The Gut Health Podcast

Gravity Resilience: The Gut-Brain-Diet Connection with Brennan Spiegel, MD

• Kate Scarlata and Megan Riehl • Episode 24

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Dr. Brennan Spiegel, author of Pull: How Gravity Shapes Your Body, Steadies the Mind, and Guides Our Health, reveals how gravity shapes everything from our digestive health to our emotional wellbeing in this fascinating exploration of "biogravitational medicine." He presents the revolutionary concept that conditions like IBS and depression may be tied to how well our body resists gravity.

• Gravity resilience refers to how well your body manages Earth's gravitational force
• People with hypermobility conditions like Ehlers-Danlos syndrome often experience gut issues when their internal suspension systems are compromised
•  The gut hangs from a suspension system like ‘ornaments on a Christmas tree,’ and if it weakens, the intestines can sag, leading to digestive issues
• Our language around emotions reflects our relationship with gravity – we feel "down" when sad and "up" when happy
• Most serotonin (90–95%) is made in the gut with help from our microbiome, where it helps regulate muscles and systems that manage our body’s relationship with gravity
• Strategies to strengthen gravity resilience
• Hypopressive exercises that draw the belly upward can improve internal organ support
• The STACK TEN diet focuses on tryptophan-rich foods to support serotonin production
• Mental and physical resilience share similar concepts - the ability to "bend without breaking"

Check out Dr. Spiegel's new book "Pull" releasing October 7th, which explores how gravity affects human health and how building gravity resilience can help us find balance, stand stronger, and live longer.

References and Resources:

The Gravity Doctors Podcast Link

Brennan Spiegel MD’s book, Pull (This is an affiliate link. We may earn a small commission at no extra cost to you and only recommend products we trust.)

Effect of diet on serotonergic neurotransmission in depression. Neurochem Int. 2013;62(3):324-329.

Tryptophan-rich diet is negatively associated with depression and positively linked to social cognition. Nutr Res. 2021;85:14-20.

J. Wurtman: Brain serotonin, carbohydrate-craving, obesity and depression. Obes Res. 1995;3 Suppl 4:477S-480S.

Research on sleep & tryptophan Sleep and Diet: Mounting Evidence of a Cyclical Relationship. Annu Rev Nutr. 2021 Oct 11;41:309-332.

Amy Cuddy's paper on "The Power Pose" highlights how adopting confident postures can boost mood, increase self-assurance, and positively influence how others perceive you!

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Kate Scarlata, MPH, RDN:

The Gut Health Podcast will empower you with a fascinating scientific connection between your brain, food and the gut. Come join us. We welcome you.

Kate Scarlata, MPH, RDN:

Hello, friends, and welcome to The Gut Health Podcast, where we talk about all things related to your gut and well-being. We are your hosts. I'm Kate Scarlata, GI dietitian.

Dr. Megan Riehl:

And I'm Dr Megan Riehl, a GI health psychologist, and today we welcome back a friend to our show, Dr. Brennan Spiegel. He is the Director of Health Services Research at Cedars-Sinai in Los Angeles and leads the Cedars-Sinai Center for Outcomes Research and Education, where his team investigates how digital health technologies from wearable biosensors and smartphone apps to virtual reality can strengthen the patient-doctor connection, improve outcomes and reduce costs. He developed one of the largest and most widely studied medical VR programs, helping establish the emerging field of medical extended reality, which applies immersive technologies to conditions such as pain, anxiety, depression and IBS all things we care about on this podcast. Dr. Spiegel has authored bestselling medical textbooks, has more than 270 peer-reviewed articles and has been featured in all the major news outlets, including New York Times, Forbes and The Wall Street Journal. He's also the author of VRX How Immersive Therapeutics Will Revolutionize Medicine, which was named by Wired as one of 2020's top science books. Today, though, he will be sharing his insights on groundbreaking hypotheses related to gravity and its impact on human health, including digestive health.

Kate Scarlata, MPH, RDN:

So we are so glad to have you back. We're a fan of your work and the way your brain works, especially me. Well, I know Megan too. I'm obsessed with the way you're doing.

Dr. Brennan Spiegel:

I'm a fan of you guys too, so thanks for having me.

Kate Scarlata, MPH, RDN:

So we are glad to have you here. We are going to be talking about Dr Spiegel's new book called Pull, which is going to be released October 7th, and I have had a preview and it's just very insightful, intriguing and novel and a must read for really anyone. Don't forget to check out. We had him on for episode 13, where we talked about the vagus nerve and virtual reality for gut health, so check out that episode as well. So welcome back, Dr. Spiegel.

Dr. Brennan Spiegel:

Well, thanks so much for having me. And hey, you know, the vagus nerve has to do with gravity too. So who knows, we can bring it all back to gravity.

Kate Scarlata, MPH, RDN:

Oh, yes, let's bring that in. So we know that gravity doesn't just keep us on the ground. It shapes our bodies, minds and even our emotions. And in Pull, dr Spiegel reveals how this invisible force influences everything from digestion to depression and how building gravity resilience can help us find balance, stand stronger and live longer. And I just want to interject here because you know I have a lot of questions about your book and this paper that you put out. With Gravity and IBS, we're all dealing with gravity, but it's about having good gravity resilience. So can you just quickly talk about that before we get into myth busting with you?

Dr. Brennan Spiegel:

Yeah, absolutely. Well, thanks for that starting point. Because if you take a step back right, gravity was here long before we were and it'll be here long after we're gone. So it stands to reason that every part of your body, not just the gut, even the microbiome inside the gut, every tendon, every organ, every bone in your body, even your brain, evolved to manage this fundamental force of physics. And so the better we do at managing it, the more resilient we are to it, the more we thrive and survive. And so that's the idea behind biogravitational medicine. It's like a fish is to water. You know, a fish swims in water. It doesn't, I assume, know anything about the water, but it survives and thrives and is designed to move through water.

