out there that say, you know, you go on all these social media trends or websites, things like that, and people claim that it is helpful.

Again, I just say, hey, let's just stick to a diet that's colorful, that's full of, you know, various colors on your plate. and various vegetables and fruits and go from there. Oftentimes people aren't doing that. So they may be eating fast foods, but adding this random supplement at the end of the day to kind of balance it. I was like, oh, you don't necessarily need that. You can just- Yes, we can all agree that the processed foods are definitely harmful. So eating that and then throwing on a probiotic, I would agree is not going to address the issue.

Exactly, exactly. Thank you so much. So dr what is that all about? So bacterial overgrowth. And with bloating, it can be manifest as constipation or diarrhea. We, after doing kind of basic testing and nothing coming back positive, we can send them for a breath test, for a hydrogen breath test. And that can detect if there is kind of an imbalance in their gut, right? And so it detects specific bacteria and we can see kind of what is a little bit abnormal. What we typically do for SIBO is prescribe a medication for two weeks called Rifaximin, which is an antibiotic, but it helps to again balance out that gut flora.

Um, so SIBO has also been in association with irritable bowel syndrome as well. So those two things can oftentimes run hand in hand. It can cause again, the myriad of symptoms of, of the bloating and just kind of abdominal, uh, cramping and abdominal discomfort, um, diarrhea and constipation. And it can be quite distressing for lots of patients. And so it's very rewarding for me when, You know, if I diagnose SIBO and I prescribe the rifaximin and they come in and oftentimes they'll say, hey, doc, I feel like a whole different person.

My bloating is gone. My diarrhea is gone. Sometimes the symptoms may or may not come back several months later and it's okay to re-prescribe the same regimen of the rifaximin if they do come back. But there's a way to specifically test for SIBO and that's with a breath test. Wow. Well, Dr. Shani Clay, I want to thank you so much. I have been so excited to get you on the show because I find all of this to be fascinating and I appreciate all the work that you do. For people that have enjoyed this and want to get connected with you, what is the best way for them to reach out to you?

Sure. So they can find me on social media at ATL Gastro Doc. That's A-T-L as in Atlanta, Gastro Doc. And people are more than welcome to reach out to me via DM. And if there is something going on and you need to see me in the office, I'm more than happy to see them in office and can get them my information at that time.

Closing Remarks and Contact Information 18:08

Fantastic. Well, Dr. Shani Clay, You definitely have to come back to the coalition again. Oh, I would love to. I would love another invite. Lots to talk about in the field of GI. Absolutely. Thanks so much. All right. Thank you. Well, everybody, thank you so much for tuning into another impactful episode of The Coalition. I'm your host, Dr. Shani Belgrave. I am a bariatric and general surgeon in Atlanta, Georgia. You can stay connected with me at www.DrShaniBelgrave.com. I am so excited and grateful to Dr.

Shani Clay, gastroenterologist based at WellStar Health for joining the show and sharing some real gems about gastrointestinal health and the microbiome. You can get connected with Dr. Shani Clay at atlantagastro.com on social media. Thanks everybody for watching. I'll see you next time. Be sure to share and subscribe.