← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Moment: The Frustrating Truth About Food Intolerances No One Tells You
00:30:04
Dr. Trisha Pasricha explores the link between gut health and overall well-being, covering food sensitivity tests, “leaky gut,” and the brain-gut connection—while separating real science from pseudoscience and highlighting the role of mental health in digestion.
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- [00:00]
A
There's these tests that you can get done that will say your sensitivity to certain types of foods.
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B
Oh my gosh.
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A
Right.
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B
Yes.
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A
And because they may be having GI distress and they're still like trying to DIY it and they're like, well, let me figure out what this is. And I just want one test is going to tell me what I should stop eating.
- [00:15]
B
Yeah, yeah.
- [00:16]
A
And are these worthwhile?
- [00:18]
B
No, I will say I have had the experience because, you know, a lot of times, food intolerances, it feels like a big black box. Like, it feels like you are someone who, you're eating foods and they upset you. But you'll go to your doctor and your doctor will say, oh, like all your tests look normal. Like, you know, maybe they'll even do an upper endoscopy. Your endoscopy will look normal. And yet, you know, you feel this, like you're living your daily life, that certain foods upset you. And it can be really hard to figure out what those are. And then these, these companies come along and they'll, they'll tell you some list. Maybe it's based on your stool, maybe it's based on your blood, like what you have a true intolerance to. And very often I see people come in and they'll be like, look, I got these results back. They'll show me 10 foods that are now on their like, sort of list that they shouldn't be eating. And we'll look at those foods together and I'll be like, hey, did, did mushrooms actually ever bother you before? Like, did you talk to them? And they'll be like, think so, I don't know, you know, and like, to me, a food intolerance should be something that is pretty clear, like a yes or a no. Like, and sometimes what makes it to those lists are actually, like, you don't need a third party to tell you what you do or do not tolerate. You need to figure that out. And there. And those tests aren't based on real validated science. What is based on validated science is this kind of experiment called the low fodmap diet. And if someone's experiencing food sensitivities, we often put them on a low fodmap diet. And the word diet can feel a little troublesome because it implies it's a long term way of living. Like the Mediterranean diet. This is not, this should only be two weeks and it should just be a couple weeks where you eliminate all of the foods that we know traditionally cause triggers of GI symptom. Each f O D M A P stands for a different food group. And then you eliminate all of that. And then you say, wait, two weeks have gone by. I haven't eaten anything here. Do I feel better? And usually that's, that's very restrictive. Like you're just eating like very, very few types of, like, usually like refined carbohydrates. And if you feel no better than you did before, like, even just like plain pasta still hurts you, then the problem is not really a food intolerance. The problem is something else inherent to your mucosa or the cells in your gut or your enteric nervous system. We need to figure that out better. If you feel a lot better, then the problem is food. And then you systematically can add those foods back in one by one. Give yourself two weeks on that new group. And then you keep a food diary. You work with a registered dietitian and you ask yourself, do I feel a little better? Do I not? Which food is it? And over time, that's how you identify what your food triggers are. It's a long process this is going to take of adding foods back in. And I never like people to do this alone without a dietitian who's working with them. But the low fodmap diet was just, was first written about by Monash University. They developed it, we've been studying it for decades. So it's a really nice system, a lot of research backing it up that can help people. The food sensitivity industry that, that markets these tests that's not based on that kind of valid data. We know that there are molecular reactions that people are having to different kinds of foods. And there's been a lot of studies on that. But that's not what they're tapping into when they're doing these food sensitivity tests. So I think that those can be a big waste of time. And I've rarely met somebody who said that. I got one of these tests and it helped me. Usually they get the test and they're like, help me. I don't understand what to do with this now. And like, what are they testing in those tests? They'll test like, lots of different types of, well, oh, what are they looking for? Yeah, I don't know. It depends. Every company's looking for different things and they'll tell you, oh, we're looking for different antigens, different antibodies and things. It'll all sound very plausible. It'll sound like, yeah, this is what I want. Yeah, it makes total sense. And then there'll be another type of test that will Say, okay, we're going to look at the composition of your microbiome. We're going to look at bacteria that we know grow in response to that changes every day.
- [04:04]
A
Right?
- [04:04]
B
Or every. Yeah. There's like a whole industry out there that responds to people who are desperate for answers with GI symptoms. And that's because as much as our gastrointestinal tracts and our physiology has been well understood, there's also so much. I mean, I think it's like one of the most exciting areas of research. There's also a lot that still either needs to be understood about the microbiome and there's a lot that needs to be translated from what we know to the public. And I think that gap is where, you know, everyone can jump in and make a quick buck. And they do.
