The links between gastrointestinal health, metabolic health, and fertility

Integrative medicine doctor Robin Rose on getting to the root cause, and how GI health and metabolic health impact fertility.


Article highlights

  • Gastrointestinal issues like IBS often stem from gut microbiome imbalance, which impacts fertility, insulin resistance, and other aspects of metabolic health.
  • Restoring microbial diversity through diet, probiotics, and lifestyle improves gut barrier function and reduces inflammation underlying chronic conditions.
  • Time-restricted eating, stress management, sleep, and natural anti-inflammatories like lemon water support a healthy circadian rhythm and microbiome.
  • Genetic testing helps personalize nutrition needs, like restricting bad fats for those with high Alzheimer's risk who may fare poorly on ketogenic diets.
  • Eating locally grown, minimally processed whole foods preserves nutrients and microbiome-nourishing fiber lacking in the standard American diet.

When it comes to how gastrointestinal issues relate to metabolic health, there’s no one better to talk to than Dr. Robin Rose. Dr. Rose is the founder and CEO of Terrain Health, where she works with her patients to identify the root cause of many different GI conditions.

She and I sat down on a recent episode of our podcast, A Whole New Level. We talked about how things like diet, fertility, and other lifestyle factors relate to GI issues, and how people can mitigate some of these conditions to live healthier, happier lives. Below is an edited version of that conversation.

Modern Times, Modern Issues

Ben Grynol: According to the National Institute of Diabetes and Digestive and Kidney Diseases, 60 to 70 million people are affected by some type of digestive disease. A large number of people are affected by these diseases. 

What are some of the common types of GI issues that people would face, or that people might have heard of?

Dr. Robin Rose: Let’s start above, and we’ll move our way down. Starting up above: gastroesophageal reflux disease—people who present with heartburn, epigastric pain, throat burn, feeling like something is stuck in their throat, that sort of thing. Then there’s dyspepsia or functional dyspepsia, a global term for upper GI discomfort—bloating, feeling full quickly, nausea, things of that nature. 

You also have things like peptic ulcer disease, SIBO—small intestinal bacterial overgrowth—and irritable bowel syndrome, which could be of the constipation-predominant type, the diarrhea-predominant type, or the mix type, where you’re alternating between both.

Irritable bowel syndrome constitutes both the modification of the bowel habit or bowel movement, plus abdominal pain and/or bloating. People get that confused with chronic constipation or chronic diarrhea. The people who have chronic constipation or chronic diarrhea lack the abdominal pain component. That’s what makes that person fit into the category of irritable bowel syndrome, when you have the abdominal pain piece.

Then there’s inflammatory bowel disease, Crohn’s disease, ulcerative colitis, and microscopic colitis. There are so many different gastrointestinal illnesses and problems. We could name probably a hundred more.

Ben Grynol: It’s apparent that as things become more convenient and we start to strip away a lot of the nutrients, we strip away fiber and what we need in our diet to promote a healthy microbiome. 

You hear people say, “I’ve got IBS,” or some other GI issue. What has contributed to some of these diseases becoming more prevalent in conversations today?

Dr. Robin Rose: When you talk about the four pillars of health—sleep, movement, nutrition, and stress management or mindfulness—all of those things contribute to dysbiosis and imbalance of the gut microbiome, leaky gut, and so forth. And it’s then leading to any of these disease manifestations we just talked about. Clearly, the standard American diet doesn’t help the situation.

The way we eat and the way the food is processed—we’re moving away from a whole-food, plant-centric diet to one of processed foods—combined with a lack of sleep and movement, plus stress and cortisol levels that are through the roof, all play a role in the health of the gut microbiome and our overall health.

Ben Grynol: How many microorganisms are in a person’s gut?

Dr. Robin Rose: There are hundreds of trillions of organisms, mostly bacteria. But there are also fungi, viruses, parasites, organisms called Euryarchaeota or methanogen-producing organisms, candida—all these things. The vast majority are bacteria. You have all these organisms, but there’s something called microbial diversity. You want to have as much diversity as possible, because that equates to a healthier gut microbiome and overall health.

There are only about 250 different identifiable species we know about, or that have been researched. Having as close to those 250 different species in your gut as possible is something to strive for. Many people fall very short of it, especially in the United States, because of our lifestyle and how we eat. But you want to try to get as close to that as possible.