Dr. Brennan Spiegel:

And that's the same with us to gravity. It's almost so obvious that it doesn't need to be said, except that so many of our chronic medical conditions are a result of gravity intolerance. So some people can manage this force better than others, and we'll get into the details. And gravity resilience is how well you stand up to gravity, not just physically, there's your gravity fortitude, your strength, also the inner pumps and hydraulic systems, including the gut, the cardiovascular, the lymphatics, how well you pump up against gravity to get that blood up to your brain. So we don't pass out talking to each other right now, but also your nervous system, inner ear and your brain itself are all managing gravity.

Kate Scarlata, MPH, RDN:

All right, so you've done this before. We're all about myth busting here at The Gut Health Podcast, so can you bust a myth regarding gravity and gut health?

Dr. Brennan Spiegel:

Yeah well, gravity. In general, we tend to think of it as a pull. In fact, that's the name of my book. It's Pull. That's how we feel it. We feel like we're being pulled down to the earth, but in fact it's almost of relativity. The idea behind relativity is being pulled down is the same as being pushed up.

Dr. Brennan Spiegel:

Now what does that mean for us? Well, it means that in a way, we can think of the ground beneath us as buoying us up, pushing us up, and we can leverage our relationship to gravity almost like a trampoline. Right when I run, for example, when I run marathons, I use these almost barefoot shoes because I want to feel the earth push into my foot and bound me up into the air. So it's an interesting pivot. I mean, if you think, right now you might feel like you're being pulled down, but if you change your mindset and think, oh, actually the earth, the chair, the feet, the pressure beneath my feet is pushing me up, it's a reverse mindset and that has mental implications, not just physical. So that's a myth. It's actually not a pull, it's an upward acceleration against us.

Dr. Megan Riehl:

Yeah, that makes me think about like grounding exercises that I'll do with patients, or when we kind of think about the power of your feet and feeling that support underneath you, and that's something you know, if you are an individual blessed to have feet, that you get to have that sensation of grounding. So that's a great myth, and you know. Let's kick this off a little bit more broadly and tell us a little bit more about gravity and how it may impact our gut. Tell us a little bit about that paper that you published and you certainly dive into it and pull as well.

Dr. Brennan Spiegel:

Yeah. So I'll start with a story. I saw a patient in clinic just a few weeks ago maybe a month ago who had been diagnosed with irritable bowel syndrome young woman and she had had persistent abdominal pain and diarrhea and bloating and nothing really had been helping. So I went in to see her with my student and I shook her hand like I do with all my patients. I said hi, and the first thing I noticed is her wrist was really clicky as I was shaking her hand, and that can happen. But to me that was the first clinical clue that there actually could be a gravity intolerance explanation here. So what does that mean? Well, her wrist was clicky, it was particularly clicky.

Dr. Brennan Spiegel:

So after I said hi and so on, I asked her could you bend your pinky back for me? And she was able to bend it way back beyond what I can, which is about 90 degrees. She went way back. I thought well, that's a clue. And then I asked her can you take your thumb and touch your forearm with it? Actually bring it all the way down to your forearm? I can't do that, not at all. She easily did it. She was double jointed in her elbow. She can touch the ground easily with her hands without bending her knees, and I thought wait a second. She has hyper mobility and when the joints are stretchy, oftentimes the interior suspension systems are stretchy too and it turns out the gut is hanging off a suspension system, almost like I don't know ornaments on a Christmas tree or something like that, or a marionette on strings. If the strings are stretchy on a marionette it's going to collapse onto the ground and won't be animated.

Dr. Brennan Spiegel:

We ended up doing an x-ray of her belly, first flat and then standing up, and we observed that almost 90% of her bowel collapsed, all the way down into the basin of her pelvis. Turned out she had Ehlers-Danlos syndrome, which sometimes can mimic IBS, a condition where there's issues with collagen in the body, the stretchy protein that keeps us connected, and for her the treatment was abdominal exercises, hypopressive exercises where you suck your belly in and hold it tight. Lower back, she had a lot of back pain, the anti-gravity muscles in the back and so on Swimming, so she can be horizontal rather than vertical when she's exercising Tilt table therapy she had a gravity intolerance. So that's just an example to give you a sense of the physical ways and when that happens the gut compresses down. It's almost like a garden hose that gets kinked and it gets backed up with water.

Dr. Brennan Spiegel:

So she had bacterial overgrowth as a secondary consequence of this accordion-like compression of her intestines because she was intolerant to gravity. She also got lightheaded when she stood up too quickly, which is another form of gravity intolerance, and you need to drink a lot of fluid and get enough salt within limits to maintain the pressure to get your whole body moving with its circulation. So that just exemplifies what I mean by gravity intolerance. And there's so many other stories we could talk about, but that one to me illustrates it well.

Dr. Megan Riehl:

Yeah, and some of these common comorbidities that our patients are experiencing that may go misdiagnosed for a really long time. You might be looking down the wrong rabbit hole.

Kate Scarlata, MPH, RDN:

Absolutely. And just you know I'm again a fan like that. All those clues that you found just by assessing, to know to look for those things I don't think is standard of care. And yet we know people with connective tissue or hypomobility joint issues often have digestive problems. So maybe we should be monitoring those telltale signs that you were, you know, were very tuned into, which is so amazing. So let's think about astronauts. They've been studied and obviously they're not exposed to the gravity we are here on Earth and we know that there's effects to their digestion and circulation and mood. And with that recent episode where the astronauts were stuck up at the space station for even longer amounts of time, I wonder if we learned even more. But how can you know some of this science influence how health strategies or interventions for us down here on Earth, where we are exposed to a lot of gravity?

Dr. Brennan Spiegel:

Yeah, you're right. So up in space, and we call this microgravity orbit. So there still is gravity up in low Earth orbit, but it doesn't feel like it because they're in what's called parabolic flight, so they're always falling towards the Earth, which makes you feel like you're floating. But, boy, astronauts get a bunch of gut issues. They get a lot of issues, not just the GI tract. So they get abdominal distension, can get bloating.

