Season 3, Episode 2: Gut Health Science: What's Actually True?

Welcome back to The Gut Show! In this episode we are going to uncover some nutrition myths or fads that are out there, specifically around gut health with our special guest is expert Jessie Hoffman!

Jessie is a registered dietician, associate professor and a researcher in the field of human nutrition. Her dietetic and research expertise are in GI conditions and the gut microbiome. This is really exciting because Jessie's gonna pull out some of her information and things that she's learned through her research of the gut microbiome in our conversation, and she was actually involved in some of the research at the kind of height of the gut microbiome, coming to the forefront of nutrition news and education.

Additionally, Jessie is passionate about scientific and nutritional science communication, and also regularly through social media, which is how I connected with her, from breaking down nutrition, science, professing myths that are so prevalent in today's society, she strives to empower individuals to come responsible consumers of social media content and experts in their own bodies.

In this conversation, we're going to nerd out a little bit on some things that we think about as dietitians whenever we're evaluating claims that are made and research that is presented from different voices on social media, so you're going to take away some really cool tools to be able to decipher if something is true, if it's a fad, or how to make kind of the truth come out of statements that might be in the headlines or on social media posts.

So enjoy the episode! Take a few notes if you want to and then come back and connect with us later if you have any questions or any thoughts you want to share.

Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.

This episode is sponsored by Spoonful! Spoonful is THE app for low FODMAP grocery shopping. Their label scanner helps you find delicious, gut-friendly food in every aisle, so you can avoid flare-ups and feel your best. Available on iOS and Android in the US, Canada, UK, Australia and New Zealand. Learn more here!

Erin Judge: Jessie, thank you for being on the show today! Before we jump into some gut health myths and start talking about some nitty-gritty around science, can you tell us a little bit about yourself and how you decided to get into the area of nutrition, especially around nutrition science and your interest in gut health?

Jessie Hoffman: Yes! So first off, thanks for having me, I'm really excited to chat! So my story with nutrition is honestly probably a little bit similar for many dietitians in the field, or people that get interested in nutrition that I've learned as I've gone throughout nutrition is that I have a personal investment in how nutrition impacted my health. I, to be completely honest, I got interested in nutrition for the wrong reasons at first during high school.

I made a New Year's resolution just to eat healthier and help with my performance on the soccer field, because I was a big soccer player, and made some really good changes because I, you know, when you reach that age of like, 16-17, you finally have your driver's license, you're like, oh, I can go by fast food whenever I want. And so that was kind of like a thing. And I probably needed to make some little tweaks to like my diet, but I'm a perfectionist, so what happened was I spiraled out of control and full-blown eating disorder in a matter of a few months. So that was where my interest in nutrition really started.

And to be truthful, what I wanted to do during undergrad was to pursue nutrition, that was my goal. But the timeline in which I developed my eating disorder was like, basically during my senior year of high school, and I knew kind of deep down in my heart, and my parents knew that going into the field of nutrition at that point in time was just probably not, was probably not too solid in my recovery yet. So I actually have a bachelor's in biology. So I went to a really small school in South Carolina, it only had like 1200 students. So very close-knit community, I loved it, I got a bachelor's in biology.

Towards the end of that when I was more solid in my recovery, I decided I wanted to go get my Master's in nutrition. And then it was kind of just downhill from there, Master's in nutrition, started taking courses to become a registered dietitian, because we have certain courses that we have to take, in order to kind of check those boxes in order to be eligible to be a dietitian. And then got towards the end of my master's, decided wanted to do a PhD and so decided to do a PhD in nutritional sciences as well, and just have totally fell in love with it. I'm there too.

My interest in gut health actually came a kind of, not by my own starting, I guess, but I became interested in it through my master's mentor who I was doing research on like metabolic health, but that was in like 2013/2014/2015 kind of time. And the gut microbiome was really new, then like super duper new, and my mentor was very interested in it and he was like, well, we'll just throw in and sequence the microbiome of these of these mice that we were doing the research on. And then through the writing process of like manuscripts and stuff, I just fell in love with the gut, I fell in love with the microbiome and it kind of went from there.

My PhD mentor, basically, going into the lab was like you can do whatever you want, as long as relates to our big like, overall what we're funded for, which the gut microbiome happened to fit in there, so I was like, sold! Gut microbiome, studying gut health and the gut microbiome, this is what I want to do! So that's kind of like my roundabout way to getting to where I wanted to, I never had specific plans on like, I want to study nutrition, I want to be a dietitian, it kind of just at each step I was like, I'm gonna take this step, I think this is where I'm interested in and kind of course corrected along the way. So it was a long explanation!

Erin Judge: No, that's so interesting! And I think it is interesting that you know, gut health, as we know it today, like with the focus on the microbiome, so I think really, the science of gut health is so young and new. That was all coming out whenever I was in my internship. So I was in my internship between 2014 and 2015, right after I graduated, and I was just blown away by all this information, but it also wasn't integrated into our actual like learning. So it wasn't integrated into my courses. It wasn't anything I actually really learned, but everything that was coming out on the science behind it was mind-blowing. And then the fads came and it's been kind of a roller coaster since, but kind of the same thing like that new research really hooked me, and I thought it was so interesting. I know you have you share on Instagram, like some of your personal experience with gut issues as well correct? So where did that kind of fit in or come up?

Jessie Hoffman: So I was perfectly normal with my gut health pre-eating disorder and then I am convinced that a lot of my eating disorder, just the ramifications that came from that spurred a lot of my IBS like issues. Also, my IBS is very driven by my anxiety, which goes along with like eating disorders very, very much, a lot of people with eating disorders have high anxiety or more high strung, so a lot of mine are more stress triggered.

And then I actually when I started my PhD, I was a big runner during undergrad and my master's program and ran cross country and marathons and things like that. And then I got to my PhD program, and I wasn't able to run because I developed such severe GI complications with exercise, just really running, like I can do any other form of exercise perfectly fine, but running is just like no for my gut.

So then I became really interested in like exercise induced gastrointestinal syndrome and distress associated with exercise too, so actually, now I research that. So I kind of have a vested interest. But I do attribute a lot of my IBS like symptoms towards eating disorder, potentially changes in the microbiome during that time, like, I'm not counting that out. I don't know if that happened, but I'm sure it did. And then just high anxiety, high stress.

