EP 07 T3: Exploring the Gut-Brain Connection with Dr. Claudio Morera | A Cada Paso | Gaby Alcala

Gaby:
Hi, everybody. Hello, everybody. Hello, everybody. Thank you for coming. I'm supposed to stay as close as possible to the microphone, so it's gonna take some getting used to it. Well, I want to thank everybody for coming tonight. I know it's summer. It's a beautiful night.

Gaby:
You are indoors. I know how much. How difficult that is, but I'm very grateful. I'm very grateful to the podcast garage for. For giving us this space. This is great, and for all the support that you have given us. And I want to thank Maureen, because Maureen, when I was talking to her about doing a podcast live, she says, you need to put a date. It cannot be an idea.

Gaby:
So what is the date? And she sent me a text again saying, what's the date? That was in October 2023. It took us six months, and not for lack of effort. So thank you. So for those many of you already know, Acada Paso podcast. But I just want to go quickly. I want to explain why I do this podcast. And the reason I started doing this podcast is because I feel there are so many people around us impacting all of us and their communities, but they do it in a silent way and nobody knows about them. It's like everybody pays attention to whoever is famous, but not to the people around us that are really impacting.

Gaby:
And many people ask me when I posted this, they say, how do you find these amazing people? And I said, these people are around us, and so we just don't want to. We need to pay attention to see those people that are really impacting us. So I want to thank you for joining. Claudio. Claudio. I was at a birthday party, Lana's birthday party, and I said at some point something that probably shouldn't have said, and he very nicely responded in the nightmare. And we're going to get to that. And that's how we got the idea of doing this.

Gaby:
So, Claudio, can you introduce yourself?

Claudio Morera:
Well, of course. Well, thank you first for inviting me. It's great to have this opportunity to chat a little bit. My name is Claudio Morera. I am a pediatric gastroenterologist. So I will probably be able to see all you guys in my clinic. You know, the age that I usually see is 22 years and younger. But many of the things that we're going to be talking today applies also to adult patients.

Claudio Morera:
And I work at children's hospital and Boston Medical Center. I been here almost 20 years, and here I am. I'm a great cookie.

Gaby:
Want to see him more for that? So why do you choose gastroenterologist or gastroenterology yes.

Claudio Morera:
Perfect.

Gaby:
Why do you choose that?

Claudio Morera:
Well, I train in Venezuela, and I did my medical school in Venezuela in central University, and then I did my residency in also in Caracas, in part of the central university network of affiliated hospitals. I did in Peresca, Reno. And during that residency, I started to like gastrointestinal disorders, you know, in children. And then I did my fellowship at hospital Los Magallanes.

Gaby:
What does it mean? I start liking these issues.

Claudio Morera:
Well, you know, kids that came with diseases associated with her gastrointestinal tract that were beyond the typical diarrhea, beyond the typical short lived abdominal pain that require more long term treatment or more complex diseases. You see them when you're training to be a pediatrician and they require special treatment. So it's an evolution. I didn't get into pediatrics thinking of that. It just evolved into that or life choose for us, you know?

Gaby:
So I was going to say the story on how we arrived here. I was at this party, and I don't know why, I said something about IB's. Say what?

Claudio Morera:
It means irritable bowel syndrome, doesn't it?

Gaby:
Oh, yes. But, you know, that's mental. And you say, see this? And it is mental. It is real. So this is how we got here, because I think many people are suffering from IB's or any other gut condition, and there is a lot of dismissal about the role of the brain and these conditions. So you gave me a really nice answer about this connection. So can you tell us what is the connection between God and the brain?

Claudio Morera:
Nowadays, irritable bowel syndrome is part of what we nowadays call disorders of the gut brain interaction. There is a constant interaction between the gut and the brain. And coming back to the comment regarding it's in your mind, my answer was more directed towards mental health disorders. And this is bias that we all share, and there is a lot of stigma with mental health disorders. And a mental health disorder is an illness, like any other illness, that doesn't have an x ray that shows something or a blood test that shows something, but it doesn't make it any less real. So that was what I wanted to tell. The fact that if you have a depression that you don't have a test to diagnose, it doesn't make it less important and less so. We need to start working in destigmatizing mental health disorder, irritable bowel syndrome.