- [04:35]
A
It's really sad. Another place I think people are making a big quick buck is by talking about leaky gut.
- [04:42]
B
Oh my gosh. Yes.
- [04:44]
A
So what is leaky gut?
- [04:46]
B
Leaky gut is this word that got hijacked from this concept in GI called increased intestinal permeability. This is something that we study and I'm a neurogastroenterologist, so I studied the gut brain connection. And this is a really old and well described phenomena that throughout our day we have these cells that line our intestines and they're really close together oftentimes. But then there's these different things, even just throughout a normal day that will cause them to open up just a little bit. Those junctions between the cells open up a little food will do it. Just eating stress will do it. People who exercise vigorously, like runners, they get a little bit of so called leaky gut when they go exercising. The problem is that people on social media have taken this term to mean a lot of things that it doesn't really mean. Like, you know, I've seen these videos that are like, do you have bloating? Do you have constipation? Do you have a little brain fog? Sounds like leaky gut. And all three of those things are very common. A lot of people are going to have one of those things. A lot of people are even going to say, yeah, wait, all of those things are me.
- [05:49]
A
Right?
- [05:50]
B
But then there's no, like, you cannot connect the dot necessarily to leaky gut just from those two things. But those are also three things. Bloating. Bloating is one of the hardest symptoms in GI to treat, period. It's also one of the most poorly understood. And people know that they feel that bloating, like they'll get dismissed by providers before brain fog, Incredibly difficult thing to parse out. So when you put all of these vague, nebulous entities together that nobody's given you a good answer for before and someone confidently tells you this is sounds a textbook, like leaky gut, like you want to believe that that could be true and should be true. And there, you know, there's this whole scientific sort of sounding explanation for what that is. It's certainly true that having increased intestinal permeability over the long term is linked to bad health outcomes. We probably know that most strongly from the data between alcohol, which increases intestinal permeability, and liver damage. That is a classic example of leaky gut, that it conventionally caused liver fibro cirrhosis and liver cirrhosis. That's never what people think I'm going to tell them when I talk about leaky gut. Like, nobody's thinking about liver cirrhosis from alcohol use. They want to hear a little bit more about the brain fog and the bloating. And that's a connection that's harder to make because for the most part, with an intact, functioning liver, as I said, all during the day, we have increased intestinal permeability from lots of different exercise.
- [07:14]
A
You said, yeah, exercise, that's a good thing. I mean, exercise is a good thing, so it can't be damaging your gut, right?
- [07:21]
B
Well, that's a kind of a separate conversation, like too vigorous exercise might damage your gut, but for the most part, yeah, it's healthy. In fact, your gut thrives on exercise. Your microbes change. It can help with reduce your risk of colon cancer. For example, usually even when you have these moments where those junctions are not so tight anymore, your liver filters everything that's coming through. And I think people forget that, that what you eat doesn't go directly into your bloodstream. Right. Like, first, it often doesn't make it past that very thick mucus layer that you have to protect you. And then even if it does because it's supposed to or just it has a way of doing that, it's going to get filtered by your liver. So if you have a healthy liver, you don't need to worry so so much about leaky gut necessarily outside of certain medical conditions. But I also will say that the, the flip side of this coin is that when patients come to me worried about leaky gut, they're not actually really worried about the leaky gut part of it. They're really just worried about the underlying symptoms that they're looking for treatment for. They're Looking for help for. And so I think what's important is to find someone who takes those symptoms seriously. Because the goal is not to be like, leaky gut's not real. Goodbye. It's to be like, wait a minute, what could be causing your bloating that we're missing? Is it celiac disease?
- [08:35]
A
Or, like, why did I have leaky gut? What is prompting you to feel that way? Yeah, your doctor should be asking, why? Because sometimes, you know, patients will come to you about something and it may not make sense to you.
- [08:47]
B
Yeah.
- [08:47]
A
Like, it's happened to me all the time, but then I ask why? And then that's when you figure out, like, okay, they're worried about leaky gut because they have this miserable bloating, or they're worried about this because they can't have sex or whatever the situation is.
- [08:59]
B
Right.
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A
And so I think that it's really important, like, if your doctor just dismisses you and says, like, no, you don't. It doesn't. One, not all doctors are really great with people, so maybe that person is not your person. Right.
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B
Yeah.