Erin Judge: Yeah, absolutely. We have an episode coming later this season, all about eating disorders, and IBS. A few that are kind of around that too, of like digging deep into that, because it is fascinating how and I see it in practice, like focusing on IBS that, you know, disorder patterns, even like not even to the scale of an actual diagnose eating disorder can have such an impact in the history and the role.

I know there are some, you know, leaders out there that will say absolutely not, that's not you know, involved in IBS as we know it. But I think when we look at the physiological, the actual changes that can happen to the gut, and the way that even our bodies function, which I think we're silly to think that our bodies are these machines that can just like function one way, it's like they're so interesting and unique, and the way that they learn how to adapt and respond to us and how we respond to them, and, you know, our microbes are probably involved in that, too. It's just such an interesting thing that I can't wait to keep learning more about! So now you do your professor, correct?

Jessie Hoffman: Yes.

Erin Judge: And did you work in practice before you became a professor, I don't really know that part of your story?

Jessie Hoffman: So in my dietetics path, I finished my PhD, I completed my internship and did like a postdoc as I completed my internship and then continued to do a postdoc after I was done, and then went straight into this professor position. So I've never, I do have a private practice where I work one on one with clients on the side when I can fit things in, but I never went fully into like a lot of dieticians to go into a few years of clinical practice, and then decide to go into private practice or do something else.

Erin Judge: Yeah, that's cool. And then you said that you like to do some research around like exercise induced GI issues? Are you doing like legit, like research that's going to be published kind of research? Or is it more in the practice?

Jessie Hoffman: Yeah, it's hopefully research that's going to be published. So the University I'm at is not like a massive research institution, our primary job here is teaching focused, but we do have research on the side. And a lot of our research is really geared at students towards giving them research experiences. So a lot of my research is driven by what my students are interested in alongside with what I'm interested in. So I have a lot of students that are interested in gut health and exercise too so it kind of fits nicely.

But it is research that I hope will eventually be published. I have one student that's working on a manuscript right now that we hope to submit, and some other really exciting studies potentially in the pipeline. I'm submitting a grant today for one I'm really excited about that deals with FODMAPs, so super excited about that and hopefully that gets funded. But yeah, eventual hopes is to have those publications for those projects.

Erin Judge: That's amazing! And I think something that I think a lot of people don't understand, especially now, I think we're in this weird place with health. And I think this is where some of the fads come up, is that, you know, evidence based information, almost seems I mean, it's at war right now. But it's like, I don't think people understand what goes into actually providing evidence based information. It's like, well, if it just makes sense, or like, you know, if we have this case study where this person experienced that, isn't that considered legit and evidence based, versus like a full on study, taking time and resources and replication and all of that? Do you have anything to say on that or anything that you've kind of learned along the way that you may not have realized that goes into creating what we would consider evidence based finding?

Jessie Hoffman: Yeah, so I think with evidence base, especially when it comes to the field of dietetics, but also the field of like gut health is, an I hate to, like I don't like when people use this kind of as a cop out to justify their things that they're practicing, but this science is arguably going to take time. And so you may be working with clients and seeing benefit by implementing certain things that may not be 100%, there's tons of research studies on it, but it's relatively harmless, it's okay to implement.

So there's a fine balance between, in evidence base, between anecdotal to an extent and having that client experience and using what we would call it, like nutrition and dietetics is like your clinical judgment, being able to utilize that, but also applying like, actual research evidence. And so there's a fine balance between the two, arguably, we want to rely as much as we can on like, peer reviewed studies, strong research evidence, but then also use if we find something that's working with clients that is showing benefit to them and it's harmless, and like, it's perfectly easy, mentally harmless, physically harmless, it's perfectly fine to try, I don't feel like there's anything wrong with kind of testing that out just because we don't know enough, especially about the gut yet.

Who's to say that in a few years, what you're doing with someone giving, you know, say they're taking a certain supplement, a few years maybe will come down the line, and we'll see that oh, that actually does have a benefit. But again, I know that a lot of practitioners that may not be qualified in this field, use that as a cop out a lot to just justify doing whatever they want, and so there's there's a huge fine balance that exists between those two, in my opinion.

Erin Judge: Yeah, I agree with you too. And I think that it would be I mean, we've seen it in nutrition where fats were terrible, right? It was low fat, everything. And then we realized, oh, wait, no fats are important. Now we're swinging towards like fats are everything, like, oh, no, let's get back to the middle. And we've done that with so many things like carbs are bad, we everyone needs to go low carb, it's like, oh, wait a second fiber. That's not true. And that's not because we know as dietitians were wrong, it's because that was the information we had at the time.

Something I've learned just to becoming a dietitian too, it's something we value in our practice, is not putting all of our stake into one thing or like being so prideful, that we want to say like, well, there's no way, that is absolutely not true, unless it's been proven to not be true and we can back that up. But you know, going from the well, you know, here's why that may not be true, or here's the evidence we don't have, here's where it might be true, or based on you and your body. And then obviously the placebo effect we can't deny, which I think is probably happening more. But to me, I think the biggest red flag, and we're going to get into some of these like fads and claims and myths and things, but something that I usually use as my own navigator is on those sides if someone is just speaking from a place of absolute truth for something that they can't absolutely prove, that's a clear sign to me that like, okay, whether or not that thing could be beneficial in some cases, like the fact that it's considered absolute truth in that scenario means that that person is going to be proven wrong, and they may not be trustworthy, especially on an individual basis to tell you what to do. Would do you agree with that, like, do you see that as well?

Jessie Hoffman: Totally. So I think I would agree with you like the biggest red flag is being so hard set in like one specific way and saying like, absolutely not, this will never be true, like nuance is one of my favorite words. And like if the way someone is preaching about something or talking about something in the scientific field, nutrition field, gut health field, is not acknowledging the nuance, then that's the hugest red flag, like the biggest red flag for me, just because we know in science that things are going to evolve. We can't, like even I to this day with some of the fads, and you'll hear me probably talk about it in a few minutes. Current evidence does not support this, but in the future, I'm willing to change my mind as evidence emerges. Like, I hope that we have evidence to support some of these things that we're going to talk about in the future, and that we have tools to kind of work towards addressing these.

