Nutrition, Brain Health, and the Gut-Brain Axis With Megan Lyons

Dr. Kelechi Uduhiri: Gut function is intertwined with the health of body systems and organs, including the brain. The gut-brain axis is a bidirectional communication network that continues to be studied for its involvement in the pathogenesis of an array of disorders, including dementia and neurodegenerative conditions. What are the potential drivers of gut-brain axis dysfunction? How does this dysfunction influence neurodegeneration and cognitive health? And what beneficial role does nutrition play? Dr. Megan Lyons: The basic connection is when something's off in the gut, it is releasing different neurotransmitters. It's releasing different endocrine byproducts. It's releasing different gut metabolites to the brain that alters our brain chemistry. And so at the beginning, it's things like fatigue and anxiety. At the end, if this goes on for too long, it is connected to things like neurodegeneration, dementia, et cetera. Dr. Kelechi Uduhiri: I am Dr. Kelechi Uduhiri, director of medical education at IFM. And on this episode of Pathways to Well-Being, we welcome Dr. Megan Lyons to discuss the gut-brain axis and how personalized nutritional treatment and prevention approaches support both gut function and brain health. Welcome to the show, Dr. Lyons. Dr. Megan Lyons: Thank you so much. I am so thrilled to have this conversation with you and just honored to be on IFM's podcast. Dr. Kelechi Uduhiri: It's great to see you. Thank you for joining us today on the podcast. Let's start by talking a bit about your background. How did you become interested in practicing integrative and functional medicine? Dr. Megan Lyons: Well, it's been a long and winding journey, like I think many of us have experienced in some way. I started out as what I would call a standard American kid, standard American diet, which we all know has room for improvement, but thankfully was blessed without any kind of health conditions or anything like that growing up. And to be honest, never really thought much about health at all. I studied economics at Harvard for undergrad, and I got an MBA, and I was in the business world and still never thinking about health. But unbeknownst to me at that point, I was really burning out my endocrine system, my adrenals, my sex hormones, my thyroid. I was metaphorically burning the candle at both ends. I was traveling 48 weeks a year. I had just gotten into running, which exercise is wonderful. But when you run too much and don't know how to fuel your body for that running, it can do a number on your hormones. And so I basically burned out my mind and my body. And I, at 23, felt like something was not right. I hadn't had a period in over a year. I was just feeling not like myself. And so I ended up going to a doctor who thankfully ran my hormones, which I think, quite frankly, is pretty progressive. Looking back, this was, I don't know, 20, 23 or some odd number of years ago. It was pretty great to run hormones for a young woman at that point. And she said to me, "Whoa. I've never seen this before," which is never something you want to hear. She said, "Basically, your hormones are lower than the postmenopausal women that I work with. And I don't know why this happened. I don't know what to do. So I'm sorry, I can't help." And I'm a problem solver at heart, so I just wanted to dive in. I knew in my gut that I was able to improve my own health. And this is something, whether their situation is the same or different, this is something that I'm so honored to give to my patients and clients as a gift is that if we dive deep enough inside, our body almost always... I would say always has the answer. Almost always we can find the answer, but it's really deep within us. So I started that process of unpacking how do I learn to fuel myself. How do I learn what kind of things I can do to balance my nervous system? Of course, how do I heal my gut? Which is now one of my big passions, the gut-brain axis. And the gut was kind of a wreck looking back at that phase. And just by exploration on my own self, as patient number one, I became so fascinated with this world of functional medicine. And once you see it, I know we talked about this before, you just can't turn away from it. So I did end up going back to consulting, but I just couldn't stay there for too long. I wanted to be able to share this with other people. I ended up leaving in 2014 and starting The Lyons' Share then, and I haven't looked back a moment since. Dr. Kelechi Uduhiri: Oh my gosh. I love your story. And it is so... I hear it so many times, the way that most of us fall into functional medicine is it starts with our own personal journey, of knowing that something is not right and... There's something that you said that was quite striking to me, which was, "I knew in my gut I was able to improve my own health." So what gave you that level of confidence at that young age? Because the doctor just told you, "Something's wrong. I can't help you. Good luck." Right? So at that young age, what gave you that confidence that, "I can do this. I can figure this out"? Dr. Megan Lyons: I wish I knew. And I just got physical goosebumps as you said that. I don't know, honestly, if it was a gift from God or if it was like braggadocious confidence that I shouldn't have had at 23 years old or if it was just curiosity. I've always been a really curious person. I've always been a problem solver. And so I hadn't really been exposed to data that would tell me that I could do this, but there was just something inside me that told me there was a better way, and I followed that. Thank goodness. Dr. Kelechi Uduhiri: Yes. I'm so grateful that you did because now you get to help so many more people and give them that confidence that there is a root cause and together we can find it, right? And we're going to start- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... from the gut. So let's dig in into your practice. You said that you discovered it. You couldn't look back. I completely agree. Once you see it, you just can't unsee it, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And then you were in consultancy, but