Gut Health and Fertility: Integrative Healing with Dr. Vivian Asamoah
Have you ever asked your fertility physician if you should eliminate gluten and/or dairy? Have you wondered if your diet and gut health are optimal enough for a successful outcome? Have you done all of the elimination diets and then beat yourself up after having a pastry or something similar?
You are not alone. The majority of people in your situation have these recurrent thoughts, and the question is--how do we sort what is evidence-based and what is not? How do we live our lives with some enjoyment of food instead of strict rules and shame?
In this mind-blowing episode, Dr. Vivian walks us through the following:
the 3 components of gut health
the most common ways gut issues and fertility issues show up together
evidence-based, foundational nutrition strategies for optimal health
integrative tools for improving outcomes, including intuitive eating
the gut brain axis and working through trauma
elimination diets and what everyone should avoid
You will not regret listening. May we each take with us something which will improve our health and our outcomes.
Guest Details
Dr. Vivian Asamoah is Board-certified in Gastroenterology, Hepatology, and Nutrition. She completed her fellowship at the Johns Hopkins University Hospital in Baltimore, Maryland. Post fellowship, she earned her certification in Functional Medicine through The Institute for Functional Medicine (IFM.) She is CEO of Houston Castro Institute, a private practice serving the West Houston community in Houston-Texas, for over a decade.
She is an international speaker, educator, and patient advocate. She has run continuing medical education for healthcare professionals in conventional
gastroenterology, as well as the non-allopathic fields of naturopathic medicine, chiropractic care, and dietetics.
Facebook: @vivianabenaasamoah
Instagram: @drvivianasamoah
As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.
If you found this conversation valuable, book a consult call with me using this link:
https://calendly.com/loveandsciencefertility/discovery-call
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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.
In Gratitude,
Dr. Erica Bove
Transcript:
Hello, my loves, and welcome back to the Love and Science podcast.
I am thrilled to have an amazing guest today, Dr. Vivian Asamoah. She is a board certified gastroenterologist, which is the full name of that as we know, because we're mostly physicians here, is gastroenterology, hepatology, and nutrition. She completed her fellowship at John Hopkins University in Baltimore, Maryland, and then post fellowship, she earned her certification in functional medicine through the Institute for Functional Medicine. She is the CEO of Houston Gastro Institute, which is a private practice serving the West Houston community in Houston, Texas for over a decade. And I'm so excited. She's the first GI doctor that we've had on the Love and Science podcast, and she's also a friend. And so I cannot wait for the conversation we're about to have, Dr. Vivian. Thank you so much for being here.
Thank you so much for having me, and I'm excited to get to know your audience.
>> Yeah, absolutely. So I formed Love and Science, sort of my coaching practice, because what I was seeing in my day-to-day is that fertility treatments were not working, and they seem to be not working at a disproportionate level for physicians as compared to non-physicians.
And so when I was starting to get into coaching school for my own personal reasons, relationship, coaching, etc., at one point I made the connection. I think what my patients are not getting is the integrated tools of the coaching and the mindset and the sort of the ability to put the science in the context. And so that's kind of the framework for most of the people who listen to my podcast is the community is people who are evidence-based. That's one of my three pillars, who are interested in mindset work and growth work, as I know you are too from all the communities we share, who really want things to work, but are doing "all the right things," but the treatments haven't worked as of yet, if that makes sense. >> I completely understand, yes.
>> Yes. So when we decided to talk today, sort of many moons ago when I invited you to be a guest, we started to talk about what you see in your functional medicine integrative GI practice.
And the people who come to you are very similar to the people who listen to this podcast, right?
There are people for whom things are not working, there's something that hasn't been figured out, and they come to you to put the pieces together. So I would love to just understand a little bit more about the type of people you see in your practice and how you approach their care as a GI doctor.
>> Yeah, no, that's a great question. And I think it's really, the way I practice kind of evolved over the last maybe five to seven years, because I think society evolved, like so many things evolved, right? Post-COVID, we saw a huge shift in the way people were eating, in the way people were drinking, in the way people were interacting and looking at the impact of the virus itself.