Ben Grynol: It sounds analogous to the idea of regenerative farming. What makes for a great ecosystem? It’s the idea of diversity. Without diversity, you get into monoculture and everything gets stripped away. Where are all the microorganisms? Where are all the things that make the ecosystem rich? If people are stripping away some of these microorganisms from their microbiome, then it’s easy to see how it leads to some of these issues over time.

Dr. Robin Rose: Absolutely. Over the last century, through urbanization, deforestation, and industrialization, we’ve lost contact with nature. There are tens of thousands of organisms from unmined soil or earth we used to be in contact with on a daily basis, that we used to breathe in, that we used to swallow, that we used to absorb through our skin when we were walking barefoot in the forest. Those organisms are super important for our health. 

I use this one product called Rhizo Health, which comes from unmined soil. The array of things it helps treat is unbelievable. It helps supply these missing groupings of organisms from the unmined soil we don’t have contact with. This lack of contact is likely contributing to disease. These organisms play a big role in insulin and glucose metabolism and regulation.

Ben Grynol: In a society of efficiency, we end up stripping away some of the things that give us long-term benefit in many aspects of life. It’s this trade-off of convenience and efficiency, and living in a world we want to be faster and faster, when really we have to slow down to think about what we’re doing and why. 

Getting to the Root Cause: How the Mother’s Health Impacts Pregnancy and the Health of Baby

Ben Grynol: One of the things you touch on frequently is this idea of fertility as it relates to gastrointestinal issues. We know there’s an infertility epidemic. It is happening across men and women.

Many people tend to think that if there’s an issue with fertility, it doesn’t have to do with the men. As we start to look at things like sperm count, sperm quality—all these things decreasing over time—you’re saying, “No. This is a ‘both’ issue.”

What causes this infertility epidemic that we’re in? And how does it tie to GI issues?

Dr. Robin Rose: I’ll give you the whole background because it’s super interesting. We have partnered with a biotechnology company called Microgenesis. The woman that started it, Gabriela Gutiérrez, has dedicated two decades of her life to cracking the code of infertility. She has found that it stems from dysbiosis, or an imbalance of the gut microbiome. She was able to figure this out through what’s called microRNAs technology. MicroRNAs are these small, non-coding RNA molecules, and they play a really important role in regulating gene expression.

They can regulate cellular metabolism by targeting certain metabolic enzymes and multiple signaling pathways. The microRNAs themselves can regulate the cell metabolism by modulating the expression of different proteins involved in gut integrity, like the tight junctions in your gut, and also immune cells, and then the secretion of different inflammatory-related mediators. Basically, the microRNAs can affect gene expression locally in the GI tract. They’re expressed by macrophages, which is a type of immune cell.

Locally, they can exert their effect. They are like exosomes, and they’re secreted and transported by these extracellular carriers to different targets and organs in the human body. Whatever’s happening in the gut microbiome is mirrored in the other biomes in your body.

When we’re talking about fertility in women, we’re talking about the vaginal biome, in particular. For example, the microRNAs can be secreted in the gut in response to changes in that gut microbiome, and then they travel to the reproductive tissue, and then they affect the function and integrity of that organ.

Whatever’s happening in the gut microbiome is mirrored in the other biomes in your body.

This technology is how these things are tested. That’s how we figure out what’s going on. She has been able to figure out, over all these years, that the infertility problem a woman is having stems from the health and balance of the gut microbiome. Infertility is just a symptom of something else.

Gutiérrez has identified 64 different phenotypes—expressions—of the gut microbiome, or variations in the gut microbiome, that are found in these women with infertility. Let’s say you’re phenotype 34. It’s a symptom of something else smoldering. A lot of these women have a smoldering autoimmune process—a smoldering Hashimoto’s, endometriosis, recurrent vaginitis, or PCOS—that has never been diagnosed. The list goes on with a million different things these women can have.

Whether they’ve expressed it or not can remain to be seen. Some of the women might say, “I do have a history. I was recently diagnosed with Hashimoto’s,” or “I have X, Y, and Z.” And that’s because they are one of these phenotypes. Or if the woman hasn’t expressed it yet, we’re catching them so that they don’t express it. The idea is to restore health and balance to the gut microbiome through a specific program so that then these women can get pregnant successfully.