One thing that I always come back to is like, what is going to do the least amount of harm to the clients and individuals that I'm going to work with and provide them the most amount of benefit, whether the harm is financial, mental, physical, like we're going to try to reduce harm at all costs, and then provide them the most benefit. And so if something, if a test that they're purchasing is, like, while the science is, you know, not that great on that we don't really have evidence, maybe there's a benefit, but it's gonna cost you $1000 bucks to do. Like, that's something I would say, I'm gonna weigh, like, there's arguably some more cost effective manners that we can do to address first. So that's kind of my stance and all that.

Erin Judge: Yeah, no, I'm with you. For sure. I think that's where the clinical judgment and that experience really comes into play, and like, as a person who is making decisions, like if you're ever put on the spot where this is the only way that you're not given clear information, why and if the information is full of just sexy words, but no actual like clear data, it's like, okay, that might not be true. But also if there's no follow up, if there's no other alternatives, if there's not a really clear indication of here's what we're looking for, even if you're trialing something, like, those are some kind of things to look for when you're working with someone or someone's kind of educating you online. Because that's a clear sign that like, okay, you know, maybe that thing isn't actually true if there's not more information around it, besides, it'll heal your gut, which is okay…how do I, you know, like, where's the data on that? How do I know my gut isn't healed to start with?

Jessie Hoffman: And what does that even mean like, heal your gut thing. Like, we don't even know what that really means, so…

Erin Judge: I know, I know. And as a provider, I think it is tempting sometimes to fall down that rabbit hole. And as someone who's in, I'm in marketing as I have a business, and it is tempting to say like, oh, yeah, that's easy. People understand, they think they understand what that means. But at the same time, like always double checking ourselves and being held accountable to that is really important, which I know is something that in dietetics, like could be better, is healthy accountability among practitioners to make sure that what we're doing is legit without bashing, I think or tearing people down, because there is so much nuance, but you know, that's something that I really believe in, and something that drew me to you and just like, learning from you, because it even checks me sometimes like, oh, wait, do I know where I stand on that, you know, it's really good to have those conversations.

And, again, if providers aren't doing that, that's a problem. And even as a patient or a person who's exploring this on your own, like, it's good to question everything that you're learning, because it's a good way to see like, what do you know, what don't you know? And why is that recommended? And if it you know, if there's no reason for it, ask questions, because you might figure out that that person maybe doesn't know or that there's more to it.

So going into, like, some of the things so I'm curious about like, you know, you came along, in your studies around the time that gut, new research came about. So I'm sure that you've learned so many things along the way, are there some big things that maybe you thought going into nutrition? And you thought even in the start of gut research that has completely changed and been kind of dismantled? Are there any big things that have stuck out to you?

Jessie Hoffman: In the field of nutrition, so I will say my mindset, when I got into the gut health arena, was already in that nuanced mindset, where I was already skeptical of everything, already questioned everything. So I don't ever think I developed like hard set like truths that I thought existed within gut health. But in terms of nutrition, I guess, you know, kind of, I fell victim to a lot of fad diet anything's I, you know, I thought in order to be healthy, I had to track every single morsel that went in my body, I thought that I had to cut out and reduce as much fat as possible. I also thought I had to cut out and reduce as many carbs as possible, and then even had about where I thought sodium was the devil, and I thought I had to cut out all sodium, as much as sodium as possible. And those things as you learn more about nutrition, arguably, I think, in individuals who have had eating disorders, and are at a comfortable place in their recovery, learning about nutrition can be really therapeutic. Like actually learning about it from like, schooling can be really therapeutic because you start to dismantle a lot of those myths by just understanding the physiology, and how nutrients are metabolized within our body and what each macronutrient does for us. So I definitely think I fell a lot victim to like a lot of fad dieting, stuff pre, kind of like early in nutrition. But I can't really say the same for gut health because I started in the nutrition field, as I started to develop nuance there. Once I started in kind of the gut health arena, I just like entered that with like nuance was like, I'm never gonna like believe something is 100% fact, like, that's just not gonna happen.

Erin Judge: Yeah, I think I kind of feel the same way. I think the one thing that has changed for me is in schooling, you know, we learned so much especially in like internship and like practice, because you're learning, okay, what do I do with patients? Right? What do I do with all this information? And it's very much handout focus, right of, here's the thing you follow, like, here's the process for someone with high blood pressure. Here's the process with someone with IBS, or here's the process of someone with Crohn's disease. And I think the biggest thing I've learned in actual practice is that none of that's actually true because each person is not just one piece of paper. It's like, yeah, there might be a high blood pressure, what else is going on? And then those things may contradict, and that's something I wish we learned more. I just, I don't think that you can until you're in more practice, but I think that's a misconception. And even in the media, like, that's what sexy is like, here are the top five foods you eat for this thing. It's like, well, it's not that simple because that not might not be the only thing going on for you and your body just might not work that way. Or that recommendation may not line up with other recommendations like we see with IBS, like low FODMAP doesn't always line up with fiber diversity, you know? And so it's like we can find a combination, but that's not always what is going to be taught or experienced by every person who's going through that track. And even dieticians, like sometimes we may not know that if what we're focused on so much is here are the five steps I need to follow for this person.

Jessie Hoffman: And I think that gets at the kind of hallmark of both the field of nutrition and the field of gut health, and that you can't neglect an individuality, like inter individual variation, individuality, like what works for one person is not going to work for the next. Like, it's truly like you learn by sitting down and listening to your clients or patients and taking and using your clinical judgment to apply, like what is going to provide the most benefit without doing harm. And it's truly, like you have to be able to kind of adapt with every situation, so there is no like textbook response. And then something with the field of like gut health that I don't think a lot of people recognize about like dietetics is we're not, we don't get a specific course in like gut health for the most part. We get a little bit of it in our MMT classes, which are medical nutrition therapy, so we hit the hallmarks of like some of the big, like ulcerative colitis, Crohn's disease, celiac disease, like those big ones, but then we don't really get any sort of other education and gut health. And there's not a lot of opportunities for dietitians to expand their knowledge on gut health, besides being self-taught, or going and getting a master's in doing research or doing a PhD and doing research in the field. And that's something that I don't think a lot of people recognize, but something that I think our field really needs a lot of, because I think it would totally improve patient care if we had more training on that area.