- [09:11]
A
Maybe you find a different doctor. But two, like, they just. They're like, yeah, it's not a thing. They're not wrong. It's not truly a thing. It's not truly a condition. But, like, it. They're. They don't know what to say. Right. Because they're like, well, I can't fix something that doesn't exist.
- [09:24]
B
Yes.
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A
But the real thing is, like, why do you think. And I think as a patient, you can go in thinking, like, what's making me think I have this condition and lead with that.
- [09:32]
B
Yeah. I think so often it's. So I do this. It's so easy to be like, here are my symptoms. Let me just see what Chat GPT thinks it is. Or let me see what. Like, what's trending on TikTok about these symptoms. And there are a lot of times even something as simple as a patient coming to me saying, I have really bad heartburn, but I've tried everything, and it's not responding, and we might accidentally go down this route of, okay, they have refractory heartburn. They have really bad reflux. But if you were to take a step back and you just say, wait a minute, you came in telling me you have a diagnosis.
- [10:06]
A
What are your symptoms?
- [10:07]
B
What are the symptoms? Let's step back. And then it turns out, you know, you think. You just think it's something, because that's how everyone has always talked about heartburn. You've had pain in your chest, and so you assume it's heartburn, and you're going to use that word, and then your doctor latches onto that word, and everyone. That's the word that gets used. But in reality, maybe that's not what this was the whole time. Maybe you had an ulcer in your stomach all the time.
- [10:28]
A
Guys, in medicine, for people who are listening, when someone writes a note, if you're, like, in a big system, right? Someone writes a note and says you have a condition. If they're incorrect, that may be copied forward in everyone else's note, even if they're in a different specialty, because they just assume that that physician or that provider, whoever saw you knew what they thought it through.
- [10:47]
B
You guys had a conversation, or you
- [10:48]
A
said, this is what I have, and they wrote it down as a past medical history. And so it is really easy for things to get very muddled. And I think always lead with your symptoms. Lead with what? Is the specific thing that's bothering you rather than what you think the diagnosis is, Just because you might miss a real diagnosis that you need.
- [11:07]
B
Totally. Yeah. It's not to try to play dumb for the doctor at all. I think it's just to make sure that we're not missing out. Anything else that could lead us astray.
- [11:14]
A
Yeah, absolutely. I want to talk about your expertise as a gut brain specialist.
- [11:19]
B
Ah.
- [11:20]
A
And I read this about you, that when you were in 10th grade, you had a science project.
- [11:26]
B
Oh, yeah.
- [11:27]
A
Where you were able to determine if people were lying based on gut contractions. So you made, like, a special lie detector test, essentially monitoring gut contractions in 10th grade.
- [11:41]
B
Yeah. Can you tell I was the most popular girl in my high school. Like, how cool I must have been.
- [11:45]
A
First of all, we got to hear how you made this test. And, like, how did you not even look at this?
- [11:51]
B
Yeah. Okay. Well, there's two parts to the story. One was that I'm a theater kid. I was like, a big theater dork in high school. And I know I can even think about this, and I'm going to feel it. When you blow your lines on stage, you get this feeling in your gut that is like. So it feels like this pit that's like this big knot. And I felt it in other scenarios, too. Like, if I was lying to my mom and she knew I would feel it there. And my mom. This is the second part of this backstory here. Is that so she used to work for the FBI. She was not a woman you wanted to lie to. And she used to tell me about lie detector test.
- [12:26]
A
It was a tough house to grow up in.