Ben Grynol: It sounds like everything is a step upstream to get to the root cause of the issue, as opposed to just saying, “Well, somebody has challenges with fertility. There are so many causes. There are so many reasons that can happen.”

Dr. Robin Rose: Right. A lot of these women have been worked up. Their partner has been worked up, too. Maybe they have low sperm count, or they’ve definitely been ruled out due to a structural or anatomical issue. They go into this not knowing they can’t get pregnant. But it’s because of what we’re talking about. For the women who fall into this category, this technology, both the medical testing and the interventional treatment—which is all natural, by the way—will really help them.

Microgenesis has studied over 300 women both in the United States and in the EU and South America, and they show a 75% success rate in conception. A healthy young woman—under 35 years old—who undergoes in vitro fertilization or another assisted reproductive procedure has about a 50% chance of giving birth. Microgenesis takes that to 75% by understanding what the woman’s phenotype is and then treating her. The treatment is only 10 weeks. On average, they went through 4.2 cycles of IVF and never got pregnant.

Some of them couldn’t get pregnant for over a decade. When Gutiérrez repeated the study—the original study was with the refractory IVF patients, in Spain and South America, and the repeat study was done in American women—it took about three years, on average, for the women to get pregnant. Some of them had dabbled with hormone therapy in the context of infertility, but she reproduced the results and showed a 75% success rate in conception.

Ben Grynol: That is such a wild outcome. It’s addressing the downstream goal, getting pregnant, but the upstream root cause of everything is still not addressed. Over time, some of these chronic conditions compound. They get worse. It’s unfortunate that those can be left in the dark, or get left behind because you do achieve that one goal. But in the end, you’re still not at optimal health.

Dr. Robin Rose: Correct. That’s why I was so taken by what she has done and how she has done it. I, thankfully, never had issues with fertility, but I watched many friends struggle and go through it. They endured financial burden, yes, but, more significantly, mental, physical, and emotional trauma. 

It’s only Band-Aiding the situation. You’re not getting to the root cause. I love this so much because we are helping these women become healthier people. We are saving them from going on to express that underlying disease, or we’re helping them regress or reverse what they have going on currently.

Not only are they going to have a baby and have a healthier baby, but they’re going to be healthier. When a woman is trying to get pregnant, they don’t care about anything. They couldn’t care less about their health. They just want to get pregnant. I totally get that on every level. 

But this is so powerful because we are changing the trajectory of their health. We’re even seeing babies of the women who go through these programs, versus women who go through traditional IVF, have much healthier microbiomes—and they themselves are much healthier. You’re winning on all fronts. It’s a very powerful tool in our toolkit when it comes to chronic disease and infertility in general.

Ben Grynol: Do you have any insight around IVF with women who might not be metabolically healthy, or who might have some underlying GI conditions? What’s the success rate for these women? Assume somebody gets pregnant through IVF, but maybe they have an unhealthy pregnancy, or, unfortunately, a miscarriage. It’s disheartening in every respect to go down some of these paths.

Dr. Robin Rose: That’s what we’re trying to unravel right now. We are looking at that data. That’s what we are going to show in the months or years to come. Anecdotally, these women who go through multiple rounds of IVF are repeatedly exposed to hormones. What does that do to their health long term? Are they at higher risk for certain cancers? Are they destroying their gut microbiome and causing a dysregulated gut-immune axis from all of that exposure? 

What do the babies look like? We’re in the middle of looking at the babies and showing what their gut microbiome looks like. It’s much healthier in the babies being born to a woman who addresses her underlying health and restores the health and balance of her gut microbiome, lowering these inflammatory biomarkers. 

For the women who need IVF or an embryo transfer, we still put them through the program, because a lot of these women don’t need to do that. The program significantly increases their chance of conceiving. On top of that, you lowered their exposure, because maybe now, instead of having to go through it three or four times, they only need one or two times. Again, you’ve addressed the underlying issue of that woman’s health, of what’s driving some of the problems contributing to the infertility.

The Connection Between Metabolic Health, Gut Health, Pregnancy, and PCOS 

Ben Grynol: Are there different outcomes for somebody who goes through IVF and has gestational diabetes?

Dr. Robin Rose: No. I’m going to look that up. That’s fascinating. I will say that insulin is one of the biomarkers we use, and we repeat the labs about every 30 days. That biomarker tremendously falls in the women who go through this program, especially in the women who have diagnosed or undiagnosed PCOS—that’s a huge driver of why they can’t get pregnant.