Claudio Morera:
Disorders of the gut brain are not mental health disorders, but I use that as an opportunity for. So disorders of the gut brain interaction, the definition that we have is what in medicine call clinical definition, is based on symptoms that the patient have. There is no, what we call also in medicine, biological marker. When you have diabetes, I check the hemoglobin, a one c, which is a type of hemoglobin that is associated with high sugar. And I can tell you when it's above that much, you have diabetes. Easy diagnosis. These are disorders, but when you have a migraine, I can do CAT scans and I can do mris, electroencephalograms, and everything is normal. But you still have the headache.

Claudio Morera:
So the fact that we don't have a test that makes diagnosis doesn't make it any less real, and we use clinical symptoms to make the diagnosis. Well, irritable disorders of the gut brain interaction are very similar. There's a set of criteria that we have as physicians available to us, and they're multiple. It's not just irritable bowel syndrome in the esophagus, in the stomach, in the abdomen, in the colon. You know, constipation is one of them, reflux disease is another one of them. You know, many disorders are related to abnormalities in the way the gut communicates with the brain and vice versa.

Gaby:
But is it that because of the stress, because of the diet that you follow, what is it?

Claudio Morera:
Yes. The answer is yes, is because of all that. So all these influence the way the gut and the brain communicates. The gut is not a tube that allows to digest. It's a very, very, very complex organ that an adult can measure, 10ft, 8ft, it's very, very long. And you have a lining inside called mucosa. That is the one that interact with the environment. We interact with our environment through the skin, through the lung, and our surface that we interact with.

Claudio Morera:
The skin is one and a half square meters. Let's use that number. Then you have the lungs, which is a little bit more than that, and then you have the lining in the stomach. You eat. That's environmental, and then it gets into your gut. And then in your gut we have folds inside the gut, and each fold has like little hairs that are another folds, and each hair has different cells. And in the tip of the cells there are multiple tiny, tiny hairs, too. All that is to increase the surface so we can digest and absorb.

Claudio Morera:
If we were able to spread the surface available in the gastrointestinal tract to interact with the environment is a tennis court surface. So we communicate with our environment way more through our gut than through the rest of the other organs that we have. Then on top of that, we are not a single organ. We are an ecosystem. We, and we have a lot of bacteria and viruses and fungi in our skin, in our upper airway, in the urinary tract, in the genital area and in the gut.

Gaby:
So could ib's be caused by excess of bacteria? Because some people have it, some other people don't.

Claudio Morera:
We all have bacteria, we need it. We can't live without that bacteria.

Gaby:
These people have way more. No.

Claudio Morera:
Well, what has been shown, these are very good points. And this is an active research field nowadays, is called the microbiota, which is the normal bacteria that we have and how it affects health and disease. Not only irritable bowel syndrome, it's associated with multiple other conditions. Inflammatory bowel disease, even mental health disorders have been associated. And I'm using the word associated very purposely because it, it hasn't been shown cause, effect, just association, and has to do with certain type of microorganism and the variety. So people with certain conditions have more variety of certain conditions and of certain microorganism, and people with other conditions has a less variety. So it's not only the number that you have and how diverse they are, but we need them to fight harmful bacteria or viruses. We need them to produce vitamin K, for example.

Claudio Morera:
We don't make vitamin K, our gut make it for us.

Gaby:
I read once that latin woman are more prone to IB's.

Claudio Morera:
Well, there is nice data that's open another kind of worms because minoritized populations are, are less study regarding the thing. But there is nice data out there with hispanic population that they have also significant frequency of functional disorders of the gut brain interaction, which is very common. It's one of the main reasons to go to the gastroenterologist. 30% of population can have that.

Gaby:
So what can someone with IB's, what can they do to deal with these? I mean, it's pretty annoying. Is there something, exercise, food, what can they do?

Claudio Morera:
So one of the first things when we, the first thing is discuss it with your doctor, because there are several things that look like irritable bowel syndrome that are not irritable bowel syndrome, you know? Okay, yeah. Well, you know, for example, if you have a lactose intolerance and you drink lactose, you get belly pain, you have gas and you have diarrhea. Those are symptoms of irritable bowel syndrome too. But what you have is lactose intolerant, you eliminate lactose and then you feel better. If you have celiac disease, you have, you eat gluten bread or pasta, you have bloating you can have belly pain, abdominal pain, and diarrhea, but you don't have irritable bowels. What you have is celiac disease. So there are multiple other conditions that quote unquote, mimic disorders of the gut brain interaction. And that's the first thing.

