TRANSCRIPT EPISODE 15 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #15: the gut microbiome and your pregnancy with dr. sarina pasricha

Transcript

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00:00                                   You are going to find this episode super informative. We're talking about the gut microbiome, how it affects your health, your pregnancy, and your baby's health.

00:11                                   Welcome to the All About Pregnancy and Birth podcast. I'm your host Dr. Nicole Calloway Rankins, a board certified OB Gyn physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:48                                   Hello, welcome to another episode of the podcast. Thank you so much for being here with me today. We have a really awesome guest on the podcast this week. Dr. Sarina Pasricha is a nationally renowned plant based gastroenterologist. She speaks extensively on the gut microbiome and the brain gut connection. Because she believes good gut health is the key to a happy, healthy life. After completing her undergraduate training and biological anthropology in nutrition from Harvard University, Doctor Pasricha attended Northwestern Feinberg School of medicine for medical school. She completed her residency and fellowship training at the University of North Carolina at Chapel Hill where she also received a master's of science and clinical research. She has published extensively in the most well respected gastroenterology journals and she's given more than 50 invited national presentations. We talk today about the gut microbiome, how it affects your health, how it affects your pregnancy and the impact of the gut microbiome on your baby's health.

02:04                                   We talk about how to improve your microbiome, how to improve your baby's gut microbiome. We talk about vaginal seeding, how the gut microbiome affects postpartum weight. We cover a lot of great information in this episode today and I know you're going to find it helpful. Sarina's really easy to understand. She gives them a concrete action oriented advice for you to help improve your health and your baby's health. She's also super optimistic and encouraging, so you're going to enjoy this episode today. I promise. Now before we get into the episode, let me give a quick listener shout out to Lapsana, L.A.P S. A. N. A. She left me a review in iTunes that said, I'm glad I discovered this podcast at 22 weeks pregnant. Dr Rankins is knowledgeable and so are her guests. Listening to this show is like getting your reassuring advice from a friend. Thank you so much for that super kind review and today's episode is going to be no different. This guest is awesome and I hope you will feel again like you're getting reassuring advice from a friend. So let's get into today's episode with Dr Sarina Pasricha.

03:13                                   Nicole: So Hey Sarina, thank you so much for being on the all about pregnancy and birth pie cast today. I'm super excited to have you here.

03:22                                   Sarina: Thank you so much for having me and I'm really excited to talk about gut health and pregnancy. It's a passion project for mine, so I'm excited to share.

03:31                                   Nicole: Yeah, yeah. So why don't you start off by telling us a little bit about yourself, your work, and maybe your family.

03:39                                   Sarina: Sure. So I am an adult gastroenterologist. I grew up in Delaware and I traveled across the country for my training. I went to college at Harvard and then I went to Northwestern for my medical degree and I have always had an interest in gastroenterology. And I decided at that time to take a year off doing a Howard Hughes medical research year, which is like a basic science year where I'm in the lab working with mice and I was studying fatty liver disease and then I went to University of North Carolina, which I know that that's you. You are affiliate of that.

04:21                                   Nicole: Yeah. Yup.

04:22                                   Sarina: So go Tarheels. And that's where I did my residency and my gastroenterology training. Um, I specialized in motility diseases. So I spent, spent an additional year studying constipation, irritable bowel syndrome, a little bit about gut health and gut microbiome. And I really was debating going into an academic career or going into private practice. And I realized that I loved seeing patients and I love doing procedures and although I really liked research, it was taking time away from the clinical side. And so I decided to join a private practice group back in my hometown in Delaware. And so I live and work in Delaware. I have two girls, they're three and five.

05:12                                   Nicole: I have two girls too. And they're two years apart as well.

05:15                                   Sarina: Yeah, I, I'm sure just like you, they keep me busy.

05:18                                   Nicole: Yeah, absolutely.

05:20                                   Sarina: And my free time kind of goes there. So I'm fortunate I have my family in the area, so they helped me as well.

05:25                                   Nicole: Okay. Okay. Well you are clearly based on your training, very serious about gut health for sure. So why don't you start off and tell us a little bit about what exactly is the gut microbiome.

05:39                                   Sarina: Sure. Lots of people have been hearing about the gut microbiome. It's kind of a hot topic and I think there's reason for it to be a hot topic. Um, so the gut microbiome is an ecological community of microorganisms. And what that means is that we are made up of bacteria, fungi and viruses and these all, they live on our body and that would be part of the skin microbiome, but they also live in our GI or gastrointestinal system. And that's known as our gut microbiome. And, you know, most people, you know me included ,initially when you think about bacteria, fungi and viruses, you don't really want that to be associated with your body, right? You're trying to like be clean and hygienic. But actually these organisms are really important and they play a vital role in making sure that we all stay healthy. And this is a relatively new concept we've learned about the microbiome starting in around 2006. And so there's a lot of research coming out right now and you know, over the years as we realized how important it is. So that's why I think people hear about it. When we talk about the gut microbiome, this is a really large system. So there's actually 100 trillion micro organism cells in our Gi tract.