Erin Judge: Absolutely. I always like to say like, the gut is our organ, out of all the practitioners like the gut is ours, right? It's like, nutrient, but like absorption and metabolism, like, you know, poop formation, like all of that is us. It's like that is us as dietitians. And it makes me mad to have like, I learned all of these things in biochemistry, and you know, advanced metabolism and all of these MMT classes. And, like, we learned a lot of how things travel through the gut and what happens along the way. But we did not learn enough about it and it's like, this is my organ and I should know everything in and out of it. And then finding that information is very hard, because it is so nuanced and some of its at such a high level that like, you know, the researchers in the field are doing, and they understand it, but then being able to translate that for what education that we've gotten, you know, sometimes that can be really tricky. But yeah, I completely agree! Is that something you feel like you've tried to change and focus on as being now a professor for students that are kind of coming up in that field?

Jessie Hoffman: My dream would be able to have a gut health course, but our current, like, we don't have enough professors in our department to allow for that, for me to even teach as an elective. I would love that. But I do kind of feed that into some of my classes, like we have a, I teach and advanced like biochem at the grad level and we have a full week that we spend on just like gut health and the gut microbiome just because I think it's important to talk about. And then in every class that I teach, I teach an undergrad kind of metabolism class that we talk about gut health and the gut microbiome because I think it's important, and I know they get it in MMT some too, and we try to do a good job at like guest lecturing and some people's courses when it's like, hey, you're the expert on sports, and I'm talking about sports today, why don't you come talk in my class, hey, you're the expert in the gut, why don't you come talk in my class. So we try to give our students as much as possible. And then I try to give my students a lot through research when they when they come to me and they're like, I don't know anything about gut health and gut microbiome, but I want to learn I'm like, here's a pile of books. Like, here we go, we're gonna walk through it all.

Erin Judge: That's awesome! All right, so we'll get away from dietetics upbringing. I think it's it's important to talk about, it's important for people to know and I think that that allows you too to go into like, when you're working with someone questions to ask, like things to look for, it's all super important. But I do want to get into some of the, I considered the myths that are circulating, but we're going to determine are they a myths, or are they not? Some of this I know, but I do want to pose these as questions to pick your brain too and some of it's meant to be controversial. So if you're listening and you have a different opinion, that is okay, we're going to talk about it from the science side of what we know so far!

So the first one, and I hesitated even bringing this one up, because I think that this is so controversial, and honestly, from what I've seen, like in knowing how the gut works too like, this is very confusing, but it's all diseases linked back to sugar consumption, like is sugar, the thing that's causing every person to go downhill?

Jessie Hoffman: No, and I think, so there's nuance here, like and I'm gonna say it with every single one, like, can we overdo anything that we eat and in anything, we can over do water, we can overdo fiber, we can overdo anything. We can definitely overdo sugar and we can definitely and to the point at which we start contributing to like lipid accumulation in our body, maybe some lipid accumulation in the liver, which is not you know super advantageous, may lead to some metabolic complications and things like that. But for the most part like sugars not the devil that it’s like made out to be. It's not contributed to all disease. What a lot of people will do is they'll track like sugar consumption and then like rates of metabolic disease or something and they'll look at like the line graph and try to overlap those and see and say, oh, see they're going up at the same rate and kind of fall in the same line. But you also have to note that they've done that with almost every macronutrient at some point. And we've demonized it and we've redeemed it and things like that, we've gone back and forth, and sugar is just like the next one, it was just carbs. And then it was just fat. But now we've honed in and said, oh, it's got to be sugar then. So again, balance in everything is really important, but it's not like the contributor to all disease.

Erin Judge: Yeah, yeah, I agree. And something I find interesting, I'd love to hear your thoughts on this too, being on the more of the research side, cuz I haven't seen any new, like, I think the latest conversations I've had around this around SIBO, which is small intestinal bacterial overgrowth, but there's this idea of like, sugar feeds bad bacteria, or sugar is like, you know, the number one issue with the gut, it sounds nice. But then when you look at actual absorption of sugar, it's absorbed in the small intestine and fairly absorbed early, meaning sugar, and this is something that it's like someone brought up when we were talking about small intestinal bacterial overgrowth effects, the thought was like, well, sugar feeds all of those bacteria in small intestine, which like, okay, yeah, you know, sugar might be in the small intestine, so it could feed those bacteria. But it's absorbed even earlier than were most of those bacteria overgrow. Have you seen any new studies around that, or like, what are your thoughts on that, because I think that's not being talked about.

Jessie Hoffman: So my, my thoughts, I did a stint with a microbiologist, during my PhD who taught me all fancy microbiology, and I loved it was my favorite part of my PhD. But what a lot of people, the like fault in the argument that sugar feeds bad bacteria is that not only the quote unquote bad bacteria are going to eat the sugar, the good bacteria are going to eat the sugar too. Like bacteria, when given a carbohydrate source, love it, give them a carbohydrate source, they're going to thrive, they're going to grow. When I was doing microbiology and culture, like we would pop glucose in there, microbes love it, we would pop insulin in there, microbes love it. Any sort of fermentable carbohydrate source with sugar is technically one of those that the bacteria like to metabolize, they're going to love. So there's not, it's not just that the pathogenic bacteria or the bad bacteria are going to preferentially like say, oh, sugar, I'm going to attach to that, I'm going to go for that, all of the bacteria are going to kind of compete and fight over sugar.

And then if you want to get really nitty gritty, bacteria, also, when they produce compounds, they do something called cross feeding. So some bacterial produce compounds that then the other bacteria feed off of and metabolize. So just because you're feeding one population of bacteria doesn't mean that you're just feeding that one. Maybe you're feeding that one and then it's producing a metabolite that's feeding another population. So it's not as simple as like, sugar feeds pathogenic bacteria, the good bacteria don't touch it, and they would have nothing to do with it.

Erin Judge: Yeah, yeah. That's so interesting. I think there's so much we need to learn, but that's a that's one that I see, like circulating. And even people come in, they're like, yeah, I'm eliminating all sugar, you know, because this one popular doctor told me to, and then it's like, well, where's, like, where's the studies that say, like, how do you know, I know, it can come later, maybe one day we'll figure that out. But when we look at how things happen, like you just even mentioned, like, well, that doesn't, that doesn't make sense. But we still recommend you know, decreasing sugar when SIBOs present and it's just, it's an interesting thing of like, well, maybe that could help, maybe not.