When they go through this intervention of certain nutraceuticals, the specific probiotic strains they have to be reinoculated with, and the specific nutrition plan they’re going to do, significantly plays a role in that gut-metabolic axis. Insulin comes down nicely. That I can speak to from a clinical perspective, because we see it all the time.

Ben Grynol: There’s this misconception that exists in society that when women are pregnant, they can eat anything. If somebody is experiencing morning sickness, the tale we tell ourselves is to go grab some crackers or eat a bagel, something high carb, or high in sugar. What does it do? It puts you on this glucose rollercoaster that, over time, leads to more insulin resistance. Especially if you’ve already had mild insulin resistance, the long-term outcome of that is not great.

Having good baseline metabolic health—a good baseline of insulin, a good baseline of glucose variability and control—is going to put you in a better long-term position to have a healthy pregnancy and better health overall.

Dr. Robin Rose: My partner is a woman’s health expert. She’s been an OBGYN for over 20 years, and she does a lot with this program we’re talking about. She would never think of not putting a woman having difficulty through this program. In her experience, especially with the women who have to go through IUI, IVF, and so forth, are considered high risk. They have to be followed closely. They’re sitting on pins and needles, hoping for this woman not to have a miscarriage or a complication.

She says that this just adds a layer of protection. She doesn’t have to worry as much that this woman’s going to miscarry or have some mishap during the pregnancy, because she knows we’ve addressed these underlying issues. She sees these biomarkers that have trended down so beautifully, and it makes a huge difference in likely the mom’s health and then the baby’s health and how she carries. It makes such a difference. We’re starting to see what a difference it makes, too. It’s really exciting.

Ben Grynol: What are some of the most common issues women with PCOS might have, from a GI perspective?

Dr. Robin Rose: They could have chronic constipation—more so than diarrhea—but they could have both, plus tons of bloating, discomfort, and things of that nature. There are two different PCOS phenotypes. One stems from gut dysbiosis and leaky gut, and the other one is more of an insulin-resistant PCOS. They get treated a bit differently.

I put a lot of my PCOS patients—even if they’re not ready to conceive—through this because it regresses and reverses the PCOS. It really solves the problem in a lot of cases. It’s this metabolic disturbance that’s being driven from the health of the gut microbiome.

Ben Grynol: When we as a company talk about PCOS, whether on the blog or a podcast episode, we’re talking about it as it relates to metabolic health and insulin resistance. Maybe there’s overlap between the two different paths that women can experience PCOS. Learning about that is interesting because then you can understand different directions or different approaches that need to be taken in order to mitigate some of these conditions.

Dr. Robin Rose: Correct. It’s really powerful to go after the gut and restore health and balance to that gut microbiome, to the intestinal barrier mucosa, and to get these junctions nice and tight again. We don’t want to let anything leak out and cause this chronic, low-grade inflammation that then stimulates problems with insulin-glucose dysregulation and things like that. That’s a big piece that has been missed in these women. 

Diet and the Gut: the Time and Place for Carnivore and Keto

Ben Grynol: When thinking about diet specifically, what are some of the misconceptions you’ve come across? What are some of the diets you’ve seen that have higher instances of different GI issues? We try very hard not to be prescriptive, but what we are prescriptive about is avoiding highly processed foods and sugar. We aim to give people the foundation of knowledge so they can make their own decisions about what they consume.

Dr. Robin Rose: Before I answer that, I want to say I don’t discriminate against any macronutrient. I think you should have everything on board. I do next-generation sequencing on the gut microbiome in the vast majority of my patients. I’m able to see, at the cellular level, what’s going on in the gut microbiome. Who’s taking up real estate in the gut? What good guys are there? What bad guys are there? Are they in balance or not? Do they have leaky gut based on what we’re seeing from a structural standpoint? From a functional standpoint, what’s going on in that gut? Are they making their short-chain fatty acids? Are they producing too much ammonia, methane, hydrogen sulfide, and so forth? 

Diet significantly affects the balance of the gut microbiome and what species are taking up space there. Take the carnivore diet, for example. I’ve had patients argue with me, and that’s fine because we’re a team. It’s a partnership. They feel the best on a carnivore diet. And I’m fine with that. 