Dr. Brennan Spiegel:

The microbiome changes in space. Serotonin signaling, which is a consequence of the microbiome, also is abnormal in microgravity orbit. They get kidney stones, they get headaches, they get infections. So you'd think, why would you get a viral infection in the International Space Station, which is scrubbed clean? Well, the immune system starts to let its guard down and latent viruses like, let's say, herpes or varicella zoster will come out. So it can affect all parts of the body, including the circulatory system. So there's this Goldilocks zone of too much gravity or too little gravity or just right. So astronauts have too little gravity and they get a whole bunch of issues, whereas on Earth some people may experience too much gravity.

Dr. Brennan Spiegel:

Now, gravity doesn't change on Earth, of course, but our relationship to gravity can change depending upon the decisions you make and the way you're built and all these other things we'll talk about and what I like to think about it as is. We are born of this earth. We came out of it. We're a process of the evolutionary history of this planet. So what that means is our body is designed to take in all the data from the world, literally.

Dr. Brennan Spiegel:

The grounding exercises we talk about are about feeling the floor, interpreting it through our nervous system and then creating a mental model in our mind physical and mental about where we are in relation to this planet like Mother Earth. Okay, so we can learn from astronauts, first of all, that we're born for this planet. It's going to be challenging to get to Mars without simulating gravity, and in high altitudes IBS is more common. Colitis flares happen on airplanes, for example. We could talk about all these things because that's a gravitational effect too when you go up into the upper atmosphere and in the book Pull I talk about a lot of these examples, especially with high altitude. So a bit of a rambling answer because there's so much to unpack there, but it's a great question.

Kate Scarlata, MPH, RDN:

No, it's interesting.

Dr. Megan Riehl:

You know, as we make this pivot to thinking about, certainly it affects our internal organs and our physical health. Your book talks beautifully and I love that it incorporates the mental health effect of gravity as well. And in fact, if you don't mind, I just wanted to kind of highlight something from your book that you shared and research really showing that adopting an upright posture can have a measurable effect on our mood and how we physically hold ourselves against gravity can influence our emotional state. You wrote and so tell us a little bit about your perspective on gravity and depression and mood.

Dr. Brennan Spiegel:

So think about what it would feel like if you're on a bigger planet right now, with more gravity, more pull on your body. Getting out of bed would be difficult. You'd be exhausted all day. Your shoulders would literally be slumped over, you'd be staring at your toes. You would not have the energy to engage with the world. You would feel physically and emotionally down. Even the language that we use.

Dr. Brennan Spiegel:

I feel down in the dumps. Right Down in hell, right Up in heaven. I feel high, literally high. Okay, serotonin exploding in my brain from a psychedelic. You're high, okay. Church steeples point to the sky. We look to the heavens for inspiration. Up is good and down is bad, and that's not just a metaphor.

Dr. Brennan Spiegel:

It turns out our brain literally has a verticality to our neuropsychology. It's born into us from birth. Even little babies know and there's been really interesting experiments to show this misinterpreting the force of gravity, especially in the insula, which is a part of the brain that's taking in all this data about gravity and we get confused about what the actual amount of gravity is and we feel too much pull and it brings mind and body down and, in a way, anxiety is almost like you are falling and depression is fall in in. So on a roller coaster people get butterflies. That's their gut telling them like you're about to die, like we're not supposed to fall 20 stories.

Dr. Brennan Spiegel:

Some of my IBS patients do not want to go on a roller coaster because they feel those gut feelings all the time. It's almost like a metaphorical fall. That's what anxiety is is you're going down and what's at the bottom? This is kind of poignant. Well, in some traditions it's a grave, which is a gravity box. It's a word derived from the word gravity. We do not want to fall down and end up in a gravity box. So when we're falling we feel the gut feelings like we do on a roller coaster. So that's a big introduction to this whole notion of mental gravity.

Dr. Megan Riehl:

Yeah, and so how might some of your proposed gravity-informed approaches differ from traditional mental health interventions? Because, you know, I think some people are really going to gravitate toward these concepts and really take them as new ways of thinking about how they're emotionally feeling. So give us some ideas.

Dr. Brennan Spiegel:

Yeah, yeah, so you mentioned standing up straight. So, given everything I just said, this is to be clear no panacea for depression, right? People, as you would know as well as any of us, you know, with severe depression you can't just say, oh, stand up straight and it goes away, that's right, so no. But you know, amy Cuddy has done a lot of work on these power poses and literally just standing up straight, your spine is a chassis that holds up all the viscera in your belly. Standing up straight opens up the abdominal cavity and, just from a gut health standpoint, can help with digestion. If you're always hunched over all day long in a seat with your shoulders, you know, curled forward, you're compressing the abdominal cavity.

Dr. Brennan Spiegel:

But there's something deeper than that. There's something about literally defying gravity, using that upward push of gravity to springboard you up into the world. So you're standing strong and this has effects on the brain, even if it's subtle it's not the same in everybody. That can give you a little sense of empowerment, even smiling. Smiling is up and frowning is down. Okay, so our body language up is good. When we're excited, the eyes go up, everything moves up. So that's just one simple approach. But then we also use virtual reality, to simulate rising up without literally rising, and do cognitive behavioral therapy in environments where you're floating up into the clouds or you're floating in heaven. These are also very interesting ways to leverage this verticality of our psychology in ways that are hard to do in an office setting, let's say. Those are just a couple of examples.

Dr. Megan Riehl:

Yeah, and so tell us a little bit more about serotonin and the gut and gravity and what is the connection here?

Dr. Brennan Spiegel:

Yeah, so most people think of serotonin as sort of a happy chemical that's in the brain and it is that it can help elevate mood. Just think about that word elevate, that's anti-gravity, we're raising up mood and it's low in depression. But we spend a lot of time talking about brain serotonin when in fact 90 to 95% of the body's serotonin comes from the gut.

