 So, welcome to the Dr. Gundry podcast. You know, I'm willing to bet that just about everyone has woken up stiff, sore, or achy from time to time. In fact, according to the National Institutes of Health, 80% of adults experience lower back pain at some point in their lifetimes, 80%. And a quarter of adults have experienced lower back pain in just the last three months. Well, today's guest has spent his entire career helping thousands of patients reclaim their lives from chronic back pain. He's Dr. Vijay Vatt. And on today's episode, he and I will discuss why everything you've been told about back pain is wrong, how he treats his patients, and what you can do about back pain today without dangerous drugs. Dr. Vatt, welcome to the podcast. Thank you, Dr. Gundry. Nice to be here. So, your book, Back Rx, was just reissued this year. It was originally out in 2004, is that right? Yes, correct. That was my first, first attempt at writing a book. So, what's changed since you first wrote this book? This is totally revised and re-edited. What's happened in the 15 years since that book? Well, so I think in 15 years, there are a lot of simple things that we know now, you know, call it combining ancient wisdom of the East with scientific discipline of the West. And, you know, it's been my mission really to have simple, effective solutions for big issues like back pain. So, now we know, for example, simple things like vitamin D, for example, take an inadequate amount, keep your levels 50 plus if you have chronic back pain, because it has a big impact on not just reducing back pain, but potential depression that may sometimes present with back pain. So, you know, one of the things I'm impressed about you is that you're, you're willing to say that a lot has changed in the last 15 years since I wrote my first book, and I've learned things in the last 15 years, and I'm not afraid to say, you know, here's the new things, and I want to tell you what I've learned in 15 years. Well, yeah, first of all, in those 15 years, I've probably been blessed to gain knowledge from at least 10,000 extra patients suffering with back pain. So, that's always, you know, patients teach, as you know us every single day about little tidbits there, and hopefully that makes us better clinicians and better armed with knowledge. Also, I've learned a lot from my colleagues here at Cornell Medical Center in different disciplines, from cardiology to internal medicine. And, you know, being here, there's constant bombardment of knowledge from people that come and speak to us from all over the world. So, it's sort of that cumulative distillation effect of secrets, if you will, that I've been able to put together over the last 15 years, because I'm a quote-unquote season clinician now, whereas when I started out in 2004, I was only in practice a few years. Well, and one of the nice things, and you know, I dedicated one of my books to my patients, because if it really wasn't for my patients, I wouldn't know most of what I know. Among other things, they've taught me tips, and they've asked me questions that, quite frankly, I didn't have the answer to, or I needed a better answer than what I had been taught. So, you know, I congratulate you that you learned from your patients, and that's... You know, I think despite our degrees, we have to be open-minded, because patients can really... I mean, for example, about 2009, right after the stock market crash, one of my patients was suffering with a lot of back pain. He had arthritis in his facet joints, and we tried everything, you know? And I said, look, you're really a bad surgical candidate. And then he comes to me three months later, you know, I bought this $25 inversion table, and my pain is 80% better. And, you know, I hadn't even thought about inversion table till that point. So, it's that cute little experience. Now, it may not work for everybody, but it worked for him. And the $25 table saved him from expensive procedures and maybe lumbar fusion. Yeah, I think I'd probably rather spend $25 on an inversion table than lumbar fusion. And maybe we can get into that. And just to kind of continue that note, you know, you and I were taught that this is the practice of medicine. And I think the beauty of what you do and what I hope I do is our patients allow us to practice medicine. And, okay, you know, I want you to try this. And let's see what it works. Or a patient tells you, hey, you know, I spent $25, and guess what? My back pain is 80% better. So, so good for you. I congratulate you on that. And that's why one of the reasons I wanted to have you on the podcast. So, thank you. You were one of the early voices about sounding the alarm about opioid painkiller addiction back then. What were you seeing in the early 2000s that, you know, that alarmed you and what's changed since that time? Boy, a lot has changed. So, you know, right around 2000 with the National Institutes