- [12:27]
B
It was about, like, gastroenterologist, dad, mom, but she was an engineer, she wasn't an agent. But she did talk about lie detector tests a lot. And the thing about the traditional lie detector test is, is one staple of it is an ekg, an electrocardiogram. And so they. They hook your chest up to electrodes, and it measures how fast your heart rate's going. And the idea is that when you're nervous, when you're lying, your heart rate should go faster because you're nervous, even if you look calm on the outside. But people had come up with all kinds of ways to evade the lie detector test. Like, one, you can stay calm when you're like. If you believe you're lying, you can stay calm, and your heart rate might not spike. Or there's actually a classic trick where spies used to, like, step on tacks in their shoes so they would cause them a little bit of pain every time you ask a question, so their heart rate would spike. And because my dad was a gastroenterologist, he was working on this condition called gastroparesis, which is where the stomach doesn't empty correctly. And they used a very similar device to an electrocardiogram called an electrogastrogram, where it measures. You put electrodes on your stomach, and it measures the contractions of your stomach. Your stomach contracts about three times every minute in a pretty regular fashion, just like your heart does. It occurred to me, and this was my, like, wild, genius hypothesis, was that, like, you might be able to control your heart rate or mask it with some of these, like, painful but brilliant techniques with the tack in your shoe. But how and how in the world could you mask that feeling you get in your stomach? And so I had this idea that we could take this electrogastrogram and then try to experimentally get people to lie and see if we could recreate that same feeling. And it turns out that when people are telling the truth, and this is what I measured, it was a small study. It was like more than a dozen people when they're telling the truth. Your stomach does contract at 3 cycles per minute at its sort of baseline. But when you start to tell a lie within a minute, that cycle goes into total chaos. It's this rhythm called arrhythmia, which means we don't have a normal rhythm anymore. And you can see that playing out in real time. And it was really cool. And so that was the project that sent me to the science Fair. And then I still wasn't allowed to sit at the cool kids table, but I did feel really cool in high school. And what it turns out is happening, and this is based on the work of a lot of other people actually at UCLA and other places, is that your brain, when we're nervous, releases this hormone called corticotrophin releasing hormone. And that does a number of different things through your body. Eventually, your heart rate will go up, and maybe you can stabilize it or not. But one thing it does is that this is the thing that tells your stomach you need to stop doing what you're doing. It grinds it to a halt. And that's why the electrical rhythm, we think, goes into that arrhythmia pattern. At the same time, it also sends a signal to the very last part of your colon, saying, we need to speed up, get everything out. Which is why some people, when they're nervous, like, right before they have to go on and they're backstage, they suddenly have to poop. And a lot of people feel that. And it's because you're having these two almost opposing things happen because of this one hormone, which is that your stomach is stopping, but your bowels are trying to empty. And it actually. The evolutionary hypothesis about why this happens actually ties back to leaky gut, which is. But when we're stressed, we also know, through a somewhat different pathway, that we have increased intestinal permeability. And if that's sustained, the hypothesis is that we'd want to empty our bodies of any toxins from our stool that could be hanging out in there just to minimize the risk of them coming through. And so that's why we try to empty and then also not prevent things from coming in. What it means for you is that you might experience a sensation of, like, butterflies in your stomach. You might think that that's what that is, and that has some, like, magical feeling to it. But actually, it's just the same thing. It's actually a very similar feeling to what you might feel when you're stressed for other reasons. But it's interesting because it gives us a good sense of how powerfully our brains influence our gut. And that's half the field of neurogastroenterology, is the ways in which just thinking. There's almost no other organ. You can tell me if you disagree, but there's almost no other organ where just your thoughts can induce such strong changes in what that other organ is going to do. Right? Like the first phase of digestion is the cephalic phase in your head, like, just thinking about food, thinking about this. For me, it would be this, like, nice, cheesy fettuccine Alfredo. I could picture that. I could picture the cheese and I would start salivating. And not only would I start salivating, but unbeknownst to me, my pancreas would start to produce more insulin. Just because I'm thinking about food. There's almost no other organ that. That is so deeply controlled by the brain and that you can change what it's doing. The interesting thing about my field, and I think, which is why I wanted to go into it, is that all of this that I've described about stress and how the brain influences the gut is really cool. And it's how we thought about it for several decades. But in the last 20, 30 years or so, people are thinking more and more about how the gut influences the brain. And that's, I think, the exciting part of the field is like, all of the different ways that the gut is communicating up with the brain. Because 90% of the signaling through the vagus nerve, which is this big highway through which the gut and the brain talk, most of that 90% is coming from the gut upwards, not the brain downwards. And so my lab, we study Parkinson's disease. A lot of people when I say that, are like, why is a gastroenterologist studying Parkinson's disease of all things? But it's because we have this very nicely supported hypothesis that something like Parkinson's disease, a disease that we think of as being in the brain, actually could start in the gut. And we're trying to figure out how.
- [17:52]
A
I saw that, that you actually published recently a paper in jama.
- [17:55]
B
Yeah, thank you.
- [17:56]
A
Parkinson's disease and how upper GI mucosal damage were correlated. And this blew my mind because I take care of Parkinson's patients all the time.
- [18:05]
B
Yes, I'm sure you Dr. Neurourologist.
- [18:07]
A
So I take care of those patients all the time. And it is shocking to me to think that something that we so firmly believe begins in the brain actually might have. It may be a correlation, but it may be a causation. We don't know. Right from the GI tract. That's crazy.
