Biggest Fasting Mistakes to Avoid with Dr. Pal Manickam

The Role of Circadian Rhythm, Nutrition, and Gut Health in Metabolic Wellness

Welcome back to the Empowered Nutrition podcast! In this episode, Dr. Palaniappan Manickam welcomes Erin Skinner, for an enlightening discussion on the significance of circadian rhythm, nutrition, and gut health in maintaining metabolic and digestive well-being. Together, they explore the benefits of fasting, aligning eating patterns with daylight hours, the importance of fiber for a healthy gut microbiome, and the integration of conventional medicine with nutrition for optimal health outcomes.

Episode Highlights:

  1. Understanding Circadian Rhythm and Metabolic Health:
  • Dr. Pal Manickam and Erin Skinner highlight the impact of circadian rhythm on metabolic processes and discuss the benefits of eating within the sun to sunset window.
  • They emphasize that aligning eating patterns with daylight hours can enhance metabolism and improve overall metabolic health.
  1. The Role of Fiber in Gut Health:
  • Erin emphasizes the importance of fiber diversity in promoting a healthy gut microbiome.
  • They discuss the alarming trend of insufficient fiber intake in the population and underscore the significance of incorporating an adequate amount of fiber in the diet.
  1. Nutrition and Gut Health for Vegetarians:
  • Erin shares valuable insights on nutrition and gut health for vegetarians.
  • She emphasizes the importance of protein diversity and suggests incorporating fermented foods like kimchi and sauerkraut to improve gut diversity.
  1. Combining Conventional Medicine with Nutrition:
  • Dr. Pan Monica and Erin stress the significance of combining conventional medicine with nutrition for holistic health outcomes.
  • They discuss the need for acknowledging the essential role of food in addition to medical interventions for optimal well-being.

Best Quote:  “We just abused the plan that was provided to us, and that is the replication of what we see in terms of GI diseases.”

Conclusion: Dr. Pal Manickam and Erin Skinner provide valuable insights into the importance of circadian rhythm, fasting, nutrition, and gut health for metabolic and digestive wellness. They emphasize the benefits of aligning eating patterns with daylight hours, incorporating fiber in the diet, and the role of protein diversity and fermented foods in vegetarian nutrition. By combining conventional medicine with nutrition, individuals can achieve holistic health and well-being.

Check out the full interview on Youtube!

Interested in learning more about GI health from Dr. Pal? Follow him on Youtube and Instagram!

Ready to dive in? Listen here!

Love it? Hate it? We’d love to hear your feedback!  


Hello guys, this is Dr. Pal Manickam. I’m very, very excited today because I have a wonderful dietician that I, I’m working with. I have worked in the past working with, I will work in future. Her name is Erin Skinner. You know, I’m a gastroenterologist practicing in California and the major difficulty that people are having these days is we don’t have a gastroenterology specific dietitian because the GI dietician is a separate degree and platform on the, the separate category on its own because all the GI problems is related to diet. So I’m more than happy to invite Erin Skinner, a registered dietitian practicing in North Carolina in our show.  

Hey everyone, how are you doing? Hello.  

Hi, Erin. Hi Erin. Thank you. Thank you so much for your time today.  

Thank you for having me. 

Super, super. How was North Carolina?  

Beautiful. It’s a well-kept secret, so don’t tell anyone I said that.  

Okay, nice, nice. So, Erin, you know that I’ve been, we have been working together for many kinds of patients, right? IBD, Celiac disease, ulcerative Crohn’s disease, you name it. But in my, you are, you are a little bit surprised about this side of my life with the YouTube channel.  

It’s your secret life. 

The secret life, yes. So in this, in this side of the world, I been promoting a big time on circadian rhythm them. Okay. I strongly believe that God has had his own plan. Yeah. And then we just abused the plan that was provided to us, and that is the replication of what we see in terms of GI diseases. Mainly. That’s what my, I strongly understand. I strongly believe in that. And then in my channel, I’ve been promoting Sunrise to Sunset eating method, and the whole goal is that all the hormones sleep overnight and then wake up in the morning very active and then start digesting much better rather than eating late at night and then disturbing again. So, I know that your practice is big on metabolism as well. So how do you see this in, what is the major problem that you see in a patient that comes to you?  