of Health and National Academy of Medicine, you know, basically saying we're way under treating pain, that pain is a real symptom. So what happened, doctors took the prescription pads out and just started writing opiates left, right and center. And so we sort of are partially responsible for creating the opiate epidemic. But, but that epidemic really started at the federal government level. You know, it was message from there. And then the federal government realized that there were too many deaths, too many complications. And now we've done a 180 turnaround where there, where I think we are, there's a huge backlash against any opiate use whatsoever. And you know, there's circumstances where small amounts of opiates aren't necessarily that bad for somebody who's had a failed fusion and is in severe pain. But we've gone the other direction that any opiates are bad now. So there's a huge shift from 2000 to 2019 with opiates. So in your practice, how do you make the decision of when you're going to use these or you're trying to get somebody off of these? I'm sure you're faced with this almost every day. You know, my battle last 20 years has been trying to get patients off opiates. I mean, I really don't have this come in, get an opiate prescription, have a nice life. I go for what I call the protocol. You know, if you have a chronic disc issue with back pain, walk every single day 30 minutes, take the vitamin D. You know, one thing you and I sort of share is food as medicine, the most most overlooked potent weapon we have, you know, good food is good medicine. And sometimes you just say to somebody with chronic discogenic back pain, don't sit too much, take your vitamin D, good, good ergonomics, vitamin D and good food. And that can sometimes have a dramatic impact on lowering their back pain where they don't need opiates long term. And you know, we have other things that I use integrated things like highly absorbable curcumin that has a positive impact on managing back pain. So my goal has been to get patients off opiates as much as I can. Now, acute severe back pain five days of opiates are probably appropriate, but long term, I think the harm is more than the good. So in a similar vein, I really want to dive deep into your thoughts of food and the gut and the gut wall and back pain. I know a lot of particularly sports medicine and orthopedic physicians that I deal with give out NSAIDs like ibuprofen or naproxen like candy for back injuries. Any thoughts on the danger of just using these simple over the counter pain killers? Well, so I talk a lot about that in back RX, you know, the book, the old book and the new book, I've been on this, if you want to call it a crusade of not overly prescribing anti-inflammatories because they're 40,000 deaths a year just from going to your local CVS and buying Advil and a leave and taking it recklessly. So, you know, my philosophy has been if you want to take anti-inflammatories, take them in spurts. And to my physician colleagues, I say to them, you know, first do no harm. I mean, try not to cause the patient a bleeding ulcer that could potentially lead to death or kidney damage or high blood pressure or heart disease, which are all dangers of anti-inflammatories use long term. So I think we as physicians have to really be cognizant of that and stick to the first do no harm or that we took. Yeah, I've looked at the pharmaceutical literature about the dangers of, you know, simple NSAIDs. And it's shocking that they knew how dangerous ibuprofen or naproxen was to damaging the gut wall, even a few of them. And we were old enough to remember that actually ibuprofen, you know, motrin was a prescription drug. And it was really the FDA, the original warnings where you should only take it for two weeks because it was so dangerous. And, you know, now we have children's Advil and we, again, it's the most widely available, you know, painkiller in your drug store. 40,000 deaths a year. Yeah. Say that one more time. 40,000 deaths a year. 40,000 people die every single year by taking Advil, Aleve and those kind of over the counter drugs. Yeah. So yeah, you and I, you're right. We're on a crusade to really severely limit this. And my experience in treating autoimmune disease, and I've written about this, the number of people with autoimmune diseases that started with a sports injury or an injury that they were told to take, you know, ibuprofen and naproxen for a few weeks. And it literally, you know, perforated their gut wall and it released all of these problems. And you can, you could set the date and when this happened. And it's, it's scary. And the really scary thing is pharmaceutical companies researched this, they knew it was going to happen. And we physicians, unfortunately, weren't told about this. But it's there. So, okay, so let's go back to the gut now. And you talk about food as medicine as I do. So let's talk about pain