I think something that we come back to too is like, okay, well yeah, like when we reduce sugar consumption, we technically tend to increase nutrient dense foods and like, is it more about what we increase or more about what we decrease which I believe it's more about what we increase and focus on and if we're taking foods that are maybe heavily in sugar like cereals for example, if you're reducing your sugar intake so you replace your you know, cereal, your bowl of like honey nut cheerios with a bowl of you know, oatmeal with fresh fruits and nuts and seeds, like is it because you've decreased the sugar in the honey nut cheerios? Or is it because you increase the nutrient quality of you know, the oats with the berries and the nuts and seeds? I think it's more about what you increase, which I think research does support in terms of microbes feeding, I think we see that with like prebiotics, right? Like we can see we're certain microbe communities will grow with certain types of food, is that still what you're saying?

Jessie Hoffman: Yep, certain microbes will thrive on certain compounds. So like when I was doing my research, I isolated an inulin fermenting microbe that basically just meant like it was a bacteria that really only it liked, it can use glucose and things like that, but it liked inulin, which not all microbes like inulin and inulins a prebiotic. So we definitely have, there is some specificity in terms of like microbes and what they metabolize, but for the most part when we get down to like glucose or sugar, what basic carbs are going to be broken down to, most all bacteria for, I wouldn't say most all, but a large portion of bacteria are going to be able to access that and metabolize it pretty readily.

Erin Judge: So interesting. So the takeaway there is don't demonize sugar, focus on what we're including and let sugar just kind of fall and be it's enjoyable self when it fits. Okay, the next one is, and I know this one, but this one's a fun one. Does everyone with digestive issues or any digestive symptom at all have leaky gut?

Jessie Hoffman: So leaky gut is something I love to talk about and I was actually just talking about it with a student who had come across it in his reading, and he was just like, can you explain this a little bit more. So leaky gut is a hot buzz term, that is part pseudoscience part legit. So in the actual research field, leaky gut basically just means intestinal permeability. So in our intestine, we have what's called tight junction proteins that exist between the cells within our gut, we also have different scaffolding proteins that kind of exist and hold those together, we have a mucous layer that kind of lays on top of our gut and prevent and protects it. We also have immune components that kind of protect our gut layer too. And so all of those factors kind of work together to seal our gut because we don't want things in our gut necessarily getting into the rest of our body, I always like to tell people like our gut is really our interface between the outside world and the rest of our internal organs. So what passes through our gut, we want to keep in our gut for the most part, and we want to specifically transport certain nutrients across, want to be very selective in what we get across.

What happens with intestinal permeability and why it's a legitimate thing is because we can assess it in like a laboratory setting and we can see that some of the tight junction proteins will kind of break down, we have certain tests that we can do, where we feed molecules that aren't supposed to cross the gut barrier and if they get across the gut barrier, and we see them in circulation, we're like, the gut is a little bit quote, unquote, leaky. So it is an actual thing that we can assess in a laboratory setting. Where the disconnect is, is that step from a laboratory setting hasn't been made to a clinical setting yet. So it's not something that we can assess clinically, and what I don't like is I see a lot of not a lot of but several practice many practitioners that are diagnosing leaky gut, clinically, but they're doing so without actually running any tests. They're doing it based on pure symptoms, and current evidence is that we don't have any sort of key symptoms that are associated with leaky gut, we don't even know if you can feel it. Like we don't even know if it causes abdominal pain, but some of the things that you'll see individuals tell that leaky gut associated with or like nebulous terms like brain fog, and fatigue, and it's like, okay, well, at some point, we're all gonna feel a little fuzzy, we're all gonna, we're all gonna be a little tired like this, just things gonna happen. It doesn't necessarily mean you have leaky gut.

So I try to stay away from or kind of throw a red flag at individuals that are promoting like leaky gut is a problem that you have and you need to fix it and this is how you fix it, xyz, because the research isn't there yet. But this is where I'll say that I believe the research will get there and it will be something that we can diagnose and something that we can treat, but we're not currently there at that point. We do know, just like solid dietary habits, like eating enough fiber, avoiding foods that you may be like, quote unquote, intolerant to, making sure you're you're reducing stress and things like that can support a healthy gut barrier, but it doesn't necessarily mean that those things like cure leaky gut. So I don't believe leaky gut is the like root of all disease, or the biggest problem that we have currently in the field of gut health, but I do think it's something that we'll learn more about, and something that we'll hopefully be able to address further in the future.

Erin Judge: I love that. And yeah, I'm on the same page where it's like, yeah, we know, even individuals with IBS, like have more intestinal permeability, like we see that. But I kind of always look at that, like the whole, I mean, low stomach acid is now the thing too, and it's like, yeah, those things can be true. And we know things that can decrease stomach acid production, we know there are things that might potentially cause more permeability in the gut, we know, you know, a fiber rich diet might help in the role or healthy microbes could help too, but that doesn't mean that that is the root cause. Like I think when we're looking at root cause, or like, you know, approach that we're taking, if we're focusing on treating a symptom, like that's no different than treating the symptom of bloating, versus looking deeper at like, well, what's causing the permeability to happen? I think that's where the research is going to be the most valuable when we can test where people are at because that'll help.

Even thinking about from a practitioner point of view. it's like whenever I suspect that there could be some permeability, not because of symptoms, but because of like, oh, these things that have been present in their life, you know, that might have contributed based on what we know so far, like it's hard to measure and understand, well, when is that going to get built back up? And a lot of people come in with like, you know, the bone broth, the collagen and all the things thinking like, well, in 30 days, you know, it's just to happen. It's like, there's zero way for us to know like exactly where you were at, and when that's going to improve. And so I would love to see that in research to be able to like test for it truly, just to be able to measure like, how quick how, like, how are we moving, because I think that could be a part of food tolerance and when we look at, you know, increasing tolerance to FODMAPs like, maybe that's a piece that could be interesting, because we know, I think that there's some new data around like FODMAPs, potentially causing more permeability for some, but I think that's confusing, because it's like, well, is that mess? You know, I don't know, there's a lot there, but it'll be really interesting to see, so I like that you brought that up and I love talking about that, too.

