Gut health is becoming more well known to impact mental health, but with the rise of ‘wellness culture’ how do we separate fact from fiction? Dr. Supriya Rao of Gutsy Girl MD bridges the gap between medicine and lifestyle to give patients simple and effective support for gut health, motility, and nutrition. We talk about the topics patients are often too embarrassed to discuss, what trauma has to do with the gut, and the things we can do each day to support ourselves.
In this episode we discuss:
how gut health is linked to mental health
the enteric nervous system and trauma
why it’s important to screen for sexual abuse
motility and issues with constipation and diarrhea
simple effective nutrition tips
6 pillars of lifestyle medicine
dispelling some wellness myths
Adapted Transcript
Jazmine: Dr. Rao, welcome to the Depth Work Podcast!
Dr. Rao: Thank you so much for having me. I'm really excited to be here.
Jazmine: Yeah, I'm so happy that we get to meet and chat. So I always like to start by asking just a bit about what your personal reasons were for getting into integrative medicine and doing the work that you do now, especially when it comes to focusing on women's health, lifestyle medicine, what really brought you into that space?
Dr. Rao: Thanks so much for asking that question. I think it's really important to know. I'm a gastroenterologist. I work in the greater Boston area, and for several years when I started my practice, I found that a lot of patients were coming to me with similar complaints, whether it was regarding, abdominal pain or, changes in their bowel habits, brain fog, a lot of these kind of overlapping symptoms.
And I felt that in medical school and residency and training, a lot of times we're just told, "Okay, if this medication doesn't work, try another medication. If that doesn't work, then let's just go through this laundry list of medications". And while medications can help for sure, in some cases, I don't feel like I learned enough about nutrition and lifestyle interventions and things like that during my training. And so I felt it was really important for me to see what patients lifestyles were like, how it was impacting their health, asking: Is it truly correlated or not?
For my own self, going through training and everything, my life wasn't the healthiest. I wasn't getting great sleep. I was pretty stressed out. Nutrition is one of the first things to go away and not being super active, I also felt these changes in my lifestyle affecting me.
I thought that it was really important to get to the bottom of what this was about. And so, a few years into my practice, I decided to first do obesity management and understand a little bit more about that because we had a lot of patients who came in who had obesity or issues with fatty liver and metabolic disease.
And then again, I felt like my tools in my toolbox weren't enough, even with just that. So then I decided to go to the American College of Lifestyle Medicine and really understand and get to the heart of these six pillars of lifestyle medicine that do affect us. It's evidence based and it's not something that I made up in a weekend course or anything like that. It was really important that it was based in science and really does affect our health.
Once I became certified in lifestyle medicine, I felt like I was able to bring it to patients. Now I'm seeing patients who are going through our lifestyle medicine curriculum really come out on the other side armed with and empowered with knowledge and feeling much better.
A lot of the side effects that they've been having or the symptoms that they've been having improving just with lifestyle interventions.
Jazmine: Did you have any other influences in your work? Any cultural ancestral influences or experiences that you had growing up?
Dr. Rao: Yeah, of course. I've been plant based pretty much almost my entire life. Growing up in a vegetarian household, I only ate vegetables, lentils, beans, legumes all of those things. And I remember, when I went to college,I probably had a little bit of shame growing up about eating Indian food all the time and learning about how spices interacted and what it was like eating that food growing up and being somewhat embarrassed about it. But then when I went to college and in medical school, obviously my diet changed significantly because I was just trying to get whatever was convenient.
I found that I was much more unhealthy because again, the way I was eating culturally and everything had taken a big shift. So, in my late twenties, early thirties, I realized what I was doing as I was growing up really impacted me positively.
Once I had kids in my early thirties, I thought “I don't want to be feeding them all this stuff and all the junk that I ate throughout my late teens and twenties”. So they started then adopting that anti inflammatory Indian diet that my kids now eat but we've applied it to other cuisines as well. I think that was actually really important growing up like that to be able to then come back to it later on.
Jazmine: Absolutely. I love Indian food so much. And as someone with an autoimmune disorder, it is so anti inflammatory, so good. You mentioned brain fog and some of the common symptoms that people came to you with. Did you ever notice folks coming to you with mental health issues? And can you explain some of the ways that mental health concerns can be really interrelated with physical health concerns?