- [18:26]
B
Yeah. I think we had thought about Parkinson's as a brain first disease, just as we do so many other neurological disorders. But, you know, I think the other part of this that people don't remember sometimes, or maybe you've never heard, is that, yeah, you have this very sophisticated brain in your head, your central nervous system, but you have a huge network of Neurons in your gut, your enteric nervous system, that is its own brain, like, it operates, it can operate completely independently. But if you. You've seen people in the hospital. I have. Who are brain dead, but they're alive and they're, you know, they're functioning because their enteric nervous system is intact and. And they can be supported with breathing tubes even though the brain in their heads is not working. And so the gut is a lot more sophisticated than I think we give it credit for. It's like, not just this plumbing or a bunch of tubes that move things from point A to point B. If you think about it as a brain, then you can think about all of these neurological disorders, which we know. Yeah, they are in the brain, in the head. But that brain in your head is in close contact with this other network down here. And certainly they have to impact one another. And we see that in Parkinson's. The hallmark of Parkinson's is this misfolded protein called alpha synuclein. And we know if we looked at the brains of patients with Parkinson's disease, we'd see that misfolded protein build up in this part of the brain called the substantia nigra, where the dopamine neurons seem to be destroyed and die off because of this misfolded protein. Well, if you also do autopsies of patients with Parkinson's disease, it turns out that their guts are riddled with that misfolded alpha synuclein protein. And what we think happens is that some trigger occurs, and we're trying to figure out what that is. And it's probably different things for different people. Maybe it's damage like I found in my paper to the surface, like an ulcer, like an erosion, something that causes a little bit of microscopic bleeding. Maybe it's that. Maybe it's an infection. Maybe it's some chemical. We've talked about pesticides a lot with Parkinson's disease. Maybe it's something like that in our environment. But it enters the gut first and it starts this cascade where then that protein starts to misfold and it travels up the vagus nerve and eventually it reaches the brain. But that inciting event will have happened years, if not decades, before it hits the brain. And what's exciting about that, in a way, is that it means there's this window of opportunity where maybe we could stop it in its tracks or we could halt it, or we could maybe even just catch it early. And if we were to do that, could we start to treat it early, too?
- [20:46]
A
Yeah. Well, some of this makes Some sense to me, because one, we look at every sort of metabolic outcome, every sort of bad thing that can happen in your body, and it's all correlated with diet, which essentially has to go through your GI system. Right. Has to be absorbed and managed and all those things. And that's the first place it goes before the bloodstream, before everything else.
- [21:08]
B
Right.
- [21:09]
A
The first place it sees. So it would make sense that your upper GI tract would be the first place you're going to see issues before you see it anywhere else.
- [21:17]
B
Yeah, I mean, I'm with you. And I think that thinking about, you know, my laboratory having started to look at Parkinson's in the last few years, and then also all this data about early onset colorectal cancer, it really makes you appreciate how what you do to your body a lot earlier than you're giving yourself credit for. Like, Parkinson's is not a disease of older people. We're learning that all of these things happen when you're younger, and they build up over time. And a lot of it has to do with what we eat. And even colorectal cancer. It's like you don't just wake up one day with cancer. Right. It's like, based on these patterns, a. A lot of it is related to how we eat that start when we're so much younger. And it's made me change a lot about. I mean, I'm relatively young, in my 30s, but even then I think a lot. And I've changed how I behave because I'm thinking about the fact that Parkinson's, cancer, these are not just things that will affect me later on. A lot of it is determined by what I'm doing today. And I think a lot of people in their 20s, I see a lot of college students in my practice, but a lot of younger people, I think, feel like that's a time in their lives when they're immortal and they'll start to do the work when they get a little older and when they need to. But the work really starts when you're much younger than I think you appreciate.
- [22:30]
A
Yeah, I think there's probably. I mean, this is a theory, but I think that probably you are protected when you're younger. Younger, and your body's pretty resilient. But as you start aging, I think it starts 30s and 40s. I think you really don't have a choice but to make your choice. And obviously, the younger you start, the better you are. But I suspect that there's probably some protection in younger age. But I don't know. That's just a theory. Let's just talk a little bit about psychological health because I think that's another issue. And you've mentioned there's this beautiful connection between the brain and the gut. How is our psychological health affecting our gut and vice versa.