and the gut microbiome and the gut wall. What's, what's your thoughts about the relationship of pain, the microbiome and the gut wall? Is there a relationship? Oh, there's a big relationship. I mean, you know, I've seen it in multiple exams falls off patients. You know, and, you know, again, to me, good food is good medicine, you know, not necessarily food is medicine, but good food is good medicine. And if you get the microbiome altered in a positive way, then it can actually have an impact on decreasing pain sensitization. So if you have good gut microbiome, it will actually decrease your pain sensitivity. If you have a bad gut microbiome, then it will increase your pain sensitivity. So the same injury in your disc, let's say with good microbiome, if your pain level is three, the same disc injury in somebody with a bad microbiome, your pain level will be seven. So it definitely plays a pretty significant role in our opinion and can be an effective weapon in managing chronic back pain. Yeah, I think, you know, that many of our listeners, hopefully not many of my listeners, know of this influence, but the casual person on the street is going to go, oh, come on now, a bunch of bacteria in your gut are going to control the pain you feel. Please, Dr. Bad, just get out of this pseudoscience world. But there's literally plenty of research that proves this. Yeah, I mean, there's there's plenty of research and the research is going to come out in a big, big, big way now that the medical community has all of a sudden woken up and realized that the trillions of bugs in your stomach can have a profound impact on your health. I mean, finally, the tube I went on in our colleagues and said, hey, we need to look at what we're putting in our mouth. But look, I've had patients, I'll give you a prime example of a guy who had peripheral neuropathy and significant, ridiculous pain as well. So sciatica combined with peripheral neuropathy and he was on high doses of Lyrica couldn't tolerate high doses of Neurontin couldn't tolerate severe pain when he walked, you know, was recommended a fusion for his back and not to mention the peripheral neuropathy. They were doing this IVIG infusions possibly, gamma globular infusions. And I sent him to a nutritionist and she recommended, she said, you are gluten allergic. So why don't you try gluten free diet? 80% of his ridiculous symptoms and 80% of his peripheral neuropathic symptoms went away like that in eight weeks. And he was flabbergasted that simply using good food as good medicine as a tool can have that big of an impact on his quality of life. And by the way, there are numerous examples in my practice like that. So I wish it was pseudoscience. I mean, it is potent real science. Yeah. And, you know, unfortunately, you're right. I think we're the general medical community is beginning to wake up to this. But yes, just yesterday in my practice, I saw a 63 year old woman who literally arrived in a wheelchair brought in by her husband. And she had really profound muscle wasting in her thenar eminences. And she had a she had a duped ens contracture. And she literally wasn't able to walk. And she had been diagnosed with Parkinson's, and that this was a typical presentation for Parkinson's. And I say, you know, I see a lot of Parkinson's patients in my practice. And I can tell you that, you know, thenar eminence muscle wasting and duped ens contracture is not a presentation of Parkinson's. And she had no tremor, which is possible. And she really didn't have the flat affect of Parkinson's. And I said, so did you even have just simplistically an MRI of your brain or your neck and spine? And she said, Well, no, they told me that she was an HMO, a very good HMO. And they said, no, that's not indicated in the diagnosis of what you have. It's classic Parkinson's. And she turns out her initial testing shows she carries the gluten intolerance gene. She has autoimmune markers of lupus. And no one had bothered to even consider that, you know, you have Parkinson's and try this drug. And you're right. It's just like astounding in almost 2020 that this still goes on. So I think yes, the point I think I want to make and you want to make is you got to, you got to find a healthcare provider that's going to take your issues seriously, whether it's your back, whether it's peripheral neuropathy. And don't keep looking for, you know, proper answers until you find someone who will listen to you. What are your colleagues there in orthopedics say, the spine surgeons tell you about what you're doing? Are they in favor of this? Well, I mean, this is a hospital that's built on procedures and surgeries, you know, big revenue generating hospital. You know, I'm a big believer that you got to do what's in the best interest of patients. And, you know, like with a horse with flaps on. So when I initially invented back RX, simple 15 exercises for reducing back pain, you