"A Microbial Vision: The Art Of Science" Cover Art by Dr. Gael McGill by Physician Outlook Magazine

VOLUME 3 | 2021 2021: THE YEAR WE OVERCOME

WWW.PHYSICIANOUTLOOK.COM PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS

Cover Art Created by Scientists and Visualization Artists Evan Ingersoll and Gaël McGill, inspired by the work of David Goodsell

IMAGE CREDIT: DIGIZYME EVA N IN GERSOLL A N D GA ËL MCGILL, IN SP IRED BY THE WORK OF DAVID GOODSE LL

F R O M T H E P U B LIS H ER

A Microbial Vision THE ART OF SCIENCE

Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.

he inspiration behind this month’s issue is two-fold. First and foremost, we introduce you to the microbiome and our esteemed colleagues--affectionately known as “The Biome Squad”--who investigate the makeup of our biomes in the context of disease prevention and treatment. Disease may begin in the gut, but these medical mystery solvers are up to their eyeballs in sh!t. Literally! Learn about life-changing research as presented in the recent Malibu Microbiome Conference and highlighted in this month’s The Humans of Medicine section of Physician Outlook. The Squad will educate and guide you on findings from recent fecal microbial transplant research and new technologies. What if the key to health and longevity doesn’t come in a pill? What if the prescription drugs and supplements that so many of us have come to rely on are actually doing more harm than good? From autism to Alzheimers to cancer and COVID-19, the research is too compelling to ignore. Now for the flip side - as you know, I am a Medical Doctor by training with a deep admiration for art, beauty and sci2 | 2 0 2 1 VO LU M E 3

ence. I have no innate artistic talent myself, but I am forever drawn to and mesmerized by colleagues in healthcare who have reclaimed their souls through art. This month’s cover is graced by the striking beauty and order of the eukaryotic cell that literally went “viral” in the Fall of 2020 and inspired awe in everyone who encountered it on their social media feed. Dr. Gaël McGill, molecular biologist, is the founder and CEO of DigizymeTM, and together with artist David Goodsell, they created a 3D rendering of the eukaryotic cell common to animals, plants, fungi, and protozoa. The masterpiece was created on behalf of Digizyme’s client Cell Signaling Technology, Inc. Using a myriad of radiographic techniques including plain x-ray, nuclear magnetic resonance imaging, and cryo-electron microscopy they attempt to represent the many actors and the roles they play in the living cell. (For more on Dr. McGill see The Artist of Science, by Skylar Steinberg, a gifted pre-med student turned artist/creator.) Art, science and research are inexorably intertwined. Imagine the biologically accurate artistry of Digizyme enabling

Cellular landscape by Evan Ingersoll & Gaël McGill, Ph.D. using Molecular Maya (Digizyme Inc.)

reated for Cell Signaling Technology, Inc., and inspired by the stunning art of David Goodsell, this 3D rendering of a eukaryotic cell is modeled using X-ray, nuclear magnetic resonance (NMR), and cryo-electron microscopy datasets for all of its molecular actors. It is an attempt to recapitulate the myriad pathways involved in signal transduction, protein synthesis, endocytosis, vesicular transport, cell-cell adhesion, apoptosis, and other processes. Although dilute in its concentration relative to a real cell, this rendering is also an attempt to visualize the great complexity and beauty of the cell’s molecular choreography. Interactive versions of parts of this landscape can be explored at http:// w w w.digizyme.com/cst_landscapes. html.

The Biome Squad to unravel microbial microbiome mysteries - the poopsabilities are endless! 1 Dr. Marlene Wüst-Smith Publisher

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Table Of Contents FROM THE PUBLISHER

A Microbial Vision: The Art Of Science by Marlene Wust-Smith, MD/p.2 THE HUMANS IN MEDICINE

Microbiome Signature, by Kimberly Rivers/p.6 THE BIOME SQUAD Dr. Thomas Borody Dr. Neil Stollman Dr. Alexander Khoruts Dr. Scott Jackson Dr. Colleen Kelly Dr. YingHong “Mimi” Wang Dr. Paul Feuerstadt Dr. Andreas Papoutsis Dr. Salil Khanna by Alyssa Dean/p.9 THE DOCTOR’S BAG

The Artist Of Science, by Skylar Steinberg/p.22 Hyperinflation Thrives: In The Shadows Of American Healthcare by Marion Mass, M.D./p.26 The Potential Effects Of Dieting On The Microbiome, by Trish Craparotta/p.30 Drug Addiction and the Gut, by JR Hill/p.32 PLEASURES AND PASTIMES

The Energy Paradox - A Book Review, by Jennifer Nottell/p.36 Shrimp Scampi Over Cauliflower Risotto, by Alicia Roselli/p.38 Cover Art Created by Scientists and Visualization Artists Evan Ingersoll and Gaël McGill, inspired by the work of David Goodsell

WWW.PHYSICIANO U T LOOK . C OM | 5

P HOTO C RE DIT: DR. SA BIN E H AZA N

T H E H U MAN S O F M ED IC IN E

Microbiome Signature TREATING COVID-19 THROUGH THE GUT WITH THE QUEEN OF

Wri t t en by K i mberl y Ri v ers

t is commonly understood that individuals metabolize medications differently based on gender, weight, age and overall health. This means that a drug being tested will work differently based on those traits. But another physiological trait of a person is currently being left out of all clinical trials, creating a flaw in how trials are done: the gut microbiome. Double blind, placebo, randomized trials are used by the U.S. Food and Drug Administration (FDA) to test the safety and efficacy of new drugs and treatments. But without tracking the gut microbiome of trial participants, the findings don’t tell the whole picture. 6 | 2 0 2 1 VO LU M E 3

“The trials are not truly valid, until we can measure the immunity of gut flora of the patients,” said Dr. Sabine Hazan, a medical doctor, specializing in gastroenterology, internal medicine and hepatology. Her experience includes over 150 FDA authorized clinical trials on pharmaceutical products and 42 self sponsored trials on the microbiome. A trial participant “with a great gut, compared to a person with a gut like a trainwreck cannot be compared. It’s apples and oranges.” Hazan is the CEO and founder of Ventura Clinical Trials and Progenabiome, and she was on the panel of speakers for the March 2021 Malibu Microbiome Meeting that brought together

doctors and researchers to examine the role healthy gut flora play in immunity and health. She spoke about her work and the three active FDA-approved trials on prophylaxis and early treatment protocols for COVID-19. Microbiome signature Early on in the pandemic Hazan and her team identified the full COVID-19 genome in the gut of people who were testing positive(1). This was of particular interest because it confirmed what Hazan expected, that the virus was actively replicating in the gut of those infected and it meant treatment and prevention protocols needed to focus on the gut.