Dr. Brennan Spiegel:

And I'm going to guess this has come up in a lot of your discussions over time on this podcast, but it's always surprising and it turns out we need a microbiome to create serotonin, which is one reason why among many, infants and little babies can't walk. Yet they don't have serotonin. They're busy forming their microbiome to kickstart serotonin production, which is vital to stand up. It primes your muscles, serotonin, and it primes the cardiovascular system so that the pump and tubes can push enough blood up into your brain. In an upright stance, of course, the gut itself is moving in all direct, no matter if you're upside down, you can digest food because of serotonin, and so serotonin is a gravity management substance and if we have an abnormality in the microbiome serotonin complex, we'll call it.

Dr. Brennan Spiegel:

One could see how you might get lightheaded or dizzy or have abdominal pain or get some swelling in your body. Ankle edema from low return of blood or lymphatics, baroreceptor reflex, which is a system in your body that tells you if you're standing up, to increase your blood pressure quickly and not pass out serotonin. The inner ear, the vestibular system that keeps you from toppling over serotonin. So this is why people on SSRIs, who withdraw quickly from SSRIs, sometimes get very dizzy because their relationship to gravity has literally changed Because the serotonin levels are changing so rapidly in the inner ear that you've lost your relationship to the planet. It's extremely disorienting, depersonalizing, derealizing. So serotonin is very profound. It's not just a happy chemical.

Dr. Megan Riehl:

And you know it highlights this bi-directional relationship between what happens in the gut and what happens in our brain and why we see these comorbidities of anxiety and depression in high prevalence with some of our gastrointestinal conditions like IBS, as well as inflammatory bowel disease. So, again, giving us different ways to think about targets for treatment. And you're certainly right that standing up straight is not going to be the end all cure for somebody with major depressive disorder. But I do think you're giving us a tip and a trick for, you know, if you're just having a hard moment, if you're having, you know, a really busy day, I would think of some of that from a mindfulness-based perspective, of taking a couple moments to have a deep breath, but also sit up straight, open the chest, pull the shoulders back, put that head up toward the heavens and there is some science to support that that can help with then grounding yourself and moving back with maybe a little bit more motivation, a little better concentration and energy.

Dr. Brennan Spiegel:

And, if I can add, there's also a therapy called flotation therapy or flotation rest therapy, where you get into a flotation tank full of Epsom salt, so it's like being in the Dead Sea in Israel, and you get into this nice sort of dark room, the water is warm to your body temperature and you literally just float. It's an anti-gravity experience, and evidence shows this too can be helpful for depression and for mood elevation in general, and there's been functional MRI studies in the brain showing that it can change the perception of time. In the same areas of the brain that are managing gravity, which is a process called gravisception. It turns out we have another sensation called graviseption, which is your ability to perceive gravity, and flotation therapy can help reset your graviseptive processes. So that's just yet another interesting approach that I talk about in the book.

Dr. Megan Riehl:

That sounds great. Let me float.

Dr. Brennan Spiegel:

Yeah, I mean I'm ready to do it.

Kate Scarlata, MPH, RDN:

Dark room. See you later, right. Especially young moms out there. Right.

Kate Scarlata, MPH, RDN:

I think, that's an automatic boost to the mood. So let's talk. I kind of mentioned gravity resilience in the beginning and I know that there are some people that are less prone to having good gravity resilience. So I want to talk a little bit about who are these people that are less resistant to gravity? And then, what is gravity resilience and how can we get more of it? Because clearly, you know, this is vital information for some, for all of us, but maybe some people more than others.

Dr. Brennan Spiegel:

We're all too sedentary and we know that sitting is the new smoking. That's a meme that's out there and there's so much research now that shows that the stronger you are, the longer you live. The lighter you are, the longer you live. And, of course, the types of calories that you take in are all important and we're going to, I'm sure, talk about this. And so why is that? Well, because that helps you fight gravity better.

Dr. Brennan Spiegel:

As we age, gravity doesn't change, but our relationship to gravity changes. We become a little bit weaker, we become a little more frail. We start to get literally pulled down to the earth. Kyphosis, or lower back curvature, starts to come into some older individuals. So the way to become gravity resilience to start off with is to become stronger.

Dr. Brennan Spiegel:

So I use a standing desk. I'm standing right now. I typically although not right now wear a standing desk. I'm standing right now. I typically although not right now wear a 20 pound weighted vest. All day long I wear ankle weights 20 pounds on each ankle. I use a balance board to constantly practice my balance while I'm working.

Dr. Brennan Spiegel:

Sometimes I step in place at my desk and it turns out that there's something else in the body called the gravitostat. It's like a thermostat in your body for weight. If you suddenly put a lot of weight on your body all at once, not gradually over months and months, but all at once, the bones feel the compression and they say to the body, to the brain, essentially hey, things got heavy, like gravity just changed. We need to increase metabolic rate, we need to lose weight and in fact there's research that you can lose four pounds in about four weeks just by wearing a weighted vest all day. And now there's this new trend of rucking. Where you run around, you know you might see people with weighted vests or backpacks. Running comes from the military, mainly. Very effective. So this is one way to become more resilient, is just to strengthen your body.

Kate Scarlata, MPH, RDN:

Okay, so what about conditions that are? You know, you mentioned hypermobility. What are some other conditions maybe that would make someone less gravity resilient?

Dr. Brennan Spiegel:

Yeah, maybe that would make someone less gravity resilient. Yeah. Well, you know, lower back pain is a form of gravity intolerance, just starting with the most common condition, because we can get into POTS and mast cell activation and a lot of these conditions that I know your listeners care about, and those are forms of gravity intolerance too. But if we just start with lower back pain, that is a form of gravity intolerance. You know, we originated as four-legged creatures and it's only in the last about 10% of our evolutionary history that we stood up and as we stood up, all the systems had to reshift, including the gut. Hanging down, the back suddenly has to port around the sack of potatoes. We got a sack of potatoes in our belly. It's the gut, and some people are better at carrying around the sack of potatoes. We got a sack of potatoes in our belly it's the gut, and some people are better at carrying around that sack of potatoes than others. And it turns out there's a few ways we do it. Lower back, strengthening that back, pulling up the diaphragm. Diaphragm is the top, like the ceiling tack that pulls up that sack of potatoes. The mesentery are the suspension cables on the inside that, if they're caked down with too much fat tissue cannot work well. The gut can get sort of tangled up, compressed. You stand up straight, strong back, everything pulls up. Not only does the back get better, but the gut gets better. A lot of people with IBS have back pain. Why is that? Way higher than the general population. It's because the back and the gut are so closely connected that they are completely interrelated in terms of how their physiology and anatomy works. So those are just some examples.

