Dr. Amy Coleman: Gut instinct: Personal wellness and the gut microbiome
The following is an edited transcript of Nicole Erwin's interview with Dr. Amy Coleman. Click below to hear the full audio:
Nicole: I'm talking with Dr. Amy Coleman, CEO and founder of Wellsmart and author of the book, “Discovering Your Own Doctor Within”. Dr. Coleman, thank you so much for joining us.
Amy: Thank you, Nicole. It's great to be here.
Nicole: You have such an interesting background, from serving as the first female commander of the U.S. Air Force Special Operations Clinic, to being selected as the primary physician for four-star generals, U.S. Embassies, Special Forces teams and even for NASA for space shuttle support. From being a fighter pilot and going with an instinct — what you call "flying with the feel" — to gut decisions in our everyday lives, your ethos seems to be all about listening to yourself and how the gut could be or should be the loudest voice. Can you tell me about the first time that your gut “spoke” to you and you listened?
Amy: Oh, that is a great question, Nicole. I believe that's something that we inherit and grow into, actually. As children, we can be given examples of how to do this or how not to do that, and hopefully there's a path that allows us to find our way. I believe the biggest gut instinct came to me during 9/11. At that time, I was an intern after medical school, finishing up my internship year. My granddad, who was a sergeant major in the Marines, had always said, "Go into the Air Force. They'll pave your way to school." It was a great idea. He said, "They've got great technology, they treat women well, and wherever you go, you fly in style."
So, I said, "Why not?" When I went into medical school, they picked up the tab.
I had the opportunity to go through my residency before I started becoming an active duty doctor for the military. But when 9/11 happened, right after I had finished medical school and my internship year, I decided to defer my residency and just go immediately in to active duty. That actually allowed me a great benefit and opportunity to be a flight surgeon, which was really a good instinct, to go into that direction. It's made all the difference because, as a physician, I was able to really meet my patients where they are — boots on the ground, in their facilities, in their squadrons and where they work — and see their environment and really experience what they were experiencing. For the first time, I really learned teamwork in a way that never is taught in medical school. Even seeing doctors working together — that's not something that happens a lot of times.
So, in the military, I've really learned teamwork and how to see my patient as equal to myself and just as important as making the decisions in their own health as I was. So, yeah, listening to my gut in that made all the difference in how my style as a physician developed.
Nicole: And your path.
Amy: Yeah, exactly.
Nicole: Admittedly, I'm a bit of a hypochondriac. I listen, probably, to too many things affecting me, both mentally and physically. How do you drown out the unnecessary bits of information and focus on what's really going on inside?
Amy: Well, that's a super question, Nicole. A lot of people come to me and ask that. They have trouble sleeping because of that. They might start the day with one thought that's concerning to them, and by the end of the day, they have a snowball of thoughts just like it that just gather. We really have to kind of decide what track we want to take. The “monkey mind,” as I call it, makes us want to just turn over furniture and just be destructive, like a monkey in a room — just losing control. Those types of thoughts actually drive you to a way of being, which is a survival mode. That survival mode is driven by neurotransmitters that are really meant to tell you to run from a bear or dinosaur or whatever is threatening you; to live in that state is, really, chaos. So, if we choose to listen to those thoughts that just continuously multiply in our head, it drives us to those fight-or-flight states, which are exhausting to the mind and the body.
One of the things that I do is get out into nature. I find that nature resets you. “He,” “she” or whatever you want to call [nature] is an energy in and of itself that just kind of has a way of letting time stand still around you as you’re finding your focus in something that's beautiful and creating a sense of awe for yourself. When you do that, you are increasing the quality of your thoughts, just like the quality of food you eat or the quality of air you breathe is going to make you feel much better. Once you get in those states of awe and thankfulness and inspiration that nature can provide, then, oftentimes, you find yourself settling down in the thoughts that come with those types of inspired, “awe” moments. It's just a cut above all the rest. I prefer to live there. Actually, one of the disciplines of my journey through this life is really to just make that a discipline — to completely create those types of moments wherever I am. I call it my “walking meditation.”
Nicole: I have heard you refer to a phenomenon called the “nocebo” effect. Can you explain what that is?