P HOTO C RE DIT: DR. SA BIN E H AZA N

Dr. Sabine Hazan and Dr. Paul Feuderstadt

Just like a person’s DNA, the gut flora of an individual not only tells the story of that person’s state of health, it also holds the key to the immune system and how the person will respond to treatment. Hazan points out that double blind, randomized, placebo trials don’t take into account the individuality of the microbiome. Currently, FDA clinical trials do not have a mechanism for creating different cohorts based on the microbiome, Dr. Hazan Knows her Sh!T... microbiome diversity (or lack there of) may be the key to identifying those most at risk from COVID-19

something Hazan says is key to truly understanding how the human body is responding to illness, including the SARSCoV-19 virus and any treatment. Among the trial participants “The microbiome is not at the same level.” She points out that a placebo given to a person with a healthy gut may be able to hold off a serious COVID infection, whereas a one with a compromised microbiome would be susceptible. She says in her current trials she is “seeing problems in the placebo group. However, it’s not a fair measure.” Because they are unable to do a full genomic sequence of every trial participant’s microbiome, which would allow a true evaluation “of their immune system,” to see

their unique gut signature and without seeing what is going on in the gut, a researcher only has part of the information about how the drug is working. One person she treated, a medical director at a community hospital with a busy medical practice,“super stressed, a high intense person,” just that kind of lifestyle “kills his good bacteria.” He required a certain protocol, whereas his wife, “who is a gardener, and plays in the dirt, is at peace and not stressed...They have different gut microbiomes and different [treatment] results.” “Clinical trials, in my opinion, should be designed in a different way.” Hazan said the current method, placebo controlled, is “putting patients at risk, it WWW.PHYSICIANO U T LOOK . C OM | 7

(from left to right Dr. Jessica Allegretti, Dr. Colleen Kelly, Dr. Stacy Kahn, Dr. Sabine Hazan

should be done with an open label. I really don’t think placebo control is the best method to analyze this ... everyone is different.” And that difference needs to be part of the research. The health of a person’s gut microbiome can be determined and ranked, with that information being a rubric used along with gender and age in the trial results. The current FDA trial requirements are “based on the old methods of doing research,” we need to “be changing those methods. I believe we cannot compare two groups unless we first understand the gut.” She hopes her trials will demonstrate to the FDA the importance of considering the state of a person’s immune system, by assessing the state of the gut microbiome, in determining effective treatments for illnesses across the board. She points to cases where one family member did not contract COVID while the entire family tested positive. In that family, one person got very very sick. Others experienced symptoms barely worse than a common cold but one person remained negative and asymptomatic the whole time he was exposed to his family who were positive for Covid 19. The person who didn’t contract COVID went to the same party where his wife contracted the virus. He was around her and 30 people who all con8 | 2 0 2 1 VO LU M E 3

PHOTO C REDIT: DR. SA BIN E HAZA N

“In our aim to protect the patient we have lost the patient”

tracted the infection for a few days yet he never contracted the virus. Why? Hazan says it’s likely that he has a “super good microbiome, his gut immunity is stronger. This is the basis of my research. Understanding what makes his microbiome able to be in a party with COVID. Sleeping in the same bed with his wife, who had COVID...and he never gets contaminated, compared to someone else who gets it after a short exposure.” She believes that a person’s “microbiome signature” is what protects them from contracting, getting seriously ill, dying from or surviving SARS-CoV-2. “We are testing everyone’s microbiome before and after. So when we look at the placebo group we can get at the question of why did this person crash? Was there something in the microbiome?” Keeping doctors independent Hazan’s research is self funded. Ventura Clinical Trials does not have the backing of any pharmaceutical company or foundation for the work they are doing related to COVID. Separate from those who are participating in the trials, Hazan is treating hundreds of patients off-label with treatment protocols that may include hydroxychloroquine and Ivermectin, azithromycin, doxycycline, along with vitamins C, D and Zinc.

Many of the patients coming to her for treatment were unable to get treatment from local doctors or hospitals. Hazan is seeing strong pushback from hospitals due to the off-label use of these medications, even though they have been in use for decades, treating thousands of people safely for other illnesses. A major hurdle in getting early treatment to patients is the lack of local doctors understanding the approach. “I’m trying to shake them up. By the time the treatment protocols being tested today are accepted guidelines, it will be two, three, five years. Maybe COVID will disappear by then, maybe it will become stronger.” She says that many doctors are hamstrung by the “guidelines. They are not practicing the art of medicine, they are practicing the guidelines. Maybe that saves you from a lawsuit, but it doesn’t save the patient.” Hazan and other doctors around the country are comfortable treating patients off-label, at home and early on for COVID. “In our aim to protect the patient we have lost the patient,” and the tendency of “not trying new treatment options allows for death of the patients. Ultimately, if we do not try and we don’t push we’ll never find answers.” The answers are within us and we must be brave enough to try for the sake of the patients but for the sake of survival of humanity. The “right to try” (when patients are begging for investigative products) is an integral part of medicine and one that remains part of the patient-doctor relationship but also part of informed consent. Informed consent protects the patients and the doctor and allows for investigative products to be attempted in a new virus that has killed hundreds of thousands of people. 1 Visit us online at www.PhysicianOutlook.com to read about the Billings and Hassham families’ experience with outpatient COVID-19 treatment

T H E H U MAN S O F M ED IC IN E

The Biome Squad Wri t t en by A l y ssa D ea n

his issue of Physician Outlook highlights just some of the exciting research that was presented at the historic and exclusive Malibu Micro-

biome Meeting in March of 2021, which brought together pioneering leaders from across the globe in the vast burgeoning field of Gut Microbiome Science. The study of the human intestinal microbiome and the role that it plays in medicine is in its infancy. It is truly the next frontier of medicine.

We as physicians spend many years mastering the principles of basic science before we are granted the privilege of practicing medicine. Understanding the complexity of the microbiome requires a solid understanding of the fields of both cellular and molecular biology, and it is only fitting that we begin our journey at the very beginning, at the very core of basic science: the cell, the basic membrane-bound entity that houses the fundamental molecules from which ALL living things are composed. WWW.PHYSICIANO U T LOOK . C OM | 9

T HE HU MA N S OF MED I C I N E

Father Of FMT THE MAN FROM DOWN UNDER WHO FIRST HAD SUCCESS WITH THE FECAL MICROBIAL TRANSPLANT..... Thomas Borody, M.D. The CRAPsuleTM

r. Thomas Borody completed his BSc(Med) and later MBBS graduating in 1974 from the University of New South Wales in Sydney, Australia. He then completed his MD by thesis at the Garvan Institute of Medical Research and University of Sydney School of Veterinary Science. After having spent 3 years in clinical research at the Mayo Clinic, Rochester, Minnesota mentored by the late Sid Phillips, he gained his PhD at the University of Newcastle and his DSc at University of Technology. Given this rigorous background, Dr. Borody established the Centre for Digestive Diseases (CDD) in Sydney, Australia in 1984 and has overseen its growth into an active clinical research institute overseeing treatments for around 10,000 patients per year. As Dr. Borody’s interests focus on solving clinical problems by developing novel treatments often infection-associated, his first patented and effective treatment was the Triple Therapy which cured H. pylori. He then went on to develop a Crohn’s disease