Dr. Brennan Spiegel:

Now I mentioned postural tachycardia syndrome. That's where people get very lightheaded and dizzy when they stand up quickly. Some people call that being allergic to gravity. Headed and dizzy when they stand up quickly. That some people call that being allergic to gravity. You know mast cell activation syndrome. You have a lot of histamine in the body, blood pressure drops, people get lightheaded, tachycardic, their heart starts to go quickly. Those are signs that your neurophysiology is not managing the force of gravity. And if we measure not just the heart rate but the heart rate variability, the beat to beat variations in the heart, we can see that it's off in people with those syndromes. It's also off in astronauts who don't have gravity. These are all gravity management systems and we can see similar abnormalities in astronauts, as we see in some of these people who have postural tachycardia syndrome, for example. The connections go deep and far.

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Kate Scarlata, MPH, RDN:

I'm just thinking about, like core. What kind of exercises? What else, so we get the weighted vest and standing more, standing tall, being stronger, yeah, what else.

Dr. Brennan Spiegel:

So I really like I'll come back to those hypopressive exercises because there is evidence that this can help, especially with low back pain, pelvic pain and abdominal pain. So the idea is you suck in your belly like, pull up your belly towards you, almost like you're trying to take that sack of potatoes in your belly and pull it up, suspend it up into your chest, hold it, relax, take a deep breath and then hold it and relax and if you do that routinely you get much stronger diaphragm, which helps bolster and strengthen all the connections inside. It's not just about the gut and it's not just about the muscles. It's about the connection points between the spine and the bones and the gut and the viscera. This is called tensegrity. That's a term that means tensile integrity and the way I think about that, it's like a tree can bend in the wind but not break. We want to be resilient, meaning we can bend but not snap.

Dr. Brennan Spiegel:

This is why Tom Brady was the most durable quarterback ever in the NFL. He wasn't the biggest guy. He actually learned to strengthen his inner connections and become physically resilient. He changed the way quarterbacks trained, using resistance training and bands and not necessarily just bulking up. Gronkowski was a big guy who had ACL injuries and shoulder injuries. The biggest guys in the NFL often get injured and they're out, because it's not just about how big and strong you are, it's about how the interconnection points are moving together as one seamless unit. We have seams in our body and so part of this hypopressive activity is not just bulking up the abs, which you do with sit-ups, but strengthening the diaphragm, the tendons and all the connection points on the inside to bolster and hold up the gut and the entire core.

Kate Scarlata, MPH, RDN:

And it's not talked about. Right, it's not talked about that much really.

Dr. Brennan Spiegel:

No, not at all.

Dr. Megan Riehl:

I was thinking. You know, we do work with people in the psychology space on resilience from the emotional standpoint, and we have research that shows that those that are more emotionally resilient have better outcomes. We see this research in inflammatory bowel disease, and so it is a modifiable factor. I always like to stress for people that even if you feel like you're not the greatest, you're not the most resilient, we can work on that. And similarly, from a physiological standpoint, it sounds like it is something that is modifiable and we can really work on that too.

Dr. Brennan Spiegel:

That's a great analogy, and I think it's more than an analogy. Sometimes we think we're just talking in metaphors, but actually mental resilience has the exact same concepts as physical resilience, and really we've talked about this in my last podcast. Mental and physical are, in a way, one in the same, and so I think about the body as an extracranial extension of the brain. The brain is in this control center and it sends out and it comes right out of the skull and it forms in this seamless way into this entire apparatus that is our body, that is informing our brain at all times. So we talk about resilience. It's physical, it's mental. These are just words that we use, but what it means is you can bend without breaking, whether it's mentally, physically or both, and this is why study after study shows physical strengthening, exercise, cardiovascular fitness all of these things improve mental health.

Kate Scarlata, MPH, RDN:

That's right, bend without breaking people, let's do it.

Dr. Brennan Spiegel:

That's right, exactly.

Kate Scarlata, MPH, RDN:

So should we talk about diet and how?

Dr. Brennan Spiegel:

Of course.

Kate Scarlata, MPH, RDN:

Hello, yes.

Dr. Brennan Spiegel:

We cannot do that. We got to get you in on this.

Kate Scarlata, MPH, RDN:

I want to get in on this. I've always been a little obsessed with serotonin. There was a researcher at MIT, Judith Wurtman, that did a lot of serotonin and diet relationship research early in the 1980s, and so this is something I've kind of tracked throughout time. But I know you have this stack 10 and you talk about how diet can enhance serotonin levels through use of tryptophan rich foods. So let's chat about that.

Dr. Brennan Spiegel:

Yeah, absolutely, and I'd love to hear your thoughts about this. So we just got finished talking about exercise and cardiovascular fitness, how it can improve mental health. It also can improve serotonin biology, so you can boost serotonin through these activities. But in order to boost serotonin, you have to have the substrate for serotonin available, and that's tryptophan. So tryptophan is an amino acid. It doesn't get manufactured in our body. We need to ingest it through our diet.

Dr. Brennan Spiegel:

So thinking about how to enhance tryptophan levels in the body through the diet is the idea behind what I call the STACK TEN diet. I kind of just made that up because it just sounds good. But no, the way I think about it is try to stack my diet with 10 foods that are all known to be rich in tryptophan and I'd love to hear your thoughts about this, Kate, because every food isn't necessarily right for every person. But you know salmon and seeds that would be the S. You know turkey, of course.