The problem is: What’s going on at a cellular or biochemical level with these people? We do extensive testing when we see our patients—probably 150 analytes or more. When you go to your primary care doctor for your yearly physical, they’re checking 42 analytes, and then they say, “Oh, you’re within the normal range,” which is nonsense. We are looking at trends, and we are looking at all these different biomarkers, especially cardiovascular biomarkers. We’re looking not just at the number—LDL or HDL or triglycerides—but at what’s called LDL particle size and number. We’re looking at your ApoB and LipoA, and then we’re looking at hsCRP, Lp-PLA2, oxidized LDL, myeloperoxidase. 

Many of the people who are strictly carnivore have a ton of cardiovascular inflammation. I’m not saying they have insulin-glucose dysregulation, but they do have cardiovascular inflammation.

Your HDL and your LDL are immunomodulators, meaning that when your immune system is negatively impacted, your HDL and your LDL will also be impacted. It’s not just your genes. It’s likely coming from your gut. The main source of energy of the bacteria in your gut comes from what’s called saccharolytic fermentation. The root of that word is “sugar.” But I’m not talking about refined simple sugars. I’m talking about complex carbohydrates, high-fiber foods, and resistant starches. That’s what those bacteria prefer. That’s the energy source they use to produce all these amazing postbiotics or metabolites in our body, such as short-chain fatty acids. You need that. 

From an evolutionary standpoint, the bacteria developed a secondary source of energy utilization, which was proteolytic fermentation, which comes from protein. Way back when we were hunter-gatherers, we mostly ate all the different colors of the rainbow. You were picking off as you went, and you were eating that. You were foraging, unless there was drought or something of that nature. That’s probably when gaming started. Then you had to develop a way to break down animal protein, which is this proteolytic fermentation. 

Based on epigenetics—what we eat and how we interact and adapt to the world around us—you can turn a gene on and amplify it, or tone it down. We have the power to switch the gene.

The problem is that when you have too much of that, you make these byproducts of protein metabolism that can be very toxic to the gut lining and to the gut microbiome in general. That’s the issue. Not that we don’t need some of these products of protein degradation—we do. But I always say to my patients, “It’s the Goldilocks Rule. You want just the right amount of everything.”

In a lot of these patients, that’s off the charts. That’s causing leaky gut, causing chronic low-grade inflammation stemming from the gut, and dinging the immune system. Then that, in turn, is causing all these issues with cardiovascular inflammation, metabolic issues, and so forth.

Ben Grynol: Life is made up of behaviors and decisions and how much willpower we have to stick to them. We say, “I’m ready to make that meaningful change.” That meaningful change might be removing all processed food, or avoiding sugar altogether. It might be going keto, or eating carnivore or Paleo—name your diet.

The overdrive function comes in, where we almost game ourselves. We will consume way too much of the one thing, which is no longer good. The best intentions no longer come through because we have pushed ourselves so far over the edge that we’re actually maybe doing worse. 

No one’s going to argue that eating whole foods is worse than eating sugar and highly processed carbohydrates. But in general, too much of anything is never good. It’s about finding that balance. I’m curious to hear more about what you’ve seen with keto as it relates to GI issues.

Dr. Robin Rose: One of the advanced biomarkers we check is called the APOE genotype. That genotype is not only for cardiovascular risk, but for Alzheimer’s and dementia risk, too. When you inherit your genes, mom and dad will give you a two, three, or four. You get one from mom, and one from dad. You can be any combination. You can be a 2/3, 3/3, 4/4, 3/4, 2/4—any of those combinations. The most common genotype is a 3/3. You get a three from mom, a three from dad. About 25% of the population is a 3/4, and then a lower percentage is 4/4.

The issue is with the four allele. Let’s say you’re a 3/4. You have a three-times higher risk of Alzheimer’s, dementia, or cardiovascular disease. If you’re a 4/4, you have a 12 times higher risk. But you can tone the gene down. Based on epigenetics—what we eat and how we interact and adapt to the world around us—you can turn a gene on and amplify it, or tone it down. We have the power to switch the gene.

This is where keto comes in. First of all, patients who are 4/4 should never do a ketogenic diet. I would say almost never, and I’ll explain why. 3/4s should be pretty cautious. If I have someone with a 3/3 or a 2/3, I feel fine if they want to go ketogenic. But the 4/4s and 3/4s have issues with fat and fat metabolism. It’s for that reason that the gene gets weak. The accumulation of this and what’s happening in the body is what turns it on and increases that risk. 