Dr. Rao: Sure. So I would say when patients come to me, they're usually coming because of abdominal pain, changes in bowel habits, acid reflux issues, bloating, discomfort. But then when you actually get into it a little bit more beyond just the surface of their presenting symptom, you often find that there's a lot of mental health issues tied into that. And the way I think about it is in terms of this gut brain access.
Our GI tract, our gut is linked to our enteric nervous system, which gives us millions of nerve endings into our gut. So, stomach pain eventually also causes like some of these issues that we feel in terms of anxiety and depression.
When that connection is healthy and thriving, then both our physical health and our mental health improves as well. But when certain substances are being secreted or if there's disturbances in our gut microbiome, that can then affect our mental health because the nerve endings get hypersensitive leading to pain.
This can then affect the motility of our gut leading to constipation or diarrhea. It can then lead to changes in serotonin and dopamine that are being secreted, which then affects our mood. And so I found the amount of overlap we see with GI illnesses and mental health is unbelievable.
And so being able to help patients both in a parallel fashion is really important.
Jazmine: Yeah, truly. Can you explain a bit more about the enteric nervous system? Because I think many people are familiar with the sympathetic and parasympathetic nervous systems. Especially when folks are interested or engaged in trauma healing, trauma processing, that's something that gets thrown around quite a bit. However, it's so rare that we talk about the enteric nervous system and even in academia. I went back to school to study neuroscience and even in neuroscience classes, we talk about the sympathetic, parasympathetic and then we get to the enteric and they're like, "Oh yeah, by the way, there's this third one. It's called the enteric nervous system and we don't really know what it does". So we're just going to kind of put it over here. So tell us a bit more about the enteric nervous system.
I found the amount of overlap we see with GI illnesses and mental health is unbelievable.
Dr. Rao: I think it is still kind of nebulous for a lot of people and a lot of research is being done in it because of what we're seeing with both GI and mental health.
So basically in the entire nervous system, like I said, it has millions of nerve endings that go all throughout our gut, our stomach, our small intestine, our colon. What happens is when the food that we eat or the practices that we have in our everyday lifestyle, it interacts with our gut microbiome, so the organisms, the bacteria, the viruses, everything that lives within our colon, and so when it interacts, especially if you're eating a really healthy diet, it will then form what are called short chain fatty acids like butyrate or other substances similar to that.
That kind of maintains the integrity of our gut, prevents inflammation, has kind of chain reaction down the lines in terms of cell signaling and really helps whole body inflammation. So it's gonna help your metabolic symptoms. It's gonna help cardiovascular symptoms It's gonna help in terms of cancer. All of these different things.
But then not only are those effects seen that help with our anti inflammatory throughout our body, serotonin and dopamine are also produced in the gut along with these other substances. So actually the gut is the number one producer of serotonin in our body, instead of the brain.
When these neurotransmitters are produced, they eventually travel back to our brain influence what's going on there. So you kind of have this bi-directional pathway, which then again, can have effects on your mental health in both a positive and negative way, depending on how it's going.
Also, in terms of like neurologic health, you mentioned that you're in neuroscience, neurologic health, when it comes to both cognitive decline, Alzheimer's and other things, there's research to point to that to say that our gut health can affect our cognitive and brain health as well.
A lot of research is still being done on this microbiome, the research in it in the last 10 to 15 years has skyrocketed and we're still trying to understand it. I think we've barely scratched the surface of it, but this microbiome gut brain access, I think, is really a key to both having a healthy physical and mental health.
Jazmine: Absolutely. You mentioned inflammation as one of the key drivers, I believe, of poor metabolic and mental health. Can you explain how that happens? if someone is eating the standard American diet or through whatever mechanisms become inflamed throughout their whole body, how does that manifest in disease and mental health concerns?
Dr. Rao: For example, if you're eating the standard American diet for over a long period of time, I mentioned how short chain fatty acids are produced when you're eating a healthy diet. So when you're eating the standard American diet TMAOs are being produced and that's a substance which has been implicated in cardiovascular disease.
A lot of saturated fats, processed foods like meats and things like that, when they interact with our gut microbiome, they're producing these TMAOs. And then again, it's kind of this cascade signaling pathway over time, which increases the inflammation, decreases the junctions in the lining of our gut, which then allow the inflammatory substances, which are present to pass through and then get into the bloodstream.