know, clinical trial results or clinical trial results, you know, we went through the whole IRB and rolling the patients and the results were amazing. You know, simple 15 mind body exercises done minimum three times a week had a profound impact on decreasing back pain, recurrence of back pain, use of opiates and medical procedures. So the proof is in the data, you know, I mean, so they can throw mud at me as much as they want. Look in this, you know, doctors, especially in a procedure driven place, they're not necessarily happy if you say to them that we have tools and ourselves to keep you, you know, simple solutions to keep you active that does not involve medical procedures or surgeries. You know, they feel threatened by that because medical economics is a sad part of medical practice. But I think if you're true to the principle of being a physician where you put the patient's interest first, there are a lot of simple solutions for staying active. And I think we have to arm patients with those tools to be able to take better care of themselves and rely less on the healthcare system. So that's, yeah, that's a great segue into back RX. So what are the most common issues that, you know, you see in the patient who comes to you and what causes them and we'll go from there? Well, so, you know, sitting is the new tobacco, right? So excessive flying, driving, sitting at work, then coming home sitting on a sofa, you know, that sitting is a number one reason for huge explosion in back pain. And that what that does is it puts a lot of stress on the disc and it predisposes the risk to get it to predisposes the disc to get injured because it's not getting in nutrition during the 24 hour cycle because so walking actually is very good for the disc because it does this kind of thing and bring nutrition to the inside of the disc. So I see a lot of disc issues, big time and especially nowadays in younger and younger population, you know, in their early twenties because people are just sitting more. And then at the other end of the spectrum, I see a lot of spinal stenosis is the general term, but I just call it wear and tear in your back from just living life where the disc wears out, the joints get arthritic, you get back pain or sciatic pain. So those are the two most common categories of people that I see. So what sort of, what kind of lifestyle changes can, you know, our listeners make to reduce their risk of these chronic forms or acute forms of back pain? Well, I mean, to me, the most important weapon during the work day is something, you know, you and I have been sitting for maybe 30 minutes now, you know, you just sort of get up and do like a single leg stand with your arms bent backwards, let the disc breathe a bit. You know, if you can do that every 30 minutes to an hour, you're on your way to really reducing your risk of heart eating a disc. I mean, I can't think of anything more simple than that, get up every 30 minutes to an hour at work. You know, I think that's a great recommendation. I actually haven't heard it expressed that way and I love that. You're not, you know, stretching your back, you're exercising your disc and you're kind of giving your discs a massage. I like that. I like that a lot. And I think given nutrition, actually, when you stand up in that position, you're bringing some nutrition into the disc. Fantastic. Okay. So computers aren't going away. Desk jobs aren't going to go away. You and I are, you know, seated usually when we're seeing our patients, other than just standing up every 30 minutes. What do you think about, you know, everybody using standing desks? Well, that's, that's a big thing of mine in the last two or three years. And as there's a, as data mounts that those who stand more during their work day than sit, you know, they tend to have less chronic health issues. They enjoy better quality of life and potentially better longevity. So, you know, I'm a big believer if you can get a standing workstation, then go for it, especially if you're 20, 25 years old and you've got 30, 40 years of work like life ahead. If you get used to having a standing work desk, great investment. Any tricks on a plane in an economy seat across country? You know, whether it's economy, business or first class, it's still the pressurized cabin is the big deal. Pressurized cabin with low oxygen content. Now that's changing as aviation changes with better ergonomics, better oxygenation and better humidity. So if you look at the new Dreamliners, you know, they have better ergonomics, better humidity and better oxygen content. But you know, not all of us have a luxury of always flying in a Dreamliner. Right. So, so I think you got to figure out a way to try to recline the seat back a bit that alone helps whenever you're allowed to do that. And then if possible, every hour and a half, two hours, just get up and just try to walk in the back and come back. Even if you