Absolutely. I think if we’re thinking about the topic of metabolic health, and even since you brought in the idea of digestive health, the two are very closely interrelated and both related to what you mentioned in terms of circadian rhythm. And in fact, there’s so much research now on this topic that there’s a name for it. It’s called chrononutrition, meaning the study of the timing of eating and, and realizing that we do have these metabolic clocks, really. And so for example, I might have a patient that might come to me and say something like, oh, I think my metabolism is slow. What we now know from the science is that your metabolism is not just this steady thing that’s the same 24 hours a day. Your metabolism is really different depending on what your circadian rhythm is doing at the time. And it’s gonna be, to your point, your metabolism is gonna be more prepared and ready to metabolize food and energy when it thinks that it’s daytime.  

So like the twofold problem we have in the modern world is one, we we’re not realizing that we need to be consuming energy only when our metabolism is ready for energy, which is during, as you said, what it thinks it’s the daylight. But then another kind of deeper issue we have is that actually our bodies don’t really know when it’s daylight very well if we’re not exposing ourselves to natural sunlight or if we’re disrupting our circadian rhythm with artificial light from things like smartphones and televisions and computers. And so really the, it’s, it’s a twofold thing of a, getting your circadian rhythm where it actually is synced up with the actual natural sun cycle, and then b, eating in the timeframe when your body is prepared for that energy so that you have better metabolic health and better health outcomes.  

You know, that’s a wonderful point. I always tell my patients to walk out right after you get out of bed and then get some 20 minutes of sunlight. Yeah. And then, but people are sleepwalking these days on the daylight after listening to that advice. Yeah. So the, in, in terms of your practice, do you, how do you, how do you make them exposed to sunlight in the morning and do you have any tips at trick? 

Well, it’s tricky in our world because I think we have a lot of pressures on us to hold down a full-time job, do all the things for our children, make the perfect food, exercise, meditate. And so I think it’s hard for people to feel like they have the time to, to get exposed to natural light at those optimal times, like say sunrise. And in fact, I think a lot of people are waking up before the sun so they can work out and do all the things. And so they might be awake well before sunrise. And so I don’t put a lot of pressure on them. I mean, if they can see sun at Sunrise, sunrise, that is helpful. But what I tell them is just to make it a little less overwhelming, I try to have them just get sun exposure as much as possible. 

So let’s say you have a lunch break. Can you, can you go for a short, even a five minute walk outside or in the evenings? Is there a way that you can get out before the sun sets and go for a short walk outside? Is there a way that you can park your car a little bit further from your office and have more time where you’re walking in during the sunlight hours? But we, to your point, we do know that that sort of like sun, sunrise, sunset time is more powerful in terms of calibrating our circadian rhythm, but  

Absolutely, absolutely. It’s very powerful. Yeah, it’s very  

Powerful. Yeah.  

And then, you know, in, in our practice, I mean you also promote fasting as one of the regiments of metabolic health. What is your view on it and people, do people come to you for fasting help, or do you implement fasting as one of your treatment regimen? That’s the difference to,  

Sure. What I would say is the majority of people are not coming asking to fast, but they’re coming asking for the outcomes that I know fasting can help them achieve. So they’re looking to have sustainable and healthy weight loss. They’re looking for those metabolic outcomes, so improved insulin sensitivity, improving even type two diabetes, heart hypertension, high cholesterol, high blood pressure, all those metabolic related concerns. And so what we’ll typically do is we’ll take them through the process of getting their metabolism healthy through three phases. And the second phase of that is a, a fasting routine. And so it is a part of a larger framework and I think that’s important for people to understand that. I think it can kind of be like attractive to people the idea of just jumping straight into fasting, but changing nothing else or jumping straight into a ketogenic diet and changing nothing else. But what we’ve learned is that a lot of the problems that people have are actually related to undernourishment. And so if you’re not eating nutrient dense quality foods and nourishing yourself in terms of vitamins and minerals and essential fats that you need, you’re not gonna do as well with those more restrictive things. Right? Yeah. So the first phase is quality food, getting that in place and so just, it doesn’t have to be super complicated, just kind of thinking about processed foods versus whole foods.  