But even before that, I noticed that as a gastroenterologist, I didn't get a significant, at least I felt like I didn't get enough training in nutrition to be able to really implement it in my practice of gastroenterology. We were trained to think like in turnest, there was a lot of procedure-based testing to go with that, and then you churn out a results like a diagnosis and a treatment approach. But over the years, as I evolved, as I grew as an attending and then a CEO, I realized that there was an aspect. And for me, it was almost the soul of the practice is really where I think you become a holistic and integrative provider or physician, let's use the word physician, where you now see your patient as a whole person, not just a diagnosis of IBS or Crohn's disease, but as a person that has spiritual needs, that has spiritual in terms of what nourishes the soul and what nourishes the body, nutrient wise, needs connection in a different way, needs a different type of coaching to go through whatever they're going through in terms of, you know, we see a lot of people with chronic gastroenterological issues like Crohn's disease that you live with for many, many years. So how do we support their anxiety? How do we get them beyond depression? And what's driving that? A lot of the times it's the disease itself. It's that chronic illness or that, and maybe with some of the people in your community, it could be the infertility or the struggles, you know, and sort of the societal pressures and all of that with that.
So I felt that to be able to serve them, I needed to develop that sort of holistic side of myself and holistic side of my practice. And that's what led me into integrative medicine, functional medicine, bringing nutrition into the practice, now bringing gut psychology into the practice, and really being able to develop a comprehensive gut health approach for that wholesome person, right? Because that's what we're dealing with. And so that's, you know, I started seeing patients who, who, you know, said, you know, I understand you're giving me something for constipation, but I feel like I'm just putting a band-aid over the issue. Why am I constipated? Right? Or why did I get autoimmune? Why did I get autoimmune disease? Is there anything that I can do? And patients were looking for to feel empowered and also feel like they could really get some, a deeper understanding of why they were dealing with whatever situation they were dealing with, whatever chronic illness, and also looking for ways to be able to not just survive, but thrive beyond. Like how do I overcome this? How do I get on the other side? What, what tools do I need to be that person who can go through this, but still come out victorious? Right? So that's kind of, it is a very spiritual journey for me, I think with my patients. That's fascinating. You know what I think the irony of being a board certified gastroenterologist and still saying, geez, there's a lot that I don't know about nutrition.
There's a lot of that. And this is what I found in my practice. I'm board certified. I'm not helping people. There's a disconnect. And how can we bridge that gap? Right? And so what I'm hearing you say is you take a holistic approach to each patient in front of you, which involves the whole person, their spiritual needs, their physical needs, their mental, emotional relationships, all the things, and you try to get at the root cause. Right? And then from that space of understanding what is actually happening for this person, then you can bring in the tools to support that particular person. Absolutely, doc. And I would say we try to get to the root cause. If that partnership and that collaboration is really important, it's a very important part of integrative or sort of this more holistic approach where you are not just the, you know, the physician that kind of paternalistic, I'm telling you what to do and here's the prescription and go do it, but you are open to your patient asking questions, asking deeper questions, wanting to explore different options, whether it's Eastern medicine or anything, and you are sort of their guiding light to provide them with some evidence based resources, information so that they're not going into this kind of like arena of people just trying to make money and, you know, selling different things, but at least empowering them rather than saying, Oh, that's nothing. Oh, we don't believe in that. Oh, that's nothing. I think you have to keep that open mind to learn. And that's where that trust in that partnership builds and you have a stronger relationship with that patient. And generally, we know that those great relationships between physicians or providers in general and their patients leads to better outcomes. And we've seen it in many scenarios, right?
So fascinating. And I just, I love your journey and I love, you can just tell how much you're able to help people with this approach. I'm curious. So of the people that you see, well, let's, I'm curious about the people you see with infertility, but I actually, let's, let's back up for a second and talk about gut health. And, you know, when I, as a, as a gynecologist, as an infertility specialist, I think about gut health. I think to myself that, okay, and this is a very crude and, and, and sort of rudimentary, I think, okay, well, you know, that the system is flowing, right? There's, it's not too slow. It's not too fast. There's not any active areas of bleeding. Everything's in balance, you know, and that sort of my just stall about like gut health. But what you're talking about also is like the gut brain access and the gut brain connection too, and how central that is to this piece as well. So would you like with your more nuanced approach and definitions, what would you say like gut health means to you and the people who you're able to help? Like when you've had a successful patient case, you know, what, what does that look like?
Wow. That, that is such an amazing question. You know, I've been on so many podcasts and no one has asked me that question in that way. And the reason is because I think everyone assumes they know what gut health is. They all assume they have some kind of idea of what it is. Right. I think that term gut health is really evolving. Right. As we, as we learn a little bit more, but if I look back at the patients that I've worked with over the years who've come in with this question, I think what you're saying about things are flowing is right. That's number one. Motility is on point, right?
From mouth all the way to anus, things are flowing. And we know that getting the, the, you know, pooping defecation, which is our, our, our professional term, the right way to say it is extremely important to eliminate waste toxins, metabolites of, of medications from your system.