It then causes the lining of our blood vessels over time to get sticky. And then that increases our chance of plaque buildup, which then can lead to cardiovascular disease. There are substances that are produced that especially in eating red meat and processed meats that we know have implications, especially in colon cancer, as well as other cancers in the body, again, like through similar pathways with cell signaling and inflammatory substances being produced.
Also in eating highly processed and high sugar diets as well. Again, it's the same pathway in terms of cell signaling, inflammatory substances being made. You're thinking about fatty liver, cardiovascular disease, cancer. And then when you're seeing increased inflammation, in terms of the rest of your body, you're going to see increased inflammation in your brain as well, which then can lead to cognitive issues, mental health issues, things like that.
Jazmine: Yeah, I believe it was fairly recent that we discovered that cytokines can cross the blood brain barrier and create brain inflammation. Prior to that, we thought that that wasn't possible.
Dr. Rao: Absolutely right.
Jazmine: Yeah, so what are some of the most common things that you see with folks and this is maybe not an aspect that you specialize in, but one of the things that I've noticed is that trauma survivors, in particular, people who have experienced high amounts of stress, distress, trauma in all kinds of different ways that can manifest as disease often autoimmunity, there's massive links between trauma and autoimmunity as well as mental health concerns. Have you seen some trauma survivors in your practice? And maybe you can point to some of the things that you've noticed. there? I think a lot of people are also wondering why is there such a correlation between experiences of trauma and particularly gut problems?
Dr. Rao: I think we carry our stress in our gut. I think that especially in patients who have had trauma, over time, their nerve endings, in the enteric nervous system, become hypersensitive. And a lot of those patients end up having something that's called visceral hypersensitivity. So organically, if we do a colonoscopy or an endoscopy, we may not find anything that is structurally wrong or that there's inflammation inside the colon or anything like that. But it's these nerve endings and the substances that are secreted that then cause the problem. And so oftentimes, I would see patients saying , "No matter what I eat, I have pain. No matter what I do, I just can't seem to get rid of the brain fog. I can't seem to get rid of my fatigue. I don't understand why every time I eat something, I have to run to the bathroom and it just runs right through me." And then , like I mentioned, that also affects our motility and our gut as well. So that's what I see a lot of in terms of patients.
It's hard sometimes in a very short office visit to really delve down deep into what's going on, but we definitely try and especially in patients who have issues with constipation and diarrhea, I really do talk about rape, sexual trauma, things like that, because oftentimes when we see patients who have pelvic floor dysfunction... we see it a lot in patients who have had children and so they've had trauma to their pelvic floor, but in younger patients who have not had children, but who have severe pelvic floor dysfunction, you have to really get to the bottom of "why would they have that"? And often it's because they have been traumatized as a child they've been raped. And so it's really important to understand that because once that is uncovered, it's actually one of the first steps towards healing, both obviously their mental health, but also a lot of these physical manifestations.
Jazmine: Absolutely. I've seen that too with a lot of trauma survivors that I've worked with massive gut problems. Is there also something about constriction in the diaphragm? That's another thing that I have noticed in terms of nervous system overwhelm.
Dr. Rao: Right. I mean, I think that people sometimes say that bloating and everything that they're feeling in that way. Or some people even say that they've got a difficulty swallowing. And if we do an endoscopy and everything looks normal, we do pressure testing and that's all normal. It's often diaphragmatic breathing that I refer them to, to really get them to understand like how to breathe, how to use those cleansing breaths to kind of calm themselves down. And oftentimes that releases some of the trapped air and bloating as kind of a side effect with that improved breathing.
Jazmine: So I want to get to the motility piece. Why have you decided to focus on motility specifically? Why is that important?
Dr. Rao: Because so many people have problems going to the bathroom. It's really crazy. Motility is actually one of the first things I got into once I started practicing out in the community. It was initially just trying to figure out why people have difficulty swallowing or people have difficulty going to the bathroom, but then when I got into it more, it's the same overlap in terms of mental health and physical health and being able to help these patients through either medication with neuromodulation or looking at pelvic floor dysfunction and seeing what the nerve testing is like for them. Having a bowel movements is like this well choreographed dance almost like certain muscles have to relax, certain muscles have to contract in a really nice way. And you're not supposed to stay on the toilet for very long because then that can kind of cause muscle issues over time.
And so being able to help patients understand this. I have men who come in and say, "I can't get out of the bathroom unless I've been in there for at least three hours". Things like that have become normal for them, but that's actually not a normal habit.