06:58                                   Nicole: I mean, isn't this something like there's 10 times as many bacteria compared to like human cells?

07:04                                   Sarina: That's exactly right. Yes. And when you take it down to a DNA level, we are actually only 1% human and our genes are 99% bacterial.

07:14                                   Nicole: Seriously?

07:16                                   Sarina: Yes.

07:16                                   Nicole: Wow, that's crazy.

07:18                                   Sarina: Yeah it is. I know I was trying to put this in perspective cause like when you hear 100 trillion microorganisms cells, it's so tough to put it in perspective. So one way to think about it is that if you talk about it in time, so 1 million seconds is the equivalent of 11 days when you talk about 100 trillion seconds. So the amount of bacteria we have, you're talking about more than 3 million years.

07:46                                   Nicole: Gosh, wow. That is a really neat way to put it in perspective. We're like walking like, I don't want to say petri dishes, but we kinda are.

07:56                                   Sarina: We definitely are, yes. Yeah. We have more micro organisms on us that you know, the dirtiest spot you could ever think of, you know, ever since.

08:06                                   Nicole: Right, right. So there's obviously research that shows that having a healthy gut microbiome is important for your health. So what are three things at least, and you can do more or less whenever you think is appropriate, the things that women can do during their pregnancy to help them have a healthy gut microbiome.

08:24                                   Sarina: So you're, you're exactly right that there are things that we can do to help our gut microbiome. So let me start off by saying everybody has good bacteria and bad bacteria. And the goal is to have more good bacteria than bad bacteria. And, and when you do have that, then you live a healthy lifestyle. But when you get imbalanced and when you have more bad bacteria than good bacteria, that's something called dysbiosis. And that's when you can get a lot of chronic inflammatory conditions. And this dysbiosis has been linked to arthritis, diabetes, inflammatory bowel disease, heart disease, obesity, lung disease, and cance.

09:05                                   Nicole: All kinds of things.

09:06                                   Sarina: Exactly. So that's why, right? It's so important to have a healthy gut microbiome. So let, let's talk about that. The first thing that I recommend to I'm pregnant women and actually I should take one setback and my recommendations for pregnant women are really the same recommendations that I give to everybody.

09:25                                   Nicole: Okay. So this is good to know. So you guys, this is something you can do before you get pregnant during your pregnancy and after your pregnancy.

09:32                                   Sarina: Exactly. It really doesn't change much except that if you're pregnant, it's really important to be a little bit more mindful of these things because not only are you impacting your own health and you want to stay healthy as a mom, but you're also potentially impacting the gut microbiome of your child. So, the first thing is to eat a predominantly plant based diet. And if that's not possible to eat as many fruits and vegetables as you can. Okay. So there was a, there, there is a research study and research out there called the American Gut Project. It's by Rob Knight, who's a researcher and a scientist and he's taking stool samples from people all across the country. And he examined why and what makes a healthy gut microbiome. And he found that the single greatest predictor for a healthy gut microbiome is the diversity and variety in the fruits and vegetables that we eat.

10:31                                   Nicole: Okay. Okay.

10:32                                   Sarina: So that's for everybody. And it's not just eating the same foods and vegetables every day, every week. It's the variety. And if you can ideally have at least 30 different fruits and vegetables, then you are on track for having the best gut microbiome you can have.

10:48                                   Nicole: Ooh, that feels like a lot.

10:50                                   Sarina: It is a lot. And I'll be honest and say, you know, the reason this is such a important topic to me is that my own personal, health habits have changed as I have delved into the research. So I was not a plant based doctor or plant based person before. I actually used to eat a lot of meat and unhealthy food and processed food. And it's only when I became a mom and started to learn a little bit about this, that my views changed and I started to change. So it does take, if you're not used to having 30 different types of fruits and vegetables, it does take some work and some effort to do that, but you can do it.

11:40                                   Nicole: Okay. Okay. Okay. Do you have any, um, great resources you think, uh, folks could use in order to try to incorporate some of those things, any websites to recommend or anything like that?

11:52                                   Sarina: There's a lot of good people that I recommend following on Instagram and maybe we can link them to the podcast.

12:00                                   Nicole: Oh yeah, I'll link those in the show.

12:02                                   Sarina: So I'll, I'll give you a number of really great resources. These are plant based physicians and they have their own great programs and provide good recipes and things like that to follow. So. Okay, perfect.