Dr. Brennan Spiegel:

You think about people get all sleepy on Thanksgiving and some people think that's because of tryptophan, which can lead to serotonin and then to melatonin. So these are all part of the biology of tryptophan. The A is avocado, I have to remember. The C is chicken, and then chickpeas and chickpeas, I hear, are a little controversial for some people, but chickpeas, K is kidney beans, and then that's the STACK, and then the 10 is T for tofu, E for eggs and N for nuts. So I'm sure there are many other foods that have tryptophan in it, but that's how I remember the key ones.

Kate Scarlata, MPH, RDN:

Yeah, no, I'm with you on that. I mean, not everyone's going to be amenable to all the different choices, but I think that's what's nice about having a variety of different selections for different people.

Dr. Brennan Spiegel:

Right, yeah, yeah. Are there any other foods that come to mind that I should be including or that you recommend for serotonin or tryptophan?

Kate Scarlata, MPH, RDN:

You know, not really. It was interesting and I have to look back at this Judith Wurtman. But she had some carbohydrates that she pushed without having the protein, so it was like almost she had more of a dietary pattern. That made it different and I'll pull that research and attach it to the show notes. You know, again, this is back from the 1980s but these are really tangible things that most people can include and may not be including enough of. So I you know, I'm in agreement with your list. I think it's great, great.

Dr. Megan Riehl:

Well, nobody's asking me, but I mean, ice cream really gets my serotonin going. But that just didn't make the list.

Kate Scarlata, MPH, RDN:

It did not make the list so.

Dr. Megan Riehl:

I will stick with-.

Dr. Brennan Spiegel:

It gets the dopamine going for sure.

Kate Scarlata, MPH, RDN:

There you go.

Dr. Megan Riehl:

Yeah, there you go Well it's always fascinating to think about, you know again, just different tangible ways that we can address this, whether it be food or our emotional health or physical health. It's nice to have different entrance points for this our emotional health, our physical health. It's nice to have different entrance points for this. And you mentioned the roller coaster a while ago and this sensation of butterflies in the stomach, and I always think too about those butterflies being attached to our gut instinct and tuning into that and having some ability to listen to what our body is telling us. What does that make you think of? And what else might we take away from kind of those sensations in our body?

Dr. Brennan Spiegel:

Yeah, so in the book I talk about how I used to ride a lot of roller coasters and for me I really got the feeling in the gut and I remember once riding on the Colossus, which used to be the biggest wooden roller coaster in the world, at Magic Mountain here in LA, and at the end of the ride you know they usually take a photo and on the way out they show you a photo. So I was with my friend, Chris, who ended up becoming a Broadway dancer, like a really strong, robust guy, and I am next to him curled over in a ball, white, knuckling the rail, looking like I'm absolutely dying, and he's got his hands up in the air and he's smiling and he's not even holding on. And I realized we were having different experiences and reactions to this gravity challenge. My belly ignited and his didn't, and so if we had an MRI scanner, our brains would look very different. In that moment my amygdala, which is this sort of almond shaped emotion center that we have in our brain, would be on fire, just going crazy, and his probably would not. And so in the book I talk about that and I even talk about this guy, Alex Honnold, who is famous for free soloing El Capitan in Yosemite. He's an incredible rock climber that got all the way up the side of this rock face without any ropes. And you think, well, how does he manage gravity? Because at any nanosecond he can fall to his death? Well, it turns out when they do MRI scans of his brain, his brain is like the opposite of some people with chronic pain or IBS or fibromyalgia His amygdala silent, nothing like just quiet, Whereas if you look at the amygdala and the related connections to people with chronic pain, it's the exact opposite. It's like he has an inverse brain. He is the ultimate gravity fighter. He's not going to be worried about going on a roller coaster for sure. So this is just telling us about our neurophysiology and how we're all a little bit different and how, something like anxiety.

Dr. Brennan Spiegel:

When I think about gut feelings, I'm thinking well, why are you having those gut feelings? There could be a purely physical explanation. Like you know, you have an infection in your gut or colitis, but sometimes it's almost like a ventriloquist throwing its voice. It's like the amygdala. It's the brain throwing its voice into the gut and it's your brain talking through your body. That's why I said before, this language is imprecise. It's all one system, but we think about oh, the brain talks to the body. Well, the body is the brain, the gut is the brain. It's all connected. There are seams that are really seamless, and so it's like a ventriloquist, though, and I say well, why do you feel like you're falling right now? Next time you have gut feelings, think why do I feel like I'm falling, why am I falling? It's an illusion. You are not falling. You're literally not falling. Your brain feels like it's falling. You are misinterpreting gravity right now and your relationship to the planet. You're not falling. You're not, and that's a totally different way of thinking about a gut feeling.

Dr. Megan Riehl:

You know, it makes me think. Over the summer I was with my family and one of my children. We were out tubing on a boat and one was really hesitant, didn't really want to get out on the tube, was seeing it zipping around and going up in the air and over the waves. And this is one of my more gentle children, a little quieter, a little more in tune, Whereas another child of mine, who happens to be the youngest and the only girl, was on that tube in a matter of seconds and we are literally zipping fast.

Dr. Megan Riehl:

Her little arms are up high in the air. She was having the time of her life and it just. I think, also when we think about personality constructs and how we approach children too, my parenting style is a little different with each one, and that just made me think about that in terms of again those instincts of one having that kind of yellow red flag go up and the other is like green for go, let's go. And that, I think, is also a little bit of what we're talking about here, the pull to make a decision.

Dr. Brennan Spiegel:

How we raise kids now, helicopter parenting, controlling our environment. We're all controlling our environments more and more to try and exclude threats. 200 years ago, where I'm standing right now in LA, this would be chaparral. There would be not much out there. There'd be farmers trying to just make it through the day, like 200, not 2000 years ago. 200 years ago, no one was worried about helicopter parenting their kid.