So very important. Number one, very true. The second M I would say is that microbiome that we've been learning so much about over the last 20 years. Right. And realizing how symbiotic our relationship as humans are with this trillions of bacteria, virus, fungi, parasites, even that live in our gut and, and how much they, they're, they're like a little, you know, factory inside our gut, you know, making nutrients, helping us digest, you know, really providing us with the right neurotransmitters. Unbelievable how important those little bacteria are in our daily mechanisms and everything we do at a, at a very, very cellular level. And then the third thing I think that is really important when it comes to gut health that we talk, we're hearing a lot more about in the last, I would say in the last five to 10 years is that the gut organ access, right? Not just what's going on in that microbiome, but how does it affect each human being in a very systematic way. So we, we systemic way. So we hear about the gut brain access and that bi-directional pathways, right? Between that, with that vagus nerves in terms of neurotransmitters being released in the gut and affecting the brain and also whatever is happening in the brain in terms of anxiety, having an impact in the gut as well.
But now when you explore gut health, we know there are connections with the gut hormone balance, right? The HBO access, which we'll talk about gut lung, gut liver, gut bone, gut everything.
So gut health is real. I think the reason why it's so it's, it's got such a big name in, in medicine, in research, and even in social media is because we realize how impactful it is to human health. And so for me, those are the three areas of gut health that I look at and I evaluate when I'm trying to assess a patient's gut health. Yeah. Okay. So you said motility and microbiome and the gut organ access. And I'm sure there's a uterine access. We just have, Oh, there's a, there's a, there's a gut, there's a gut uterine ovarian access. There is a gut hypothalamic pituitary and ovarian access. I mean, yes, there is, it's all there. Yeah.
It's so fascinating. Okay. So that makes a lot of sense. So then what tools are in your toolkit to help, you know, maybe specifically related to people you see who also have infertility?
Who also have, that's a great question. So, you know, when we were talking about this podcast, I said, you know, do you ever have patients coming to you that say, you know, is there anything I can do to improve my gut health that could possibly improve my, my chances at, at, at having, at fertility, at having, at being able to have a child? And, and that's what I hear in practice, you know, so I think because, oh, I believe because people know that I'm, I'm practicing a different way. I do get patients referred to me even from fertility experts saying, you know, let's not, not only should you, you know, maybe your patient has hepatitis B or C and we want you to evaluate that, but this patient is also interested in assessing their gut health. And, and so I usually start with a sort of a foundational consultation where I'm explaining, just like you asked what gut health is, where we are in the science right now and what, you know, what is evidence-based and what's not evidence-based. But I start with the foundations of nutrition and lifestyle. Those are the basic foundations, right? And trying to assess, well, these are the things that feed your gut health or your microbiome. And so where are we with respect to that? And we know there's definitely, I mean, at this time there's, there's certainly data that has shown that dysbiosis and fertility issues are associated. Now, whether it's cause causation or just a consequence that we don't know, but there's definitely data showing that. So I do get patients who may have chronic gastrointestinal issues like Crohn's disease, where they have, they have perianal fistulas or enteroenteric fistulas. Those are connections because of inflammation in the bowel or patients who have celiac disease, an autoimmune condition that we know can affect fertility in some patients, or even patients who may have, I was thinking of one more, a fatty liver with what we now call metabolic associated st ato liver disease, who have insulin resistance issues and suffer from PCOS and have fertility.
So those are, I would say are the categories of, of, of presentations that overlap between what we do and where the question of gut health does come up. Yeah.
That's fascinating. As you know, I totally forgotten about Crohn's, but as you say this, like some of my toughest patient cases have been people with IBD and you think, oh, it's just because you've had multiple abdominal surgeries and it's going to be a tubal factor situation.