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triple anti-Mycobacterium treatment (AMAT) which completed two successful pivotal trials, and in a paper just published, individualized antibiotic treatment followed by microbiome restoration achieved Crohn’s disease cure for the first time. To date, the CDD has completed over 30,000 FMT treatments, naming Dr. Borody the ‘Father of FMT’ -likely the most experienced in the world. Among emerging new treatments that involve the microbiome, Borody has developed an oral capsule of filtered, freeze-dried donor fecal microbiota, also known as the Crapsule™. In a joint venture with Finch Therapeutics, these refined lyophilised FMT capsules are approaching FDA approval for treatment of C. difficile infection and Autism Spectrum Disorder as a novel indication contingent on trials. At the Malibu Microbiome Meeting, Dr. Borody discussed how FMT is being applied to treat other conditions beyond C. diff focusing on Crohn’s disease and neurological conditions. 1

From left to right: Dr. Thomas Borody, Dr. Sabine Hazan, Dr. Neil Stollman WWW.PHYSICIANOU T LOOK . C OM | 11

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P HOTO C REDIT E A ST BAYGI_COM

GI Expert A GUY WHO KNOWS HIS SH!T, ALL THE WAY FROM NEW YORK TO NORTHERN CALIFORNIA Dr. Neil Stollman

r. Neil Stollman received his medical degree from the New York University School of Medicine, completed his residencies in Internal Medicine at The College of Physicians and Surgeons of Columbia University, and fellowships in Gastroenterology and Advanced Therapeutic Endoscopy at Jackson Memorial Hospital and the University of Miami School of Medicine. Today, Dr. Stollman serves as an Associate Clinical Professor of Medicine at UCSF and Chief of the Division of Gastroenterology at Alta Bates Summit Medical Center in Oakland, CA. Also the Director of the East Bay Center for Digestive Health Research Center, Dr. Stollman conducts and publishes clinical research that can be

The Pharm-er ROOTING A NEW BRANCH OF MEDICINE Dr. Alexander Khoruts

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r. Alexander Khoruts is a physician-scientist with a background in immunology and clinical specialty in gastroenterology. A product of the University of Minnesota, Dr. Khoruts was a Howard Hughes Physician Fellow whose early research focused on basic biology of T cells and autoimmunity, but subsequently has redirected his efforts into development of microbiota-based therapeutics. Now serving as the Medical Director of the University of Minnesota Microbiota Therapeutics Program, Dr. Khoruts is leading the only academic institution that manufactures microbiota-based products under the current good manufacturing practice regulations enforced by the FDA. With an objective

identified in various journals such as The Lancet and The American Journal of Gastroenterology. As a recognized expert, Dr. Stollman has a comprehensive background in treatments of C. Difficile and Fecal Microbiota Transplant (FMT), diverticular disease, H pylori infection, acid ref lux disease, GI bleeding, microscopic colitis, eosinophilic esophagitis, and Barrett’s esophagus. At the Microbiome Meeting, Dr. Stollman introduced and explained the fundamentals of the human gut microbiome and its role in health, FMT as the proof-of-concept for bacteriotherapy, and gave insight on an emerging therapy that can positively influence a baby’s microbiome. 1

to develop the ‘pharmacology’ of microbiota-based therapeutics, Dr. Khoruts works to root this new branch of medicine by supporting clinical trials for a variety of potential indications in collaboration with investigators across the US. At the Microbiome Meeting, Dr. Khoruts explored the impact of regulatory policies on the future of fecal microbiota transplantation and addressed how the FDA’s approval process impacts patients, research, and innovation in the field of health and science. Ultimately, his presentation explored the challenges in doing research to develop and make available the next-generation microbiota therapeutics and identified how we can help move this new branch of medicine forward. 1

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Standards Seeker MAKING MOVES IN MEASURING ‘MAGIC POOP’ Scott Jackson, PhD

pon completing his PhD research at the University of Maryland and Johns Hopkins University, Scott Jackson served 11 years as a principal investigator with the FDA. Now serving at the National Institute of Standards and Technology (NIST), Jackson leads the Complex Microbial Systems Group in the Biosystems and Biomaterials Division where he is dedicated to measurement research in emerging bioscience areas, including the microbiome. Jackson plays a vital role in improving measurement tools and reference materi-

Gastro Girl SHIFTING TREATMENT PARADIGMS FOR PATIENTS WHO SUFFER FROM DIGESTIVE DISEASES Dr. Colleen Kelly

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r. Colleen Kelly is a gastroenterologist in the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative. She is an assistant professor of medicine at The Warren Alpert Medical School of Brown University and a faculty member in the fellowship pathway in women’s gastrointestinal diseases at Alpert Medical School. Dr. Kelly’s passion for the microbiota and fecal matter transplant (FMT) has contributed to a shift in the treatment paradigm for patients who suffer from digestive diseases like recurrent C. diff, Irritable Bowel Syndrome (IBS)and Inflammatory Bowel Disease (IBD), naming her”Gastro Girl.” As the first in the Microbiome Movement to get an Investigational New Drug (IND) approval from the FDA for FMT, and the NIH

als that aid in analyzing microbiome DNA. At the Microbiome Meeting, Jackson described the importance of developing products and standards for microbiome research, and presented a 2020 pilot study that found storing and preservation methods to have impact on the biological attributes of the fecal material stored for FMTs. Additionally, he gave insight to this technology by exploring the challenges associated with the measurement of SARS-CoV-2 in human stool and wastewater. 1

to fund a randomized clinical trial, she has also collaborated on several studies investigating the impact of FMT on patients with IBD, Nonalcoholic Fatty Liver Disease, and Alopecia Areata. With a major interest on in the long-term effects around the manipulation of gut microbiota, Dr. Kelly serves as the primary author for the forthcoming American College of Gastroenterology (ACG) 2019 C. difficile treatment guidelines. Additionally, she is one of the primary investigators for an NIH-funded FMT National Registry, which will answer important questions around the safety of FMT. At the Microbiome Meeting, Dr. Kelly reviewed evidence from randomized controlled trials and described the efficacy and safety of FMT in C. difficile infection. 1

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REVITALIZING CANCER TREATMENT WITH THE MICROBIOME Dr. “Mimi” Wang

r. Yinghong Wang has a strong academic background and profound clinical experience from world renowned medical programs of Johns Hopkins and Cleveland Clinic. She possesses extensive experience taking care of patients with complex Crohn’s Disease and Ulcerative Colitis and has been recognized for her expertise in managing cancer immunotherapy induced GI toxicities. She also plays a major role in developing management guidelines for immunotherapy induced colitis and works on building a detailed management algorithm at the institutional level. Dr. Wang and her team have achieved a new breakthrough of successful treatment for immunotherapy

Professor GI EDUCATING THE NEXT GENERATION ON MICROBIOME-BASED THERAPIES Follow Dr. Feuerstadt on Twitter at @DrPaulGastro and on his website www.everythingcdifficile.com.