Claudio Morera:
So when you discuss it with your doctor, I have these symptoms. We do this basic test, and the treatment starts at that moment. We tell the patient, I'm doing these tests not to find out what you have, because your symptoms are very compatible with irritable bowel syndrome. I'm doing this test to find triggers of your symptoms, because there are patients with lactose intolerance that don't have all these disorders, have certain symptoms that are not that distressing. So you can have both. You can have irritable bowel syndrome and lactose intolerance, but if you eat lactose, you trigger an event. So you need to control your lactose intolerance. So that started a moment.

Claudio Morera:
I know what you have. You have irritable bowel syndrome. I'm looking for triggers of your episodes.

Gaby:
So what else can a person who.

Claudio Morera:
Has ideas, so there are multiple management options. The first thing is that when I tell a patient of mine that they have a disorder of the gut brain interaction, particularly ritual, papa will see now say, this is good news and bad news. Good news is nobody dies from it. Bad news is nobody gets cured from it. Okay, so we manage those symptoms and we help the patient. So, and I start with education, with explaining what the patient have. In many chronic illnesses or diseases, the patient needs to understand what is going on, so can have a give them control. When you understand what is going on, it gives you a little bit of control.

Claudio Morera:
It's one technique for resilience. You do better. I have hypertension, and I know that hypertension is a chronic disease, that there is a genetic component and a diet component, and it's not a mysterious stuff. We know what you have, and that alone helps the patient. Okay, so I start with education. I explain that disorders of the gut brain interaction are complex disorders where there is a component of how the bowel moves. So patients with irritable bowel syndrome and constipation, the colon is more sluggish, or patients with irritable bowel syndrome and diarrhea, the colon moves faster and have diarrhea. And one of the reasons they can move faster is because the bacteria are, quote unquote out of balance, or have bacterial overgrowth, or they have a digestive issue like fructose intolerance.

Claudio Morera:
For example, and all these types of things and that produce the diarrhea, but also how we feel it. So the sensation from the gut. 70% of the information between brain and gut is sensory, is the brain feeling what is going on, you know? And then you can have lower threshold of pain because of mild inflammation. If you have lower threshold of pain stimuli that shouldn't produce pain, your brain feels it as pain. Or you can have what we call allodynia, meaning that an abnormal interpretation of the sensation is a normal stimuli, but your brain interprets wrong. Pain lives in the brain. Pain doesn't leave where you feel it. I have two examples for that.

Claudio Morera:
People with chronic diabetes, the nerve endings die because of the diabetes, and they are walking on big ulcers in the food and say, how can you walk on this thing? It's not hurting a lot because the nerves doesn't transmit the information when you need stitches. And the doctors put numbing medication. The numbing medication, what it does is blocks the transmission of that stimuli to the brain so it doesn't get to the brain. So the brain, nothing is happening. And you have the other example, people that, for example, lose a limb because of an accident, and then they have an itch in a foot. How can you have an itch in a foot that you don't have or pain? Because the area in the brain where that food was mapped gets activated and is interpreted as pain. So these triangle of abnormalities affect the production of symptoms. And because there is a component in the brain, if you are nervous, certain psychological.

Claudio Morera:
This is an over simplification for didactic purposes. It's more complex than that. Certain filters that we have that block normal information are open. And I used to feeling receiving information from your parts in the body that you shouldn't be getting. But the higher parts of your brain doesn't understand that and that you have pain when it's a normal sensation.

Gaby:
So I hear. I mean, I talk about these with a lot of my friends. And one thing that I hear a lot is it doesn't happen for many people when they're not in the United States. States, they're eating other type of food. So what's the role of food here in the United States? I mean, it sounds like when they're. Or is it that they're relaxed when they're out, what is it?

Claudio Morera:
All that could be. Could be that they're just more relaxed and then they have having a better time. They're eating foods that are familiar. But also there is a dietary component. Definitely there is a clear association with certain foods, the amount of bacteria that is in the food, the probiotics, you know, all that influences the sensation and the movement of the bowel. So all that is true. And there's multiple factors associated with that. The lines of treatment of particularly readable bowel syndrome, not necessarily for other gut brain interaction disorders, is several things we work with.

Claudio Morera:
Diet, there are certain foods that are recognized, can trigger symptoms that produce gas, that the non-cilia gluten intolerance, the lactose intolerance that we talk about. If there is fructose malabsorption, if there is a little bit of bacterial overgrowth, then that's why certain antibiotics work with certain people. And then you have certain medications, anxiety, depression, and stress management, also that helps.