I'll tell you, most of these folks have severely low egg reserve, way lower than you'd expect for their age. And we really don't understand why. And, and truly, I mean, some people I've been able to help, but some people, you know, I have not, you know, or they've gone on to use donor eggs or other treatments. But I will say now that you mentioned it, I hadn't even thought of that in preparation for this, this podcast, but that has been some of the hardest cases I've had have been IBD, which you just wonder about what's going on there. Is it, you know, inflammatory environment? Is there, you know, sort of the anti ovarian antibodies that are floating around and we just can't measure it both, you know, so then I guess for each of those types of patients would, well, I guess, first of all, would you be willing to walk us through what your foundational, you know, sort of counseling is about what you think is relevant based on your reading of the literature and everything about nutrition and lifestyle. And then maybe for each of those types of patients, what sorts of things you might talk about? Absolutely. So when we get on the conversation of fertility, and you are the expert, I have what I generally know, and I start off with, you know, it's complex, right? It can be influenced by genetics, by the environment, by lifestyle. And when we say environments, that's where nutrition comes in, right? That's, that's where nutrition plays a role. And, and I think that it's important for them to sort of understand what they're doing, and I think that it's important for them to sort of understand a little bit about the science behind it before diving into, well, what can I do? So I talk about the complex relationship between diet, the gut microbiota, and female fertility, really with that focus on that hypothalamic pituitary ovarian axis, and the microbiota and the gut brain connection in the body. And so we clearly know that when there's chronic inflammation throughout the body, we know, we know that if there's dysbiosis in the situation of Crohn's disease, which I think is really interesting that you mentioned this, because I think it would be interesting, it would be, it would be exciting to do a study and look at the microbiome of our patients with Crohn's disease and how that correlates with the AMH, right? The antimalarian, is that, is that right? Yeah, I mean, I don't see if there's any correlation, but when there is dysbiosis, which is an imbalance in that gut microbiota, and I say it's like, well, you have good soldiers and bad soldiers, and they should, you should normally have more good soldiers than, than sort of the bad guys, right? But if there's an imbalance in that ecosystem, we can see chronic inflammation throughout the body and metabolic issues, right? And this inflammation can impact the reproductive system. And that's, that's, that's where I think we're making the strongest correlation with like conditions like endometriosis and pelvic inflammatory disease, right? And what causes this dysbiosis? Well, it could be many things, many environmental things, infection and whatnot, but the most common thing is really going to be a diet high in processed foods, what we call the Western diet or the standard American diet, also known as the SAD diet. Okay. Oh, and I heard that. Yes. The SAD diet. And we know that that those ultra processed foods with preservatives and emulsifiers and excess sugar and all of those things can affect the gut permeability. The term that patients will often refer to as cause leaky gut, which is a true term. We call it intestinal hyperpermeability, but it really means the same thing. And when you have leaky gut in that setting of dysbiosis, you've got a lot of pro-inflammatory compounds in the gut, like LPS, right? Lipopolysaccharides, which, which we know is also directly implicated with endometriosis and can compromise fertility.
So there are connections there just simply with inflammation. And another thing I explain to patients is that when there's dysbiosis, we know how important the microbiome is in regulating hormones, particularly estrogen. And so there are certain types of bacterial strains that produce an enzyme called beta glucuronidase. And this beta glucuronidase actually decongigates estrogen in the GI tract. So it allows it to be reabsorbed and may even lead to higher estrogen levels.
And studies have shown that that particular, those groups of bacterial, say strains of bacteria, are usually associated when people are eating a low fiber diet, high fat, and a lot of processed foods. And that is where we see the hormonal disruptions with dysbiosis. So chronic inflammation from dysbiosis from diet, right? Inflammation can affect other things. And then the hormonal imbalance from dysbiosis as well. And then finally, the gut brain access issues that we talk about.
So those, I think those are the three main mechanisms that the gut microbiota or gut health can impact fertility. I think there's a lot more, there's a lot more research coming out, a lot more studies coming out about whether we can actually really connect the dots and say, well, well, if you have this type of microbiota array, this is the issue. This is the kind of, this, we'll see this kind of fertility issue. We're not there yet, but we know there are definitely connections. And whether it's causation or just a consequence, unsure. So I focus a lot of inflammation and I focus a lot on the diet and I show them how it can impact hormonal balance, right? And, you know, one thing that I think a lot of my patients and clients come to me saying is, you know, I am doing all the right things. I'm really worried that, you know, there's something else going on. Should I cut out gluten? Should I cut out dairy? I've, I've read so much about these anti-inflammatory diets online and I started to delve into it and I'm literally becoming a crazy person because I had like a pastry on one Saturday morning in a whole month and I started to think I had like thrown it all because, you know, again, most of my clients are female physicians, type A perfectionist or like I like to say recovering perfectionists, but still. And so I feel like there's this hypersensitivity. How do you help people adjust their diet and still live in the world and not, you know, how do you sort of help people? Yes. I think that when we can sort of crave the things that are good for us, I think that's probably like the sweet spot of when we live the healthiest. It's not about the willpower. It's about sort of, you know, today I had a salad and I was like, I really want that salad. It's not like, oh, I'm going to be good and have a salad. It was like, I really wanted a salad. Like, yes, you know, sort of retuning our preferences to the things that are good for us, I think is important, but how do you help people live in the world when, you know, there's all these messages, like if you fall off the wagon, it's going to be all over. Like that's, that's, that's the thing I struggle with the most in my patient population is helping them live in the world and trust that their bodies are going to do what they're supposed to do when they do mostly make mostly the right choices. That's such a great question and a very, very important one.