Dr. Brennan Spiegel:

I'm guessing, I don't know, I wasn't alive, then, but if you think about what I'm saying here in terms of gut feelings is we don't want our kids to fall, sometimes like literally like oh no, he fell down, oh baby. Oh, you know we do that, it's a natural instinct, I mean listen, I do it with my kids too.

Dr. Brennan Spiegel:

But if you do that so much, you literally learn that you are hardwired into your neurons. I don't want to fall. If I fall, I'm going to get hurt and die, and it's not just physical, it's an emotional fall. Every little thing that goes wrong becomes some kind of catastrophe, and if you're raised that way you know I have it in me too Then you start to misinterpret things around you as catastrophic threats and you feel as if you're falling. And I think that's one reason gut feelings are so common and anxiety is so common, not to mention social media and all the other factors. But my point is like we're changing, as a species, how we think about managing threats, and it's been so rapid, in such a short period of time, because of technological advances in our civilization, that we bear no resemblance to the people we were just 100, 200 years ago. So that's something we need to wrestle with no-transcript you're learning aggression.

Dr. Brennan Spiegel:

They're practicing graviseption exactly I almost feel like arrested.

Dr. Brennan Spiegel:

Graviseption is the underlies some of the mental health issues that we deal with. If you don't allow a developing life, whether it's a human or an animal or whatever, to learn how to balance. And it's not just physical, it's the mental-physical relationship to this planet. And we are so advanced in our mental capabilities that we can transmute those physical phenomena into mental phenomena and then have our own mental gravity map in our mind's eye.

Dr. Brennan Spiegel:

And if that's off a little bit and you're misinterpreting your relationship to this planet, what could be more upsetting to somebody than feeling as if you're literally not born for this planet? Right, you can see how, if you feel like you don't belong on this planet, physically, emotionally, it's too much gravity you can see how things can get really dire. But it also has implications. If you rethink about what that means and how we can reverse that and how we can try to strengthen the body, strengthen the mind flotation therapy, vagus nerve stimulation, tilt table therapy, elevating cognitive, behavioral flotation, meditation I mean we can go on and on. That's to me the whole big picture about how to reverse this graviceptive mismanagement.

Dr. Megan Riehl:

Yeah, so for some of these people that are thinking about you know how these factors impact anxiety, depression, attention deficit disorder, kind of neurodivergence, PTSD. You just listed a whole new realm of therapies that I think are a little bit in their infancy in terms of applying them in larger research terms. But are there any clinical trials underway looking at some of these things for mental health conditions?

Dr. Brennan Spiegel:

Not near enough that I'm aware of. There's a guy named Lachlan Kent who I talk about in the book, and he's in Australia and he's a neuroscientist who coined the term mental gravity and he's written some really fascinating papers about the things I'm talking about. So a lot of what I'm saying is informed by his work. So I really want to be clear about that and you know, he has laid out a framework that I think is ripe for examination and there's very few people thinking like this right now. But I think there's something much bigger, much bigger story, and it's so fundamental. I think what happens is we get caught up at the wrong level. You know it's important to know what peptides do or what this does or what this microbiome does, but when we get down to it, in all of physics there are only four forces, fundamental forces. One of them has to do with stars, so it doesn't even apply to us. One of them has to do with our bodies not exploding instantly. Okay.

Dr. Brennan Spiegel:

So once we don't explode, okay, that's the nuclear forces we're only dealing with two things electromagnetism and gravity, and that's it. So what we're talking about here is so fundamental that everything, everything that we experience and feel in this very moment talking, boils down to those two forces, and we're talking about one of them today. So, if we understand and work our way back up, physics came first, biology second and then psychology emerged, and it's a through line from the physics all the way through to the psychology and then even to sociology and politics and all of human civilization. And I believe serotonin is a master key near the base of that, that is, transmuting the physics and allowing us to transmute physics into biology. And that's what's happening at that base level with serotonin.

Kate Scarlata, MPH, RDN:

So interesting and so zoomed out. You know, I think you know to your point we get into the little microcosms of health and disease and we're not really zoomed out to this level and maybe we need to be more so, you know, really to be able to take care of our patients better and to live better. One of the areas that are really like been hot on this podcast has been IBS and small intestinal bacterial overgrowth, and you alluded to these shifts in gravity impacting the gut microbiome, the impact of gravity on just the way the gut collapses on itself and can increase risk of SIBO or small intestinal bacterial overgrowth. Can you just get into the weeds a little bit with IBS and SIBO and the gut microbiome and gravity?

Dr. Brennan Spiegel:

Yeah, yeah. So the example I talked about earlier with Ehlers-Danlos syndrome is a really clear one to me because it's so physical. Right, you have the suspension system and the cables are stretchy and then you know the garden hose gets kinked and whatever analogy the marionette collapses and then things back up and off you go and you know the first thing is just to come back to that. That is underdiagnosed. So I routinely find flexible joints in my patients and there's been one study that showed almost 50% of people with unexplained abdominal complaints in one study had over hypermobile joints. I'm not saying that's the explanation for everybody, but it's absolutely worth testing in everybody, Everybody who has IBS. Pull your pinky back, put your thumb over and if it's stretchy go talk to a doctor. They can make a diagnosis, they can do the x-rays to see if you have that collapse. So that's a really clear one. But you know we can go back to some of the things we talked about before, just back strength. I mean, sometimes what I say to patients is hey, I think you need to lose weight, I think you need to strengthen your back, and here's why. And then I go through the whole discussion. I show them a picture of the abdomen, the cross section, I say look how close your spine is to your gut. In fact, that suspension system that you have, it ties in right about L4, right about lower back. That's the place where you are hoisting up the sack of potatoes. So when I explain it that way, it all starts to come into play. But then I explain how the gut microbiome requires that your functional stack we have this stack, this again sack of potatoes it needs to be moving, it needs to be fluid, needs to be fluid, needs to move things through so that bacteria don't back up, the gas, doesn't form, get trapped. So this language is very helpful to motivate weight loss, exercise and core strengthening, and I keep coming back to those ideas. And the microbiome is right in the middle of it, generating serotonin and the diet and the tryptophan and all that.

