Integrative Primary Care and 5 R’s for Gut Health with Dr. Jyoti Patel, MD

Prepare yourself for a mind-blowing episode as Dr. Carrie Lam, MD talks with Dr. Jyoti Patel, MD about how she is using integrative medicine approaches in Primary Care, making changes in the community through gardening and education, and fixing the gut using the functional medicine 5 R method. Remember that digesting doesn't just happen in the gut, but also in the mind.

1:30 - Dr. Patel's journey in Integrative Medicine
5:30 - Integrative Medicine in Primary Care
8:40 - Community Garden
10:15 - Group Visits
12:00 - Healthy Food Access
15:30 - 5 R's of Gut Healing
25:00 - Removal of Toxins
27:00 - Replace with Enzymes or Acids or Fiber
31:00 - Reinoculate the Microbiome
33:30 - Repair the Gut Lining
35:25 - Restore Mind-Body Connection

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Dr. Jyoti Patel's Information
» Website: https://aimsforwellness.com/
» Instagram: @drjyotipatelmd
» Facebook: Jyoti Patel MD
» TikTok: @jyotipatelmd

Transcript

Dr. Carrie Lam, MD: 0:06

All right. Hello. Welcome to the Dr. Lam show. We today have a special guest, Dr. Jyoti Patel. She's based in Arizona, and she's a Board Certified med pedes and integrative medicine certification in functional medicine. She is located in Arizona loves gardening, loves creating safe spaces and has been practicing both primary care. And also, you know, integrative functional medicine to all types of people. We're so excited to have you here today to tell us about how you have been able to approach primary care in a functional way. And also tell us about your love for gut health. What I always like to ask, first off, Dr. Patel is how you came to integrative medicine and what drives you to continue to practice it.

Dr. Jyoti Patel: 1:11

Thank you so much for having me, I just love having these conversations where we can influence people's thoughts, beliefs and minds when it comes to medicine. So thank you for having the platform. I've been practicing integrative medicine for the last six years and prior to that I've been doing primary care internal medicine and pediatrics. For the last 18 years, I have been a solo practitioner in a small town, just outside of Scottsdale, and I have been the only pediatrician and the only female internist in town. And having my solo practice, I felt like that small town Doc, I got to know all my patients, they know me and I was treating four generations of families. A wonderful way to get to know your patient population. And It was good. It was a good transition for me to

Dr. Carrie Lam, MD: 2:04

Yeah. everything was good with the practice and my care, I just felt like something was missing. As I continued on through practice, I noticed that it was sort of a merry go round of patients coming into the clinic, the same patients not really getting any better. The number of prescriptions increasing, but the disability and disease not changing much in the model that we traditionally practice medicine. Also there's a level of frustration with patients looking for more and they wanted more. I wanted to deliver more, but I only had limited tools. I had my prescription pad and I had my referrals. And that was it. I felt like there's gotta be more to treating these people. That's when I was introduced to integrative medicine, a good friend of mine and other physician had completed the fellowship at the University of Arizona, the Andrew Weil center of integrative medicine, and I got introduced to the information as she was learning it. And I just got this renewed enthusiasm for medicine. I was like, what, why don't we learn this in medical school? find a different way to practice medicine for my patients. And as I started to learn to the fellowship, how the importance of nutrition, and gut health, emotional wellness, movement, relationships and purpose. I was able to then, in lifetime, bring that back to my patients in the clinic. So I'd learned something through the fellowship and I'd bring it back. The patients were excited because this is new information for them and it was transformative. So definitely, I think that every physician needs to hear that there is a better way of practicing medicine. I don't mean throwing out conventional medicine, I mean, adding more tools to your tool belt. How can we as doctors, serve our purpose, provide care to our patients in that holistic way, where not only are we really good listeners and we're present, but we're giving them other things they can do besides a prescription to reverse and prevent disease. I love that. Yes, it's it really is another tool right? in your toolbox in that patients usually when they come to you, they don't want to go on medications. This is free and all natural and it's so simple to do but it's so powerful and so whether it's a nutrition, lifestyle, stress reduction, sleep, Dealing with the whole body is so important and so natural and we should be changing the way medicine is being practiced. In medical schools, they definitely don't touch on that. When I was in medical school, we got to two hours of nutrition In our classes, which is very, very sad. I remember, they got some dietitians to come, they gave us a plate and we had some plastic food and they're like, okay, fill this plate with the plastic food of what you should be telling your patients, I'm like, wow, this is like for grade school. We have that thirst to want to be able to offer our patients more. So I'm totally on board with integrated primary care. So how does that look like for primary care?