And I think that one that we really have to advocate for with our patients is allowing themselves some grace. That's number one. Allowing themselves some grace. And I do that because I tell patients myself, I'm like, I just had this candy bar. I tell patients, I'm very honest. I'm like, I've been trying to quit, but it's really hard. So today's kind of like, and, and, and, and saying it without judgments, you know, without making them scared that they're going to have symptoms, you know, in our integrative program, one of our goals is to help our patients have a healthy relationship with food and enjoy eating a diverse array of food because that diversity is really what enriches that gut microbiome. And so we know there are many studies doc that show that being on a low FODMAP diet, which is a very restrictive diet where you can't have gluten and you can't have, you know, you know, high, high, high FODMAP foods like rich in legumes and things like that. We know clearly that that diet long term is deleterious on the gut.
It does not help the gut system. It actually depletes you of those good soldiers. And when the recommendation came out to do that kind of restrictive diet, the recommendation was just for four to six weeks, but people have just kept going on. And I always explained that the therapeutic food plans are therapeutic. You're supposed to use them for a certain amount of time, but the goal is to then embrace and introduce, reintroduce all foods. Right. So we start with the foundations of what is a healthy diet. And when you look at the research, whether it's for insulin resistance, whether it's for groans disease, inflammatory bowel disease, or it's a Mediterranean diet, which is a wholesome diet, lots of fresh fruits, lots of fresh vegetables, nuts and seeds and lots of grains. It's that diverse diet that that's the ideal.
That's the one where we have a lot of research to support its impact on hormonal health and support its impact on insulin balance and insulin metabolism. So that's sort of my perfect, right?
That's what I say. That's what we strive for. And look at all the elements of the Mediterranean diet. It's diverse. You get to eat a bit of everything. Some foods are cooked. Some foods are raw. Like you really are embracing everything that's wholesome that comes right out of the earth. So I said that should be our goal. Now, in some people, they do have, I would say, an intolerance or reaction to certain types of food, or some people could notice that well, gluten triggers inflammation in my body. And it is true. We've gone away from you have celiac disease or you don't. And we now know that there's a spectrum, right, of people who may have non-celiac gluten sensitivity all the way to people who have celiac disease confirmed on biopsy, blood work, as well as on pathology. And those people must be gluten zero. But we have some patients who are extremely sensitive to gluten. It's an antibody, just like you can be sensitive to so many different things, who have to really reduce consumption of gluten and go gluten less, right. And they do better. They thrive that way, right. And so my job is really to educate our patients in terms of what's a healthy diet? What works for your sister's friend may not work for you. So let's focus on you. What can you tolerate? Don't you tolerate? I won't have you go gluten free if it does nothing for you, if there's no impact, right. But I will test for gluten. I will do some specific one by one elimination diets just to see if, of course, this is not just because you're struggling with one aspect, right, fertility. No, I usually will base it on symptoms that you're exhibiting, right. And this may come along with other issues. So constipation, diarrhea, I'm always bloated, you know, my gynecologist has done a thorough workup. They're not finding any ovarian issues, right. You know, I feel full all the time. So it really is based on symptoms that you may have.
And instead of just giving you a prescription to just mask the symptom. Yes, we like to go back to nutrition and say, Okay, is there something you're consuming? I mean, it could even be as simple as an emulsifier, an additive, something like that, that we're trying to tease out. And so we try and educate our patients and do one elimination at a time when if they have symptoms, and the most common ones that we notice is gluten and dairy. Those are the common two, right? Those are the common two. And in some situations, the microbiome is just off, there's dysbiosis, where we don't tolerate certain foods, we're not able to break down starches the same way, we're not able to break down those legumes the same way. But if you're able to repopulate that microbiome, and we'll talk about that, you can then start reintroducing these foods that you thought you were allergic or intolerant to, and do just fine. So that's always our goal, bringing food back, because you know, you want to enjoy life and enjoying life, you want to go out with your friends and go out with your family and be able to eat without being so restrictive all the time.