And so being able to do some testing and ask ‘Do you have pelvic floor dysfunction? Why do you have pelvic floor dysfunction?’ We have biofeedback therapy and physical therapy in our office that we provide that service and our pelvic floor physical therapists are unbelievable.
And the way they're able to help these patients get back to at least maybe instead of three hours, they're going down to like half an hour, which, it's still a long time, but for them, is a life changing thing. So being able to help these patients get control of their bowel habits, really dial in and focus in on certain lifestyle factors that could be affecting it. It really does change your quality of life. Being able to go to the bathroom and having normal bowel habits. A normal bowel habit could be like going to the bathroom from three times a day to every three days.
So there's a wide range in what normal is. But to go for two weeks without having a bowel movement or to have 12 bowel movements a day is not considered within the realm of normal. So being able to help patients move towards a little bit more normalcy in their bowel habits is actually quite life changing.
Jazmine: Truly. Honestly, I'm not the doctor here, but I suspect that more people than we realize struggle with motility based issues, or at least the kind of generalized term "irritable bowel syndrome, IBS", the bloating , feeling like crap after you eat .Maybe their bowel habits are normal but maybe there's still some problems, things aren't moving through them in the right way.
And I'm someone who has struggled my whole life with what got labeled as IBS, which I think also, people tend to even still now, consider it a women's issue, or it's just stress. Now, I think we know that there are many, very real, tangible causes of IBS. SIBO, small intestinal bacteria overgrowth, is one of them. And that's what I have definitely struggled with over the years. But even in seeing integrative and functional medicine doctors for my SIBO, not many of them focused on motility. And I will say that since I started taking some natural motility agents, it was a game changer for me. I mean, truly a game changer.
Dr. Rao: People are really embarrassed to talk about their bowel habits. They think it's something that we shouldn't be discussing, even in this day and age. I want to make people feel comfortable talking about it. This is what I do every day.
It's not something to be embarrassed about. And it's just one of these things that it's important for your bodily functions to work normally. And so you're right, I think it is under-diagnosed. I think people are scared to talk about it sometimes. But my hope is through avenues such as yourself , we're able to like normalize this conversation and let people know it's okay and to discuss these things with your physicians or other clinicians.
People are really embarrassed to talk about their bowel habits. They think it's something that we shouldn't be discussing, even in this day and age. I want to make people feel comfortable talking about it. This is what I do every day.
Jazmine: Absolutely. Tell us a bit more about some of the nutritional interventions that you might talk to people about. Why is nutrition important and what do you generally recommend for people?
Dr. Rao: Nutrition is very important, like I mentioned, and it's something that we do multiple times a day. Eating is one of the things that we do most often that can affect our health.
The way I probably used to eat was something that was super highly palatable tasted really good in the moment, even if I didn't feel great later on, like, "Oh my gosh, this cupcake is amazing. It tastes so good. " my sugar receptors are firing in my brain. I have this little mini high from it. And then an hour later, I'm exhausted, want to go lie down and that kind of feeling.
I think that recognizing that and really thinking, "What are the foods that are going to sustain you? What is it that I'm putting in my body? Is this thing going to serve me?" I have this one body, I have this one life, so whatever I put into it should be something that first of all, tastes good, but also it's going to be fuel to make sure that my body runs really well.
I really preach about Mediterranean diet and plant based eating for me. A diet that's really high in vegetables, fruits, nuts, seeds, lentils, beans, legumes, whole grains. And I know people tend to demonize carbs quite a bit, but carbohydrates are a macronutrient and we need them to survive.
And so I think refined carbohydrates and things that are high in sugar, like baked goods and things like that, obviously that's a different story, but grains like farow, quinoa, eating sweet potatoes, things like that I feel like is really important because it can't just cut out the whole macronutrient from your body and be able to sustain that.
So that's what I preach. when I'm seeing patients, if they are completely in a fast food kind of environment that's what they're eating most of the time, I'm not expecting them all of a sudden to come over and be completely plant based and everything.
I talk about the food continuum often. And so we've got foods on one side which we know are super unhealthy. Those are animal products highly processed foods are high sugar foods are Sodas juices, which are high in sugar. And, then on the other side, we have all the healthier foods that I've discussed.