Nice, nice,  

Nice. Yeah. And then fasting after that. Yeah. Super.  

So I see it in two different angles at an let’s, a good discussion to have. So there are two patients population. I see. One is that, you know, I don’t want to decrease my diet at all, you know? Yeah. Have you ever heard of biryani?  


It’s an emotion for Indian people. Yeah. We cannot live without biryani. Yeah. So for few patient population, you know what I’m, I’ll be okay with the timing.  


But biryani is actually a good thing where they add spices and everything. It gets bad when their carb content is more, of course the oil is more in terms of fat and everything, course, but the restaurant meant biriyani and usually it’s like, you know, rich in calories. So the patient population where they say that, you know what? I’m okay with the timing, but I want eat whatever I want. Yeah, yeah. So then what I do is that I tell them that it is okay to start with that angle initially until you set the different thing. Then you focus on the quality effort. The other group of population is that, hey, you know, this timing thing is not going to work for me and I’m not able to cut down on the calories and I will eat whatever. 

I want. I just want you to create magic for me.  

That’s where the problem is. Then I say that, you know what, okay, let’s, let’s focus on the quality of food, right? So know no package food, no possible, and then just try to cut on as as possible. In this tube method I, in my practical experience, what I’m seeing is people are preferring the timing method a little bit better. It’s simpler in terms of it’s easier, simpler, it’s relatively easier, totally relatively easier. So let’s say that people start like, you know, 12 hour fasting, 13 hour, 14 hour and everything. When you say quality foods, what is the one thing, one food that you would, I mean one macro or something that you are really focused that they should get during this eating?  

Yeah, so I would say when we’re thinking about metabolic health, we know for sure that the importance of the microbiome is really important because we have basically, there’s something called metabolic endotoxemia, which is when you have, as I’m sure you know about, you have these things called lipopolysaccharides that come from problematic gut bacteria. If the gut lining is too permeable, they come into the bloodstream as this sort of pro-inflammatory cascade that can kick off all the features of metabolic syndrome and weight gain. So to me, in, in a world where the majority of people get less than half of what they need in terms of fiber,  


That’s a problem. Because fiber is what’s gonna help to reduce that process that causes that inflammation that’s driven by gut health issues that causes metabolic syndrome. So when I, so that’s an an example of what, why I worry when someone wants to only fast but not change their diet quality, you’ve taken your 50% of your fiber needs down to maybe only 30% of your fiber needs. So you’re gonna have downstream problems from that where let’s say maybe fasting stops working for you, or if you stop fasting, you gain weight very quickly. And so just as a nutrition professional, I’ve seen that too often where you’ve gotta not only set people up for some, some short-term weight loss, but support them with their long-term success. And of course, if someone’s only willing to start with fasting, great start with that. But from the very beginning, we’re having that conversation of like, this alone is not gonna be the full answer for you. You’re gonna, if this helps you get some momentum and lose some weight and start to get excited and get some more energy, then that’s, we’ll leverage that into working on your diet quality and move in that order. But it can’t just be that it’s fasting alone.  

Right, right, right. So, you know, when you say fiber, you know, we tell patients that, hey, go and get 25 grams of fibers per day, and then they don’t, and then they come back to me again, which is good for my business.  

Yeah, I know. Or if they can’t tolerate it, sometimes they feel like they can’t, they try to eat fiber and they don’t feel good. So they have a deeper issue there. They need help. 

I see. Yeah. I see. So, so you, when you advise patients and then I said to you that, you know, I don’t know what to do, you know, you go and talk to Erin so that you know, she can help me increase the fiber content. Yeah. And so when you start, sometimes patients who are starting on fiber will get bloating. Yeah. Is that what you’re seeing as well?  