Amy: Right. We are all familiar with the placebo effect, and that's when you're taking something that could just be a sugar pill, but you're feeling the effects of it as if it's something that's quite potent. That actually wraps around the understanding of the power of your beliefs. A lot of times, people and physicians alike consider the placebo effect something that is to be ignored, or it’s talked about around the water cooler as just an interesting effect, but it's much, much more than that. A person's belief system really runs their life, and a belief system actually fuels you to either become more relaxed in your day-to-day walk of your life or feel more threatened. So, you really do have to meet people where they are in their belief set. If someone is taking a pill they don't believe in or that they feel is going to cause them a bad effect, you really have to look at that constructed thought that's been created. A thought is a thing, and that mental construct can build within a person a resistance — resistance against taking what you're offering them. If you're building resistance in a person, it's like arm-wrestling them on an energetic level or a mental level. With that, every time they take the pill, they've got an increased risk of having the side effect side of those medicines, which aren't the helpful side effects but the ones that cause some kind of suffering. So, nocebo effect is when someone takes a pill and feels the opposite of it being helpful — they feel all of the negative side effects. A lot of times, that comes with an internal dialogue. They have a belief set that wasn't met by their physician and they felt like they were kind of pushed or something was pushed on them.
Nicole: Communicating with co-workers, family and loved ones can be challenging. How does someone communicate effectively with their physician if they don't feel like they want to do what they're saying?
Amy: Oh, that's such a great question, too. What I would say is, you always have to find the provider that matches your belief set in ways that allow you to be a team — a team working as a group, together. There are physicians out there who are looking to do that with patients, and a lot of times, it's [because] they’re more integrative, holistic, functional medicine-type physicians.
Unfortunately, the very structured nature of our clinic system in the current healthcare model doesn't allow physicians a lot of time with their patients to be able to sit and have these types of conversations in a meaningful way. So, your better option is to find a physician [who aligns with you] — even if you might have to find one that you either pay out-of-pocket or pay with a different kind of payment service.
There are lots of ideas out there and new technologies that are allowing physicians to charge on a monthly basis. Those are called direct primary care clinics. But they are out there. Physicians are out there, and patients really need to know that they have a choice. It’s like anything else; you have to look for the service model that you want to represent you. That includes your hairdresser. That includes your accountant. Sometimes, you have to go through a few of them before you find the right fit.
Nicole: And just to back up a little bit, going back into the gut, how did you get interested in the microbiome field?
Amy: When I was a child, I was very sick, and I had to take a lot of antibiotics from the time I was probably six months old to the time I was about four to five years old. I can't even remember a time when I really wasn't taking antibiotics. What happened to me, after being on so many medications early in my life, was I did find myself very weak. My doctor told my mom that I wasn't going to be physical, I wasn't going to be very active, not to expect a lot from me. Of course, there goes the challenge that's laid down. In that, I had to start redefining what made me feel good.
So, I started cooking for myself when I was 13, because I was really on an American diet; my mom was a working mother, so Hamburger Helper and Fruit Loops were her go-to so she could quickly feed me and get to work. In that day and age, things were supposedly fortified with vitamins — commercials would say how nutritious they were. We know better now. When we know better, we do better.
At 13 or 14 years old, I started eating foods that really made me feel good. I was steaming rice and vegetables and grilling lean meats and things like that. I found that I just felt so much better. Little did I know that I was changing my microbiome, which was supporting my immune system. Back then, we didn't even know the microbiome existed. The only thing we knew back then was that it helps you digest food and you have some bacteria down there. Now we know it's so much more important. So, I was really, I guess, following my gut even back then.
Nicole: How did your mom respond to you cooking? Did you cook for her, too?
Amy: Oh, yeah. I tried to cook for everybody, but unfortunately, the culture of eating is very much a social event that often is based on how you're raised. Sometimes, if you don't change your diet, I suppose, early enough in life, you pretty much get stuck in those ways.
It was an intriguing entertainment for them to watch me eat. My dad would always say, "Oh, if I ate what you were eating, I'd be hungry ten minutes later." I would tell them, "You can eat small meals throughout the day." It actually started the progression of me going down a fitness track that truly reformed my body into complete physical health.
Nicole: How will a better understanding in the gut environment impact the wellness industry?
Amy: The gut environment is something that we really need to understand. For the first time, we're actually starting to look at what we used to think [of] as an enemy and calling it friend — all the bacteria in the gut. There are so many of them that could harm us, and now we're starting to turn around and say, "Where is this ecosystem within us that we need to repair, just as we see outside of us these ecosystems that we need to repair?" What's happening outside is happening within us as well. I mean, look at the Great Barrier Reef and look at global warming. Well, within us is something similar, with the loss of the ecosystem of our gut.
The rebuilding of that, I believe, in the wellness industry is going to be about nourishing and teaching people to be good CEOs of every little cell in their body, and nurturing care is something that we really haven't learned. I think wellness industries are going to be well-served to teach the lesson of how to repair your ecology and how to be one with your ecosystem and how many ways we can relearn nurturing yourself. From that, I hope that we can nurture the environment when we learn how to nurture our self.
Nicole: How receptive are people when they hear you make those connections? Is being able to test the microbiome significant in being able to show what's happening, and can you do that?