Yes, that's so amazing. So what I'm hearing you say is that diversity is important that our gut likes variety, that when we consciously say not this, not that, not the other, especially over long periods of time, that that actually is worse for our gut health overall, which now we know affects all the other kinds of health in our body and all the other organ systems in our brain chemistry and all those things. So we want in my Sicilian roots, I'm part Sicilian and my Sicilian is strong, they're very, very resonating with my soul that you're saying this Mediterranean diet is, is helpful because I love those sorts of things. But again, you know, really that, and that's what I say with my patients and clients is, okay, well, if you think dairy may not be good for you in particular, try it without and see how you feel, you know, right, get a food diary and see if you feel fantastic without dairy, then guess what? Probably that's not your go to food, right? But we're not taught how to have that like feedback, right? We're not taught how to have that sort of conversation with ourselves, that trial and error, same thing with gluten, you know, we can run the testing, but hey, how do you feel when you have gluten? If you, you know, if you take it away, do you feel better? Do you feel the same? Do you feel worse? You know, all of that is important data, even if we can't print it out on a sheet of paper to get that confirmation. So I think we need to be having these conversations and teaching our patients how to listen to their bodies, because I think our bodies have so much wisdom that is untapped, untapped information for sure. Absolutely.
That is I'm so glad you said that, because that is usually the first step. When we go through our process of an elimination diet, and we usually will, depends on the patient, it's very, very personalized per patient, right? We'll usually eliminate a few things and patients will say, well, how will I know if that's what's affecting me? And we say, listen to your body. Just listen to your body. It will tell you it will guide you. And because they're going through the process, they become a little bit more intuitive about, oh yeah, I think I did remember eating this yesterday. Because some of those reactions happen days later, they're delayed, right? Oh yeah, and I'm now making the connection. So it's been eye opening for a lot of patients. But to go back to what you said, just so I can put that little plug in. You asked me if I wanted to put a plug in for anything. I would say there are two food groups that we definitely encourage our patients to avoid.
The first one is sugar, refined sugar. And I always say, I don't mind you having three servings of beans or you want to eat a double portion of, I would rather you have that with some protein than sugar. And if you are consuming sugar, because sugar is pro-inflammatory, that is a fact.
And if you are a refined processed sugar, and if you are consuming sugar, what alternatives, sugar alternatives are going to be easier in terms of glycemic control and reducing inflammation in your body. And I say there are many options out there right now. Look at options like monk fruit, look at stevia. Those are all options. Look at organic raw honey that's local, that's grown in your neighborhood because that has a lot of protective effects for you. So that's the first thing I try and switch in their pantries is that sugar. The second thing, especially for women over the age of, I used to see over the age of 40, but now I go back over the age of 30 is alcohol.
Because sugar is alcohol. And now the data is just vast about the impact of alcohol, not just on the liver, but the increased risk of at least nine different types of cancers.
Right. And in women, you know, consumption and the way our body metabolizes alcohol is very different to our male counterparts. So we are definitely more affected. So sugar and of course, alcohol turns into sugar anyway, right? But those are the two things that I think are toxic foods.
Now, a little glass of wine, one sinner blue moon here and they're totally fine.
But it's important to have these conversations with our patients because we've gone to a place where two glasses or three glasses at dinner every evening is considered normal. And it's not.
It's not. And I think we also, speaking of root causes, I think, that sort of creep of like one glass a night, two glasses a night, just part of the routine, the habit habit. So powerful, you know, it comes on, but we can take it off too. And, you know, a lot of trust me, I'm sure you do too. In your practice, I take this history on so many of my couples, right? I have single people too, but, you know, I'm often taking history from two people and I'm just amazed at how much marijuana alcohol and I think about it. I'm like, why? You know, I understand celebrations, et cetera, but I think we have this untreated anxiety in all state of men. Listen, if you smoke so much pot, no judgment, but your sperm are stoned, they're going to swim in circles or it's not, they're not going to get to the right place.
They're going to be confused. We see the stones from under the microscope. I'm like, you gotta stop.
But then, you know, I love these men. They're like, but then I can't sleep. It helps me sleep.
You know, it's it is like, okay, well then why aren't you sleeping? And again, it's like the why the elevator to the basement trying to understand. So why, why do we need two glasses of wine a night? We know that. And I just gave a talk on the stress and infertility. We know that people who have infertility have comparable anxiety and depression rates to people with cancer because it is so threatening. And so I know. And so, and the sort of, and with every treatment cycle that doesn't work, this climbs, it goes up and up and up. And so we have to find a way to treat the anxiety, you know, coaching or therapy or combination. You know, we have to say, okay, if alcohol is part of my lifestyle, you know, what, why, and you know, what, what can I do about that?
And if I take it away, what feelings come up and who can help me process those feelings?
Because it's like cleaning a messy room. It's only going to get worse before it gets better.