But yeah, it's true and there's leakiness in some cases, but when we focus so much on like leaky gut, it's like, I think we're missing the forest for the trees, like we're looking at too little of things, we need to be looking at the bigger picture and the recommendations are usually the same. And when you look at the recommendations of some of those practitioners, like the solid core recommendations are actually the same. And then there's like the fancy little things spread in it, have no data, but then it's like the things that do have the data, they are similar. It's like, let's take away the complexity and like simplify and create consistency, and we'll get to where you want to go. Okay, so another fun one is celery juice. Is celery juice is magical as it claims to be and is there any data really supporting that?

Jessie Hoffman: Nope. And I went on the hunt for it. I mean, arguably, I've not been on the hunt for like data supporting celery juice in a year or so because it's kind of gone into the background a little bit and then it kind of research I don't get the way fads work sometimes. But innocence, like celery juice is not gonna harm you, but do you need to be juicing celery for health? Probably not. And if you don't like it, don't drink it like absolutely not, don't waste your money on salary if you don't like it. Celery is mostly water, some minor minerals and some like electrolytes and things like that. But nothing that you can't get from just eating normal foods. The most benefit that you're getting from celery juice, even if you see a benefit is just added hydration, which can be achieved with just drinking some water. And maybe if you're low on electrolytes, or certain like minerals and things like that, you can add those in and you know, you get those through your diet, but you could take a like electrolyte supplement if you were really concerned about it or something. But celery juice isn't magical, the best benefit you're getting out from it is just hydration.

Erin Judge: Yeah, I think that one's been disproven pretty easily. Because that's the most like, there's not really an ounce of truth to like the claims out there.

Jessie Hoffman: I believe, didn't the Medical Medium start that whole trend? I think that was a thing. And then, it was a long time ago. It was like, right when I first got into like, science, communication, nutrition communication, I like had called him out and he had a million followers or something like that, like several million maybe and I got blocked by the Medical Medium. So that is like my, I don't know, claim to fame is I was blocked by the Medical Medium for saying that what he was promoting was BS.

Erin Judge: Yeah, yeah. And he's, he's one that's definitely on the list of like, okay, no, like, there's no, there's nothing there. Which is a big thing to think about. And yeah, you're right. It's like, there's, and that's a good example, I think of what we mentioned earlier of when things are recommended with absolute truth of like, this is the secret versus the nuance of like, hey, this might have this nutrient that does this thing and like, that's our theory, which that's what the theory is like, it's a theory, like, that's a thought maybe, who knows? Probably not. But you know, also thinking about, well, what are the benefits of increased hydration? What are the benefits of some of these extra minerals? What are the benefits of getting that much water first thing in the morning, or, you know, it's like moving your body, whatever it may be, you know, there's so many pieces to that whole practice.

And I think intermittent fasting goes along with that, like, there's a lot of pieces to it that may have different benefits for different people and so it's being able to really talk about it like, well, that might be why and then you can make the decision if you want to drink the celery juice, and if it works for you, awesome. But I think that absolute truth, it also feeds just misinformation from people who do it, and it works for them and then they believe like, well, that was the absolute truth, so that means that my cousin needs to drink this, and this person needs to drink this and in some cases, that actually could be very harmful, like celery juice, maybe not. But I mean, if someone you know, with diabetes that really needs to be eating like a balance, like breakfast in the morning, and they're going to drink celery juice instead, like that could be detrimental and like harmful and we don't know that nuance because it's claimed as absolute truth.

So that's, I think a good example of it's not that the Medical Medium is like the worst human on the planet, because I think it's not fair to say but that absolute truth kind of claim like is a clear sign of like, hey, that person may not really know all they're talking about or they may not have your best interest in mind with what they're talking about, because they're not providing you all the information that you can make decisions from which is so important.

Along that same line, so one of the things we saw with celery juice was this whole idea of like detoxing, right? And I think that's something that, you know, has popped up in different ways for different superfoods and ingredients, but now we're starting to see it go in a almost therapeutic direction, and it's getting a little scary. So what are your thoughts on this focus of like, liver support protocols, and these really intense like detox cleanses, and even that diagnosing component to like needing detoxes?

Jessie Hoffman: Yeah. So my first thought is that it's incredibly scary if you're starting to take a lot of supplements that some of the supplements actually do have evidence that they interact with the liver, not necessarily that they detox, but they definitely, anything that we take to theoretically interacts with the liver, because digestive path, you go through our gut, you enter the portal vein, you into the liver, for the most part for a lot of nutrients, and things that you're taking medications and stuff. So though, honestly, taking a lot of supplements that even just interact with the liver scares me because you're taxing your liver, an extent where you're potentially even overriding its natural detox mechanisms because you're throwing something else at it. And that's just my underlying thought.

My other thought is that, I think I mean, the detoxing thing, I know a lot of dietitians preach this, but it's like you have detox mechanisms in your body that work perfectly fine, for the most part. And if they weren't working perfectly fine, you would probably be very symptomatic and you would know and you need to go to a medical doctor, and you need to be treated appropriately, not with some liver support protocol that you can just buy from a functional practitioner just on the internet, that may not be actually diagnosing you or be able to ethically and legally treat what you have.

So you have your gut, which helps you detox some things, you have your liver, you have your kidneys, your skin helps you, you have lots of organs within your body that help you detox. Most often those organs don't need extra support, and throwing things into the mix that are like harsh could cause extra problems. And then with gut health, specifically, when we see like people doing gut detoxes, a lot of times, it's just like a really strong or maybe not really strong, but just a form of a laxative, which can cause problems in individuals, long term use of laxatives can dysregulate our natural like motility of our gut and prevent us from actually being able to move it ourselves. It's kind of like working out in the gym where you're using your muscles, like if you are pushing something through your gut that is making your gut kind of eliminate on its own without using its own mechanisms, you might atrophy those mechanisms and then have trouble actually go into the bathroom later.

And then some other things like nutrient malabsorption, nutrient deficiencies, also like things like dehydration, that's a big concern. So detoxing is not something that I recommend, and that I always say if you have an actual concern with one of your detoxification organs that exists within your body, you need to go see a practitioner to get it like adressed appropriately. And they're often not going to throw a bunch of supplements at you so that it's kind of like a hallmark of probably not the best interest.