So if I can just get patients, okay, let's just have one goal here. Let's stop drinking soda. What can we do to help you stop drinking soda? How do we make water more interesting? How do we make maybe having some herbal teas and stuff like that, if you're bored. So I try to meet people where they are.
I have a nutritionist that I work with as well, who is of a similar mindset. And being able to make changes in patients who have had these habits for decades to kind of start slowly peeling back and unraveling some of those and replacing them with healthy habits, it does take time. And so to realize where people are coming from, where they're coming from culturally, a lot of these patients have been eating these foods because their parents raised them on these, or that's what they have known culturally. And so for me eating the fruits, vegetables, healthy fats it's really important.
I have this one body, I have this one life, so whatever I put into it should be something that first of all, tastes good, but also it's going to be fuel to make sure that my body runs really well.
Jazmine: Yeah, truly. And to your point, I think it's so important to humanize this and to not place the problem within the individual because this is structural and societal. I mean, I grew up in a food desert where I had 30 options for fast food restaurants growing up and maybe one grocery store that was a long car ride away to get any kind of healthy fruits or vegetables, right? So we have so many people, at least in America, living in those kinds of conditions. What's considered normal eating or standard now is so beyond the norm.
It is not what our ancestors or anyone was really eating. And our bodies don't really know how to adapt to it. So I completely agree. Starting with some small steps and understanding that it's not an individual problem. What are some of the maybe easy things or low hanging fruit that people can start to implement if they want to move towards more quote unquote "healthy eating", knowing that healthy is maybe different for each person based on their body? But generally what would be really advantageous for most people?
Dr. Rao: Fiber as a gastroenterologist is like my number one vitamin.
Being able to have a diet that's high in fiber, 97 percent of Americans don't get enough fiber in their diet. And we're aiming for about 35 grams a day. Again, thinking about how to increase fiber in the diet. A lot of people like smoothies, so again, thinking about even if you throw in fruit, frozen fruit and some greens into that, that's going to increase the amount of fiber in your diet.
When you're looking at your plate, remember half your plate should be vegetables. A quarter of your plate should be a lean protein. And then a quarter of your plate should be a whole grain. And, thinking about healthy fats, olive oil, avocado oil, algae oil, things like that, which are helpful.
And then drinking water. I think sugar sweetened beverages are one of the biggest culprits in terms of metabolic disease and inflammation in this country. So cutting that out because it's just liquid calories, which have no nutritional benefit at all. In my mind, low hanging fruit is just having a plate that's vibrant, all different colors of the rainbow. Mostly vegetables, fruits, some protein and some whole grains and that's kind of how I model all of my meals.
I think about my complex carbohydrates and protein, a lot of times beans and lentils kind of crossover with that. Tofu is a really great plant based protein. If people are having really difficult time like cutting out animal products, then fish is a good source of omega fatty acids, omega 3 fatty acids, but a lot of nuts and seeds can have those as well.
So, it's just kind of really looking at what you're eating, and looking at labels and seeing, okay, does this have any nutritional value at all? Or is it just, empty calories? And so that's kind of how I have patients. I talk to them about the plate. I talk to them about fiber and I talk to them about what they're drinking because drinking those sodas and things like that, you can do it really fast and it happens really quickly, but it's like eating these high fiber foods, it makes you full, if you eat it slowly, because you have such a large amount of food to equal a large amount of calories. Whereas for some of these like really highly processed foods, small amounts of foods have high amount of calories. So if you're eating these nutrient dense, low calorie foods, you're going to feel full because it just takes so much more volume to reach your calorie limits.
Jazmine: Absolutely. Can we also talk about healthy fats? For me in my journey, there were two big factors that supported my mental health most of all. I mean, first of all, definitely cutting out anything that I had allergic reactions too. I have celiac disease, so gluten was one of those. But beyond that, and for folks that may not have food allergies, the two biggest things that had a remarkable effect on my mental health was adding in really high quality fats and having a greater amount of fat than I think I was used to. I mean I grew up in The 90s where that was demonized, it was like low fat everything. And then I agree to not demonize complex carbohydrates, but also getting off the blood sugar roller coaster that I was on, which cutting out sugars and simple carbohydrates or starches, baked goods, things like that was huge for me. So talk to us a bit about healthy fats.
Dr. Rao: Yeah. So healthy fats, there are a lot of seed oils or like there are a lot of oils that people use, which, the debate goes back and forth about what people think are healthy and what are not. , a lot of people cook with coconut oil, but coconut oil has a lot of saturated fats.