Such is very 100% agree with you. These are really important questions to have us to the why.
Why do you reach for that glass of wine? What's going on? And so a big part of, you know, my practice, maybe, and maybe I'm finding a lot more connections because at first I was like, what are we going to talk about? And now I'm like, okay. So a big part of my practice in terms of gut healing is, is, is, is gut psychotherapy. Oh, tell me more. Please tell me more.
Therapy. So, so we talk about the gut brain access, right? And we know definitely there's that connection. Majora, I think 90% of serotonin is made in the gut, melatonin in the gut and all those neurotransmitters like epinephrine and norepinephrine, dopamine, all derived from an amino acid made in the gut. So if there's gut dysbiosis, this can affect what's going on.
Interesting. Right. And if there's anxiety and you know, those neurotransmitters are released and the if E. Farrington Vegas, the Vegas nerve is stimulated, there's that bidirectional pathway where now this Vegas nerve that controls the motility of the entire GI system now is firing away and either causing constipation or diarrhea causing motility issues. Right. So there's that connection. And so very often we can understand the pathophysiology of what's going on in Crohn's disease and celiac or whatnot. We can work on nutrition, you know, and our patients can be like very disciplined and, you know, avoiding alcohol, avoiding this, eating wholesome foods.
But sometimes I run into a brick wall when the underlying trauma, anxiety, depression has not been addressed. And of course, I'm not equipped. I'm not a therapist. I'm a gastroenterologist, but I recognize the signs and we actually have a few questionnaires we have our patients do.
And when there is, you know, unresolved trauma, unresolved anxiety, unresolved issues, that's that this require a lot more coaching and therapy, we don't see their gut symptoms improve.
It's like the last step. Right. And so over the years, I realize that, OK, I'm handling the nutrition part. We're doing good with life, but there's something. Why? Why is this guy not doing better? And as the data came out about the gut brain axis and that bidirectional pathway, I said, you know, we have to go beyond just giving our patients a low dose and tricyclic, because that's what we do. We'll give you. We'll have a low dose amitriptyline that's going to help with the pain receptors. Right. But why don't we fix the step before the pain receptors? Why are these pain receptors firing? And so I've been working with a group called GI Psychology, and they are basically therapists who help patients with gut related symptoms. Right. Wow. And they they focus on the therapy. So they do a lot of talk therapy. There's group therapy. There's cognitive behavioral therapy. There's gut hypnosis. A lot of mindful breath work. Right. Which also involves like how you're eating. So mindful eating and mindful breath work and just providing our patients with tools to learn how to cope during these situations, even before reaching out and getting that food.
Well, why am I getting that glass of wine? Why am I getting that extra chocolate bar? Why am I and sort of dialing bath and doing some breath work and talking to themselves through it and empowering themselves? And that has been a game changer. Wow. Wow. That has been a game changer.
I am doing something similar in my coaching practice. You know, what when people ask me what I really do, you know, my RAI colleagues, my fertility specialist, I say, I calm the nervous system. That's what I do. Obviously, we talk about the data. We talk about the science. We talk about the evidence based decisions, although we can't even begin to assimilate that until the nervous nervous system is calm. Right. And so, gosh, this is so fascinating. And I do feel like there's so many people who I see, you know, who do have trauma. I believe trauma is stored in the pelvis and maybe the GI tract. I'm not sure. But both both. Yeah, I think both of us can claim it. Yes.
Yeah. Yeah. Yeah. And it's just like the I say to my patients with chronic pelvic pain until we address the trauma. I don't we can't do anything. Any suppression, any hormones that I give you, it's not going to make a difference because the trauma is it's living there. And we need to we need to get it out of your system. We need to process it so that then you can move on. So it's you know, I think what's coming up for me in this conversation is that we're so complex. You know, it's not just like the GI tract or the GYN tract or the gut, you know, the brain and all these different. But we are one system. And I think the more that we can take this integrative approach and really seek individual answers like what is it? You know, who are you today? How is that informed by your past? Where are you hoping to go? How would you want to feel? And how can we start to connect those dots with all the different tools that we have? You know, that seems to be the best way.
But I don't think most people are doing this. I think that's why modern medical care is failing most people is because I think that this is a very new understanding. And maybe it's very old, you know, there's Eastern medicine that kind of brings a lot of this together. But I think in our in our current day, there's not a lot of people who are thinking in this way. And I think that's why we're seeing so many people who are just not getting better. Their fertility treatments aren't working. Maybe they have persistent GI issues. And we have to we have to transcend that.