Sometimes. And sometimes the problem is that they go too quickly. So usually the first thing I’ll try is just advancing more slowly on it and making sure to not be getting fiber from foreign foods that they didn’t already tolerate. So it is better to eat more of your current tolerated fiber foods than to say, oh, I normally don’t eat beans at all, but I’m just gonna start eating a lot of beans and legumes. That might not be a tolerated food for you, so, right, right. Working with what you’ve already got. And then there are fiber types that are more tolerated in the food world, which is more nuanced, but there’s even things like acacia fiber and guar gum that people can purchase that are typically less likely to cause bloating. So sometimes we’ll use that to, as an initial step of just taking some of these fiber powders that are usually more tolerated.  

You’re talking about Metamucil, benafiber, that kind of powder?  

Yeah, sun. Sun fiber is a gargum. Metamucil is more complicated as a supplement. It’s not just the fiber, but yeah, benefiber as well. They’ve got some sort of non-fiber things than that, but like a sun fiber would be a good example. Psyllium husk is not totally as, as low of risk. I use psycilium husk a lot, but I find that people are more likely to get bloating with that than the guar gum or the acacia fiber. So we usually start with that.  

So guar gum is, what is the, is it a, a tablet or a gummy?  

No, it’s a powder. It’s technically partially hydrogenated fiber. So pH g and it’s interesting, they, this also has like prebiotic properties, so even that’s like a super food in the world of gi when you have something that’s unlikely to cause bloating. But at the same time, a prebiotic is gonna nourish healthy gut bacteria. Yes. So it’s like a stealth Trojan horse thing that’s gonna come in, be well tolerated, but help to increase your healthy gut bacteria, which then in turn reduces that problem we talked about with metabolic and a toxemia where you have the dysbiosis and the leaky gut. That’s, that’s colloquial term for like intestinal permeability that is allowing that inflammatory process to continue that metabolic dysregulation.  

Got it. You know, from a doctor’s standpoint, there’s multiple reasons saying that, you know, fiber heals the, the gut connection. The cells, the distance between the cells Yeah. Of the small intestine is tightened up so that there is no leaking of the inflammation into the body. And there are multiple studies associated with that. And you might even improve in my, from a practical experience, I’ve seen patients with ulcerative colitis, Crohn’s disease, where there is an immune inflammation going on where they increase the fiber, where they make sure that there’s good gut bacteria, the medication, the disease is not completely reversed. Yeah. But the flareups is reduced, the medication that they’re on, the dosage can be reduced. Yeah. So I’m seeing that practically along the same line of discussion of this fiber supplements, I always get this question on spirulina. Any idea about it? Do you use it? Where do you use it? Or you say goodbye?  

Yeah, spirulina I use a little bit differently. Basically it helps with like your natural, it feeds into like your natural detoxification pathways in terms of what the, what polyphenols are in there and some minerals that are in it. But I wouldn’t say that it’s like a top choice in terms of something that I would use directly as like a prebiotic fiber to help with the gut lining. But yeah, it has a powerful like anti-inflammatory effect if you are slow in your detoxification pathways, which can have genetic or nutritional reasons why that can happen.  

Do you recommend that as a supplement on a daily basis or only for patients who have failed or internal tolerating fiber supplements? Fiber intake,  

The meantime, I’m gonna do a spirulina. So we do a lot of like nutrigenetic testing. So we would test, we would run a test where we see all the genetics see, and then the algorithm of the test is really good at kind of saying, okay, here’s the pathways that are more likely to be highly impacted by this person’s genetics. And then we, we couple that with their clinical presentation and then we see kinda zoom in on like, okay, well what are, which specific genes are most likely to be causing your specific health challenges? Like for example, with weight and weight loss. And then we’ll make targeted supplementation around that. So typically with spirulina, I’m gonna be doing that if they’re impaired in those specific phases of the detox pathways that spirulina can help with. But if we’re talking more about gut and gut health, I’m more likely if it’s not gonna be fiber or with fiber, I’m more likely to actually give a prebiotic specifically, which is not quite the same thing as fiber. Fiber is less specific, whereas the prebiotic is to, to be a prebiotic. There has to be like clinical trials showing that this specific compound actually creates a, a significant health change that’s driven by a modulation of the gut microbiome. So it’s a more targeted microbiome modulator. So if that’s a, that’s a better way to step up from fiber, I would say, than like spirulinas.  