Dr. Brennan Spiegel:

But it gets so interesting when you look at high altitude. And why in the world does the microbiome change? Or serotonin, we don't actually even know. But you know, guess what? Those bugs in our body. They also evolved alongside with us at sea level and so they're not designed to be up in the high mountains or in space either, and they are also living organisms and we don't even really understand how they change in relationship to this fundamental force.

Dr. Brennan Spiegel:

And with this little bit on this, we came out of the seas, this buoyant world where gravity is there, but it's not that important. We think life came out of hydrothermal vents hot, dark, gassy places, kind of like a gut, kind of like the colon and what happened is, as I see it, we co-evolved. As we had to crawl out of the ocean in these amphibious forms, Serotonin biology became very important, which meant we had to bring a microbiome with us. So we gave it a hydrothermal vent. It gave us serotonin. We then were able to stand up and deal with this force of gravity that hit us head on when we came out of the ocean and we symbiotically evolved with it. So, yeah, it makes sense that if we're going to be affected by changes in altitude, then so will the gut microbiome, but it's a big mystery still, like exactly how.

Dr. Megan Riehl:

So interesting, well, so why don't we take this opportunity to have a little bit of a speed round with you?

Dr. Brennan Spiegel:

Okay, let's do it.

Dr. Megan Riehl:

All right, you're ready to go? VR or building gravity resilience. If you had to pick just one to transform healthcare, which has the most potential impact? Virtual reality or gravity science?

Dr. Brennan Spiegel:

Gravity science, for sure, I mean. It gets to what we've been talking about. It's fundamental. I think VR can help us manage gravity, but gravity science, I think, is literally at the bottom of all of this.

Kate Scarlata, MPH, RDN:

Okay, so interesting. So are you a morning bird or a night owl?

Dr. Brennan Spiegel:

Oh yeah, I'm definitely a night owl, for sure, I stay up late, stay up way too late. I wish I can get up earlier. I just I struggle with that sometimes.

Dr. Megan Riehl:

All right, would you rather travel the space or the deep ocean?

Dr. Brennan Spiegel:

Speaking of well, it's kind of like do you want to go up or do you want to go down? They're both incredible and I think we need to learn a lot about the ocean, but I would go into space for sure. Yeah, I would definitely. I'd feel pretty good about going into space.

Kate Scarlata, MPH, RDN:

Okay, yeah, I'm with you on that. He's going up. He's going up.

Dr. Brennan Spiegel:

Let's go up, up and out.

Kate Scarlata, MPH, RDN:

What's the strangest gut fact you've ever shared at a dinner party?

Dr. Brennan Spiegel:

Oh wow. I am known for telling lots of stories at dinner parties, so I'm trying to think about the strangest. It may not be ideal for a podcast, but I have fished a lot of things out of people let's put it that way. So I have shared, very anonymously, some stories about things that have come out of people. Yeah, I think almost every GI has those stories.

Dr. Megan Riehl:

I think so. Yeah For sure. What's worse? Sitting too much social media or poor diet?

Dr. Brennan Spiegel:

Oh God, that's so tough. All of those are really bad. Yeah, I would say, you know, sitting too much using social media, with a high BMI, I don't know. I think probably of those, probably sitting too much in the end has the greatest effect, but they're all interrelated.

Kate Scarlata, MPH, RDN:

Yeah, I agree with you there.

Dr. Brennan Spiegel:

Yeah.

Kate Scarlata, MPH, RDN:

Before we wrap up the last time you joined us, you were wearing a weighted vest. There it is.

Dr. Brennan Spiegel:

Yeah, I don't have it on right now because it's kind of weird. But yeah, I'll be putting it on later.

Kate Scarlata, MPH, RDN:

And standing at your desk, which is amazing. So what are you up to these days for your overall health and well-being?

Dr. Brennan Spiegel:

Yeah, I try to do that really every day, you know, not just for like an Instagram reel, but actually to do it, and I found that very effective. I'm training for the marathon again. I got injured and I realized like my gravity resilience was undermined, so I'm trying to strengthen my body and I run in these barefoot shoes so I'm getting my strength back in my feet and my legs. I'm also trying to be a little bit more thoughtful as I get older about what are the right exercises, so that you know I don't break my body in half and focus more on tensegrity, which is that idea we talked about earlier, where the seams between the organs within the body need to be strengthened. We need to zip ourselves up from the inside out, and so I haven't done enough of that yet. But that's my goal for next year is to start working on my physical resilience maybe more yoga, for example, and Tai Chi and these sorts of things.

Kate Scarlata, MPH, RDN:

Okay, let's work on those seams. People, let's work on those seams.

Dr. Brennan Spiegel:

Seam resilience, yeah, leads to gravity resilience.

Dr. Megan Riehl:

We'll see how your yoga practice is going the next time you come back and join us. Thank you so much for coming on and giving us a really new perspective on something that's certainly universal but invisible, which is gravity. We're all dealing with it and so, friends, if you enjoyed today's episode, don't forget to check out Dr. Spiegel's very new book Pull, and if you missed his first interview with us, go back to episode 13 for a deep dive into the vagus nerve and virtual reality. It was a really fun talk and until next time, thank you for tuning in. Take good care of yourself, others and especially your gut.

Dr. Brennan Spiegel:

Thanks for having me.

Kate Scarlata, MPH, RDN:

Thank you for being here. October 7th, Pull be on the lookout.

Dr. Megan Riehl:

Thank you for joining us as we grow this gut health community. We hope you enjoyed this episode and don't forget to subscribe, rate and leave us a comment. You can also follow us on social media at The Gut Health Podcast, where we'd love for you to share your thoughts, questions and experiences. Thanks for tuning in, friends.

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Kate Scarlata

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Megan Riehl

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