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r. Paul Feuerstadt attended the University of Pennsylvania where he earned his Bachelor of Arts degree graduating summa cum laude. He attended the Weill Medical College of Cornell University in New York where he earned his medical doctor degree and stayed at New York Presbyterian Hospital for his residency in internal medicine. His clinical gastroenterology training was completed at Montefiore Medical Center in the Bronx, New York. Dr. Feuerstadt has been involved in research focusing on fecal microbiota transplantation (FMT), C. difficile infection, irritable bowel syndrome

induced colitis refractory to immunosuppressant by fecal microbiota transplant. The initiative Dr. Wang has taken in setting up an IBD clinic and FMT service available to patients is identical to that of a pioneer, putting Dr. Wang as one of the leading ladies in the Microbiome Movement. With her specializing in areas such as Inflammatory Bowel Disease (IBD), fecal microbiota transplantation (FMT), and cancer immunotherapy induced gastrointestinal toxicities, Dr. Wang described how gut microorganisms impact the outcome of cancer and cancer therapy related gastrointestinal complications, and how microbial manipulation may transform patient care. 1

(IBS) and ischemic bowel disorders. While he is an author and co-author of many manuscripts and textbook chapters, Dr. Feurerstadt can frequently be found educating and mentoring medical students, residents and fellows in the realm of research at the Divisionof Digestive Disease at Yale-New Haven Hospital where he serves as the Assistant Clinical Professor of Medicine. At the Microbiome Meeting, Dr. Feuerstadt described the unique challenges to conducting clinical trials of microbiome-based therapies in C. difficile infections. 1

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HEALING PATIENTS BY DISCOVERING THE POWER OF THE GUT FLORA (MICROBIOME)

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Not-SoTraditionalist AN ADVOCATE OF MAINTAINING TRADITION IN PRACTICE TO EVOLVE NEW THERAPIES

r. Faming Zhang is a doctor, Vice Chief, and researcher at the Institute for Digestive Endoscopy & Medical Center for Digestive Diseases at The Second Affiliated Hospital of Nanjing Medical University in Nanjing, China. He is also the Director of Intestinal Diseases whose perspective on the microbiome and disease is unique, taking on a holistic approach that most Western physicians do not consider. In a recent study, Dr. Zhang saw potential to utilize Traditional Chinese Medicine (TCM) philosophy and concluded that it was a helpful outlook to deeply investigate the complex ecosystem of gut microbiota.

Dr. Zhang believes that standardized procedures will move FMT into mainstream medicine, thus he’s developed a clinical f low for FMT procedures as well as an automatic system--GenFMTer, that auto-purifies isolated microbiota from the stool. His contribution to move microbiome procedures like FMT into the mainstream is simple, but necessary for standard of care practices. At the Microbiome Meeting,Dr. Zhang described the latest progress on methodology, safety, and benefits related to FMT in conditions beyond C. diff infection. 1

Super Dad RAISING HOPES FOR FAMILY, FRIENDS AND THOSE WITH AUTISM James Adams, PhD

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lthough an engineering professor, Dr. James B. Adams’ motivation to research autism spectrum disorders (ASD) began with the intention to understand and help his daughter, who was diagnosed with ASD at age 2.5. Today, Dr. Adams currently serves as the Director of the Autism/Asperger’s Research Program at Arizona State University. His research focuses on the medical causes of autism, how to treat and prevent as well as the areas of nutrition, oxidative stress, gut problems, gut bacteria, toxic metals, and seizures. In addition to having over 150 peer-reviewed articles published, with 50 of them being related to ASDs, Dr. Adams also serves as the President of the Autism Society of Greater Phoenix, President of the Autism Nutrition Research Center, is the co-leader of the Scientific Advisory Committee of the Autism Research Institute, and chairman of the Scientific Advisory Board of the Neurological Health Foundation.

Recently, Dr. Adams and his collaborators Profs. Rosa Krajmanik-Brown and Dae-Wook Kang have demonstrated long-term beneficial effects for children diagnosed with ASD through a revolutionary technique known as Microbiota Transfer Therapy (MTT), originally pioneered by Australian Gastroenterologist, Dr. Thomas Borody for children with ASD with gastrointestinal disorders. Remarkably, they found that two years after treatment stopped there was a 59% improvement in gut symptoms and a 47% improvement in ASD symptoms compared to pre-treatment. Dr. Adams and colleagues are inspirationally breaking ground in autism research, and are raising new hope for the family and friends of an entire population that goes underserved. At the Microbiome Meeting, Dr. Adams dove deeper on the topic of Microbiota Transplant for Autism and reviewed a phase 1 clinical trial of MTT in children with autism. 1

PHOTO CREDIT: JAMES ADAMS

Dr. Faming Zhang

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MICROBIOTA TRANSPLANT FOR CHILDREN WITH AUTISM Imagine moving from a diagnosis of “severe” autism to no longer meeting the criteria for autism spectrum disorder (ASD). The recently completed Microbiota Transplant Therapy (MTT) Phase 1 study indicates such results are possible and sustainable.

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T H E H U MAN S O F M ED IC IN E

Dr. Unknown THE MAN BREAKING GROUND BEHIND CLOSED DOORS Andreas Papoutsis, PhD

ndreas Papoutsis is a bioinformatics scientist with extensive experience in oversight and execution of molecular clinical trial testing with rigorous quality systems programs. He has a deep understanding of methodologies and data analysis focusing on the human genome and microbiome profiling. Dr. Papoutsis has researched and investigated new technologies for the analysis of genes associated with various types of cancer and is currently working with next generation sequencing technology to analyze and identify

GI’s Tour-Guide

GUIDING PROFESSIONALS AND PATIENTS FROM DIAGNOSIS TO TREATMENT ON COMMON DIGESTIVE ISSUES

Dr. Sahil Khanna

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r. Sahil Khanna completed medical school at the All India Institute of Medical Sciences in New Delhi followed by Post-Doctoral Research at University of California San Diego, CA. Upon completion of his Masters in Clinical and Translational Sciences at the Mayo Clinic in Rochester, MN he now serves an Associate Professor of Medicine in the Division of Gastroenterology and Hepatology and directs the Comprehensive Gastroenterology Interest group, C. difficile Clinic, Fecal Microbiota Transplantation program, and C. difficile related clinical trials. Dr. Khanna’s clinical interests include epidemiology and emerging therapeutics for C. difficile infection. He has contributed increasing awareness of the

pathogens like SARS-COV-2 in stool samples. At the Malibu Microbiome Meeting Dr. Papoutsis presented on the topic of metagenomics to enhance the understanding of the methods used to study the composition and function of the gut microbiome and went in depth on a clinical trial for gene sequencing in stool samples. Papoutsis’ insight on the hidden realm behind the analysis of the gut microbiome is not only foundational, but fascinating and extremely relevant for future medicine. 1

microbiome by developing an education module intended for healthcare professionals who care for patients with digestive issues that discusses the role of the microbiome and reviews the importance of a healthy microbiota and strategies to prevent dysbiosis and restore balance. His most recent book, Mayo Clinic on Digestive Health, contains content on the latest medical research on digestive health and serves as a fundamental guide for treating common digestive issues from diagnosis to treatment. At the Microbiome Meeting, Dr. Sahil Khanna guided us through microbiome based therapies for recurrent urinary tract infections and examined the role of microbiome based therapy in chronic UTI. 1