Absolutely. I you know, that's you've said it very beautifully and eloquently. And I actually think we have to go back to the roots of medicine. I actually I don't think this is modern medicine. I think this is how medicine was practiced. I really think so. And so we are now and then everything got siloed into these different specialties and now subspecialties. And now one person who does x-rays only does x-rays and doesn't do MRIs. And, you know, everything is becoming such a subspecialty. But we need to one learn to work together as a community to help our patients heal.
Right. And we also need to empower our patients with the knowledge that the healing begins within.
And to stop expecting us to give me a prescription, give me a supplement, give me this. What test can I do that's going to you know, no, no, no. The healing really begins within. And we are we are just vessels. We are we are advocates going along this journey with them and just being very open.
So, yeah, I agree with you. And I hope medicine is going to shift in that direction. And, you know, some people get nervous about A.I. But I have a feeling that A.I. may, you know, may take us back to that how it used to be and when it worked and when we really talked to our patients and saw them heal by just holding their hand or giving them a hug and really just going back to that and may and maybe that's where we as physicians really now have or I would say any practitioner, right?
Anyone who's in the healthcare space that cares for patients now really holds their value in that relationship really kind of connects with the patient that way. Yeah. Oh, this is so beautiful and so powerful. So, so where do you obviously you have your Houston office. Where can you see patients? Do you do any telehealth? Like I'm just thinking of all the people who are listening to this. Yes. I want to see Dr. Vivian. Yeah. Yeah. So our practice is, you know, I have a sort of a traditional bread and butter G.I. practice with a physical location in Houston, West Houston, Texas, actually Katie, where we see our patients referred by primary care, someone coming in for screening colonoscopy, easy peasy, you know, we take care of you and and then about the other half of my practice is my integrative functional G.I. practice and that is a virtual practice. I have two amazing actually three now amazing dieticians all who want two dieticians, one nutritionist, all experts and passionate about about gut health. And again, I said, I didn't get that depth of knowledge and nutrition. And so bringing them on board has been fantastic for our patients because they are just a wealth of knowledge. Right. And so that practice is online. It is virtual. We align since in 12 states. We also accept coaching. If you're not in a state that we're aligned since the widths, as long as we can coordinate care with a physician, your physician in your state, so we would introduce ourselves and ask to coordinate care. But yeah, we have that we have group group programs and we have individual one on one programs. And my favorite are the group programs.
I have grown so much as a physician learning from my patients in group programs because they they support each other. They cry together. They laugh together. They heal together. And most of the time I'm just a bystander kind of watching that dynamic happen. And there's so much strength in community.
And that's what I love about the group program. So so yeah, I'm virtual. Yeah. All right. Let's do it.
And you probably know I have my support groups as well because that's where we see so much transformation at Love and Science. So we have these parallel and I think it's parallel, but I also think it's like a braid because I know that people listen to this or like, oh, I have bloating and I've wondered about silent endometriosis, but they've treated that and I'm still not getting better on those things. And so come find Dr. Vivian, right? This is my message. Come find her. She knows what's up. She knows what's up. If you believe in what I do, we are on the same wavelength. So where can people find you? So I am on all the social media feeds on, you'll find me on Instagram, Dr. Vivian Asamoah. It is Dr. And then Vivian Asamoah. I think it's the same thing on TikTok, on Facebook, also Dr. Vivian Asamoah. And I have a private Facebook group, but everyone's welcome, called Natural Gut Relief that I started about three years ago, because I just wanted a platform where I could share information about something new that I learned that was integrative. So we talk a lot about nutrition, recipes, acupuncture, pelvic floor therapy, anything that yoga, we talk about anything that's going to help heal the gut naturally. And it's a platform where everyone's welcome to share advice, share information, or ask questions about, you know, is this evidence based and can I really trust this? So you're welcome to join us on Natural Gut Relief. It's a private Facebook group. All right. So we'll put all this in the show notes as well. Thank you so much for being a guest. I have learned so much. I know our listeners are going to learn so much.
And I hope many of them come and find you because like I said, you know, what's up, you are doing the healing and we are all about healing at Love and Science. That's the space where things start to work. And so anything else you'd like to add before we say goodbye for today?
I wanted to thank you and your viewers for this wonderful opportunity to share my practice and what I do in my philosophy and my passion. And it's always wonderful to be on a platform where your host is just as wonderful as Dr. Erica. And we align in so many ways. So it felt really comfortable and just very safe to be here today. Absolutely. Well, thank you again so much. And I really look forward to all the collaborations to come. All right. And to my listeners, you know, I love you.