Erin Judge: Yeah, yeah, absolutely. And I think it's good to remember a lot of these, the claim is, well, after you eliminate all that stool, you kind of feel empty, or you you know, get rid of some of the fluid you're holding on to which is probably from the diuretic component to things and like how it's pulling, which isn't a good thing, like you should have some hydration in your body. Like sometimes that's claimed as being like the sign that your body did it, you know, and that's terrifying, because it's like, well, you know, having really expensive diarrhea or, you know, doing a colon clean out before you know, your colonoscopy, it's like, yeah, for that minute, you might feel good, because you got a lot of stuff out of your body but it's not like that waste has been hiding away and like causing all these issues and now, that is the one secret.

It's like, you know, are you supporting healthy digestion? Are you supporting like your body to functionwell, which comes down to like, how you're living your life every day, and what you're taking and putting in can make a difference, but not to the degree of like, oh, your livers just completely, you know, shut down. And if it really is, you're right, those supplements are probably not going to work and could cause some really intense damage that we do not want to see. But yeah, I'm really terrified by that. And I think it's something that, I don't know if we'll even see that as much in research. I am interested in the move towards like natural like detoxification pathways, you know, the use of saunas and sweating and things like that, which I think those that go back to what we said of like, you know, if it does no harm and it makes you feel good, and even though we can't prove like across the board that like, oh, that's doing everything that it claims to do, like, if you feel good going to a sauna, like I would use that, you know, it's like if I feel like going there and like if it feels good for me to sweat, like, great, but you know, maybe we'll see some more research in that one day which would be phenomenal to think about about some other ways to promote, like, our body to function like it should. But I think, you know, the things that we're taking internally that could have harm associated, it's very scary just trying it out.

Or like, I've seen, you know, influencers of like, oh, I'm doing this thing, and you should do it too. And it's like, oh, that's a little scary, you know, it's like you don't know what medications are taking. And there's this idea that supplements are all safe, and they're really not. And some we don't even know what they are and it's terrifying. And some are fine, but you know, figuring that out can be hard.

On the topic of supplements, what about collagen? So collagen I feel like is one that maybe, it's kind of like, it's a fad? Maybe it's not a fad? It's a fad? Maybe it's kind of riding that line? So what are you thinking about collagen and have you have you guys done any research on that or seen any interesting research of that specifically being taken in the effect on the gut?

Jessie Hoffman: I have not done any research on it, but from just what I've looked at for the most part, in terms of like, just collagen and its proposed benefits, and what the actual research does say, there may be a little bit of evidence for it supporting like skin health, and maybe in potentially things like joint health, to an extent. The question is there, whether just normal, adequate levels of protein would do the same thing. So collagen is a protein, but something unique about collagen, and arguably like to a downfall is that it is an incomplete protein. So it lacks all of the essential amino acids that we need to make it a complete protein, which is not like a huge deal, but it just doesn't have like the same amount of amino acids in a complete form as like something like whey does. So that's kind of where like, if you're taking collagen for like protein supplementation, that's where I would kind of say like, maybe not, if you can tolerate other forms of protein supplementation, I would probably go towards that. But for skin and joint health, I mean, it's likely not going to cause an issue so it's one of those things like if you find that it benefits you and it's something you enjoy added into your your daily routine, likely fine.

Collagen is the is the reason bone broth has a lot of hype around it around it too currently, and that's one of those things, it adds a little bit of extra protein to like soups and stuff that you're making so if it's something that you like including like perfectly fine, I've not seen adequate evidence or much evidence at all supporting that collagen is like going to repair your leaky gut or going to heal your gut. Likely the amino acids that support kind of that natural turnover over your intestinal cells are going to do that regardless of what type of protein that you're eating and there's nothing like unique specifically about collagen that's going to do that over like another type of protein per se.

Erin Judge: Yeah, something I've seen, and I can't remember where I saw it, so it's something I always say like, I could be wrong, so I'm interested to see if you’ve seen this as well, you know, it's one of the things I found and then I can't find now it seems like, but I found somewhere where constipation could be a side effect of high collagen intake. And I wonder if that's, you know, we know with like super high protein diets, they could potentially interfere with digestion a little bit. Have you seen that?

Jessie Hoffman: I haven't seen that but I would assume it is like kind of along, like what you just said was probably like super high protein intake could lead to more constipation. But I feel like now that you're saying that I feel like I had a student asked me about that last semester. Maybe they did, I can't remember. And I literally answered in class, like, I don't know, why don't you find that question for me? I can't remember if it was collagen, maybe it was something else that they thought caused constipation? I can't remember. Yeah, it makes sense, I believe that you found something like that at some point.

Erin Judge: It may have even just been, oh, I don't know, those things happen sometimes. Which does make sense, I think it's something that people don't realize. And I think we've seen this with, I mean, we've seen these trends of high protein diets, really high fat diets. And proteins great, fats are great, you know, they have roles, but when we go to these extremes, constipation comes up a lot, because like, those are hard things to break down and like fat slows the digestive system down because we have to process it. I think that there's some new data around even really high fat diets, and it's not to the point where we know this to be fully true, but kind of an interesting like lead of that even being associated with the potential small intestinal bacterial overgrowth. Like, which makes sense, it slows down the small intestine, kind of the ileocecal break situation, and proteins as well. It's like, we have to break those all down and figure out if we're going to use them and then get rid of them and that kind of disrupts that natural flow and so that's probably true.

I also find it really funny because whenever collagen first came out, this was the conversation, it's still going, it's like what's one, you know, it's part of a protein, it's not a complete protein. So like if you're taking a protein supplement like you know, you may need to add more if you're doing collagen only because you might not actually be getting everything you need there, unless you're eating, you know, well during the day, but now a lot of the manufacturers of collagen have added more, have you noticed that?

Jessie Hoffman: Yes!

Erin Judge: And I find it so funny because I'm like, okay, they clearly also know that it was a problem and no one has come out and say like, oh, hey, we've may have had this wrong and like, maybe we are looking at like, overall like, you know, protein intake versus actual collagen, but it still will say like collagen and then you look at it and it now it has a bigger, you know, more well rounded makeup, which, to me is always a big red flag of like, okay, like, you know, they, they added to or you know, things, you see it even in supplements, sometimes sort of like, okay, I see what you did there. And that's why you're getting that benefit that you're recommending, like we see, I think with probiotics often where then they add like, you know, prebiotic fiber, something that we know has another benefit, and it's like, okay, well, is it the bacteria? Or is it this other thing that you added that now has the benefit to it? Which is just kind of funny.