Nice, nice, nice. So in this, in this discussion about, you know, what are the things that you take, we just want to make sure that, you know, all this can be taken just through regular natural diet as well. Yeah. It’s based on your body as you said. You know, one of the ways to find that out is a genetic test and to see, you know, where do you stand in this big spectrum of things? Or you could do trial error method as well and then see what was the slower way to do that. The, the biggest other biggest problem in fasting in my patient population is when they fast they lose weight. You know, the first 10 pounds just flies off pretty soon, but that is a concern and the significant impact as well in terms of muscle loss as well. Yeah. So I always tell them to make sure that you increase the protein intake good accordingly as well. Yeah. So in your practice, what kind of protein intake target that you give and then what is the guideline that you give so that they can, you know, take their practice as well?  

Yeah, that’s a great question. And that’s part of the diet quality piece that we’ll start with. So, because I find that for some people it’s really hard for them to get up to their protein needs on its own, on their own. They have to really work at that. And so it’s better to get up to your protein needs before you tried also fast in most cases. And, and you’re also gonna be more protective against lean mass than if you just started fasting and losing weight and you’re not meeting your protein goals and that takes you a few weeks to get up on your protein. Well, you’ve already lost lean mass during those weeks. So that’s part of why we start with diet quality. And it is easier if someone does eat animal protein and eggs to achieve their protein needs. But then dairy can be also very high protein food. 

So like Greek yogurt for example, it’s a great way to achieve it. If someone only eats fish, then we’ll use a lot of fish and seafood and then eggs. And even, even if they eat eggs, we’ll use sometimes use like liquid egg whites and put it in unexpected things like cereal and soups and things like that to kind of help with. Yeah. And then there’s, there’s protein powder. So sometimes we’ll need to use that, especially with, if someone is vegetarian, will use a vegetarian protein powder to augment, not be the only protein source, but to augment it really needs to be, so for women, I’m usually trying to get them to a minimum of 80 grams a day and for minute to a minimum of a hundred grams per day. And then with individuals will calculate that more Exactly. Based off of like their height and their activity level and everything. Yeah. But just as a general rule, if you’re below 80 grams as a woman or a hundred grams as as a male, then you, you should be good. You’re gonna not, you’re gonna probably lose more lean mass if you lose weight. Yeah,  

Right. Lemme tell you, you know, a lot of patients from India, because, you know, I’m from India, I know that dietary habits, so the, the biggest problem is a vegetarian person reaching 80 grams of protein. It’s hard. It’s really hard. I think they just give up. They give up. So I say that, Hey, you know, it is okay to supplement with whey protein isolate or if you don’t like the whey for any kind of dairy, I mean, my patients are okay with dairy,  


Okay. So they’re not vegan, they’re vegetarians, they don’t eat chicken fish, Martin, I mean lamb beef. But so I say it’s okay to supplement with whey protein, it’s all vegetarian protein as well. Yeah. Can you that, you know, using whey protein, I mean, artificial protein supplement will damage your kidneys or any of your body? 

No, I mean that’s, that’s just a, you’re just, if you’re only using it to achieve your natural daily protein needs, then there’s not a risk there unless you already have some preexisting renal problems. And in that case, you should be working with your provider. But I think that’s a common myth that a concentrated protein source is a risk to your renal health at baseline. That’s actually just what your, your body’s meant to have that much protein. And so you’re just coming up to what your body is almost expecting if you’re kind of within that realm of the 80-100. 

Absolutely. The other other problem we always say is, you know, when, when I grew up, and I think the culture is changing now, but you know, we don’t focus on strength training or Building muscle during the younger days. Yeah. Which, which is easier. And we start looking at it only when you know, something happens. So you go to a doctor and then the annual checkup shows a cholesterol level of this much and you’re having some problems, then they focus ok, what? So even with that cardio has been one of the main ways to go for us. And we don’t really focus on that much. So in your practice, when you increase the protein intake, there is another myth that you should increase your protein only when you are lifting weights. What is your take on that?  