12:15                                   Nicole: Perfect. That sounds great. I'll be sure to get those and we'll have those in the show notes for everybody. So. Okay. So we, you said the one thing is incorporating more eat primarily plant based diet and uh, 30 different types of fruits and vegetables. Were there any other things?

12:30                                   Sarina: That's 30 in a week, just to be clear. The second thing is when we talk about diet is trying to have as much fiber as you can. And this kind of goes hand in hand with the fruits and vegetables because you only get fiber from plant based foods. So most Americans are fiber deficient. The average American has between 10 to 15 grams of fiber a day. And the goal is really to have 20 to 30 grams of fiber a day, based on our government recommendations. Really, if you look at some of the research for people who live the healthiest longest lives, so having at least 50 grams of fiber a day. So for example, one prune has one gram of fiber. And one Avocado has 13 grams of fiber. So you can definitely get 20 to 30 grams of fiber a day if you are eating a plant based diet or trying to focus on that.

13:26                                   Sarina: And that's not just helping your gut microbiome because fiber is an example of a prebiotic. Many people might have heard of probiotics. Not everybody has heard of prebiotics. So I'll just explain that. So probiotics are the things that when you go to the grocery store or pharmacy, you'll see all over the counter. It's a multibillion dollar business. And so you'll see a lot of advertising and those are live bacteria that you consume. And it often sounds like a lot because they'll have 20-50 billion micro organisms. But then you have to put it in perspective. And remember you have 100 trillion, so still a small amount and they're not FDA approved. There's not that many research trials done on probiotics. And the results can be a little bit fleeting. So when you take the probiotic, you're getting the good healthy bacteria, but when you stop it, you're not necessarily getting good healthy bacteria. So instead of a probiotic and spending your money on that, I recommend prebiotics and prebiotics are the foods that we eat that help feed our good gut bacteria. And that's exactly what fiber is. Fiber when you eat it is feeding all that good gut bacteria to promote those healthy bacteria, to get them stronger and to get more of them.

14:46                                   Nicole: Okay. So it just sounds like we really should be, instead of focusing on necessarily, I mean supplements and things have their roles, but if you can get stuff from the source, is that better? So like natural foods and things like that.

15:01                                   Sarina: 100%. So, and the thing about fiber too, especially since, you know, we're talking about pregnancy and we're talking about people going into labor is a one common complaint that I see as a gastroenterologist, is people coming in with constipation and hemorrhoids.

15:17                                   Nicole: Absolutely, yes.

15:19                                   Sarina: And that is, oftentimes because we're not getting enough fiber. So in addition to feeding your gut bacteria, it'll just help you feel better and have you have more regular bowel.

15:29                                   Nicole: Okay. Yeah. Constipation's really common ladies because, progesterone, one of the hormones and pregnancy kind of slows down gut motility. So definitely increasing your fiber is a great way to help deal with that constipation. Okay, great. So that's the second thing. increasing fiber and more prebiotics. What's the third thing?

15:47                                   Sarina: The third thing is avoid antibiotics unless you have to take them.

15:52                                   Nicole: Ooh, okay.

15:53                                   Sarina: So one course of antibiotics, and an example of Cipro Floxacin, which is a really commonly prescribed antibiotics for diverticulitis or urinary tract infections. One course, a five day course can wipe away the 80% of your gut microbiome.

16:12                                   Nicole: I'm sorry, 80% is that correct? Oh Wow. Okay.

16:15                                   Sarina: And it can take up to a year for your gut microbiome to start to turn back to normal. And I would actually argue that the research is showing that your gut microbiome might never go back to normal because now you have selected for antibiotic resistant bacteria. Okay. So antibiotics have added years to our life and when we need to take them, we shut. So I'm not advocating that people should not take antibiotics when it's necessary, but if you have a viral illness or if it's not necessary, then try to avoid it.

16:53                                   Nicole: Okay. So don't you know if you have a cold, if your doctor's telling you you have a cold and really antibiotics aren't indicated, then this is another important reason not to push for antibiotics if they're not really truly necessary. Right?

17:06                                   Sarina: Yeah.

17:07                                   Nicole: Okay. But as you're saying, do take them if you need them. Exactly. Yeah. Okay. All right, so those are three great things. Anything else you want to share?

17:18                                   Sarina: I think those are probably the most important factors to maintain a healthy gut microbiome for all adults, but especially during pregnancy.

17:27                                   Nicole: Okay, great. Now what do we know if we know anything? You know, since the gut microbiome is so fairly new. What do we know about how the gut microbiome can affect a growing pregnancy?