you wanted to help more people. So tell us more about your practice, The Lyons' Share Wellness. Dr. Megan Lyons: Yes. So the practice started in 2014. As I said, it was just me for several years. I have branched out. We're still a small team of seven total people, including myself, and we see... We like to describe them as people who like to do everything. So what that means is kind of high-performing adults. They are active in their career. They're active in their family. They're active in their community. They're doing all the things. And when we do all the things, sometimes we forget to put ourself at the top of that list. So that applies to women. We do see 60 to 70% women, but we have a great handful of men as well. We mostly see people dealing with some combination of metabolic dysfunction, whether that is blood sugar control or, quote, "metabolism" the way that the colloquial public would think of it. Then a combination of gut symptoms, a combination of brain symptoms as we're about to talk about, which might manifest as fatigue or brain fog or memory slowness or anxiety or insomnia, something like that. Usually our patient population is dealing with a confluence of all of those things. And it's not just one isolated problem. They might say, "I'm doing all these things, and yet I still don't feel like myself." We know that that's where functional medicine can shine by really getting in deep and asking all the questions and hopefully getting to the root of what's going on. Dr. Kelechi Uduhiri: Absolutely. When I hear how you're sharing about your practice, it's that man or woman who, like you said, is just multitasking. They're carrying family life, and they're taking care of other people. They may have a career that's really intense, and they may be in that sandwich generation, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Taking care of young children or slightly older children and taking care of elderly parents at the same time. And so like you said, who puts themselves first? They don't, right? They put themselves actually last. Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: And so it's so ripe for metabolic dysfunction. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And so they come to you, and they are confused. They know something is wrong. They're feeling off. And you can really start to help them put the pieces of the puzzle together. That's what I'm hearing is how your practice is set up. Dr. Megan Lyons: That's exactly right. And people will even tell us that right at the beginning. "I know I'm not putting myself first." And they're almost shaming theirself. They're like, "I know I can't pour from an empty cup," to use that phrase, but it's hard to do. So I have a lot of compassion for that. And sometimes having an outside- Dr. Kelechi Uduhiri: Absolutely. Dr. Megan Lyons: ... facilitator, whether that means showing them how that's manifesting in labs or educating them or figuring out systems that will fit into their exact lifestyle or just giving them a sounding board and letting them spill out to someone. Any of those things can help them, and we're here for all of it. Dr. Kelechi Uduhiri: Okay. Awesome. So now we're going to narrow down a little bit to a specific part, which is what the theme is for today, right? Gut-brain axis. So today we're focusing on that nutrition and brain health. Let's dive in with a general overview of the gut-brain axis. So to orient our listeners, just in general, what is the gut-brain axis? Dr. Megan Lyons: Yes. Well, I heard you refer to it earlier as the bidirectional communication network or bidirectional highway. And I love this analogy. I always call it the bidirectional highway because people think it only goes one way. But you and I know these two organs, and, in fact, the whole body, are sending messages both ways. So the brain sends messages to the gut. The gut sends messages to the brain. And we think of the gut-brain connection as one big nerve, as the vagus nerve, which is a big part of it. That's the neural network. That's the physical connection between the brain and the gut. But I like to help people expand that definition. Now it's not just a bidirectional highway, but it's a multi-lane highway. And sometimes there are various lanes. One lane is for trucks and one lane's HOV and one lane's express, whatever. All these lanes are different ways that our brain and our gut communicate. So there's the endocrine system. There is that neural network, which is the vagus nerve and other nerves. There are hormone and gut metabolites, which are little mini chemicals that communicate between the gut and the brain. There's immune parts of that bidirectional superhighway. There are gut metabolites. I think I already said that, but even little bits of our microbiome, little bits of bacteria and other organisms. This is all part of the communication network between the brain and the gut. Dr. Kelechi Uduhiri: And the word that you use was even better, I think, than mine, which is multi-lane. It's not just two back and forth. It's a lot of lanes going back and forth. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And so that's why someone can present to you with multiple brain or mental health symptoms. How does a patient present to you? What is your most common symptoms that you're seeing that patients are presenting to you that are most likely dealing with a gut-brain axis dysfunction? How do they show up in your office? Dr. Megan Lyons: Yeah. It's a great question. And I'm going to skirt the question a little bit by saying there's not just one symptom, which I think makes it a little bit more difficult for both clinicians and patients to understand that this could be some kind of gut-brain dysfunction. But I would say in terms of the gut symptoms first, it's generally like that, "Oh yeah, I'm bloated, but isn't everyone bloated?" Or, "Yeah, I'm kind of regular. I go to the bathroom. I have a bowel movement every three days." Or, "Yeah, I have loose stools, but I've had that all my life." Something like that. They don't often say, "Wow. This is a serious problem. I'm having a toilet full of blood," or something like that. It's just kind