If you want to increase your muscle, then you do need to have two things. You need to have the stimulus, which is the strength training combined with sufficient protein intake, which would be the diet piece. But when we’re talking about the threat that weight loss poses, what’s really happening there is that your body isn’t getting enough protein from your diet to run your amino acids, which are protein is basically what, that’s like the wheels that your car drives on in terms of your body and all the processes that it runs. And so if you don’t have enough amino acids coming in from your food, your body’s gotta keep everything running. It’s gotta keep you alive, it’s gotta run everything and all the things that your body does. And so what it’s gonna do is it’s gonna go to your muscle to, and tear it down because that’s, its kind of like emergency protein backup method. And so right in that situation, you’re gonna spare your muscle by just having enough amino acids, having enough protein inside of your body. And so if your goal is to just protect the muscle you have during weight loss, you just need to eat enough protein. But if your goal is to increase your muscle, which really should be everyone’s goal, then yes, you need to strength train as well. So we, we basically try to get everybody strength training that comes into our practice. Super.  

Super. Yeah. Super. And then the other piece to this puzzle is that, you know, when you take, you know, I mean talking about vegetarian, people trying to, meeting the criteria for protein intake, whey protein, I mean whey protein isolate or protein supplement as an option. What are the other options that you usually tell you vegetarian people to foods is one of them.  

Yeah. For food. So yeah, we’ll do a lot of soy protein because that’s gonna be a complete, it’s not that all of your protein sources have to come from an, when I say a complete protein, I mean it has all of the essential amino acids in it. So like a grain or legume or a bean is not complete. It doesn’t mean you can’t use it at all. It just means that you’re gonna have to, you’re gonna have to get those other missing amino acids from other foods except, whereas like soy is an example of a complete protein. So it’s gonna have all the different amino acids. And so we’ll do definitely some tofu or like Tempe soy protein sometimes. But they’re so, like when they do really depthful like statistical analysis on like soy and breast cancer risk, they find that soy, whole food soy, like edamame, tofu, Tempe is not associated with an increased risk of breast cancer. But soy protein isolate is- not to a huge increase in risk, but it is a real increase in risk from a statistical standpoint. And so we don’t encourage soy protein, soy protein isolate, soy protein powder drinks with soy protein in it. Instead we’ll use whey, which is also a complete protein that comes from dairy. 

A, that’s a good point. You know, we see the soy milk on the  

Yeah, well  

That’s a soy protein. That’s good.  

Milk can be either way yeah, sometimes they literally just break up soybean and that’s whole, whole beans soy. But a lot of times they take water and fortify it with soy protein isolate. That’s the bad soy milk.  

Oh, that’s a good, that’s a very good, the other concern is the thyroid issues with the soy. Is that totally. Is that Totally,  

Yeah. So protein diversity is really important. So I worked with, actually, I worked for a company that had almost all vegetarians in it. So I have a lot of experience with vegetarians and I’ve seen that problem quite a bit. So what we’re always working on is diversity. Like, will you eat a, an egg or, or even like an egg white protein, then that can be helpful. Or if you, if you’ll do dairy, what are some dairy items that you’re not currently eating that we can start to work into your diet? What are some ways of preparing tofu and Tempe that maybe you haven’t tried? So sometimes there are ways to advance a vegetarian diet without changing the foods that are consumed.  

I see, I see, I see. Just a thought going back on the thyroid thing. So same thing. So protein I isolate might be linked with thyroid and not the whole soil. That’s  

The same, actually not the same thing. It could be the, even the whole beans, soy with that.  

Oh, I see, I see. So you just have to bring variety of protein intake.  

Yeah. Yeah.  

So tofu, tempe, soy protein altogether, plus the vegetarian protein supplement might be okay,  

You can start to get there. 

If you just keep saying that I’m, I’m just going to eat like, soy protein every day, then that’s a problem.  

Exactly. Exactly. Then that’s a  

Problem. Okay. Super. Super. And do you measure the gut bacteria in their small intestine by any kind of test or something in your practice?  