- [23:06]
B
Yeah, they're closely, closely connected. And sometimes people will come in for just one or the other issue because the other one is the thing that embarrasses them. Most GI symptoms are hard enough to talk about, but mental health is actually also incredibly hard to talk about and their vicious cycle. Like for example, people who have irritable bowel syndrome, which is one of the most common conditions in gi. It's like one of the most common neurogastroenterological conditions. They have very high rates of anxiety and depression. And because clinically, the way we define irritable bowel syndrome is a diagnosis of exclusion. Meaning we've done all these tests, all the tests are negative. So it has to be irritable bowel syndrome. It really can feel like the problem is non existent, that it's all in your head, because yeah, you are stressed. And we know there are these studies, I've done one of them. But there are lots of studies that show that stress causes GI symptoms, causes changes in your gut. That I think a lot of providers, sometimes when somebody comes in with chronic diarrhea or chronic constipation, different GI symptoms, they'll say the answer for you is an anti anxiety medicine, or maybe it's mental health treatment. And that's often part of the answer. People often need that and they will find their symptoms get better. But there's this other half of this equation which is that many mental health problems and more than we're appreciating can start in the gut. And we actually have several studies that have identified some of those cellular and molecular abnormalities. For example, we know that when somebody experiences trauma early in life, the neurons in your gut will rewire. It's not just the neurons in your brain. We certainly know childhood trauma is linked to depression and anxiety later in life, but it actually is, it turns out it's linked to the neurons in your gut reacting at a much lower threshold than for people who haven't been traumatized. So it'll take a lot less to trigger those neurons to send pain signals up to your brain. And so sometimes people, for example, will come in with this long list of food intolerance. So they'll say, what is it about what I'm eating? And it's actually not something inherent to the food that is triggering your symptoms. It's something inherent to the neurons. The neurons are just reacting at a lower level. And that can certainly, if you're living your whole life with this system that's constantly firing that nobody else can see, certainly that's going to fuel your anxiety as it would for anyone else. And so it sometimes hard to separate, well, what came first, the chicken or the egg. But I think what I hope people appreciate is that sometimes the treatment involves medications or therapies that are directed at the brain in our head, but we actually have a lot of therapies that are just directed at the gut. And sometimes those actually sound like antidepressants. Like we in gi, we use SNRI medications, we use tricyclic antidepressants. Not because we think we're trying to treat your depression per se, or we're not actually trying to get to. It's like great if we do and you need that. But those medications that sound like antidepressants were developed to help do the same things we want to do to the enteric nervous system and they can help rewire those over the long term. So we need to have louder conversations about both of these two issues. But I also think if, you know, if you've been told that there's nothing wrong with your gut and you have gut symptoms and we don't have any way of treating this directly, it might be worth getting a second opinion too, because there's this whole other half of that conversation.
- [26:43]
A
Yeah, it's a very common issue and I see it. We see. So when I learned about something called interstitial cystitis, which is a inflammatory diet, it's sort of a diagnosis of occlusion as well. Very similar pain symptoms of the bladder that persist for long periods of time. What I was taught is sort of, it's part of the central sensitization syndrome, right? Where they, you might have like five or six diagnoses. You've got fibromyalgia, interstitial ibs, migraines, restless leg syndrome, whatever it is. And they all are actually just one thing, right? They're all sort of a issue with the way your body perceives stimuli that are normally non toxic, right. Like it could be someone just rubbed your arm and that's painful, or someone you had a bowel movement or you ate and that's painful, or you drank something and now your bladder hurts. Right. Whereas normally that wouldn't be painful. But because you've been, your nerves have changed. It's actually sort of causing these multiple diagnoses.
- [27:44]
B
Yeah. I love that you bring all of that together and you can't. None of those are easy to diagnose on simple tasks. Like, you know, to be clear, when we do colonoscopies, we're not. We shouldn't usually ever get to the level of the myenteric plexus, which is this deep network of nerves in the gut, because it's in the muscle layer. We're just like, when we get a biopsy on a colonoscopy, we're getting, like, a little bit off the top surface layer. And that's not the way to make these diagnoses. And so I think a lot like fibromyalgia, you'll get a couple of these different diagnoses, and it'll just feel like there's nothing wrong because there's no formal lab abnormality, but, you know, it's there. It's just hard to actually get deep enough to look.
- [28:26]
A
Yeah, you can't really look at the nerves under a microscope.
- [28:28]
B
Yeah, not unless we were to poke a real hole.
- [28:30]
A
If you like guys like that clip with Dr. Trisha Pasrija, check out the full episode right here.