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Dr. Draghinas and Ryan are both podcasters. Desiree built their teams to help support them and others to consistently produce content. All three knew how challenging that was to do in the midst of busy schedules, competing priorities, unpredictable monetary compensation, and fluctuating motivation. Physician podcasters are there for the doctors and healthcare providers that make up their podcasting audience. But “this can be a tough and lonely journey for the podcast creator.” Doctor Podcast Network is there for the physician podcaster. It’s a place where they can come together, learn from, collaborate, and confide in one another, as well as facilitate the monetization of their shows. Having soft launched with 15 founding members in October 2020 and formally launching in January 2021 with 17 shows, the network has shown its capability of creating the community and environment that podcasters need to thrive.

Doctors Unbound is a podcast created for doctors who are busy with unique side passions outside of their normal schedule. Dr. David Draghinas shares their stories of triumph, learned lessons, and, ultimately, their humanity. Financial Residency is geared toward early-careered physicians looking for practical ways to manage their finances. Ryan Inman is usually found nerding out over phoned-in questions by his listeners asking about student debt, investing, insurance, and balancing budgets. The Physicians Guide to Doctoring is hosted by Dr. Bradley B. Block where he seeks to answer the question, "what should we have been learning while we were memorizing Kreb's cycle?" His podcast is a practical guide for practicing physicians and other healthcare practitioners looking to improve in any and all aspects of their lives and practices.

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VISIT US TODAY AT WWW.DOCTORPODCASTNETWORK.COM Find other physician-hosted shows on Doctor Podcast Network’s website, www.doctorpodcastnetwork.com. You’ll find a list of amazing shows, focused on various aspects of physician life. They’d appreciate your support by subscribing to (for free) and sharing their shows. If you’re a doctor who is either wanting to launch your own podcast or join with your existing show, the network is accepting submissions. If you are a physician that enjoys listening to podcasts, check out DPN for new shows that will bring value into your life. WWW.PHYSICIANOU T LOOK . C OM | 21

T H E H U MAN S O F M ED IC IN E

The Artist Of Science UNDERSTANDING COMPLEX SCIENCE THROUGH BEAUTIFUL IMAGES

Wri t t en by S k y l a r S t ei nberg

t the intersection between art and science, Digizyme™ is at the forefront of technology and creating new ways to view and teach biological processes. The company was co-founded by Dr. Gaël McGill, a cell and molecular biologist and skilled computer animator, who is a current faculty and Director of Molecular Visualization at Harvard Medical School. As a young scientist entering the world of research, he noticed an unmet need for scientifically-informed design and visualization services in the research and biopharma space. As a graduate student seeking a creative outlet outside the long hours at the lab bench, he started Digizyme as a way to fuse together his passion for science, visual arts, animation and multimedia. 2 2 | 2 0 2 1 VO LU M E 3

Since then his company has grown with a global team of dually-trained scientist-artists - highly-skilled illustrators, animators and programmers with graduate degrees in the sciences. I had the honor of being asked by Physician Outlook magazine to interview Dr. McGill about his work at Digizyme as well as his federally-funded visualization research at Harvard Medical School. The founder of Physician Outlook magazine, pediatrician Dr. Marlene Wust-Smith, had reached out to Dr. McGill for permission to use an image of a eukaryotic cellular landscape his company created that had gone “viral” via social media. Originally created for Cell Signaling Technology, Inc., and inspired by the stunning art of David Goodsell,

this 3D rendered image of a cell was modeled using various datasets from X-ray, nuclear magnetic resonance (NMR), and cryo-electron microscopy for all of its molecular actors. It depicts the myriad pathways involved in signal transduction, protein synthesis, endocytosis, vesicular transport, cell-cell adhesion, apoptosis, and other processes. This beautifully and accurately visualized complexity is what seems to have attracted the attention of so many online: such images are a reminder that each of our cells is a universe of complexity onto itself - a vast stage for an exquisite molecular choreography danced on the picosecond scale. In order to create complex molecular and cellular environments like the

IMAGE CREDIT: DIGIZYME EVAN INGERSOLL AND GAËL MCGILL, INSPIRED BY THE WORK OF DAVID GOODSELL

one depicted in the cellular landscape described above, the team at Digizyme has not only leveraged the use of powerful Hollywood 3D modeling and animation software suites like Autodesk Maya, but also created their own software - the free Molecular Maya (mMaya) plugin - to expand these capabilities. Although Maya is a workhorse of the entertainment industry (used in both cinema and professional animation by studios like Pixar and used in movies like Star Wars, The Lord of the Rings and numerous special effects-laden blockbusters), it was never intended for scientific visualization. When modeling and animating molecules in such environments, one runs the risk of deforming these models

in ways that are not possible in nature. To remedy this, mMaya helps scientific animators not only import scientific datasets into Maya, but also increase the accuracy of its use. Digizyme has also created a number of specialized mMaya ‘kits’ that expand the software’s functionality and greatly streamline molecular modeling, animation, and simulation. To support the dissemination of their software and also provide training resources for those interested in learning scientific visualization more broadly, Dr. McGill also launched a web portal called Clarafi (clarafi.com). These tools and methods open up a new world of understanding for biological structures. Since ‘shape is function’ in biology and molecular movement is also closely tied to function, creating

accurate 3D visuals of these processes can enable deeper comprehension. During our interview, Dr.McGill demonstrated for Dr. Wust-Smith and myself a beautiful visualization of how the SARS CoV-2 spike protein on the surface of the virus responsible for Covid-19 pandemic leads to infection of host cells. He called it the “molecular choreography” of viral entry, portraying a dance that the SARS CoV-2 virus does with the cell in order to fuse membranes and trick it into taking up the viral genome and invading the cellular machinery. This underlying mechanism is similar to how HIV, Influenza and Ebola enter cells. This dynamic visualization offers a transparent peek and deeper understanding into how viruses work and will help educate WWW.PHYSICIANOU T LOOK . C OM | 23

larger audiences (beyond just scientists) about the mechanics of SARS CoV-2 infection. Dr. McGill also wants viewers to ‘question’ the images in front of them, and be wary about their provenance and veracity. To increase viewers’ awareness of the wealth of data that are used to make such visualizations, his team is in the process of creating an interactive version that embeds numerous annotations and references throughout (something that is unfortunately missing in most visualizations where one is expected to simply accept what is shown). In 2011, Dr. McGill and his Digizyme team were commissioned by Apple™ to design E.O. Wilson’s Life on Earth, a seven-part digital high school biology textbook. The textbook was co-authored by legendary Harvard Biology Professor Dr. E.O. WIlson, Morgan Ryan and Dr. McGill and became a unique opportunity to design a new 2 4 | 2 0 2 1 VO LU M E 3