Amy: This is the most phenomenal news for me — that I can help someone redirect their microbiome just like I did when I was 14 years old. I was doing it blindly, but the system that I use for patients actually guides them through a six-step process, where they test their gut flora every two-and-a-half weeks. With those results, we implement dietary changes and we implement ways of being that actually help your gut to be enriched. I'm able to see those results come back better and better.
So, really, you're teaching someone gardening. You're teaching someone how to do interior gardening. The way that we run around in this day and age, we don't have time for gardening, but the fact is that we carry our garden within us wherever we go, and whatever we eat either feeds it [or] denies it. If you're a gardener at heart, you just remember: you're always carrying around your garden within you.
Nicole: What are some things that we can all do daily to improve the health of our microbiomes and take care of our garden?
Amy: Oh, my goodness. So many things. The gut biome is enriched by you living the life you know you need to live. That means sleeping well, because the gut bacteria have to sleep, too. When people are pregnant, they say they're eating for two or they're sleeping for two. Well, you're sleeping or eating for 100 trillion. If you were going to look at the numbers, it's a good indicator and motivator as to how to take care of yourself.
You also need to eat foods that nourish the gut flora. The bacteria in your gut are doing so many things on a daily basis, from making neurotransmitters that your brain uses to making hormone-like mediators that your endocrine glands and systems use. There is not one part of your body that the gut microbiome does not reach. It is your motherboard. It is another brain, as a matter of fact. It has so many neurons in the area of your gut that it is a thinking system. The problem is, with eating wrong, unfortunately, we're losing a lot of our heritage species of the gut microbiome that we need to survive and to do the daily work.
When the microbiome does start to diminish or dwindle, it leads to inflammation issues in the body. We're wondering why we have so many autoimmune diseases now, why we're having so many diseases and chronic issues that never really plagued humanity before. I think a lot of it does reside in the gut.
Nicole: I was always told that if you eat properly, you should be able to get all the nutrients that your body needs. But a lot of us have so many things going on with stress and work. So, if you can't find the time to get the food that you need, do you recommend supplements, or that's not an option and you need to make time?
Amy: Well, supplements are an option. Also, staying away from things in the environment. A lot of things like antibiotics will completely clear out all of your good bacteria. It's absolutely proven, and it comes back over time. But just think about a child with chronic ear infections. They're going from one antibiotic to another. Over time, it takes longer and longer to get that gut microbiome back into a healthy level.
So, some of the things that you can do are to stay away from things that you know would hurt your gut, and that is, if you have the sniffles, don't go for the Z-Pack. A normal cold lasts five to ten days, and the average person does get a cold three to five times a year. It does start in your nose and usually ends up with a cough that's dry and then becomes productive. We actually need to start realizing that normal viruses and things like that don't need to be treated with antibiotics.
If you're looking for a supplement, some of the best things you can buy are the fibers. Fibers are prebiotics that feed bacteria — they've got flora, so it’s like you’re serving a T-bone steak down there. Some of those types of fibers are cold-resistant starches. You can get them online or you can [get] them from pretty much anywhere.
Inulin has a very good one. Inulin is a fiber made of the chicory root. It's not very digestible, but yet, the gut microbiome love it and it allows the gut microbiome to metabolize that and actually help the body. But getting fiber from food is always best, to be honest with you.
Nicole: What would you say is happening in today's culture with understanding the gut and our microbiomes? And how accessible is treatment into some of these things that you just mentioned? Is it just a matter of going online?
Amy: Well, there's so much information out there, and what I see right now is that “probiotics,” “prebiotics” and “microbiome” are becoming the buzzwords. With that, there are a lot of people who are just trying to make a lot of money. So what we need to realize is that this is a very new science and it is a quantum-level science of interconnections: How do the bacteria react to you? How do the bacteria react to each other? How do bacteria react to the food you eat? All of it is a commensal, huge operation of relationships. This is going to take years to unravel and get the wisdom of what all of those relationships are.
To think that we know more than we do right now is probably the biggest fault I see. We do have to realize that a lot of the studies are just in mice right now. So, as we are looking further into people as testing entities for the gut microbiome, then we'll know a lot more. But I would just say, “Buyer beware.” I also would say make sure, if you're going to educate yourself, educate yourself on platforms that are putting out microbiome information on YouTube. TedX has some good ones. Working physicians who are leading the drive are good resources because they are typically seeing patients every day and not necessarily selling you a prebiotic or probiotic to make their living.
Nicole: Dr. Amy Coleman is CEO and founder of Wellsmart and is author of the book, “Discovering Your Own Doctor Within”. Thank you so much.
Amy: Thank you so much.
Dr. Amy Coleman was a guest speaker at Health & Wellness breakout sessions during ONE: The Alltech Ideas Conference (ONE18). Click here to learn more about the next global ideas exchange.