Dr. Jyoti Patel: 5:39

There's so many different ways that patients and physicians can engage in integrative medicine. You can use in the office and outside of the office. So in the office, you have multiple opportunities, you may have five minutes to teach somebody breath work, you may have just two minutes to impart upon them the importance of good sleep, and you give them five simple tips, you know, turn off your, technology, at least an hour before bed, stop eating and drinking three hours before bed, try to do something relaxing, maybe read a book instead. There's simple things you can tell people to do in less than two minutes, small little bits and by small steps, because you don't have time to give the people a big lecture. So what are the three things that you think this patient's going to benefit most from? Maybe it's journaling, because they find themselves stressed, and they are dealing with some kind of trauma or emotional past that they need to work through, you can give them tips on journaling, maybe you tell them to start a gratitude journal, because they need to change how they perceive their stress in their life. Very simple things you can do. So in the exam room, you don't have to have a genius comprehensive plan. A lot of times, it's those simple takeaway tips, those two, three things that the patient actually remembers, that's going to transform their life. You can do it in a group. I have a classroom here in my clinic and we have group classes where we can have discussions with multiple people not during COVID time, of course, but before that allow for discussions for diabetics to meet together and talk about the social, economic, emotional experience that diabetics can have on the family and on the patient. What a great healing experience. And, if you're working in the insurance model, as long as you are established with each one of those patients, and you've collected the information to start an office visit and you explain the HIPAA rules, you can actually do a group visit. And as long as you follow the rules to have, you know, an insurance based model when it comes together. And then side of the exam room and outside of the office, how you can bring integrative medicine to your community was something that I learned from a 10 year old girl. Yeah. So I was interviewed by a Girl Scout, she was doing it for her Girl Scout project or leadership project. And she wanted to be a pediatrician. And she asked me why I went into medicine. What do I do? How do I study all that stuff? And then she asked me, What do you do for community service? And I said, I give talks, I donate my time, I had a really hard time coming up with a really concrete answer. So she got me thinking on that soul question, what is my purpose? And so my purpose is to educate. I want to educate my community about how they can take back control of their health, through nutrition, through movement, through social connections, to be connected with the earth. And so I decided to champion a community garden in the community. She inspired that project. So just the thought can manifest into things. And so now we have a two and a half acre community garden in the town. We have over 120 organic beds, we have over 400 gardeners, we have beehives, we have a compost program. We have an outdoor teaching Kitchen, where we bring in speakers every month to do garden to table education on different cooking demos. It's been a good community project, but it allowed me to serve that purpose outside of the exam room. So integrative medicine isn't this concrete idea. It doesn't have to be in a silo. If you're a physician, or a patient, and you're interested in this idea of integrating health, with everything around you in a comprehensive way it can be done, at home. You start talking to your friends and your family about the importance of nutrition and the importance of sleep because you heard a podcast or you or you follow somebody on Facebook, you can share this information with colleagues. So this process of integrative medicine does not have to be limited to the exam room.