Alright, so one last question, I know we're kind of getting lower on time, and this one's a good one because I think this is one that I'm very open to not knowing. And this is where I'm always like, I really don't know how I feel about it, and like I just I don't know, and it's the idea about preservatives, emulsifiers, added flavorings, that whole conversation. These added ingredients that we know are considered safe, and we know, like we're not dumb to know that, you know, our regulations over what safe or not like, yeah, we don't know the impact, like over years and years and years, something could be thought to be considered safe and maybe it doesn't work well for every person. So there's some nuance to that, but what do you think? Looking at research, or have you seen any new interesting research that's setting some of this and even the effect on the gut microbiome?

Jessie Hoffman: Yeah, so there's not a lot of research in that area with respect to the gut microbiome yet, I assume it's coming. But my general stance on like the idea around like preservatives, and added gums, and different things like that, and food colorings and stuff is one that we don't have enough research to make any claim. So the fearmongering is like misguided currently, there's no need to like freak out about it and say that, you know, this is gonna give you x disease or some of the like food colorings and food dyes, they claim that are associated with like things like autism, and we don't have evidence to like strong evidence to actually support those claims. And I feel like it's unnecessarily fear mongering, which I always get to the idea of like fear mongering causes, like a physical and mental like reaction in your body that's stressful, which is arguably more detrimental to your health than actually consuming the items in question in general.

In terms of like preservatives, and some things like that, the ones that we have more evidence on are like the like nitrates and things like that, that are in certain like processed meats, that they may be more detrimental, potentially. But then there's other ones like, like gums that are added to certain foods, they're not necessarily going to be problematic for everyone. But I do know that some individuals that have GI symptoms sometimes react adversely to some of the gums that are within foods, so like Xanthan gums, and sometimes core gums and things like that. Sometimes they react adversely. But that doesn't mean that I don't believe our evidence supports that all of these together are like harmful at a global sense for like everyone that we should eliminate, that we should be like super concerned about regulation standards and things like that, regarding it.

I think we should always be willing to like question and pay attention to like regulation standards and things like that. But also be be assured that our food and the FDA, the Food and Drug Administration regulate food very closely. And people are concerned about all these preservatives being added to foods, but then they're taking a bunch of different supplements that are not regulated by the FDA. So you kind of have to kind of balance that foods are actually regulated really heavily to an extent in the US where supplements aren't and so that's always something to kind of, I always find that a little hypocritical when I see individuals that are fearmongering all of these like additives and foods but then touting that you need to take these supplements. But again, coming back to the message of moderation. I use different types of artificial sweeteners and some of the drinks and coffees and things that I use, but I don't use like 100 packets a day. Like there's there's balance to that. And I'm also really in tune with my body so I know if I'm eating something that certain things maybe react with my body. Thankfully, it's not a lot of those things in the topic that we're talking about, but some people may be some people may be sensitive to some of those gums and artificial sweeteners, especially things like sugar alcohols too, which are FODMAP which costs a lot of gas and bloat in some people, so nuanced is like, short, short answer for that long response.

Erin Judge: Yeah, I really wish that I mean, I wish our government would be like, hey, people are fear mongering over this, let's put some money here and do some solid research to like, either disprove or prove, you know, and be able to make changes if that is true, you know. It's frustrating that that doesn't happen because there aren’t financial resources to do all of that research. And I think I follow the same thing that you do personally and professionally of like, if you have the ability to make, you know, different choices, if you have the financial resources to find alternatives to things that maybe don't have those ingredients, and then like, if you're doing almond milk every day, you know, and you can afford to buy an almond milk that maybe doesn't have that and that matters to you, great! That might actually give you better peace of mind what you're doing and, you know, yeah, reduces some of the load of complexity, and there's nothing wrong with that.

I think if you don't have those resources, and like, you know, it's not harmful, but like looking for the things that are going to give you the nourishment that you need, and again, thinking about what you're adding and including and supporting your body with. And if it has a gum in it, you know, you're getting so much more benefit from any potential risk, because we know there's not big risks, so I think that's something that's really huge.

And then even thinking about, like you said, like, you know, if you're eating, you know, things every single day, every part of your day, your entire day is filled with things that have a lot of these ingredients in them, like that's where I would want to look to like the nutrient quality of the diet. And from a healthy perspective, not like we need to demonize like, you know, are we including fiber? Are we including plant sources? And like, how can we get creative with including those things, which naturally does bring some of those others into moderation. But it is a hard conversation, it's a hard conversation when you're bringing in the nuance of the gut, which is so much that we don't know, when you're bringing in the nuance of people's beliefs and if they believe something's harmful to them, that to me, like you said, with the stress, like, it can cause reactions, and like there can be this intense fears, and that's really important. And like, do you feed into that and let them make that choice or do you challenge it?

And then even relationships with food, and you know, that's something I've struggled with, where we never want anyone to have an unhealthy relationship with their food when it's already done through, you know, their GI issues. But then we also know that like, there are certain foods that are going to feel better. And so you know, being able to educate on that is so full of nuance. And I think it's good to be curious and open to, but I do wish that we had just more solid research and it wasn't so like, this is bad or no, absolutely, this is completely safe, like don't even question it. I think there needs to be that middle ground of like, okay, well, if we questioned it, let's look at it, which I think there's some really great resources now online of scientists that are breaking it down. And you are one of them, like you're breaking stuff down, which is really great.

So okay, I know, we're like pressed for the end of our time, but if someone is, let's say they want to connect with you, you know, I'll make sure to put like your Instagram handle and everything in the show notes. But is there any other way someone can connect or learn more from you?

Jessie Hoffman: Instagram is honestly the best way. And like I mentioned at the beginning of this episode, dieticians don't have a lot of resources to learn more about gut health. I will plug that I am working on that and be on the lookout for maybe some potentially like CEU credit opportunities to learn more about gut health and the got microbiome. So keep following me and keep tabs on that because I am working diligently on something for dietitians and health healthcare providers.

Erin Judge: Awesome. That's exciting. Oh, thank you so much for sharing your wealth of knowledge. I've appreciated it so much, and I'm sure everyone else has to so thank you again!

Jessie Hoffman: Thanks for having me!