17:39                                   Sarina: So this is a really interesting area because the research and the studies are evolving. We used to think, and I would say most of the right now suggests that when babies are born, their gut microbiome is sterile. So we're not really sure how much of the pregnancy is affecting the gut microbiome. That's what I would say the predominant research is showing. Now, that being said, a lot of the newer research is showing that actually it is possible that a mom's gut microbiome can influence their baby's gut microbiome. And there's some research to show that, you know, taste buds develop in utero and what a mother eats might help develop the baby's taste buds. So if you're eating healthy, then your child is potentially more likely to have those healthy taste buds.

18:37                                   Nicole: Got It. Got It. Okay.

18:39                                   Sarina: I think the research is a little bit unclear in this area to, that's why I still think that if you're doing everything you can as a mom and being healthy in your pregnancy, that's going to give your child the best chance of being healthy.

18:51                                   Nicole: Okay. Okay. And, and not just even during pregnancy, but even before pregnancy it sounds like.

18:57                                   Sarina: Exactly. Yeah.

18:59                                   Nicole: We don't do a good job with helping women understand or helping them be as at the end of the importance of being as healthy as you can from the very first moment you get pregnant and it's really important.

19:08                                   Sarina: Yes.

19:09                                   Nicole: Yeah. Okay. So let's switch gears a little tiny bit and talk about the gut microbiome after birth and how it affects both moms and babies. So we know that or we've seen that uh, a baby's microbiome is influenced by what they come in contact with shortly after birth and a baby born via vaginal birth will have a different microbiome in a baby born via cesarean birth. And there's some theory that this difference may be a part of why babies born by Cesarean delivery, I'm more likely to suffer from immune system issues like asthma, Eczema, allergies. And so what are your thoughts on that difference in the microbiome between the vaginal birth and cesarean birth and then specifically your thoughts on a vaginal seeding if you want to talk about that a bit.

20:01                                   Sarina: Yeah, so the research does show that babies born vaginally versus cesarean do have a different gut microbiome makeup. And the babies that are born vaginal delivery, you have, their first introduction is to Lactobacillus, which is one of the healthy gut microbiome. Oh, sorry. One of the healthy gut bacteria. And actually when you talk about the probiotics and things like that, lactobacillus is usually one of those types of bacteria. When babies are born via cesarean delivery, the first bacteria that they're exposed to is usually staphylococcus. And you, you and I know in the health field that staphylococcus is one of the bacteria that we consider harmful, right? And you're right that the mode of delivery does have a, in terms of developing Eczema, asthma, celiac disease. So I encourage my people that I talk with and my patients that if they can have a healthy vaginal delivery that is best.

21:02                                   Sarina: Now not everybody can do that. There are lots of conditions where they need to have a c section and that's okay too because you can still change your child's gut microbiome later. So you have to first and foremost do what is safe and healthy. But if you can do a vaginal delivery, then that does seem to be best for your child's microbiome. And actually some research is showing that, you know, like I said, we have microbiomes everywhere, we have skin microbiomes, gut and we have vaginal microbiomes. And some research actually shows that late in the third trimester, moms vaginal microbiome starts to resemble that of the Gut microbiome. And so it's really kind of cool to see where this research is going so that there's more to this than we really realize at this point. Now that vaginal seeding, so this is when, if babies are born via c section, some people are mothers will take gauze and take vaginal secretions and wipe their babies down afterwards in hopes of getting that good healthy bacteria onto their baby to reduce the chances of having other inflammatory conditions. And I think that in theory, this makes sense to me. But I am, you know, a scientist and a physician first. And so I can't recommend that because I don't think we have enough research trials to support it yet. And so I think it makes sense and I think that as we do more research and just make sure there's no risks or if there are risks, we learn and understand a little bit more about them, then potentially this would be something that people might be doing in the future.

22:46                                   Nicole: Okay. So in theory it makes sense, but we just don't know enough yet to know whether it's harmful or helpful.

22:54                                   Sarina: Correct.

22:55                                   Nicole: Okay. All right. So then once baby is born, you know, whether by vaginal birth or cesarean birth, what are things moms can do to help their kids have a healthy gut back on a healthy gut microbiome? You know, right from the beginning or as soon as possible.

23:13                                   Sarina: So the first two to three years of life are the most important time because the first two to three years of life is when the baby's gut microbiome, will start to resemble that of an adult. So after about three years of life, their gut microbiome is going to be similar to you and me. But the first two to three years of life, there's a lot of room for changing that gut microbiome.

23:39                                   Nicole: Well that's ecouraging because I feel like a lot of moms who maybe have a subsidiary and birth and they feel that maybe they're going to like scar their children forever, you know, because they didn't get exposed. You know, if we don't know vaginal seeding works, they have this opportunity to change things.