Dr. Carrie Lam, MD: 9:59

Yes. I love that. Talking about group visits, talking about the community, all of that is just taking little steps at a time. One patient affects the whole family, the whole family affects the community. And I love that you also brought up the group visits because we also do group visits. I know you talked about diabetes, and there's also blood pressure. The one we specifically do at Lam clinic is for fatigue, where we deal a lot with people who have fatigue, and yet they don't feel like they're being heard. Because that's kind of one of the hardest things to diagnose or even to get down to the root cause. A lot of times they feel alone and having that support group to be able to voice their concerns and find there's other people as well that are dealing with this. And to be able to, not have any extra costs, through insurance and, to create that camaraderie is really good. Most of them are women, elderly, but everyone can be dealing with this. Patients love this group class, we had really good feedback. And education is a big part of this group, too. You're learning about your own health and how you can change and how that can affect not only yourself, but your family. I love your idea of the two and a half acres of gardening is is a lot for 100 gardeners is a lot and that definitely you need a big community to be able to do that. And so that's really amazing. You do have these pockets of areas who don't even have access to fresh groceries. This grassroot community project that you guys are doing is just so awesome. That's really

Dr. Jyoti Patel: 11:57

The idea that all health begins in the gut, awesome to hear. right? oral diseases stem from the gut. So when you think about this idea of how do we impact a large community in an effective way, I feel like food is the best way to do that. We talk a lot about in the community, how food is not available, many people don't have access to healthy food, fresh fruits and vegetables, just processed goods, due to financial limitations so they're unable to buy organic produce. So eating fresh, whole and organic all the time is not always the reality for different communities. How do we bring nutrition education, to the family and community and this was a good project to bring the garden so that we can make nutrition affordable. We have 10 beds that are dedicated to the food bank so we donate produce to the food bank for people to enjoy fresh produce without limitations. This is part of that education that you were talking about Dr. Lam is if people are listening to your podcast, are inspired and want to do this in their community, there is nothing stopping you from doing that. We literally converted rocks and dirt into a green space. You can do that in your backyard, patio, balcony, or windowsill in your kitchen. Start somewhere if you want to grow your own food with family members, cousins, aunt, uncle, parents, grandparents. So find inspiration in this type of community effort, and give yourself permission to start with yourself and bring those ideas to others. Gut health is such an important part of functional integrative medicine, that it's the best place to impact your community. We talk about fatigue, most of the people affected are women, so they may have hormonal as well as gut issues, brain fog, joint pains, inflammatory conditions, autoimmune conditions, and so on. You will find that the root cause is in the gut. Once we start healing the gut, we can deal with chronic diseases. And that's what I love about functional medicine, Dr. Lam, you practice functional medicine too. It's another way physicians can add more tools to their tool belt. Integrative medicine gives us that overview, looking at the person as a whole, the functional medicine tools allow you to look for the root cause of chronic disease. I do a thorough nutrition history, then there is an algorithm to help them through it. I love that the five R's of functional medicine gives us that platform. Do you use 5Rs in your practice as well with your patients?

Dr. Carrie Lam, MD: 15:41

It's a really good acronym, an easy way to explain why we're doing all of these. But just to go back and talk about the the gut and why it's such an important part of what you eat is what who you are. Could you explain a bit more about gut, break it down to stomach, intestines, microbiome?

Dr. Jyoti Patel: 16:09

It's everything, information, energy, connection. We think of digestion as a physical process of taking food and assimilating it but your mind plays a role. It's processing things like we're either accumulating toxins or we're clearing those thoughts. So when we talk about digestion of information from your eyes, nose, mouth, ears, your thoughts, touch, everything is receiving information, and you're digesting it in some way. Some people will say you are what you eat, but I say you are what you digest. When you start to think of that process, your experience at a deeper level, all we are is this awareness of our experience, through our senses. Eating food is one of those experiences. It starts in your mouth, but your senses work, when you see the food. We talk about mindful eating, sitting with your food, the setting, the colors on your plate, the smell, the touch, when food enters your mouth, and you hear yourself chewing, you experience the taste and the flavors exploding in your mouth. So your your brain is already digesting.

Dr. Carrie Lam, MD: 17:47

It's making me salivate.