Yeah. So as  

A routine,  

Not for everybody that comes in the door, are you asking about like small intestinal bacterial overgrowth  

Type? Yes. Yeah, let me, let me rephrase it. Yes. Let me rephrase it. So the patient doesn’t have any GI symptoms. So they come for like, you know, fasting weight loss and metabolic thing. Do you include that in your practice or, or do you assume that the proportion of bad bacteria is more than the good bacteria is then you start working on that?  

We usually assume that the gut health isn’t optimal. If they’re not having digestive symptoms, we’ll not typically test unless we have some kind of other underlying suspicion, like maybe they also have an autoimmune disease. That might be a time when we would, would test even without digestive symptoms. But I just having run hundreds if not thousands of gut tests on people, what I’ve learned is that a healthy American microbiome is like a rare animal that you never see hardly. So I just kind of know it needs help. And so we’ll do the things usually that are not helpful there. And then if we’re running into wall problems down the line, we might come back to it,  

Then you check super. That’s what I do as well. So the, the, the next lo logical question is how do you improve, do you improve with probiotics or the change in diet? What is your first step?  

Well, both. So we know that aside from fiber, one thing that’s really important is fiber diversity. So getting a lot of different types of fiber is important. And also polyphenols are like, if you ever, if you think about like a brightly colored vegetable or a brightly colored fruit, that color itself is independent of the fiber, the actual color compound is really nourishing of the gut microbiome. So we start working on color diversity, fiber diversity. And then the protein piece is actually really important for the, for the gut microbiome as well, because it, it has to sit on that nice healthy tissue that lines the gut, that it  is dependent on sufficient protein status for it to, to stay healthy. So if someone’s under consuming on protein, that’s a big thing that we work on for the sake of gut health. So, so the diet quality is important and then one, then probably the next thing that we’ll work on is actually might surprise you, but fermented foods Yes. Yes. Are, yeah, there’s, there’s some new research now showing that fermented foods might be better than fiber at improving gut diversity. Yes. Meaning, yeah, the amount of, 

Actually there was a study, it says the two fermented foods per serving decreases the calorie intake by two 70 calories per day.  


By decreasing the appetite control.  

Yeah. Yeah, exactly. We’ve got keep in mind that gut brain axis, so when your gut is damaged, your’re gonna have signaling that can actually impair your appetite and vice versa. So  

Absolutely. Absolutely. I think so for products you go with like kimchi, kombucha  

Y Yeah, we’ll do it all. So kimchi sauerkraut, it has to be live sauerkraut us. And, and so things like sauerkraut and pickles, a lot of times if you see ’em in a grocery store, they’re actually just made with vinegar. And that’s not a fermented food. It has to be where it has like a live culture in it. But yeah. So  

I’m gonna teach you one, one Indian fermentor product. Maybe you should introduce  

This in your practice. 

Tell me Pazhaya Soru. Or Okay, can you say this with me? Pazhaya.  




Soru. Soru, okay. Which means left. So it’s called leftover rice.  

Okay. Leftover rice.  

So basically, leftover rice. So basically, you soak the white rice or whatever, it’s with water, and then you add some onion, green chili, some Indian ma to it. And then, you know, if you want you could add some, we do homemade yogurt as well. Yeah. Homemade yogurt, not store bought. Yeah, yeah. So homemade yogurt is usually ferment. So what happens is it ferments overnight and you are going to have the best fermented bacteria ever.  


That’s, that’s amazing. This such a common practice. So I always say that in us, if you see, you know, homeless people, they are pretty big and Yeah. Obese, right? Because we give leftover, as you know, pizzas, pastas, and everything to that. In India, the homeless persons are very lean because the culture has been giving the leftover rice to them.  

Okay. Yes.  

So the thing that we thought that it was a bad thing, and this is not good, it’s actually very good for

 That’s fascinating.  

It’s, it’s really fascinating. It’s, and then, so that’s, that’s one thing I want you to include, especially for  

I’ll, I’m gonna make it, I’m gonna find a recipe and make it, this is gonna happen.  