We restrict these patients to about 30 grams of specifically bad fats. Society tends to think a lot of good fats are good, when they’re really not, like seed oils. They don’t get that. People are consuming mega amounts of those, especially when they’re on keto. I try to use some of the precision healthcare we do to tailor their nutritional needs to that profile. 

When I speak to my patients who never knew they were a 4/4 or 3/4, they’ll say to me, nine out of 10, “Oh, my God. I did a ketogenic diet and I felt terrible.” The reason why they felt terrible was because they couldn’t handle that high fat content. Their body was telling them something.

Intuitively, they knew something was off. You have a ginormous percentage of the population saying, “I’m going to do keto,” and they’re likely doing more damage than good. That’s why I believe in balance and moderation. 

The ketogenic diet is powerful for a lot of different things, but I believe it’s generally best as a short-term treatment for these issues, like any of these fad diets.

Ben Grynol: Assume somebody was a 4/4, would that lead to downstream instances of things like gallstones?

Dr. Robin Rose: I’m not really sure. It’s a good question. Maybe, but gallstones are different. It’s not just the fat in general. There are a lot of other factors, like the enterohepatic circulation and how the bile acids are recycled. 

Where Your Food Comes From—and How It Was Grown—Matters

Ben Grynol: Geography is very hard, because different cultures have different diets. But have you seen anything with GI issues as it relates to geography or ethnicity? 

Dr. Robin Rose: When I was practicing conventional GI, a lot of my Hispanic patients had irritable bowel syndrome. I believe that stems from dysbiosis, their lifestyle, and their diet for sure. A lot of Hispanic patients will tell you they have GI issues. 

But what’s even more interesting is my European patients. When I was in my conventional GI practice, I had all these patients from Poland, or France. They would have significant issues with chronic diarrhea or chronic constipation or irritable bowel syndrome—any of these functional bowel disorders. For the vast majority, it all started when they moved here. But when they go home to Poland or France, their symptoms are fine. They can eat whatever they want. They don’t have to limit themselves. They feel great. 

I believe that one of the major reasons for this difference is the United States’ use of glyphosate and Roundup. In the EU, it’s outlawed. They’re not allowed to put Roundup in the wheat. Therefore, the patients can tolerate it, because you’re removing the factor that’s likely the stimulus for a lot of their symptoms. I always found that fascinating. 

I started doing a much deeper dive into farming techniques and how they process foods in Europe or even New Zealand, Australia, and so forth. It’s so different from how we do it here. That’s why it’s important to support regenerative farms or farms where the animals are pasture raised. They’re eating from the earth and the grass. 

When we eat them, we’re eating what they have in them. We want to make sure they’re full of nutrients and amazing compounds and vitamins that we need. But we’re not getting many of these compounds, because everything is processed and factory farmed, and the soil is nutritionally depleted. I am such a big supporter of and believer in regenerative farms. If we could get back to that, that would be super helpful. People’s guts would feel a lot better, and we’d have a lot less GI problems and symptoms.

Ben Grynol: I wonder if, in continents like Europe, a lot of it has to do also with food procurement. People are used to walking to the small market. That food is not made to be shelf stable. Even in some of the supermarkets here, there’s the bakery in the store, but that bread is still made fresh every day. It’s made to have some shelf stability, because that’s what you have to do. In Europe, it’s basically: throw the three ingredients together for bread—flour, some eggs, some water, a little bit of salt.

Dr. Robin Rose: A lot has to do with that. Many of my patients from Europe too would tell me how they had farms in their backyard. They had small gardens where they grew much of their own food. In America, how many days or weeks do you think these fruits and vegetables are sitting in these trucks coming across the country to us? It loses so much of the nutrient content. 

I am such a big supporter of and believer in regenerative farms. If we could get back to that, that would be super helpful. People’s guts would feel a lot better, and we’d have a lot less GI problems and symptoms.

We do a little bit of urban farming at my house. I have a tower garden. When I make a salad from all of the fresh greens and herbs I grow on the garden, my kids say to me, “This tastes amazing. It tastes so different.” That’s because it’s chock full of all these amazing nutrients. Much of those nutrients are lost in conventional food  because of what we’re talking about, and because of urbanization in general.