So I think if you're able to do it in some amount of moderation or small amounts of coconut oil, I think that's fine. I actually just was introduced to algae oil and I'm going to be trying that out and cooking with that. It has just high amounts of omega nines, I believe, which are really good for higher smoking points and don't denature the oil to make it kind of carcinogenic and when you cook at high points, so, I'm actually gonna be trying that out. Avocados, nut butters, having a piece of fruit with either nuts or a nut butter is super healthy. Some of the seeds that we see, so flax seeds, chia seeds, they have higher amounts of fat in them, but they also have fiber and they also have antioxidants and protein in them as well.
So, those are some of the healthier fats that I recommend to my patients. .
Jazmine: Awesome. Yeah. So delicious. Also, fat just makes food taste better. Yeah.
Dr. Rao: Exactly. It does.
Jazmine: So, I know that you're also trained in lifestyle medicine. Can you tell us a bit about what that is? And you mentioned these six pillars, I’m curious…
Dr. Rao: So lifestyle medicine is a branch of medicine that again, is steeped in evidence and discusses how the six pillars affect and improve our life. So we're thinking about kind of a plant forward or plant heavy diet regular exercise or movement. I think when people think about exercise, they think, "oh my gosh, going to the gym,” exercise is a loaded word sometimes.
And so when you look at populations around the world who live routinely into their 90s and 100s, it's not like they're going to the gym every day and doing crazy amounts of hard exercise, but they're just moving their body throughout the day. And I think we've gotten away from that. When it comes to movement, a lot of people sit in meetings all day, it's a very sedentary lifestyle. Being able to move throughout the day is going to really help the body.
Adequate sleep. Sleep is like one of the first things that people are just like, "Oh, whatever. I'm just not going to sleep that well tonight or sleep much". And it's amazing how many people don't sleep well once they are asleep and having interrupted sleep really affects our hormones and can cause issues with stroke, heart disease, diabetes, obesity. And so all of these things, cognitive issues are linked to sleep .
Managing stress, you mentioned trauma and stress. And so being able to manage that is really important.
Avoidance of risky substances. So when we think about alcohol, tobacco, drugs really thinking about there is no true safe amount of alcohol and I'm not trying to tell people they should never drink alcohol, but we don't really know any safe amount. And when people say," Oh, what about my one glass of red wine a day?" It's just like, it's the substances that are within the red wine, which are helpful. It's not the wine itself. And so I think kind of reminding people about that. And I think drinking is a very social thing, and so it's really hard when you're meeting friends out for a social gathering because alcohol is sometimes automatically kind of assumed, but I think maybe changing that around and meeting for an activity or something like that is sometimes better.
And then the last one is kind of forging good social connections. We know humans were kind of social creatures. And so being able to have a group of people to support you through your life and to really be there through all the different kind of seasons of life, the trauma, the happiness, the sadness, those social connections are super important, especially as we age, because as we age, it gets a little bit lonelier. And so to be able to forge really good friendships and connections is helpful for our mental health.
When you look at populations around the world who live routinely into their 90s and 100s, it's not like they're going to the gym every day and doing crazy amounts of hard exercise, but they're just moving their body throughout the day. And I think we've gotten away from that. When it comes to movement, a lot of people sit in meetings all day, it's a very sedentary lifestyle. Being able to move throughout the day is going to really help the body.
Jazmine: Yeah, they're so fundamental and seemingly so simple and yet in our current society can be really challenging to meet all of those basic human needs. I mean, it's wild that we have a system where we can have anything that we want at our doorsteps with the click of a button. We can have a lot of our desires met, but we don't have a lot of our basic needs met.
Dr. Rao: Think that's a really strong statement. I think that modern society is not set up to be that way. I think modern society is super stimulating and can be really fun, but it's not set up for you to have a stress free day. It's not set up for you to have adequate sleep at night. For a lot of people, it's not set up for you to easily find nutritious food, which is affordable. It's not set up for you to be able to get out of your 10 back to back meetings to be able to go for a walk or enjoy something outdoors or go rock climbing with your friend because that's fun to do.
And I think social media can have a lot of benefits, but I think lately it's shown that it's affecting our mental health, increasing our stress, and making us lonelier than ever. a lot of people say like, "oh my gosh, I have this many followers, I have this many whatever," but how many people in your life are truly really close connections for you.