Dr. Jyoti Patel: 17:51

Your thoughts are digesting this information right now. When you put that food in your mouth, the food there's no good or bad. It's just food that serves you and food that doesn't serve you. So if you're consuming food that serves you now it matters, how you prepare the food, your mental state, who you're sitting with, your environment, when you're eating the food, how fast you eat, what you're doing, if you're distracted while eating, the time of the day, are important. Whether you're eating slowly, chewing it, and you're increasing saliva and digestive enzymes, that digestive process has already begun. Once you swallow that food, before it reaches your stomach, it has already received a signal from your brain to prepare to receive food. So acid begins to flood into the stomach, the food emulsifies with this acid, and the minerals and nutrients are absorbed. Then the food goes into the small intestine, it gets sprayed by the pancreatic enzymes. All the enzymes on the lining continuously works on digesting that information, which is not just energy associated with carbs, fats and proteins and phytonutrients. The entourage effect that happens in plants and food that are genetics. So it has information in it. And when that information gets absorbed into our bloodstream and touches 50 trillion cells, it's affecting our genetics, turning on and off genes, creating health, we're creating illness - epigenetics and nutrigenomics. The information in the food that's affecting our genes. People don't think of food that way. But that's what we should be thinking of. It's how are we're affecting the information that we receive and what are we digesting and absorbing and what we need is also what we get into our system.

Dr. Carrie Lam, MD: 20:00

People say they're born with this, and blame the parents. But no, you can still change your genetics and the way you express it, through nutrigenomics and food.

Dr. Jyoti Patel: 20:19

Our lifestyle is what fires those bullets, including the food, our thoughts, what we hear from people, toxic information from technology, everything is affecting us, We are digesting this and maybe accumulating toxins in our system. When you eat certain foods and you don't properly digest it, you might experience acid reflux, indigestion. These are signs that we didn't take the time to set up our digestive processes. Some people experience bloating and gas in their small intestine, they may have an overgrowth of bacteria that's fermenting that food, breaking it down. So again, it's not just what we eat, it's what we digest. And what we don't digest, causes toxicity in our system and cause an accumulation of waste matter making us sick increasing inflammation. You mentioned the microbiome, that collective experience in our colon made up of trillions of bacteria and other viruses, parasites, and fungi that, together make up more genetic material in our body than our own human DNA. And this information that they carry in their genetic material is so powerful. It regulates every process in our body, from hormones to immune system to absorption of nutrients, making vitamins, fighting pathogens, production of neurotransmitters, mood balance. These organisms that live in our colon have the utmost importance when it comes to balancing our health. This microbiome, is understood in the last 10 years, people have increased interest in it, We realize that our understanding the gut microbiome is just the tip of the iceberg. We don't know everything about it, in the Western culture, there is a diminishing diversity and volume of the gut microbiome compared to indigenous cultures. And probably part of the reason why we're more prone to lifestyle related chronic diseases, such as heart disease, diabetes, obesity and chronic inflammation.

Dr. Carrie Lam, MD: 22:56

That's very interesting. So you're saying just the variety, because we tend to eat the same foods from the same supermarket that comes from the same soil, that's why we don't have a lot of variety. They've all been washed clean, and sprayed with pesticides. The standard American diet is very limited in feeding our good microbiome. So I can definitely see that.

Dr. Jyoti Patel: 23:23

Here's another plug for that garden. Yeah, when you garden, you have your hands on the soil, those soil microbes are part of our gut microbiome. Growing our food and consuming it means we're consuming the bacteria, and it's becomes part of our gut microbiome. It increases the diversity. When I garden, I gently rinse off the vegetables, and then consume them. That way, I'm getting the gut microbiome. I love that you mentioned diversity of food, and how it affects diversity of your gut microbiome. Your menu as long as you're changing it up, you're improving the diversity of microbiome. So eating the same foods every day decreases the the diversity of your gut microbiome. In functional medicine, people go on restrictive diets and they stay on these restrictive diets for a very long time and instead of benefiting them it's actually further pushing them down this path of ill health.

Dr. Carrie Lam, MD: 24:41

That comes to the the first R.