learning experience from the ground up while leveraging the power of multimedia for the entire curriculum - from molecules to ecosystems. Much like StarTrek boldly inspired children of all ages to explore the world of space, E.O. Wilson’s Life on Earth, packed with over 500 illustrations, interactives and animations, hopes to do the same for those interested in exploring the Life Sciences. Professors Wilson and McGill met with Steve Jobs himself, who recognized that he wasn’t merely employing a media production company. “At some point,” McGill recalls, “Steve said, ‘No no, I get it, you can talk biology to my Stanford professor friends, you can talk hardware to my iPad team, and you can talk design to my iTunes and iBook software team.” 1 These unique digital textbooks harness the ability to educate in a new, profoundly interactive way and Dr. McGill now also encourages students of all

ages to learn about the visualization of science as a learning method in and of itself. Indeed, there is no better way to test one’s understanding and deepen one’s thinking than to actually create an illustration or animation of a biological process. In addition to the projects and interests described above, Dr. McGill’s current research at Harvard Medical School is focused on how visualization design can maximize learning outcomes. While Digizyme is the perfect vehicle to engage in ‘real world’ projects

IMAGE CREDIT: DIGIZYME EVAN INGERSOLL A N D GA ËL MCGILL, IN SP IRED BY THE WORK OF DAVID GOODSELL

that separates artists from scientists and fails to emphasize the critical cross-fertilization that occurs between these fields. Many agree on the power of visual media for education, but much remains to be improved in the way we select, deploy and analyze visualizations for learning. Students seldom receive any training in ‘visual literacy’ in science - i.e. an appreciation for the meaning and accuracy of visual representations and how they are created from scientific data. However, Digizyme™ is looking to break these boundaries with accurate visualization that not only deepen scientific understanding, but also help scientists better recognize the power of visualization in the research endeavor. Beyond its power for communication, visualization is a great way to identify which data are missing and can help scientists better define the boundaries of what they do not yet know. Dr. McGill hopes that, in exploring this use of visualization, the fields

of art and science may no longer need to be separated, but rather brought closer together. As Leonardo Da Vinci once said “Study the science of art. Study the art of science. Develop your senses - especially how to see. Realize that everything connects to everything else.” 1 1https://www.cnet.com/news/pixar-disneyanimation-janet-iwasa-smarter-view-ofscience/

IMAG E CRED IT TO FIONA MCG ILL

for a number of different clients and industries, it is not well-suited to asking more fundamental questions about how we learn from visual media. This is why Dr. McGill has always tried to keep a foot in academia where his research and teaching addresses some of the more unexplored aspects of scientific visualization. For example, with the support of NSF, Dr. McGill and his collaborators Dr. Jodie Jenkinson (University of Toronto Biomedical Communications Programs) and Dr. Susan Keen (University of California at Davis) have recently created the VISABLI Research Collaboration Network for Undergraduate Biology Education which explores the beneficial intersections between the educator, visualizer and educational research communities. The advancements pioneered by Dr. McGill and others like him come with their own set of challenges, as the world of education has created a model

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T H E D O C TO R’ S B AG

Hyperinflation Thrives

IN THE SHADOWS OF AMERICAN HEALTHCARE

Wri t t en by M a ri o n M a ss, M D

he first installment in this series mentioned “the shadows” of healthcare, where the general public rarely looks because it takes too much time to penetrate the darkness and understand how this complex sector of the economy works. A friend told the story of a recent brush with “the shadows” at his local pharmacy. His out-of-pocket cost had risen for a longstanding prescription covered by Medicare. Curious, he asked to see how much of the cost Medicare covered. He was startled to see how much “pain” he and his fellow taxpayers were being “spared.” That experience could be replicated endlessly across America. The money we pour into the complex, third-party payer machinery built 2 8 | 2 0 2 1 VO LU M E 3

by the government and the insurance industry is the price we pay for our beloved painkiller — the “opiate of the masses,” to borrow a phrase from Karl Marx. The pain of paying outrageous prices is dulled, usually just enough so that we don’t get too worked up. We operate under a system of price opacity. The prices being charged are not transparent, not visible to us. We don’t know how those prices are set or where the money goes. We don’t really care. That’s what opacity does. As a narcotic, price opacity is a high-performance wonder. But there’s an appalling cost to not knowing the cost. My friend’s surprise at the pharmacy is what Americans would experience routinely by looking into hospital bills,

bills for visits to clinics, and bills for diagnostic testing of all kinds. Did you hear the one about the $25,000 test for strep throat? How about the $59,490 ultrasound? At least those two monstrosities were caught. Did you know that outrageous charges are paid routinely by computerized systems and without benefit of human review? We’ve created a devil’s playground. What if we could re-establish a transparent, competitive marketplace, consistent with American principles of choice (not European principles of government control), a marketplace that would not only set prices organically and rationally, but drive them down — way down?

PHOTO BY NIK SHULIAHIN ON UNSPL ASH

Would freedom from an “opaque” system save money — money now disappearing into the great maw of third-party profiteers and supporting the huge administrative, regulation-spawned overhead discussed in our last article? Would we free up money for research to find the cure for cancer, to resolve the opioid crisis, and to meet the needs of the underserved, the uninsured, and those with pre-existing conditions? Now do you understand the big driver of healthcare’s hyperinflation over the last several decades? Why healthcare insurance premiums have become outrageous? Why the cost of healthcare is the top issue for American households? Why the snake oil salesmen of Medicare-for-All can find a gullible audience? It is we who have remained anesthetized and “in the dark,” while the play-

ers who count on our darkened stupor have profited wildly, although adding nothing of value. By preferring that darkened stupor, we’ve allowed private interests and the hyper-lobbied political class to turn American healthcare into an overpriced nightmare. Is anyone trying to let more light into this opaque system? Yes. Certain executive orders are first steps in that process. Are there powerful interests who lobby against the light? You bet. Whatever our philosophy of life, we can all appreciate the truth of the central figure of Christianity as recorded in the New Testament’s Gospel of John: ”... this is the condemnation, that light is come into the world, and

men loved darkness rather than light, because their deeds were evil. For every one that doeth evil hateth the light, neither cometh to the light, lest his deeds should be reproved. But he that doeth truth cometh to the light...” (John 3: 19-21) Call your legislator with this message: “In healthcare, we want transparency in pricing to replace opacity. Get off your duff and make it happen.” 1 Originally published March 5, 2020, https://www.buckscountycouriertimes. com/opinion/20200305/guest-opinionhyperinflation-thrives-in-shadows-of-americanhealthcare Marion Mass, M.D.; Bucks County pediatrician; co-founder, Practicing Physicians of America. Member of this paper’s editorial board. No conflicts of interest.