Who can you count on? And I think with the tobacco and alcohol, it's just, I mean, tobacco, I think in some ways has improved in other ways not, but alcohol for sure is just... more and more women are dying from alcohol related diseases. I'm seeing patients with liver failure from alcohol who are younger and younger. And so I think you're right. I think modern society is set up to meet a lot of our desires, but is not set up to have a lot of our basic needs met.
Jazmine: Absolutely. You spoke about alcohol and I completely agree. I mean, I would never judge someone for having their glass of wine in the evening and moderation is important.
But I cut out alcohol a long time ago, simply for the fact that I noticed my body couldn't handle it. Like with an autoimmune disease, I could not tolerate alcohol really. And it was affecting everything. So, that's a piece, but how do you feel about caffeine? Which I think is probably maybe with alcohol, one of just those substances, everyone does it…
Dr. Rao: Right. Yeah. I think , I'm not anyone to demonize coffee. I don't drink coffee personally, but I know the majority of the world does. And so there's a difference between like enjoying a cup of coffee in the morning, or relying on like five cups of coffee during the day, because I feel like that is kind of like disordered caffeine intake a little bit, because you're relying on a substance to get you through your day.
When honestly, in a perfect world, getting the adequate amount of sleep would then have you relying on the caffeine less. But people rely on it because they were up late doing, maybe working or doing other things. And then when you get up, you're in like fatigue, brain fog, and then you're giving yourself this drug to kind of keep yourself going.
I think that's when we run into problems. But enjoying a cup of coffee a day is fine.
Jazmine: Great. That's good news. So I'd love to hear, what's your vision for this work for integrative medicine? are there some aspects that you're really hopeful about, things that you kind of foresee on the horizon, maybe more and more people getting interested in this type of work? Things that kind of keep you going.
Dr. Rao: Sure. In my office, we have now started running lifestyle medicine classes as part of a curriculum after hours. So after I finished my day a couple of times a week, we run what are called lifestyle medicine classes. Again, focusing on these pillars, it's a 12 week course. We have 18 sessions, of kind of didactics and group support. And in addition to that, I also run like a virtual cooking class and we have nearby fitness gyms and stuff to kind of show people simple exercise they can do either at the gym or at home just to kind of help improve muscle mass and things like that.
I still feel a little bit on the fringe sometimes when I talk about these things because I think we're all very into treating illness in the US, we see an illness, we see certain diseases, we're able to treat them really well. But I think what we're not great at is promoting wellness.
And I think wellness, again, is a loaded word, because there's a lot of people out there who preach a lot of things, which I have really shaky standing in science and a lot of celebrities kind of have bought into the whole wellness thing and like a lot high amounts of supplements and things like that, which I don't agree with,
Jazmine: Wait, to pause you there, what are some of the biggest wellness myths that you've noticed?
Dr. Rao: And you need a lot of supplements. You do not like if you're able to have a healthy diet, you don't need to be taking a whole handful of pills. I mean some of the supplements I recommend Purely would be like fiber because that's some people just can't get it enough in their diet Vitamin D, if your vitamin D is low, I think it's important to stay on top of that if you are a little bit anemic iron, and then sometimes omega 3 and have some beneficiary effects.
But other than that, I really don't, you do not need to be taking a boatload of supplements. If you are eating fiber rich foods, if you are eating fermented foods.
That, that to me is like one of the biggest ones, but I think in a perfect world, we are able to, from like childhood, even before people get to adulthood, but from childhood kind of incorporate what healthy lifestyles are, what does it mean . Making it easy for kids to get nutritious food, making it easy for them to move throughout the day, have a good amount of physical exercise during the day.
Getting kids off screens a little bit too, so that they're able to like not be stimulated right before bedtime, so that they sleep well and sleep through the night. Again, this is a perfect world where I know there's a lot of kind of complicating factors and a lot of these things. But what I hope in the future is that we're able to offer more of these programs, we're able to really promote true wellness and not just treat illness and prevent a lot of these things from happening even before there's a potential of it. Preventing sometimes a patient is pre diabetic. You think, "oh my gosh, okay, we'll start with them on metformin", which is a common diabetes drug, but instead , what can we do to help this patient kind of reverse their diabetes or reverse some of the metabolic conditions that they have? So I think a lot of education, a lot of workshops, groups really work well.