23:56                                   Sarina: Exactly. And one thing I'll say about that too is that even though the first two to three years of life are the most important, there might be moms who are listening that the kids might be older. And that's okay too because there have been studies looking at eating in and adults, can we change our gut microbiome? And the answer is absolutely yes. Okay. Okay. So even as an adult that they did studies looking at people who were fed a heavy animal based diet and then they took people who are fed a plant based diet and they found that within three days of making that dietary change, the gut microbiome started to change. So it just takes a few days out. That's great because we can make some sort of quick changes. But then also if you go back to your normal diet, your gut microbiome, within a day or two, we'll also go back to normal. So it's kind of like having, it's important to have sustained small changes. Being consistent I think is important. But yes, there's room to change throughout your life. So I don't want people to stress about that aspect.

25:05                                   Nicole: Yeah. Okay, good. So what are things that moms can, can do to change it?

25:09                                   Sarina: Right. So the first thing is really breastfeeding. And you know, we talked a little bit about my journey into gut health and gut microbiome. And I would say breastfeeding was when I really started to do a lot of research about this because I was a mom, I was in my gastroenterology fellowship training. So I was working 60-70 hours a week and I was having kids and I was trying to pump and breastfeed.

25:38                                   Nicole: Breastfeeding is, it's always called a labor of love because it's just a lot of work and you do it because you love your children, you want to give them the best that's possible. But it can be challenging for sure.

25:51                                   Sarina: Exactly. And you know, you're sleep deprived and tired. And so I started asking these questions, well, is this really important? Is breastfeeding my child really that important? Or you know it or not? Because if it's maybe I won't do it because this is tough. And when I started to learn about this and do the research, I realized it is really important. You know, 30% of the baby's gut bacteria will come from breast milk. Another 10% of babies gut microbiome, will actually just come from the skin from the actual breastfeeding part. Breastfeeding and breast milk is really important in developing a healthy gut microbiome. So why is that? Breast milk contains something called human milk oligosaccharides, HMO's and there are more than 200 different types of HMO's in breast milk. Okay. These are good sugars and these are another example of prebiotics.

26:49                                   Sarina: They, their whole purpose is to feed your babies gut microbiome and to feed your babies good gut bacteria. And that's it. They're not there for anything else. So just there to give babies bacteria and things are not found in formula. Well, we are trying to replicate HMO's and replicate good gut bacteria and formula, but there's over 700 different strains of bacteria and breast milk. And the truth is that we don't even know exactly what strains, how much we're still learning about this. So yes, formula is trying to replicate it. It's not the same. Of course, I tell all moms, you know, a fed baby is the best baby. So again, don't stress yourself too much, but if you have an option and you can breastfeed, that is the best.

27:44                                   Sarina: And, and they've done a lot of studies that showed that breast milk and breastfeeding also helps babies with their gut microbiome and also their immune system. 70% of the immune system comes from the gut.

27:58                                   Nicole: Okay. Wow. Yeah. So I think a lot of people probably don't know that or realize that.

28:04                                   Sarina: And that's why that breastfed children typically have less risk for chronic conditions and chronic inflammatory conditions. Cause you're feeding their gut bacteria in and you're protecting your immune system.

28:15                                   Nicole: Okay. So breastfeeding for sure. What else can moms do?

28:19                                   Sarina: So, I recommend that you let your children get dirty and play in the dirt. My own personal habits have evolved. When I had my first child, I was probably like most typical first moms and I had hand sanitizer everywhere. You're not touching my child until you wash your hands, did you use this hand sanitizer? And then you know, once I started doing the research on this, there's something called the hygiene hypothesis and it, you know, suggests that we are being too cleanli and actually that is hurting our children because not only do you want good gut bacteria and your children, but you want diversity of good bacteria. So you want lots of different strains and when we're being too clean, we're reducing the number of strains. So you want your children to get exposed to other children. Studies have shown that kids in daycare, or kids with siblings actually have healthier gut microbiomes.

29:30                                   Nicole: Okay. All right. Now I will say, I have to say that I was a little bit nervous like in the very beginning cause I know that if they get a fever or anything when they're first born, then they get this gazillion dollar workup. But I agree. Then once they get to be a little older than for sure, just let them go for it.

29:45                                   Sarina: That's a great point. Yeah. Those first like six to eight weeks. Be cautious and you're right, you don't want your child to get sick and that time period. But as they get older, don't be so stressed about, you know, hand sanitizing, washing every single toy that's on the ground, that's okay.

30:05                                   Nicole: Okay. Okay, good. So breastfeeding, let them get dirty once they get older and get exposed to different types of bacteria. And then what's another thing?

30:14                                   Sarina: And then the third thing is back to the same thing that I recommend to the moms is the diversity and plentiful fruits and veggies. Do you want to give your kids a good healthy start. You are what you eat and if you can start early by giving fruits and veggies that's going to be the best thing you can do for your kids.