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T H E D O C TO R’ S B AG

The Potential Effects Of Dieting On The Microbiome A NUTRITIONIST’S PERSPECTIVE

Wri t t en by Tri sh C ra pa ro t t a

et’s all agree on one thing - food is never the enemy, it is however a primordial need for our survival and well being. Our diet, the type, quality and origin of our food help shape our gut microbes and affect their composition and function. A healthy balance of the microbes in our gut can be disrupted by significant lifestyle changes, constant yo-yo dieting, stress and antibiotics, leading to the development of various chronic diseases with underlying inflammatory conditions like IBS, Crohn’s, ulcerative colitis, allergies, and autoimmune diseases. 3 0 | 2 0 2 1 VO LU M E 3

During the past several decades the adoption of modern dietary habits has become a growing global health concern. It is strongly associated with obesity, diabetes and other related metabolic diseases, promoting not only inflammation but also both structural and behavioural changes in gut microbiota. Current trends suggest that the keto diet may reduce inflammation and help treat some digestive orders, like the ones previously mentioned, although more research is needed. The ketogenic diet is a rapidly growing dietary trend for weight loss and was initially designed in the US in the 1920’s for treatment of refractory epilepsy.

Meeting the keto diet’s requirements means cutting out nutrient rich fruits, veggies and grains, making it difficult to meet your body’s micronutrient needs. When the body is in ketosis it causes three specific ketones to be released. One of the ketones released, beta-hydroxybutyrate, which monitors ketosis levels, is said to block immune system receptors linked to inflammation. On the other hand the keto diet may harm your gut bacteria that could then lead to various digestive issues. One study conducted by Turnbaugh of UCST states “To better understand how microbial shifts on the ketogenic diet might impact

health, researchers exposed the gut of mice to different components of microbiomes of humans adhering to ketogenic diets. The results showed that these altered microbial populations had reduced numbers of intestinal proinflammatory Th17 immune cells - a type of T cell critical for fighting off infectious disease, but also known to promote inflammation in autoimmune diseases.” To maintain the health of your brain, muscle, bone, nerves, skin, blood circulation and immune system your body requires a steady supply of raw materials of macronutrients - proteins, fats and carbohydrates and a small number of micronutrients - vitamins and minerals.

So how can you make sure you’re fulfilling your nutritional needs to help build and maintain a healthy gut? Ideally the best way is to fuel your body with a well rounded diet of foods such as fruits, vegetables, legumes, whole grains, and lean sources of protein like eggs, chicken, fish, turkey, greek yogurt along with healthy fats such as nuts, nut butters, seeds, avocados and olive oil. If the end result is that we all want to be healthier, happier, humans living our best life, then we have to ditch the idea of a quick fix and change our mindset when it comes to how we feed and move our bodies because after all, it is our most priceless possession. 1 WWW.PHYSICIANOU T LOOK . C OM | 31

T H E D O C TO R’ S B AG

Addiction And The Gut…. IS THERE A CONNECTION?

Wri t t en by J R H i l l , Freel a nce Wri t er

wenty-five years ago, when I was in the Drug and Alcohol field as a clinician, my first job out of college, we did not have all the tools, tests, research, and information we have today. Our diagnostic capabilities were written on the pages of a published manual. Our intakes checked the box for family history, current and past behavior and in rare cases, if a patient had been hospitalized for an overdose or for psychiatric reasons, we would have access to the treatment summary as well. But we did not look at the diet. We didn’t have the sophistication of genetic testing or information from the Human 3 2 | 2 0 2 1 VO LU M E 3

Genome Project. We didn’t look deeply into the brain with powerful scans or do neurotransmitter testing. We did not know about leaky gut, or food intolerances or how inflammation impacts thoughts and behavior. And when we look at current findings from genetics, the gut microbiome, the brain, and addiction, we now have many more pieces of the puzzle to shed light on some of the underpinnings of addiction, relapse, and recovery. Researchers believe there may be a connection between the health of our gut microbiome and addiction. In recent years research has established a connec-

tion between the gut and the brain and have identified the many ways in which they communicate. This communication pathway is known as the gut-brain axis and extends from the esophagus to the anus. Your gut contains approximately 500 million neurons and your brain contains 100 billion neurons. These neurons send biochemical signals to “talk to each other” and influence how the body responds, expresses genes and self-regulates. The vagus nerve is a cranial nerve that influences the parasympathetic control of the heart, lungs, and digestive tract and sends signals in both directions.

P HOTO BY EMILIA N O-VITTORIOSI ON U N SP L A SH

Gut-Brain Modulation and the Impact of Inflammation The gut-brain axis is modulated by hormones, bacteria, cytokines, foods, and neurotransmitters and influences the overall health of the gut. More than 90% of the body’s serotonin, 50% of its dopamine and the neurotransmitter gamma-aminobutyric acid (GABA), which helps control feelings of fear and anxiety, are all synthesized in the gut. It is believed that poor gut health may contribute to anxiety, low mood, learning and memory challenges and overall cascade of inflammation that can lead to leaky gut, IBS, SIBO, Candida, food intolerances,

gas, and bloating… these chronic conditions are known to change the gut flora, impact signaling molecules, and affect how we absorb nutrition from the foods we eat. The amount of inflammation will influence our ability to think clearly, have energy, and enjoy both physical and mental health. In addition, inflammation and changes in gut microbiome have also been studied in people with mental illness. Bipolar, anxiety, depression and psychotic disorders can also arise from conditions related to the function of the immune system and gut health. Much of our immune cells also reside in the gut. The Role of Genetics Both human and animal studies support this idea that healthy gut bacteria can help regulate mood, energy, brain function and behavior. In fact, science is currently looking at the influence the gut microbiome may have on addiction and addictive behaviors. Looking at markers for motivation and reward dynamics, how stress can impact the gut, and overall genetic markers for addiction and other disorders may help us uncover how people who struggle with alcohol and drug addiction may exhibit shared patterns in unhealthy gut flora and gut/brain communication. Several genes have been associated with addiction. In fact, the National Institute on Drug Abuse (NIDA) has funded studies to explore the role both genetics and the microbiome has on substance abuse. In 2015, it was estimated that almost 21 million people, 12 and older, suffered from alcohol and drug abuse and another 27 million people reported using illicit drugs. Family studies that have included twins, siblings and those who were adopted, suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs is greatly influenced by genetic makeup. Gut Health and Relapse in Alcoholics Research also suggests that bacteria in the gut may play a role in alcohol ad-