do something as simple as that, it could really help save a lot of air travel related back issues. So if I'm on the windows seat, can I bring a prescription from Dr. Vadd says, excuse me, I have to get up to people sitting next to you. Yeah, I have to get up and walk for the sake of my back. Sorry, my destiny is oxygenation. You know, you can just stand up in place. I mean, honestly, you could do the single leg stand that I showed you on the waggle. You just sit in your seat, you just get up and just do these single leg stands that are that we shown in the book as well. Just 10 count each leg and sit back down. Perfect. And maybe carry a note from you saying, I'm not crazy. This is what I'm supposed to do. Take a carry the book and shirt to the to the staff and say, look, it's right in the book. Yeah, even better. Okay. Yeah, everybody. So I'm holding up a copy of his book, back RX. So yeah, you have to carry this on the plane and just hold it up and saying, excuse me, you know, I'm protecting my back on this long flight. Great. I'm going to do that next time somebody gives me an ugly look. Okay, I like that. What if somebody, I mean, people are told, well, if you stand a long time, you're going to get barricades veins. You're going to get swollen ankles. And standing isn't such a good idea, because you're not walking. And there, there are certain people who obviously are not going to be able to stand for extended period of time. Any tricks for the seated individual? Well, so, you know, there are there are deaths that you can sort of go up and down, you know, so you could sit for 20, 30 minutes and you can stand for 20, 30 minutes. I mean, I think for them this, they called, you know, the variable deaths that go up and down could be a great solution. You're 30 minutes standing 30 minutes sitting. Perfect. And I like hearing the way these deaths came about. They were actually two cardboard boxes on top of each other. And so if worse comes to worse, get yourself two cardboard boxes and you've got a standing desk. Don't want to take anything away from the designers, but they've actually. That's the Dr. Gundry under a dollar standing desk. That's right. The under the dollar standing desk. Okay, tell me about the relationship of weight gain and back pain. Is there any? Well, there's a there's a huge relationship between weight gain and back pain. So whether it comes to putting a tear and bulging the disc or the disc wearing out sooner and you get you getting arthritis in your spine in your 40s and 50s because of increased weight has a lot to do with it. So I think besides maintaining a good core, maintaining good body weight is is crucial for trying to minimize back pain. So, you know, I've heard and I know any pregnant woman knows this that particularly weight gain, particularly in your gut really changes your your posture and and how your back, the lordosis of the spine has changed. Are you do you see that as a factor? Is it more than that? I think it's that's a factor, definitely. But the sheer lures that you're pressing on the disc are just, you know, so if you're seated, if you're normal weight and you're seated and slightly bent forward, let's say the disc pressures are X. But if you're 25 pounds overweight, then the seated bent forward, the pressures are almost doubled even just by 25 pounds overweight. So, you know, but the good part about that is it's a four to one ratio. If you lose one pound, you take about four pounds per square inch pressure off the disc and the joints. So it's a 400% return. So not a bad deal. That's a very good deal. I used to a long ago when I was doing some early TV shows when I first changed my career, you know, I had lost 70 pounds and I would bring a 50 pound bag of dog food into the TV studio and I would ask my host to take and hold the 50 pound bag of dog food in front of him or her and start walking around the studio and see how they did. And it's, you know, when it creeps up on you slowly, you know, you don't notice it, but when you suddenly have 50 pounds or 40 pounds or 30 pounds, it's dramatic what you can feel in your back. Exactly. All of a sudden you realize, oh my God, I've been carrying around those 70 extra pounds for all those years. Imagine the tension on the back, the hips, the knees, the ankles. Yeah, and certainly in my practice, we've seen people who literally were scheduled for back works, spinal fusion, hip replacement and even knee replacement. When we got weighed off of them, they actually canceled their operations and it was, you know, it was the weight that was, you know, exacerbating these conditions. Absolutely. And certainly the weight, as you and I both know, contributes, particularly abdominal fat, contributes to inflammation to the entire inflammatory condition. Absolutely. You know, increased chronic inflammation that is associated with increased back pain, arthritis, heart disease, cancer, and