Right, right, right. It’s got leftover. Right. There’s a, there is a video on my channel as well. So leftover rice, please include that in your thing. And also I’ll, you must have heard about curd, right? Curd,  


Yeah. Curd is a different form of yogurt that we make as a, from milk, from ferment and Yeah, milk and butter. Butter products. Yeah. So that is pretty common in Indian culture. 

Yeah. Is that different than the paneer cheese though? That’s in the Yes. Okay. Yes,  

Exactly. Exactly. So if you ask an Indian patient to drink kimchi, kombucha, right. And then we will say, let’s go to a different doctor.  

Totally. I I think that exactly. And and same thing with like, I’ll have like maybe like a Korean client. They don’t wanna hear about how they should eat German sauerkraut. And, and one thing that I think is so fascinating about fermented foods is that if you really think about it, most of the world’s traditional diets have a traditional fermented foods. Yes,  


Absolutely. Yes. And, and that’s the wisdom of nutrition. Like sure, we didn’t have clinical trials and like NIH grants hundreds of years ago, but we had eons of lived in experience with food. And there’s wisdom in that people figured out what worked well for their health and longevity. And you can see consistency across the world in terms of fermented foods being something they decide to continue to incorporate. And I think that’s really just kind of underscores like the value of them. It’s not, it’s not an accident that these persist all over the cultures, you know?  

Absolutely. I, same thing with fasting. Fasting as well, right? Yeah. Every culture, every religion has some kind of fast thing linked to it. Yeah. And there is a reason behind it. Maybe the gods are different, but the one supreme power is already there looking after us. Yeah.  

Yeah. I mean I just think science is coming in improving what the human race is already kind of figured out through trial and error. That this is something beneficial both on a short timeline in terms of metabolic health, but also on a long timeline in terms of autophagy and how that impacts like risk of dementia, risk of cancer, the progression of aging. And, and it’s just an unfortunate truth that I’m thankful you’re remedying that people aren’t told about the benefits of fasting anymore. And as we fall away from as much of religious fasting as a routine practice in many cultures, it’s just kind of this powerful tool is getting lost.  

Yes, yes. Absolutely. 

Absolutely. But you’re bringing it back.  

Yes, I’m bringing it back. I tell, I teach all my American patients about Pazhaya Soru.  

Nice. Okay. I’m gonna make it.  

Yes. And they ask me, oh, how do you make it? I said, you know, here it is. I give them a sample right at the office. I’m not even making it up.  

That’s amazing.  

I’m not making it up. I’m so 

Excited to try this.  

Yes. And they say that, oh good, where do I get this? I said, oh no, go see my channel. And  


It was a wonderful conversation was, oh my God, I think we covered a wide variety of topics. If I, if you have to tell one take home point that you tell your patients so that my audience will get benefit out of it as well. What will you say  

If you need to work on your weight or your metabolism, work with a professionalist if you need to, but try to consume all of your energy within eight to 10 hours a day. Only when the sun is up. That’s what I would say. Good.  

Perfect. I absolutely love it. So people who are listening to this, Erin Skinner has a beautiful practice called Empowered Nutrition. Yes. She’s in North Carolina. She’s growing very, very fast. Yeah. She used to be my dietician. Now she has six dieticians under me. 

I Got you. New one now. 

New one. Yeah, exactly. Exactly. So she gave a new one because she moved to North Carolina, you other dietician, she’s wonderful as well. She’s from California. But anyways, it was an absolute pleasure to work with you. Your patients are so grateful to have you as a dietician. And it’s, I want bring dieticians on both in this channel because I always believe that Western medicine is not practice in a way that it’s supposed to. Yeah. Diet is first and then medicine. And both has to be linked together.  

Both have to be together. Exactly. So I think on the other end, we don’t wanna just say that conventional medicine doesn’t have a place as a critical place. Yes, yes. It’s just making, just maybe, maybe bringing in acknowledgement that food is essential and then you could put the two together. You have the best combination.  

Absolutely. Absolutely. Perfect. Thank you. Thank you so much for being on the show. Thank you.  

It’s, it’s been pleasure. 

Thank you. Thank you. 

Take care.  


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