30:35                                   Nicole: Yeah. And I have to say, you know, my husband and I, we made some changes of, I feel like we've always been, always been fairly healthy, but for sure, once we had children we incorporate more fruits and vegetables and starting your kids young with fruits and vegetables. And when I say fruits and vegetables, I mean like just plain broccoli. Like you don't have to sauce it cheese it or anything like that. If you give them plain stuff, they'll develop a taste for it. And my older one in particular is just a huge lover of vegetables. So I mean I can't say that that's a guarantee. And of course that's just my two children in my examples. But I really think if you start them young with the actual taste of the food and not covering it up with a bunch of stuff, they will develop a taste for it.

31:21                                   Sarina: That's so true. And actually by the time I had my second child, I was a little bit more aware of all this research and so I could actually tell a difference in my second child compared to my first one definitely favors more sweets and one favors, you know, more healthy foods.

31:39                                   Nicole: Right, right.

31:40                                   Sarina: You know, we're all doing the best we can as moms. So isn't that the truth? Yes. Can't feel too guilty about it though.

31:46                                   Nicole: Yeah, that's for sure. For sure. Okay. Now, another thing I want to talk about, um, if you know any research about this is how does the gut microbiome and mom play a role in it losing that postpartum weight.

32:01                                   Sarina: So as we are doing research about the gut microbiome, we are realizing that it actually has a lot to do whether we are obese, thin, gaining weight, losing weight. Now this is true in the general population. So whether you're postpartum or not postpartum, our gut microbiome makes a difference. There was a study done out of Harvard and they took a pair of twins. One twin was obese, one twin was thin and they took poop samples and the gut microbiome from these twins and they put that in mice. And these mice lived in the exact same laboratory conditions, same environment, same food, same everything. And then they found that the poop and the stool samples from the obese twin turned the mice obese and the poop from the thin female, the thin twin turned those mice thin. That's just an example of how the gut microbiome influences our body weight. You'll meet people too who a lot of people, especially postpartum or in general who some people lose weight really quickly. And some people it's a real struggle and they're doing everything that they think is right and everything that they know how. But the gut microbiome actually plays a large role in that. So again, the healthier your gut microbiome is, then the better chance you'll have of of being healthier.

33:33                                   Nicole: Okay. All right. So get that healthy gut microbiome. And one of the big things about that is a plant based diet. And by plant based you mean like pretty much all vegetarian or any dairy or how do you mean?

33:48                                   Sarina: I recommend a whole food plant based. So what that means is minimizing processed foods, minimizing refined sugars, and really minimizing dairy and meat. Now if you can eliminate those, that is the best, but you have to do what's sustainable for you. So I say that I am a plant based gastroenterologist, but what that means for me is that 90% of the foods that I eat are nonprocessed, healthy fruits and vegetables. Now 10% of the time I might cheat and that's okay. But as much as you can sway and cut those foods out, that's the research shows that's the best for your gut microbiome.

34:34                                   Nicole: Okay. All right. And, I will say I'm not plant based Diet. I don't eat, I don't eat red meat or pork. I was a vegetarian for a while in college, but I just kinda incorporated chicken and fish back into my diet. But and I do love cheese, but I do try to limit things like, like, like Sarina's saying, just do the best that you can. And for us, I think some things that I find that are helpful and my daughter has been actually a big thing for this. She's like a natural vegetarian I swear, she's like, we need more vegetarian stuff. So we do at least a couple meals a week that are, you know, days where we're completely vegetarian and let me tell y'all, there are some good vegetarian recipes out there. It is not like you're going to be deprived of food that tastes good.

35:21                                   Sarina: That's exactly right. Like, so whoever's not plant based or vegetarian sharing, like that's okay. Like I said, I was not, I actually in my medical training, even though I was studying to be a gastroenterologist and I was you know, physician and training, that was actually the type period where I probably ate the unhealthy. I definitely was eating a lot of processed food, a lot of meat, Deli meats, you know Deli meats have been shown to be carcinogenic, meaning cancer causing. So that's something that I would definitely recommend eliminating. But I have slowly transitioned and you're right, taking like certain days like meatless Monday and just starting simple and slow or you know what, for lunch this week I'm going to see if I can pack my kids food that doesn't have animal products and just see how that goes and and don't feel like you have to make this like 180 degrees switch and it has to be instant because that's not going to work. Most likely. That wouldn't have worked for me. And so just really small changes, you know, starting really small. Like I cut out dairy and I switched to oat milk. So something small like that were pretty similar and it doesn't make too much difference, you know, so it's, it's little things here and there. Don't, don't do it all at once.