Gaby:
What is the biggest misconception that exists between the connection of the gut and the brain?

Claudio Morera:
That's a tough question, because I can tell you what I think it is for what I remember, based on the patients that I see, when I tell the patient there is a component of anxiety and a psychological component, it has to be worded in a way that is conducive to communication, that I don't block the communication. So an important part of my job is like, read the audience pretty much, and then understand where the people are at that. And then, because they feel okay, they're telling me that this is psychological. No, I'm not telling you it's psychological. I'm telling you there is a component of psychology, and you're a one body, you're not a God, you're not a brain. So everything is interconnected, you know? And I say the example, for example, a child, a child that has a cold and doesn't feel well, and then during the day, yeah, it's kind of cranky, and then it's running around, but then at night, start more cranky and crying more. It doesn't mean that the cold got worse. It's now tired.

Claudio Morera:
So now you have another layer of complexity to the symptoms that make the symptoms worse. But the cold is not worse. It's just the child that is one child. It's not separate symptoms. Everything affects the other. 190. The number of nerve cells that we have in our gastrointestinal tract is almost the same number of nerve cells that we have in the spine that many. The nerve cells communicate with each other through substances called neurotransmitters that are released by one nerve cell and gets to the receptor in another nerve cell.

Claudio Morera:
That's how they talk to each other. The variety of neurotransmitters that we have in the gut is the same variety of neurotransmitters that we have in the brain. 50 odd something. Many of the medications that we use for depression and anxiety are what they call serotonin. Selective receptor inhibitor. 95% of the serotonin in our body. Where do you think it is? Is in the gut. So all the medications that you use for the brain works in the.

Gaby:
God, you gave me really bad news right now. I thought it was my brain talking to me the whole day, but it's probably the God.

Claudio Morera:
It's probably your God talking to you the whole day. What do you think? I cook?

Gaby:
So let's turn now about you, not necessarily about the gut and the brain. You are a person who enjoys life really nicely. I mean, you seem to be a very relaxed person with a lot of things you love to do. So tell us about this. How do you manage the stress of being a physician, of beating this patient, and the craziness of the healthcare sector? You didn't say that. I said that.

Claudio Morera:
I don't know what to tell you, honest to God. I think it's a combination between two things. One, I consider myself a positive person. I'm a half full glass kind of person. I consider myself simple. Yeah. Well, you know, because there are three or four things that, for me, are extremely important, and the rest are not that important. And I've been extremely lucky to get many of them.

Claudio Morera:
But the first one, I have a partner in life that is the best luck that I've had, you know? Okay. That has given me the best gift ever, which is my two beautiful daughters that turned out to be how I wanted them to be.

Gaby:
Oh, wow.

Claudio Morera:
You know? Exactly.

Gaby:
Okay, can we switch the poll?

Claudio Morera:
Yeah. And then I have the incredible luck that I truly love what I do. And I don't know if I went into that activity because I loved it or I got in love with that. That's what I think. I'm simple. Because this is a good strategy. I mean, if you're stuck doing something, you might as well love it, you know? Because many times we just cannot choose where. And we, many of us here are immigrants.

Claudio Morera:
It's not that you woke up one day, I'm gonna be an immigrant, I'm gonna live. You just. Life put you in that situation, and we just did it. And many times, the decision was made in a fraction of a second, and you just do it. And then you learn to have a good life, and then you enjoy your life. So that's what I'm talking about, like, you know, a simple thing. And I remember telling my daughters that what I wish you for your career is that I asked them. There are many people out there that probably love what they do as much as I love what I do as a profession, but I doubt there's many people that love it more.

Claudio Morera:
I really enjoy, and I say I told them, I wish for you guys to find a career that you love as much as I love mine, and the same for their mom. I mean, we found career paths that we thoroughly enjoy, and it's an important part of our happiness.

Gaby:
There has to be something you don't like about your career.

Claudio Morera:
Yeah. Yeah. There are things that I don't like. Yeah. It's getting tougher and tougher. I don't mind hard work, and I don't mind, you know, long hours or anything. The oddness of the middle of the night, of being a physician and the weekends. It's annoying.

Claudio Morera:
It's not that bad. I don't hate it, but I don't particularly like it. As you advance in your career, you shift your focus a little bit more. I don't have the physical stamina when you're younger to do all the hard physical work of being a young physician. So you start preparing towards the times in your life where you use more your brain and less your body. So I'm working a lot in leadership and having leadership positions in the pediatric department and so forth, and that's dealing with people and dealing with adults. I'd rather deal with kids. So that part, you know, kids is what you see, is what you get.