of like something they've learned to deal with gut-wise. And similar on the brain side, they're saying, "I'm a little bit more moody. I'm a little bit more anxious. I forget things a little bit more, but it's not like I've totally lost my cognition." They're just starting to feel a little bit not like themselves brain-wise. And I think if and when we dive more into different drivers of gut-brain dysfunction, we can discuss more specific symptoms, but that's how I would describe it broadly. It's just a little something's off, but it's, quote, "not that bad yet." Dr. Kelechi Uduhiri: Okay. And so I'm kind of walking this journey with you, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: They present to you. They have these non-specific brain symptoms like brain fog, forgetfulness, maybe sometimes a little dizziness, and then they have the gut issues, like maybe irritable bowel, maybe constipation, maybe some loose stools. How do you start to help them see that there is a connection between the gut and the brain? Where do you begin? Dr. Megan Lyons: I think it really depends on the person. And some people love learning about this. They've heard of the gut-brain axis, but they don't exactly know what it means. So just a bit of education helps them with the buy-in. And then they can try some different things and actually see the difference, feel the difference in themselves. So that's great. Some people really like to see it in testing. So I think stool testing is amazing. It's not the end-all, be-all, and we definitely don't need it for every person. But if the person wants to see it in the labs, that's a great place to start. For some people, it's just about getting them to take a few steps so we can talk about the most important things here to start impacting this connection positively. And if they can trust me enough to make these steps for a couple of weeks and then months and they can see the difference in themselves, that often helps them get there. Dr. Kelechi Uduhiri: And I can only imagine that. Like you said, everyone is different. It depends on the patient. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: You get a great story and you hear the story and you tell them back what you're thinking and how things may be connected. And I'm guessing you start at the foundation, right? So one of- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... those pieces may be nutrition. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: What role would you say nutrition plays in the healthy function or dysfunction of the gut-brain access? Dr. Megan Lyons: Well, as a nutrition professional at heart, I think it plays a huge role in all of this. I love nutrition. And it blows my mind that still we as, I guess, a society or a popular culture or whatever, we're still saying, "Oh yeah, that can't really matter that much. It's all about this fancy supplement," or "It's all about this new thing." And I'm totally into the fancy supplements and new things if the foundation is already in place, but I think we miss the foundation. So to answer your specific question, our gut and our brain are both designed to thrive on a robust, diverse intake of whole foods. And we've lost that largely in terms of the standard American diet and standard global diet. We've lost that diversity of whole foods. Because honestly, it is easier to eat packaged processed foods when you're busy and you're on the go and you're high achieving, like my patient population. And frankly, like us as practitioners as well, it is easier to grab something in a package, but our bodies were not designed for that. So we can talk about specifics in terms of eating fiber from foods. That helps our body produce short chain fatty acids, which are hugely important for gut integrity and for brain health as well. The foods that have fiber naturally also come packaged with polyphenols, which have huge brain benefits. They also come packaged with antioxidants, which help reduce inflammation. And then on the flip side, more packaged and processed foods, because of the nature of the way they need to stay on the shelf for a hundred months at a time or whatever, they often have preservatives, emulsifiers, artificial sweeteners, things that we know, if we eat them once, it's really not that big of a deal. But if we're eating them repeatedly, that can alter our mucosal membranes, our intestinal permeability or the integrity of our gut lining. And it can actually change the communication in terms of neurotransmitters between our brain and our gut. To go back to your question, just look at the foundation of eating a more diverse whole food diet. That alone goes a huge way in improving our gut-brain access health. Dr. Kelechi Uduhiri: Absolutely. And I completely agree with you. I said that in my patient population, too. And I'm sure you've heard of this statistics, 70 to 80% of chronic disease, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: I mean, we can really address it by just lifestyle and- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... addressing the foundations of just good health and nutrition and movement and sleep and exercise and dealing with stress. Dr. Megan Lyons: Yeah. Dr. Kelechi Uduhiri: And when we don't have that balance, that balance you just talked about, which is the balance of having great food diversity, right? Dr. Megan Lyons: Mm-hmm. Dr. Kelechi Uduhiri: When we have great food diversity, fiber and polyphenols and antioxidants and all the nutrition that we need, we can thrive. But when we don't have that great food diversity, we enter this place called dysbiosis. Tell us a bit more about... We hear this word a lot, right? Dysbiosis. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And how do you explain that? What does it mean, first of all, to be more clear on it for our listeners? And how do you explain it to your patients so they understand the importance of addressing this issue? Dr. Megan Lyons: Yes. Well, I explain dysbiosis as an imbalance in all the microbiome, which are comprised of bacteria, fungi, yeast even. People think of yeast as a terrible thing, but we all... And people think of bacteria as a terrible thing. If you had no bacteria in your gut, you would not live a happy life. We all have them. More bacterial cells in our body than human cells, believe it or not. And this community of bacteria and other organisms, they do a ton for us. They help us absorb nutrients from our food. In many cases, we cannot extract certain vitamins and nutrients from food without the help of the bacteria. But these can get off balance. And people these days, I think, are thinking more of an overgrowth, so, "Oh my goodness. There must be a parasite in there," or "You must need some kind of cleanse." And yes, sometimes that is the case, but I'm definitely not one who says everyone needs a parasite cleanse that they find on Instagram or something like that. Just as often, or more often these days, I see an imbalance or a deficiency of the, quote, "good" bacteria, so those robust communities of lactobacillus and bifidobacterium and all these guys that live in our gut that do help us. And those get wiped out by stress, by alcohol, by over sanitization, by overuse of antibiotics, by a lot of things that are common in our modern lifestyle. They won't rebuild themselves or repopulate as strongly as they need to be unless we're having that diversity of plant food intake. Dr. Kelechi Uduhiri: You just gave the best explanation I've heard of dysbiosis. So thank you for that. Dr. Megan Lyons: Yeah. Dr. Kelechi Uduhiri: So I'm hearing diversity is the key, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: That microbiodiversity, which comes from food diversity. It feeds... No pun intended. They feed into each other. And so when there is a lack of that balance, we get this dysbiosis, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Where it's overgrowth of either the good or the bad bacteria. So let's now pivot a little bit into the brain, right? Dr. Megan Lyons: Okay. Dr. Kelechi Uduhiri: So you've explained what it should look like. You've explained what it tends to look like now with our modern diet and our very busy lives and all the things that we do that sort of throw us off balance. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And so that leads to this dysbiosis. And so how does that connect... How does this gut dysbiosis connect to neurodegenerative conditions or affect our brain health? What's that food-to-brain connection? Can you share more about that? Dr. Megan Lyons: Yes. Well first, I will give the caveat that I don't know everything about how this works. And in fact, I don't think anyone knows everything about how this works. This is such an emerging field of research, which to me makes it so exciting. I actually do think we're going to get to the point, probably in the near future, I don't know, where we can identify what is the optimal microbiome balance for one person, and we're not there yet. Even in the really cool advanced stool tests that we do, we're comparing to healthy populations, but we know that one person's gut shouldn't look exactly like someone else's gut, so there is some ambiguity still here. But what we do know are things like lipopolysaccharides or other endotoxins that happen when we do have that dysbiosis or we do have intestinal hyperpermeability. Our body releases some of these "chemicals", in quotes, that are toxic to our brain. And this can start showing up in terms of that brain fog, that anxiety, that fatigue. It's like, "Maybe nothing's wrong, but something's kind of off in me." This can very often be tested for and/or we can infer that something there's going on. So the basic connection is when something's off in the gut, it is releasing different neurotransmitters. It's releasing different endocrine byproducts. It's releasing different gut metabolites to the brain that alters our brain chemistry. And so at the beginning, it's things like fatigue and anxiety. At the end, if this goes on for too long, it is connected to things like neurodegeneration, dementia, et cetera, as you're mentioning. Dr. Kelechi Uduhiri: Yes. It's so interesting because I think the body is still a mystery, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: As time goes on, we evolve and we find new discoveries and new ways of testing and perhaps new treatment. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: But fundamentally, I believe the body is able to heal itself once- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... we are able to take better care. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And that's really the role of nutrition, is to bring in that balance back to the microbiome, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And then when you bring in that balance, it can now do what it needs to do because it's in its optimal state. Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: Does that sound about what you were trying to share with me? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Okay. Dr. Megan Lyons: That sounds exactly like what I was trying to share. Dr. Kelechi Uduhiri: And so I think nutrition is so key. And like you said, it's been so altered in our day to day. And that alteration brings in other chemicals that don't belong in the body that throw it off and that leads to the dysbiosis, that leads to the dysfunction and dysregulation, that leads to all the diseases. So that being said, are there any specific nutrients either in food or through supplementation that you have found that helps people maintain their brain health or their cognitive function as they age? Dr. Megan Lyons: Yes. So I'll talk first about nutrients that I think are good for almost everyone. And then second, about maybe nutrients that could be depleted that we might want to replenish in certain people. So first, for almost everyone, or I would say everyone listening, the most research, the biggest bulk of research on this is done on the Mediterranean style diet. There's a twist on that called the MIND Diet, M-I-N-D, which is easy to remember when we're talking about brain. And both of these are focused on whole food, plant forward, but not exclusively plant-based. So we're really getting a lot of those polyphenols that I mentioned. And I love the IFM handout that's called Polyphenols