“We now have studies that delineate the genetic basis of drug addiction by integrating host genetics and the gut microbiome.” diction and the likelihood of relapse after rehab. Alcohol addiction is often associated with an imbalance of gut flora. In fact, one study found that 26 out of 60 alcoholics suffered from leaky gut syndrome and had low amounts of the critical bacteria known as Faecalibacterium prausnitzii, which is known for its anti-inflammatory properties. Leaky gut syndrome has been linked to inflammation and diseases like Crohn’s disease, food allergies, asthma, and arthritis. After 19 days without alcohol the 26 alcoholics with leaky gut still scored high on tests that measured depression, anxiety, and alcohol cravings. By contrast, 34 subjects with normal gut flora recovered faster, measuring lower on the same tests. In fact, their scores decreased to levels comparable with a control group who did not have a drinking problem. Putting the Pieces Together: A Comprehensive Look One of my doctors always says “test, don’t guess.” We now have comprehensive testing for the brain, and we can evaluate the health of the gut where many signaling molecules, hormones, neurotransmitters, and nutrients are produced or governed. We can look at our genetics and our genetic markers and put together a comprehensive view of how our mind and body functions and as we learn more about the intricacies of addiction and how all of these body systems are related, we can do more to treat addiction. Recovery isn’t about pure willpower or determination, it’s also about what’s going on inside the body - the systems and organs that impact and influence mood, behavior, reward and mindset. Many clinicians have been implementing some of this testing and as we continue to learn more, treatment for addiction will become more sophisticated and comprehensive. 1 WWW.PHYSICIANOU T LOOK . C OM | 33

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PL E ASU R E S A N D PA S TIM ES

Sick and Tired… No More! DR. STEVEN GUNDRY’S NEW BOOK “THE ENERGY PARADOX” IS A MUSTREAD FOR EVERYONE WHO WANTS TO GET THEIR ENERGY BACK. Wri t t en by Jenni fer N o t t el l

ats off to Dr. G!! He loves to poke the bear by challenging the establishment. The dichotomy between ineffective health practices and effective health conditions is evident after reading and applying the strategies in The Energy Paradox Program. At 51 years old, I’m a true convert, however my journey didn’t start with the “The Energy Paradox.” Although it is very possible for one’s journey of success to start there, I started with his first book, “The Plant Paradox.” My motivation for reading these books was based on goals for growth and to prevent the diseases that plague my family. “The Plant Paradox” taught me about all the foods I should be eating and 3 6 | 2 0 2 1 VO LU M E 3

what foods I shouldn’t be eating, as well as environmental factors influencing my body and its functions. I continued with “The Longevity Paradox,” incorporating intermittent fasting (very intermittently) and continued to healthier living. Fasting was challenging for me because I was often fatigued and needed to maintain my energy levels for work and play and I also plateaued in weight loss (I’ve gone up and down throughout my years, my highest being 380lbs in my early 20’s). Recently, I found myself losing strength and endurance, and it took much more effort to stay focused throughout the day with work and family. While listening to Dr. G’s podcast I learned about his new release, “The En-

ergy Paradox,” and the anticipation was overwhelming. “The Energy Paradox” was timely, for me anyway, offering solutions to problems unveiled by recent life circumstances and the big stressor we’re all dealing with … COVID-19 and the nuances that fall prey to its presence. It is also right on time for diving deeper into the conversation surrounding microbiota (gut) and nutrition. It provides an understanding of just how our body systems talk to each other and use each other on a cellular level. Dr. G has an exquisite way of explaining the research and medical lingo the commoner (such as myself) would understand in a simplified and often entertaining manner.

P HOTO BY MOHA MED N OHA SSI ON U N SP L A SH

In Part 1, The Epidemic of Fatigue, Dr. Gundry explains his theory on how our society has grown to epidemic levels of health-related illnesses as well as how inflammation, poor gut health and damaged mitochondrial function steal energy from our bodies and our brains. Part II is the program itself and is based on three main objectives: heal your roots; regenerate your soil; and end mitochondrial dysfunction. He promises that ”It doesn’t take that long to improve your gut biome and ATP production, which means that you will notice improvements quickly and be motivated to stay on track.” He encourages, “I’m not going to make you eat anything you don’t want to eat. This program is

built on flexibility and options …” He offers choices with Do’s and Don’ts for boundaries. Timing meals is another BIG component of the program. By increasing time between meals, your mitochondria build metabolic flexibility and insulin sensitivity (based on the foods with which you’re fueling – ie diet). “Greater metabolic flexibility allows you to process a variety of fuels efficiently. In other words: It’s less likely for your favorite carbs to show up later as belly fat.” While reading the book I employed his strategies. It took some getting used to (I now drink black coffee in the morning so as not to break my fast) and I started rock climbing with my husband in a fasted state. I can’t tell

you the amount of energy I have … AFTER climbing! The 20 lbs I lost as a result of gaining more energy is simply icing on the cake. Even if I eat a pint of my favorite ice cream, I can get right back on track the next day (mitochondrial flexibility and insulin sensitivity – yeah!) … because my cravings have literally disappeared. I’m in control of how my body and mind are fueled and I can make better choices with an understanding of “why” after putting it all together. My favorite quote from “The Energy Paradox:” “I’d like you to think about taking your mitochondria for a six week spa treatment.” Now, doesn’t that sound good? 1 WWW.PHYSICIANOU T LOOK . C OM | 37

PL E ASU R E S A N D PA S TIM ES

Shrimp Scampi OVER CAULIFLOWER RISOTTO

Wri t t en by A l i ci a Ro sel l i

his recipe is inspired by Dr. Gundry’s “just say yes” list of energy and biome-boost-

ing foods. Pair with a simple side salad - arugula, lightly dressed in extra-virgin olive oil, lemon juice and toasted walnuts, sprinkled with kosher salt and pepper, to taste. 1 3 8 | 2 0 2 1 VO LU M E 3

dan-de nni s -uYo Ox s 9Tf H0-u n s plas h

Ingredients 4 T unsalted (French/Italian) butter 1lb wild caught shrimp 4 cloves garlic, minced Juice of 1 lemon 1 head cauliflower, stem removed (about 4c when riced) 2 leeks, finely sliced 1 large shallot, finely chopped 1 c mushroom or vegetable stock ½ c grated parmesan cheese Kosher salt and freshly ground black pepper to taste 2T freshly chopped herbs of your choice Preparation 1. Cut the cauliflower into chunks. In batches, pulse the cauliflower in a food processor until coarse in texture, like rice. 2. In a large skillet over medium heat, melt 3 tablespoons of the butter with the leeks and shallots and stir until browned, about 5 minutes. Add half of the minced garlic and cook 2 minutes more. 3. Increase the heat to medium-high and stir in the cauliflower. Saute for 1 to 2 minutes. Add the stock and simmer until the liquid has mostly evaporated, 1 to 2 minutes. Stir in half the cheese and fresh herbs. Move to a serving dish and wipe the pan. 4. Heat the same skillet to medium-high and melt the remaining tablespoon of butter. Add and saute shrimp, stirring constantly, until they start turning pink. Add remaining garlic and saute an additional minute. Add the lemon juice and allow the pan to deglaze, one minute. 5. Serve the cauliflower risotto onto individual plates, top with shrimp and add parmesan, salt and pepper to taste.

WWW.PHYSICIANOU T LOOK . C OM | 39

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