on and on and on, you know, neurodegenerative issues. So it pays to keep the weight down and keep the inflammation down. Yeah. And, you know, getting back to what we talked about earlier, I mean, there is a very strong correlation to NSAID use and coronary artery disease and vascular disease in general. In fact, you know, many of us forget that several of the, you know, prescription NSAIDs were removed from the market because of this association with increased heart attack and stroke. And so all of these actually share a common factor. And there's really none of these that are safe for long-term use. That they're absolutely not. And that's one of them. That's one of the reasons, you know, I invented a medical food called Vanakvar. You know, it's highly absorbable curcumin that we just finished clinical trials showing that it's pain-reducing efficacy is similar to that of the proxen without having the side effects of the anti-inflammatories. As a matter of fact, this particular curcumin, the microactive formulation we have, the serendipity was, that it reduced high-sensitive CRP. So the corneal, cornealcardiologists are sort of salivating over this serendipitous discovery. That's great. Yeah. I'm a, I'm a big fan of curcumin and people who are listening to us. That's the active ingredient, if you will, in turmeric. But unfortunately, you and I both know that turmeric is very poorly absorbed. And that's why, you know, we have, my team in Boston put together technology to increase, not just absorption, but is, we call it bioactivity to get into the inflamed tissues. Yeah, exactly. Okay, shifting gears, every good old Dr. Sarno was famous for his claim that all back pain, back pain started in the mind. What say you about that? Well, so, you know, I used to invite John Sarno to come and give grand rounds at our hospital. And he was a positive influence on my journey. That I think his contribution was that the mind plays a big role in back pain. You know, after 9-11, I saw a big number of people with herniated, real herniated disc from the stress of 9-11. So there's a real relationship, the mind-body relationship. I think when he went a little bit overboard is that all back pain is tension myositis. Well, back pain, there are multiple diagnoses that can cause back pain. And whereas 10% of back pain could be the tension myositis that Dr. Sarno says, where there is nothing structurally wrong with you, the other 90% have structural issues. Maybe that the mind and the stress contributed to either the disc blowing out or the pain spiking up, but there was a real underlying structural issue. So, but I do believe his overall contribution is a good one. Despite sort of over going on one diagnosis as the end of the offer back pain. So are there any mental exercises that people with back pain can benefit from? Absolutely. You know, I mean, I tell patients with chronic back pain, do five minutes of meditation at night before going to sleep. Or, you know, that's why back rx is truly a mind-body exercise regimen. I mean, the book title is actually an exercise program where you do deep breathing combined with 15 postures. But to this date, I get letters from 2004 to 19, 15 years from patients saying just the breathing aspect of that exercise program had a profound impact on my pain. So I think control deep breathing, meditation, mind-body therapy, these all have a huge positive impact on back pain. And remember, often back pain can present with depression. So it can have a positive impact on both. Yeah. So, okay, so we've got, we've got the mind, we've got path posture, we've got your great exercises. You're in, you're in my food recommendations look very similar. And I think a lot of us working in this area for so long have very similar views. Give our listeners your thoughts on what foods in particular are really going to benefit them with back pain, for instance. Well, so, I mean, the anti-inflammatory foods, really. So, you know, in sort of corn oil, I'll try to use olive oil. You know, minimize intake of processed sugar. Now, if you have ice cream one day a week, it's probably not going to have any huge negative impact. But in general, minimize processed sugar as much as you can. But, you know, I'm a big believer in plant-based diet. So I think that has an impact. But plant-based diet doesn't mean, you know, eating popcorn and chips. But it means eating complex carbohydrates. So the more bulgur, the quinoa, those kind of complex greens. Obviously greens, you know, fish to me gets sort of a rare exception for meat that truly has very high anti-inflammatory properties with omega-3. But you got to be careful about lead poisoning and things like that with fish. Also, it's not a, it's not a gamey. But so I think the general recommendations are less processed sugar, less fatty meats, more greens, more complex carbohydrates, more complex greens, more things like olive oils, more