Cause patients are able to lean on each other. Talk to people about what is healthy food. Some people don't know truly what it is. There's some education gap. So that's what I hope. we need medicines. We need medications for sure. But , we also need this lifestyle piece. So to be able to have those be part of a whole body treatment moving forward, I think would be what I would hope for in the future.
Jazmine: Yeah. I think that's a really powerful thing that you just mentioned. It's so odd how we kind of view it lifestyle medicine or healthy habits as like a luxury, like something that's auxiliary. It makes sense based on the context we're living in. But to your point, yeah, so many people don't know what healthy foods are, or we talk about superfoods, right? It's like , "this is a superfood!" That annoys me so much because so many things are superfoods.
Dr. Rao: Superfoods, yeah, yeah.
Jazmine: Yeah, nutrient dense foods are everywhere. But I really empathize with folks because I grew up, like I said, in a food desert, but also not really knowing how to cook nutritious meals. I don't blame my parents, it was the 90s, you eat freezer food, you eat Top Ramen. I mean, I think my body was built on Top Ramen and mac and cheese, literally.
Dr. Rao: Especially in college, oh my gosh. I like cringe sometimes thinking about what I ate in college. And then like getting your like schedule, eating at like two in the morning. That's not healthy. Like you should not be eating at that time. And so, just some of the habits that get promoted when we're on our own sometimes.
Jazmine: Yeah, absolutely. Yeah. Well, thank you for your wisdom. This was really lovely. Is there anything else that you would like people to know also about your work, how people can find you?
Dr. Rao: Sure. So , I really appreciate this. This was an amazing conversation. Thank you for having me. I think it seems like a lot. It can be overwhelming.
There's so much information out there, but making small steps, using goals that you're able to do, instead of being like, "okay, fine, I'll work out five times this week", but being a little bit more specific. Okay. I'm going to go for a walk at lunchtime, Monday through Friday.
So setting yourself with little goals, being able to Habit hack and habit exchange. Like I'm sitting watching TV. So normally maybe I would snack on something while watching TV, but instead of that, maybe I can knit something. So my hands are doing something else instead of mindlessly eating. Getting up and moving around during the commercials, even though people don't really watch TV with commercials anymore, but like, you're getting up and moving around.
So I think, really looking at your habits because everybody kind of knows in general, like they know that eating a hamburger is not healthy necessarily, but it's our behaviors that are preventing us from doing these things. So really kind of tuning into the behavior piece I think is super important. But I think, we also need to be kind to ourselves and not get down or completely fall apart when things aren't working out the way we want small sustainable changes over time make a big impact.
I practice gastroenterology, obesity, and lifestyle medicine in the greater Boston area. You can find me on Instagram as well. I'm gutsy girl MD. And I talk a lot about all these different topics, have recipes on there as well.
If you're interested in seeing me or my colleagues who are like minded about these things, my practice is called integrated gastroenterology consultants. Our website is my IGIC.com. So happy to have been on here and thank you so much!
Jazmine: Yeah. Beautiful. Thank you so much for your work.
Bio
Dr. Supriya Rao (she/her) is a quadruple board-certified physician in internal medicine, gastroenterology, obesity medicine and lifestyle medicine who focuses on digestive disorders, gut health, obesity medicine, and women's health and wellness. She received her undergraduate degree from the Massachusetts Institute of Technology after which she graduated from Duke University School of Medicine. She completed her internship and residency in Internal Medicine from the Hospital at the University of Pennsylvania. She went on to complete her fellowship in Gastroenterology at Boston Medical Center. She joined Integrated Gastroenterology Consultants in 2014 and is now a managing partner. She completed further certification in obesity and lifestyle medicine and is the Director of Medical Weight Loss at Lowell General Hospital and runs the Metabolic & Lifestyle Medicine Program at IGIC. She also runs the motility program, which focuses on disorders of the esophagus, irritable bowel syndrome and anorectal disorders. She is passionate about empowering people to improve their health through sustainable changes in their lifestyle. She enjoys cooking, traveling, running, yoga and spending time with family and friends. You can also find Dr. Rao on Instagram @gutsygirlmd.
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Sessions & Information about the host: JazmineRussell.com
Disclaimer: The DEPTH Work Podcast is for educational and entertainment purposes only. Any information on this podcast in no way to be construed or substituted as psychological counseling, psychotherapy, mental health counseling, or any other type of therapy or medical advice.