Ben Grynol: Growing food is common in different parts of Europe. It’s just part of what you do. Here, the practice is becoming more common. But because of seasonality, because of interest, because of population density—all of these things—you get things like apples sprayed with wax and pesticides, which make them shelf-stable.

There are common fruits such as apples, or even vegetables like potatoes, where they’re sitting in different silos or warehouses at a cool temperature for years. It’s the only way we can get this consistent food production and delivery, as far as the supply chain goes. Food doesn’t magically appear on shelves. There has to be a system. If we are growing our own food, it is a lot more difficult, but it does taste better. It is more pure. It is better for us.

Best Practices for Optimal Gut Health—and Health Overall

Ben Grynol: What is your advice for someone who wants to get in front of a GI issue? What are some of the recommended takeaways you have for people, aside from the natural things like getting more sleep and exercise?

Dr. Robin Rose: Everyone thinks this is just a fad, but I have many of my patients stop gluten and dairy. Both of them are extremely inflammatory, and extremely damaging to the gut microbiome. When many people take those two things out, I can’t tell you how much better they feel. That in and of itself is a big deal. I always say it doesn’t have to be forever. You have to heal. The diet that heals is the diet that seals. I always tell patients they can go back to the 80/20 rule, unless they have an underlying condition that predisposes them to not being able to go beyond these particular things. I always say to try that first, because it makes a huge difference for a lot of people—that is driving a lot of their symptoms. 

The other thing is hydration. People are so under hydrated, and drinking a lot more water is super-duper important. I always tell people to have a big tall glass of lemon water, because the lemon water helps the distal colon become more basic. When that happens, the bad bacteria don’t like that environment. They prefer a much more acidic environment. That’s helpful, too. 

In our clinic, we are also big about getting people to sleep, and about getting people into deep sleep, because our circadian rhythm is timed with our gut microbiome’s circadian rhythm. They have this bidirectional pathway and influence each other in a lot of ways. 

Most of us don’t sleep. There is an insomnia epidemic as well, and people don’t get into deep sleep, either. When that happens, it does a lot of damage to the gut microbiome. Our vagal tone goes down and the vagus nerve is super important to the gut-brain connection and in controlling motility. Also when you don’t sleep, guess what? You want to eat crap. You want to eat all the sugar and all the chocolate and all the bad stuff all the time, because you’re so tired and run down. It’s like a feed-forward cycle.

We use continuous glucose monitors on the vast majority of our patients, and I can’t tell you how many women think they’re healthy, but their glucoses are through the roof during the night. That’s because of cortisol, and cortisol is married to glucose. They’re stressed and they’re not sleeping. 

It’s like a triangle: the gut, metabolism, and hormones. It’s fascinating what we learn from these medical devices, from this little bit of information, and the changes you can make based on that.

Ben Grynol: It’s exactly what you touched on earlier, which was the importance of monitoring multiple analytes. You could have your HDL and LDL look great, but you’ve got elevated insulin levels. Somebody is insulin resistant. There are all of these factors. Glucose is super important, and so is insulin, and so are all these markers, but in isolation, they are only a single marker.

And if we’re looking at one point in time, which is non-continuous monitoring, that can cause challenges where we make decisions and extrapolate that in perpetuity. Having a holistic view, looking at the root cause—it’s important to see how it all is interconnected.

Dr. Robin Rose: I couldn’t agree with you more. It’s exciting, and such a great way to take care of and heal patients. When we practice conventional medicine, it really is medicine. We’re seeing 30 patients. There’s a revolving door of people coming in and out. We can’t spend the time we need with them. We can’t be investigative. We can’t be that stealth detective and figure out what’s going on. It just becomes a pill for every ill. You’re just Band-Aiding the problem.

That’s the reason why a lot of doctors get burned out and leave medicine, or are depressed and why the suicide rate is so high, unfortunately. It’s not rewarding to practice medicine that way. It’s not. This is a much more rewarding way, and it’s such a great way to help people.

Ben Grynol: Thank you for all the work you are doing to spread awareness about it. Where is the best place for people to find you?

Dr. Robin Rose: They can go to our website,, or I am on Instagram and Facebook. @Goterrainhealth is the practice’s handle on Instagram and Facebook.