by Color. I use that all day, every day, just to show people that a lot of the plant foods that they enjoy do have polyphenols. So we think about pomegranate and green tea and my favorite chocolate, which is if we're getting a really good quality chocolate, I think that can be great for our brain health. But also, almost every vegetable and fruit has some combination of antioxidant or polyphenol in it, so eating more of those is super important. And then dialing in our fat quality, so more omega-3 fatty acids from walnuts, chia seeds, fish, olive oil, things like that, and less of the lower quality fats that we know do both vascular and brain damage. Then thinking about all the little micronutrients, so vitamins and minerals. And specifically when I said the second group would be nutrients that we would replenish, I see B vitamins to be deficient in a lot of people with this confluence of gut-brain symptoms. So whether that's B12, folate, even B6, I do see that we need to be careful with the balance of zinc and copper. So some people need zinc, a few people need copper, but we do want those in balance. My very favorite nutrient to replenish, because it's one that I rely on personally is magnesium. I just love magnesium for the gut-brain axis. And there are various types of magnesium. So if someone listening has just bought magnesium or they've had a colonoscopy and they had to clear out with magnesium, they're probably thinking I'm crazy, but I... Personally for gut-brain axis, I like magnesium L3 and 8, which crosses the blood-brain barrier really well and has been indicated in some pretty good studies in terms of neurodegeneration and things like that. But also, glycinate is great. Magnesium in general, because of our soil quality being depleted, even if we are eating the vegetables and nuts and seeds and chocolate, again, many of us are not getting adequate magnesium to put up with our stress levels. So those are some nutrients off the top of my head: B vitamins, zinc, copper, magnesium, omegas. But really getting back to that Mediterranean style diet is very beneficial. Dr. Kelechi Uduhiri: Absolutely. It's so important that you started answering that question with nutrition, like whole foods. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: We know about the Mediterranean diet. Start with foundational nutrients. Start with looking at what the person is eating right now and what are the things that... How can we support him or her to make better choices, right? Because it's almost like we've been programmed to eat a certain way because- Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: ... of our lifestyle. And then they come in. It's almost like you have to deprogram that and then start to bring in some healthier options. So as you are seeing this patient in your office, what are some of the tools that you provide to support them to make these changes? Because it sounds really easy, right? Dr. Megan Lyons: Yeah. Dr. Kelechi Uduhiri: Do this, do this, do this, so that you'll be fine. But we know it's hard. We know behavior change is hard. So how do you in your practice support your patients to make these critical lifestyle changes? Dr. Megan Lyons: Yes. Well, several comments on that. The first one is, it sounds easy, but I know it's hard. Almost every single day I have someone come in, a new patient. They're like, "Okay, what's the plan?" And it's almost like they're bracing themselves and thinking I'm going to tell them only drink kale smoothies for the rest of their life and it's going to be so hard and whatever. And I say, "First of all, there's no plan because it's all customized to the individual." Just like you said, we're starting with where the person is, and we're helping them make gradual changes. But second of all, I almost want someone to leave the session feeling like, "Is that it? That wasn't that bad." Because when we're in the session, things seem a lot easier than when we're out in the real world, and things do get hard. So I really want people to be confident in the changes they're making. I would rather underwhelm them and then build on over the course of our sessions. But then to what you said about what tools and how do we actually help them do that, it really does depend on the person. I do believe that home cooked food is the best when it's available. But some people will just flat out tell me, "Hey, I'm not going to cook." And so for them, we're going to help them look at restaurant menus, investigate other food prep, meal delivery options, whatever it takes for them. I do believe in, again, what you said, meeting the person where they are. We in our practice actually really like to use a very simple form of tracking that I developed in 2014 when I opened the business. And for any clinicians listening, I recommend this. It's just a Google Sheet, literally a Google Sheet that then we have to go through security measures to make sure that it's fine and HIPAA-compliant. But that's where it starts, is a Google Sheet or an Excel, and it has dropdowns. And we try to stick to four to five goals for each person for each week. And all the dropdowns will say is, "Yes." And sometimes, depending on the person, it says, "Go me," and then it turns green or, "Not today." So we don't like to shame people. And it doesn't turn red, none of that. We just like to say, "Yes. Go me," or, "Not today." And by narrowing down their goals to something like that, four or five things they're working on, and then having a simple method of tracking, we really see great success to where then we can build on it the next session. Dr. Kelechi Uduhiri: Oh, that's great. Right. Because I know personally, I love to track, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And when you find that patient that loves to track and loves to see progress... And I think that is so beneficial to show- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... People that you're doing it. It doesn't have to be perfect. Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: If you do this 80% of the time, you're doing great. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: It's not about perfection. It's about progress. Dr. Megan Lyons: That's exactly right. Dr. Kelechi Uduhiri: Yes. So I love that you empower your patients, A, to take ownership, be part of the journey- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... and know that it's okay if it's not perfect because that's not the goal. Dr. Megan Lyons: Exactly. Dr. Kelechi Uduhiri: Right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: The goal is to keep making those small changes day after day, day in, day out. So that is awesome. Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: And what does your team look like to support patients through this work? Because this is hard. I know it sounds easy as we're talking about it on the podcast. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And as professionals, we even struggle with it, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: So is there a way? Is there a team? Talk about your team-based approach a little bit more so that our clients who are out there trying to see how they can operationalize this can get a really good sense of how to do this work with their clients. Dr. Megan Lyons: Yeah. Well, we of course love functional medicine. So I'm a certified functional medicine practitioner, FMCP. And Dr. Ashley on our team also is a doctor of clinical nutrition and FMCP. And we both went through the IFM process at the same time, so we're thrilled to have that offering. And then we have Cass on our team who has a master's in human nutrition and functional medicine, so another functional medicine enthusiast. Her background is in health coaching, so she fills the role of the coach on our team, although we all do coaching. We firmly believe that coaching is important at any stage of the journey. Some patients are more open to it and excited about it and some are less, and that's okay. But we love the coaching approach. Then we have Audrey, who's our client services director. And she helps us do all the logistics and all of that. Which for any practitioners listening, once that's feasible for you, if you're in a small business, that has just been such a gift for our patients and ourselves as well to take some of that off the plate. And then we have other support team members as well who help with newsletter and podcast and social media and all the things of doing a business. So it's a really great team. I love them all. Dr. Kelechi Uduhiri: And I love hearing about your team because it lets people know that you don't have to do it all. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: You don't have to be the one person who is the health coach and the clinician and the nutritionist- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... or the dietician and all the things. It's not meant to be one person doing it all. And the team-based approach is so important in this work. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: How important is this collaborative therapeutic partnership to your patients? Do you see the results when they have a team to support them? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And how do they feel about being part of this process with the team? Dr. Megan Lyons: I hope they feel amazing. That's our primary goal. Honestly, I would rather someone feel like they had a great experience and that they learned things that they can continue sustainably even after us versus, "Oh, I learned a great new statistic" or "I saw a great new study." Me, Megan, I get excited about that. But for them, I just want them to feel like they can do this. And I do think the team approach is super important to that, as well as the other practitioners that we collaborate with outside of The Lyons' Share. So none of us are MDs. We collaborate very closely with other MDs in the area and elsewhere. If someone is coming in and their MD is open to a conversation with us, we're super happy for that. We also collaborate with chiropractors and with physical therapists and with... You name it. We have a whole suite of people because I don't think that any one clinician in any area can manage every aspect of a patient's health. It's just not like that. But as long as we as practitioners can work together and can contribute our strengths, then we can better serve our patients. Dr. Kelechi Uduhiri: I couldn't agree with you more. I don't want to do it all. And I rely on my nutritionist, my health coach to really- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... support this work. And I cannot emphasize enough how important it is for the patient to have that health coach. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: I think everybody needs a health coach, right? Dr. Megan Lyons: Yes. I agree. Dr. Kelechi Uduhiri: Because they have such amazing strategies to help you keep moving forward. Small wins. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And empowering you that you're actually making a difference just by showing up and owning the work and being part of that journey. So kudos to what you've created at The Lyons' Share, bringing your team together and also understanding that there are others outside of your immediate circle that support the work, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Not just the four or six of you, but you work with even more extensive team of clinicians. Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: Because I think it's so important to understand that when we're practicing functional medicine, really there's so many pieces to this puzzle, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And not one person has to have all the answers. That's the beauty- Dr. Megan Lyons: No. Dr. Kelechi Uduhiri: ... of it. Yeah. Dr. Megan Lyons: I really wish I could. I wish I could be everything to every person- Dr. Kelechi Uduhiri: Everybody. Dr. Megan Lyons: ... in the whole world. My heart is there. My heart is big enough, but practically it doesn't work that way. Dr. Kelechi Uduhiri: And it doesn't have to work that way. It doesn't have to- Dr. Megan Lyons: No. Dr. Kelechi Uduhiri: ... be that way. And to be reassured that you don't have to know it all. Because I think sometimes when we get started out in functional medicine, we think we have to know all the pieces, otherwise- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... we're just not ready, but it doesn't have to be that way. And that's what your story is sharing, is bringing to light today. So I'm always curious, where do you see the field of nutrition, gut health, brain health going in the next few years? Because I feel- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... like there's always something new coming up. Dr. Megan Lyons: I really do think it's an exciting time. I think the number of people these days who are even familiar with the term gut-brain access or they know something about their gut health or they've even heard gut health, it's skyrocketing. And so that is an indication of where the research goes. I used to know the statistic. There we go. I used to know the statistic of PubMed studies on gut-brain access. And I don't know to this day, but it is enormous how much that research has been increasing in recent years. So a couple things that I see and hope are coming forward. One I hinted at before, which is a little bit more precision targeting of the microbiome. There are several companies out there that I would say are trying to do it right now, but aren't quite there. And so what this could look like in the future is having even more precision in terms of a probiotic strain that would be beneficial for someone's personalized microbiome and personalized symptoms that they're experiencing. I also see things like personalization of even macronutrients and micronutrients, which we can get fairly close to with lab work, but not close enough yet. I think precision nutrition grounded in behavior change has a lot of improvement to make. And so also in that, you and I mentioned that we love tracking. I love tracking. I love tracking everything. Data to me is super fun. But I do think that with AI, we're going to eliminate the need to track certain things for people for whom that's overwhelming and that they may be able to get biofeedback on their nutrition just by wearing a ring or device or something like that. Dr. Kelechi Uduhiri: Yeah. Wearables. Yep. Dr. Megan Lyons: Yes, some kind of wearable. And so we're close on a lot of that stuff with continuous glucose monitors, other wearables, et cetera. But then finally, last thing I really see coming is prevention starting a lot earlier. What I see our kind of prime patient population is in their 40s, 50s and 60s, and they're like, "Oh, shoot. Now I really need to start paying attention." I think it's going to start to be cool at 20- Dr. Kelechi Uduhiri: Right. 20. Yeah. Dr. Megan Lyons: ... and at 30 to start thinking- Dr. Kelechi Uduhiri: Absolutely. Dr. Megan Lyons: ... about this stuff- Dr. Kelechi Uduhiri: Absolutely. Dr. Megan Lyons: ... and really focusing on our cognitive health well before it becomes an issue. I believe strongly that's coming. Dr. Kelechi Uduhiri: I see it. Because even now, we didn't talk about all the omics, but just the field of nutrigenomics, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Are you using any of those tools in your current practice? And if so- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... what do you love, and how are you using it? Dr. Megan Lyons: I have a love-hate relationship with it. And yes, we're using some nutrigenomic testing. The love part is it's really cool. For someone with the curiosity like I have to understand my body at a deeper level, it's a really interesting start. The hate part of it is... I'll use MTHFR because it's really popular these days. I literally was messaging with a patient this morning who said, "Well, I can't do X because I have MTHFR." And I'm like, "No. Any kind of variant in our genetics does not mean I can't-" Dr. Kelechi Uduhiri: Right. I can't. Dr. Megan Lyons: "... lose weight," or- Dr. Kelechi Uduhiri: Yes. Dr. Megan Lyons: "... I will never be happy" or some dramatic thing that these supplement companies are trying to sell us. Dr. Kelechi Uduhiri: Yes. Dr. Megan Lyons: Yes, it is valuable to know, okay, you might need more methylation support. And let's make sure if you're taking a multivitamin, it has a methylated B complex and methyltetrahydrophoid and whatever. But it is not a sentence or a restriction- Dr. Kelechi Uduhiri: Yep. Yeah. Dr. Megan Lyons: ... yes, the way that some people are making it out to be. So I use them with caution. I think in stubborn cases where something feels a little bit off or in cases where someone's really curious about how they metabolize caffeine or whatever kind of genetic snip we might be able to test, yes, we use it, but it's not something we do on every single patient, and I do still have caution. Dr. Kelechi Uduhiri: Yeah. I think it's important because there's so many new tests popping up. I think just about every other month there's a new- Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: ... tool, and it looks really sexy, and it's like, "I got to try it." Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: But maybe it's not the right time. And like you said, we have to really think a little deeper about this. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Is this really going to change what I would normally do for my client? Dr. Megan Lyons: That's right. Dr. Kelechi Uduhiri: And so last couple of minutes that we have here, share a case that you have worked with either recently that you saw a huge or a significant change in health outcome because of the work or the application of nutrition and your team for this patient. Can you kind of share a case with us? Dr. Megan Lyons: Yes. I was not prepared for this question. But as you were speaking, I have the perfect one, because it was a case that I wondered, "Oh, my goodness. Are we ever going to get there?" And if I fast-forward, we worked with this... And we're still working with her kind of loosely, but we worked intensely with this patient for probably about 16 months. She is an attorney. She's a very successful attorney. She has two kids. She travels all over the place. She's, call it, about 55 or so. And she was on nine medications when she came in that all created various gut-brain symptoms for her. So these were