36:36                                   Nicole: Right. And I will put a plug in guys for the podcast community Facebook group. I often post recipes in there that I find that I try, that I think work great. So definitely join the podcast community Facebook groups so you can grab some recipes there. And then of course the marina is going to give me those links for the people to follow on Instagram. So we're going to hook you up with some resources. We're not going to leave you high and dry.

36:58                                   Sarina: Exactly. And one of the things when we talked about doing like the 30 different fruits and veggies, one thing that I've done for my kids and myself is I started to make a fruit Veggie smoothie and that's a great way, you know, you can throw in spinach, Broccoli, cauliflower berries, avocado, banana, like you know, you can get 10-15 different types of fruits and vegetables in one drink. And so, and something you can kind of make it. And your kids might like it too.

37:28                                   Nicole: Yeah, exactly. And then the last thing I want to say about this as I know some people may have some concerns about this being expensive and it's true that sometimes fresh things can be more expensive, but I have to say I feel like prices are coming down and then lots of stores have like, I don't want to say the generic version, but like the store brand version of things that are organic and less processed that are less expensive. So there are definitely options for you that you can do this in a way that's affordable.

37:59                                   Sarina: Exactly. And I started to go to my local farmer's market and that's a great way to get organic food at a really great price.

38:08                                   Nicole: Awesome. Awesome. Well good, good. What this is such great information. I think this is going to be really, really helpful and I really appreciate it. So what I want to do now is just kind of finish by just asking you a few questions just to kind of help the listeners get a sense a little bit more for who you are, kind of as a person and how you feel about your work. So why don't you tell us, what do you feel like is the most rewarding part of your work?

38:32                                   Sarina: One of the greatest things about being a gastroentrologist that I see people over time, you know, people have usually chronic issues. So I get to follow them for years and I get to follow their families, which I absolutely love. And probably the most rewarding part is when I can talk to people about lifestyle changes and I can get them to start slowly taking off or in some cases completely getting off their medications. I think that's a great feeling because I see a lot of patients with reflux, constipation, irritable bowel syndrome, and all of these things can be managed with lifestyle changes. And so that's the most rewarding thing I think. Because, you know, one medications are expensive. They all have potential side effects. And so if we can all live a healthier, better, happier life, then I think, you know, that's, that's the goal for all of us.

39:27                                   Nicole: Yeah. And I'll just put a plug in guys. I mean, not, not all doctors as you can tell from, from what she's saying, we don't want people to be on tons of medications. We're not trying to push a bunch of medications. So if you find someone who is really, really having heavily pushing medications without giving you the benefit of trying some lifestyle things first, then maybe you need to shop for somebody who's a little bit more in line with what you're looking for.

39:52                                   Sarina: Yeah, that's right. Because medicine only can, can only do so much. And a lot of times, you know, actually one of the things we didn't talk about, but stress can really negatively affect the gut microbiome and can cause a lot of issues. And so dealing with stress and lifestyle, how we manage things is really important.

40:13                                   Nicole: Yeah, absolutely. For sure. And on the flip side of that, what is something that's like really frustrating about your work?

40:19                                   Sarina: So I see people who have been suffering with symptoms and issues for years at oftentimes I might be the second or third gastroenterologist that they have come to. And I think one of the most frustrating things is patients and some of my patients are not feeling well and they might be suffering from irritable bowel syndrome and they're looking for a quick fix. And I wish that I could fix them quickly, but they have been dealing with a lot of issues for years and it does take time to kind of get them back on track and feeling well. So that can be frustrating for me as well as the patients. I don't want them suffering, they don't want to be suffering. I think as long as you find a provider that you guys can develop a good working relationship. And that's what I tell my patients, you know, I'm here for you. It's not going to be a quick fix, but I'm here for you. And as long as you're willing to work with me and to keep going back, like we will get you to feel better.

41:21                                   Nicole: Yeah. Yeah, for sure. For sure. So what are you especially passionate about when it comes to caring for women in particular?

41:30                                   Sarina: So I see a lot of predominantly women, I see a lot of men too, but I think as a female gastroenterologist, more females are drawn to female. And so I see a lot of patients with irritable bowel syndrome and irritable bowel syndrome is a complex syndrome that can present with abdominal bloating and discomfort. And one of the things that I'm really passionate about and talking to them is that like we said, stress can affect it. And as a mom, I understand that, you know, a lot of us moms, we take on the stress of our family and when you take on that stress, it goes right to our gut and we feel it in our gut. And so I'm actually really passionate about talking to these women and moms about, you know, making sure that you take time for self care. That's really important because if you don't take care of yourself first, then you're not going to be able to take good care of your kids and your family.

42:27                                   Nicole: That is so true. I think so many women want to, they want to do the best for their families, but they really don't realize that. I don't always say the same thing about pregnancy. You got to have a healthy mom to have a healthy baby.