Dr. Jyoti Patel: 24:51

So the five Rs is an acronym to address a gut reset in functional medicine. The first R is Remove. Removal So we can get to our to our five R's, which would be what Dr. of toxins, can be mental, emotional, people, environments, activities, habits. So, things that we need to remove that doesn't serve us. It can also be certain foods because some may have food allergies, causing a reaction like swelling of the mouth, throat, tongue, difficulty breathing, hives, rashes. If you have food allergies, ask your doctor, because what we're saying here today is not medical advice. It's only for educational purposes. So make sure that you speak with your doctor if you have food allergies. Also, some people have food intolerances and food sensitivities that dont show up in an allergy test, but could be affecting your health. Removing inflammatory foods for a short period of time, before reintroducing it can be beneficial. And there are many elimination diets out there, Dr. Lam, your audience may have had different ones tried and tested. This is personalized medicine as every person is unique and you should see a doctor to see which foods you should eliminate based on your own pattern. Food journaling is a great tool to write what you ate and how you felt afterward giving yourself ratings to see if there's ertain foods you want to liminate. There's so many ifferent ways of doing the limination part. So removal of oxins, additives, pesticides, olors, dyes, processed foods, ugar, refined, food, empty alories. Clearly those are hose are in the R category. The econd R is Replace. Replacing he proper tools for digestion ike chewing food and saliva to elp break down the food. astication is part of digestion Patel? nd when we stop chewing food, e can have digestive issues, so eplacing that saliva, the igestive enzymes. Also acid in our stomach, as we eat we roduce less acid, people are aking PPIs and acid reducers hat can affect our digestion in

Dr. Carrie Lam, MD: 27:33

If you go to the doctor with heartburn, they negative way. will prescribe an acid blocker like pantoprazole, omeprazole but these are not good for lon term leads to mortality osteoporosis and many sid effects. So what does someon with low stomach aci symptom wise d

Dr. Jyoti Patel: 28:08

You can go to a gastroenterologist, and they can do a capsule study to measure the pH of your esophagus and stomach, have the pressure measured in your LES which is your lower esophageal sphincter to see if you actually have acid reflux or if it's just anxiety. There are many other ways but people with low acid states might have poor absorption, more acid reflux, with low acid states. You can have abdominal pain and gastritis even with low acid states, poor absorption of minerals, like you mentioned, your process downstream conditions of having low absorption of minerals can happen.

Dr. Carrie Lam, MD: 28:48

Bloating after they eat if they're not digesting well, and they just feel that the food gets stuck there.

Dr. Jyoti Patel: 28:58

And you can do a trial of time and HCl to see if they feel better or worse. Working with the practitioner is really important. The replacement of digestive enzymes, pancreatic enzymes, bile, things that maybe your body is not producing, Many people ask why they are not producing acid, bile or pancreatic enzymes? It can be age related, but often it is due to the vagus nerve. The vagus nerve controls our parasympathetic function, which is digestion. It's cranial nerve number 10 originating in our brainstem. It passes through our vocal cords or airway, regulates your heartbeat, our breathing cycles including secretion of acid, bile secretion, pancreatic function, and small intestinal and large intestinal motility. When we are stuck in fight or flight, that's when we're anxious, nervous, angry, cynical, bitter, all those sorts of difficulties, we shut down the function of the vagus nerve. It also also innervates the lower esophageal sphincter, so when we are stressed, it can open the diaphragm causing more acid reflux, increasing the production of acid, and decreasing the digestive processes. So while somebody may be working on their mind body balance, I might suggest taking replacements for pancreatic enzymes and for acid needed.

Dr. Carrie Lam, MD: 30:44

Work on the vagal nerve, do the breathing, get out of the fight or flight to deal with the stress can also help with your gut. I think we don't talk about mindfulness enough. So I love that you just keep bringing it up, like it's a part of digesting is not only just the gut, but also digesting your information and the thoughts that you have. Then the third R would be Reinoculate?

Dr. Jyoti Patel: 31:15

We talked about the microbiome and the reinoculation of the microbiome doesn't always come with a capsule and a probiotic. Though in some cases that might be helpful. Typically, I suggest using natural ways. The first and only ingredient is always fiber, from plant matters, helps feed our gut microbiome and creates diversity, volume, balance, helps with detoxification, with bowel movement. So having sufficient amount of fiber is really the most important part of that reinoculation. Instead, standard American diet typically allows for less than 15 grams of fiber a day, whereas the daily allowance should be around 30 to 40 grams. So we need to double our fiber. The gut microbiome plays a role in immune function, hormonal balance, estrogen metabolism, production of vitamins and nutrients, detoxify, fight off pathogens, production of serotonin and dopamine.