cardiovascular medications, blood sugar medications, anxiety medications, PPI, which we didn't even scratch the surface on, but that's a whole other thing. She was just on a lot. And it's not in my scope of practice to take people off medications, but what we do is work with the people on supporting their own body through nutrition supplements and lifestyle to where we can have the conversation with their prescriber to see about reducing the medication load. So what we started with her... Because honestly, she came in, and she couldn't even form a sentence. She was so anxious. She was so overwhelmed. She was so out of touch with what it felt like to feel good. And she thought it was the end. She thought this was the start of her decline. And I just knew there was something different. Because what was she eating? She was, quote, "trying to be good," which I hate that that's thrust upon us, especially as women. But she was eating a protein bar for breakfast because she had heard that she needed to eat more protein. She was probably having five to six coffees per day and very little, if no water. She was eating just a salad at lunch, but she knew the dressing wasn't optimal for her, so she didn't have dressing. She didn't know the quality of the chicken or whatever protein was there. So basically, she was just eating iceberg lettuce for lunch. That's it. And then she would, of course, like most people do, come... Most people who only eat a protein bar and iceberg lettuce, she would come home and over snack on processed foods. And she felt like this cycle was just impossible to get out of. So we did start with the foundations. Everything you and I have talked about today, we started with adding in more whole foods, trying to support her body with hydration, trying to give her literally two-minute breaks during the day, which we all know is not like everything, but it really matters to take a two-minute breathing break, to try to optimize her sleep, to get in little, short, five-to-10 minute walks. And we built on it over the course of the 16 months. I am very excited to say that she's off all but one of those medications. She has lost weight, even though that wasn't her number one outcome. She feels like she's a better mother. She feels like she's a better attorney. Her health markers, oh my goodness, the insulin reversal, the insulin resistance reversal, the A1C drop, the lipid markers, the inflammation markers, all of that is looking really good. And it's a journey. I'm not trying to say she's perfect. Definitely neither am I. But the difference in who she is as a person now versus 16 months ago is just enormous. Dr. Kelechi Uduhiri: That's amazing. Thank you so much for sharing that story, because I think it so highlights the importance of having a nutritionist, the importance of having a health coach, the importance of addressing behavioral health, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And that when you really help people reset at that foundational level, they can start to get their life back. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: They can start to understand what good feels again, right? Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: And so it's such a great example of why this work is so important. So as we bring this episode to a close, what are the key takeaways you like practitioners to remember regarding nutrition and brain health? Dr. Megan Lyons: Oh, so great. I am sad that our time is almost over because I could talk about this forever. Dr. Kelechi Uduhiri: Yes. Dr. Megan Lyons: But I'll take us back to where we started, which is the gut-brain access is this bidirectional, multi-lane super highway. So the gut impacts the brain, the brain impacts the gut, and there are so many ways that that happens. So we can't just focus on one. We've got to treat and manage both of those together. And one great way to do that is with nutrition. So it's not just about, quote, "eating healthily" or losing weight or anything like that. It's food's impact on our microbiome and our inflammation and our glucose regulation and our metabolites, all of those short-chain fatty acids. All of that is impacted by our nutrition. I think of every bite we take as not just human nutrition, but microbiome nutrition as well. And I want to feed my microbiome with things that it wants and it knows how to process. And I think dietary patterns overall matter a lot more than just picking on any... There's really not one superfood that if you continue eating the standard American diet, but you just eat this food, everything's going to be fine. And also vice versa. If you eat a generally supportive diet and then you want a cupcake on your birthday or whatever, that also- Dr. Kelechi Uduhiri: [inaudible 00:49:54]. Dr. Megan Lyons: ... is totally fine. Dr. Kelechi Uduhiri: Right. Dr. Megan Lyons: It's just about the overall dietary pattern. I think that brain health and gut health can feel very nebulous to people, but I hope this conversation has empowered them. Because the little things, the foundations, they matter a lot. And we see huge progress when people can start focusing on themselves and reprioritize those basics. Dr. Kelechi Uduhiri: I love it. So food first. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Lifestyle's important. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Find a great nutritionist. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Get a health coach. Get a team. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: Because when we do all those things, we really can start to see a reversal in health, and we can start to see that multi-lane pathway gets a little clearer. Dr. Megan Lyons: Yes. Dr. Kelechi Uduhiri: It gets a little smoother. They start communicating with each other a little better. And that optimally will lead us to better health. So, Dr. Megan Lyons, thank you so much for being with us on this episode of Pathways to Well-Being. Thank you. Dr. Megan Lyons: Thank you so much for having me. Dr. Kelechi Uduhiri: Absolutely. Thank you for listening to Pathways to Well-Being. Discover the latest research and clinical insights at ifm.org. The future is functional.