berries, those kind of things. Great. Getting back to supplements, you started our conversation with mentioning how important vitamin D is. And I second that. I think it's number one, it's a hormone. It's not a vitamin. And I think it's probably essential. I'm glad to see there are a lot of labs in this country that are raising the normal vitamin D level up to about 120. And, you know, I, in my practice, try to get my patients somewhere between 80, 100, I'll take 120. I've run my vitamin D level greater than 120 for the last 17 years now to prove I'm not dead. And so, so far so good. Any other supplements that just as a general rule besides vitamin D3 that we should be thinking about? I mean, you know, practice what you preach. You know, for me, I take daily vitamin D3 and I take curcumin. I mean, for me, curcumin has benefits of potentially reducing risk of Alzheimer's, potentially heart disease, colon cancer. I mean, outside of those two, I personally, I'm not a huge believer in taking up 18, 20 supplements every single day. But I think it's balanced diet, take things like vitamin D and curcumin. Try to exercise every day to keep your back pain and check, you know, sort of pragmatic sensible things. Okay. Well, Dr. Vatt, it's a pleasure to talk to you. And thanks so much for coming on the podcast. Where can listeners find out more about you and your work and where can they pick up the new edition of BackRx? Well, BackRx, new edition is available at Amazon, at Barnes and Noble, all that kind of places. And then, you know, more information about me is vjavad.com or hss.edu. That's Hospital for Special Surgery in New York. And hopefully, you know, I'll continue my work for finding simple, effective solutions for staying active. And please never retire and please keep seeing patients, because that's where people like you and me get all of our knowledge. And I congratulate you again on that. Yeah, patients keep me young and active. And I appreciate the tip about the vitamin D, whereas it was 50, was my personal bar for chronic back pain. Maybe I should consider raising that to 70 or 80. So, you know, learn something new every day. So I've learned something new. Yeah, and vitamin D actually is very essential for activating stem cells that line our gut that I reference in my latest book, The Longevity Paradox. It's very, was shocking to me to see how important high vitamin D levels are for sealing the wall of our gut and making stem cells grow. So love that. I love that hormone. That's great. All right. Thanks again. And we'll have you back again sometime soon for some more tips. Absolutely. All right. Thank you very much. Nice chatting with you. Okay, it's time for one of my favorite parts of the podcast, the audience question. And Ryan Smith, 394 on Instagram asks, Dr. G, does coffee or tea disrupt the autophagy taking place while in a fasted state? Absolutely not. First of all, for those of you who are wondering what the heck is autophagy? Autophagy is actually the cellular process when a cell is nearing the end of its lifespan. We actually have two things that can take place. We can actually recycle the cellular components and build a new cell. And that's called autophagy. And quite frankly, autophagy is incredibly good for your longevity. The other is the cell literally exploding kind of like a death star, as I tell my patients. And that's called apoptosis. And there won't be a test. So it's okay. So coffee and tea actually does not influence autophagy. In fact, there is some evidence that compounds in coffee and tea, as long as you drink them black, may actually stimulate autophagy. So yeah, have your coffee and tea. When I'm fasting during the day, I start with two cups of coffee in the morning, and then I have about five cups of green and poo air tea during the day, along with the mint tea mixed in with that. So and you can, I guess, see the effect on me, which is so far so good. So but that's a great question. So thanks very much. And another question I get all the time from my patients is, can I still take my supplements if I'm fasting? And absolutely, there's going to be no effect on taking supplements while you're fasting. In fact, I happen to think that there are certain supplements that will really benefit you during fasting. But now is not the time to talk about that. Okay, and here's our review for the week from Maria Mamina, who gave a review on Apple Podcast. I believe that we have the wisdom to cure all diseases and Mother Earth help is with that. This podcast shows we don't need medicine in order to be healthy. We need to be aware. Thank you, Maria. That's a great comment. And thanks again. All right, that's all for this week's episode of the Dr. Gundry Podcast. We'll see you next week. Bye for now. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher, or wherever you get your podcasts, because I'm Dr. Gundry, and I'm always looking out for you.