Dr. Carrie Lam, MD: 32:26

So just to break it down, the fiber actually feeds the gut bacteria. That's what that's why fiber is so important. The gut microbiome loves the fiber because it stays in your gut and you're able to feed it. For example, you're giving prebiotics through fiber to feed the good gut bacteria.

Dr. Jyoti Patel: 32:56

Prebiotics are especially good for our gut bacteria. And those include things like chicory, artichokes, onions, garlic and soybeans. If you feel you're not getting enough fiber, you can take a fiber supplement. If you're working on a chronic illness, and you need probiotics, then talk to your doctor and getting a reputable brand, that's effective is important as well. So the fourth R is Repair. When we have a chronic state of inflammation in our colon, most people don't know this Dr. Lam that the gut lining is only one cell layer thick. And it replaces itself every five to seven days. So even if you have an inflamed gut lining, you can repair the lining. Nutrients like glutamine in bone broth can help. Don't take any supplements without your doctor recommends such as vitamin A, zinc, tannins and, and colorful fruits, vegetables can also be beneficial. So repairing the gut lining is is is the fourth R. The final R is Restore and I love talking about the last R which again ties it back to mindfulness. Often we think that our gut is siloed from other organs but our mind and body are connected. They may be actually one and same. This river of intelligence that is created by our experiences, our beliefs are reactions, it's all connected. So when the mind and the body are seen as two separate entities, we are at a disadvantage but when we start thinking of our mind and our body as interconnected, then we can actually create wellness in the whole body. When you're stressed, you have butterflies in your stomach, or abdominal pain. They are bi directional network of neurons that connect our mind and body. The fifth R is restoring our mind-body connection. I recommend doing daily meditation. I have my own meditation practice where I, put aside 30 minutes a day for my own practice. I encourage my patients to do so as well as well as do a regular form of exercise outside and connect with nature, either with animals, body of water, gardening, again, something that connects you to the planet. Sleep is important for restores, making sure you're getting that 7 to 8 hours of good restorative sleep and sleep hygiene is really important. When we have purpose in life, when we connect with our loved ones, we feel whole. And that in itself can also heal on any digestive issues.

Dr. Carrie Lam, MD: 36:29

So to be able to deal with but not only the gut, but also the mind. Just to recap, remove is the first R, removing toxins, any bad foods or anything that could be causing inflammation. Number two R is replace, replacing acid, enzymes, bile if you needed it. Number three is re-inoculate your gut microbiome, whether it's probiotics, prebiotics, feeding the good gut bacteria for a good microbiome balance. And then the fourth R is repair, whether it's using nutrients, with providers' help, not do any supplements by yourself. To find good ways of repairing that gut lining. And then the fifth R is to restore your your life back through stress reduction, relaxation, mindfulness and good sleep. Thank you so much, Dr. Patel for what a wonderful show we have today to learn that not only about primary care, how you're practicing, how you're affecting your community in such a positive way, and also how well we can do for our gut. So if people wanted to find you what's the best way that they can find you or contact you?

Dr. Jyoti Patel: 38:04

So my website is https://aimsforwellness.com/ and my handles on social media or just my name. So it's Jyoti Patel MD on IG, Facebook and tik tok.

Dr. Carrie Lam, MD: 38:25

You are located in Scottsdale, Arizona if you want to visit the clinic. We're so glad to have you as our guest on Dr. Lam show. And talking with like minded people is what we always love to do and be able to change and rewrite the the future of medicine. And so we hope that everyone listening, enjoyed this podcast episode. Definitely subscribe like both to Dr. Patel and also the Lam clinic if you are looking for help. You know, there's plenty of help from amazing practitioners like Dr. Patel. Thank you for your time today.

Dr. Jyoti Patel: 39:12

Thank you Dr. Lam.