42:42                                   Sarina: That's right. And so taking care of yourself first and foremost, that's not lazy. That's not selfish. Like you, you just have to do that for yourself.

42:51                                   Nicole: Yeah, for sure. Now speaking of being a mom. How do you feel like your personal experiences as a mom has influenced your work as a gastroenterologist?

43:01                                   Sarina: Well, you know, we've touched a little bit on this earlier, but I think my focus on the gut microbiome had gut health comes very clearly from the fact that I was pregnant around the same time as I was researching this. And so, you know, it's definitely changed who I am as a gastroenterologist, what I talk about. I would have hoped that I would talk about gut microbiome and diet and lifestyle with my patients if I wasn't a mom. But that really triggered something very personal to me. And so, that is something that affects me every day. And I'm very cognizant when I talk to other moms and about their gut, gut microbiome, gut health and their self care stuff.

43:45                                   Nicole: Yeah. So I know you just talked about the importance of self care. Is that that would, you know, always ask everyone when I have them on. What's that one piece of advice that you'd like to give to expect moms? Would that be it for you or is there something else you'd like to share?

43:58                                   Sarina: I think in addition to self care, it's going with your gut. You know, in an intuitive sense a little bit. And though the one thing that I see with a lot of moms that people is, you're getting stressed and especially when you're pregnant and you're having kids and there's so much out there, you can get stressed about c section, vaginal delivery, breastfeeding, formula, and a lot of it is not in your control and that stress will hurt you. So I actually think my one piece of advice to moms is kind of let it go. Go with your gut. You're doing the best that you can do and focus on the positives.

44:41                                   Nicole: Yes, yes, absolutely. Absolutely. So just trust yourself and you know, give yourself a little bit of grace. Do you do the best you can and be okay with that.

44:51                                   Sarina: Exactly.

44:52                                   Nicole: Yeah. So this has been a great conversation and I know that folks are going to find this extremely helpful. Where can women find you if they want to find out more information about what you do?

45:03                                   Sarina: So you can follow me at DocSarina. I'm on Instagram, which is my primary platform, but I'm also on Facebook as well and that's probably the best way to reach out, follow message me and we can chat there.

45:21                                   Nicole: Awesome. Awesome. Well thank you so much again for being here. This was a true pleasure. I learned a lot. I know that the listeners learned a lot, so I really appreciate your time.

45:29                                   Sarina: Thank you so much for having me.

45:30                                   Nicole: Okay. All right. Bye.

45:31                                   Sarina: Bye. Bye.

45:33                                   Nicole: See, didn't I tell you that you would learn a lot in this episode? That was some really awesome and super helpful information. Now every time after I have a guest on, I give something called Nicole's notes, which is my top three or four takeaways from the episode. So here we go.

45:51                                   Nicole: Number one, your gut health is really important not just during pregnancy but also outside of pregnancy in it affects so many things. Your weight, heart disease, diabetes, arthritis, so you really want to take good care of your gut health.

46:10                                   Nicole: Number two, y'all we just got to face the facts. We need to have more of a plant based diet. Yes, we need more plant based foods in our diet, so even if you can't go completely vegetarian, I know I'm not personally 100% vegetarian. You can certainly incorporate more vegetarian recipes into your diet and I'll give some resources in the show notes about some places do. You can go to look for some great recipes. I am learning that it doesn't have to be tasteless. You can have really good delicious food that is plant based. So we're all going to work on increasing the amount of plant based meals and our diet.

46:55                                   Nicole: Number three, it is not too late to improve your microbiome or your child's microbiome. This is something that can change and evolve over time. So if you end up having a c section or if you had a c section, all is not lost. There is an opportunity for you to make changes and those changes can happen pretty quickly if you change your diet. So implement some of the things that Sarina talked about and you can lead to a healthier microbiome for yourself or for your children.

47:25                                   Nicole: All right, so that's it for today's episode. Let me know what you think in the All About Pregnancy and Birth Podcast Community Facebook group. It's a great place to connect. After the podcast I share helpful tips for pregnancy, inspirational quotes and like I said, also put recipes in there too. And I go live in the group to answer questions from time to time. I will put a link to the group in the show notes so you can join, if you are not already there, or just search All About Pregnancy and Birth on Facebook and it'll pop right up. Now be sure to subscribe to the podcast in Itunes or wherever you listen to podcast, and if you feel so inclined, I'd really appreciate you leaving an honest review on iTunes. It helps other women on my show and I make give you a shout out on a future episode. I love doing that, so leave me a review.

48:11                                   Nicole: Next week on the podcast, I am talking about feeling your baby move. It's going to be a really fun episode. So come on back next week, and until then, I wish you a healthy and happy pregnancy and birth.

48:25                                   Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education course, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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