Claudio Morera:
Adults, you always have to be walking on eggshells many times, you know? And I'm sure you guys, you know, have similar experience, you know?

Gaby:
So how do you deal with the things that you don't enjoy as much? What do you. So when you wake up in the morning and, you know, you have a hard day, I know you're a hard worker, but you're gonna be in a meeting the whole day with these adults. What do you tell yourself to kids?

Claudio Morera:
I just do it. I just like, okay. Like, okay, this is what I need to do. And, you know, once again, I'm, in general, positive, and I say it at home all the time. Okay, what is the learning experience from this? There's always an opportunity to learn something, and then, I don't know. I don't have a straight answer for that. I just don't put too much thought into that because I don't have a choice. I'm like, okay, let's do it.

Claudio Morera:
That's it.

Gaby:
What is the biggest mistake you have made in your life?

Claudio Morera:
I've made a lot of mistakes, so I don't think one is bigger than the other ones, but the mistakes, I cannot give you an example, particularly of one. But what I can tell you is that the mistakes or the. The decisions or actions that I've made, that then I regret or I wasn't too happy with them, happened when I did not respect myself. In my rhythm and in my time of making that decision. There are decisions that you need to think more or that you want to think more. Not necessarily you need to, but you want to think more. So when I have not respected those rhythms of myself, I made decisions that I regretted. Maybe if I took the time, it was going to be a mistake too, but it was going to be my mistake.

Claudio Morera:
I own it in that way. I own it because I made it, but at the same didn't. Because the person who made the mistake wasn't the person that I wanted to be when I made the mistake. So as I grow older, I try to work as a person of personal growth to what is my rhythm, what is my personal style to deal with this issue, you know, what do you.

Gaby:
Do to stay connected to that? I know, like you said, you don't think when you go to work in the morning it's gonna bother you. But how do you stay connected with, I guess, your values so that they stay present in the decisions you make every day in your life?

Claudio Morera:
I don't know for sure, but I think is I try not to lose sight of the big picture, you know, at work. I wanna. My goal of, you know, being in clinic is to have an efficient clinic, see my patients, be able to help them as the best that I can. And sometimes the help is I teach this mom to connect to the portal or the patient chart. That was the help. The other part was very routine. And the other help for this patient was to connect with the other specialists that they wasn't able to connect. I have a lot of hispanic patients and I take a lot of pride in helping them by teaching them how to fish, not by giving them the fish.

Claudio Morera:
Okay, as best as I can. And other times is, okay, what is the purpose of this meeting? Like, the true purpose of this meeting. So that allows me to like, okay, I have to put up with these type of things. And I'm not saying this is the right or the wrong way. Sometimes you need to be more assertive of. No, once again, I need to respect my personality. So this is my style of doing it that works for certain things and doesn't work for other things. And at home is pretty much the same.

Claudio Morera:
You know, what is the big picture here? What is the goal that we want to accomplish? I tell all the time is like, you know, when you give an opinion regarding something, I'm saying this because I want to be right or because I want to change the behavior. Because if I want to change the behavior, maybe how I'm saying it is not the right way, even if I'm right. And sometimes you just want to be right. But you need, once again, you need to know what is guiding your thing. Okay.

Gaby:
So I want to ask you if you could have a drink tonight or have something to eat with someone in the world, whoever you want to choose a life or not, who would that person be and what question would you ask?

Claudio Morera:
That's a hard question. I would had a drink with my father.

Gaby:
And what question would you ask?

Claudio Morera:
I would like to, because I'm almost the same age that he had when he died. He was 64. I'm not 64. I'm far from that. But I mean that. So I would like to. To ask him what was he thinking? What was his guidance? He was a very strong man, a hard worker. Canary island farmer that got into fourth grade.

Claudio Morera:
That's it. And then his three kids are college graduates. And then my second brother is a highly accomplished engineer, and the third one is a lawyer. What was. What were you thinking? You know, as a mature man, you know, how did you guide your life? You know? So I missed that opportunity many times. Yeah. Yeah.

Gaby:
Have you read or watched something that you recommend to the audience lately? Something that you love, that make you happy, that makes you smile?

Claudio Morera:
Well, yeah. Yeah. I am currently reading a book called El Universo, which is like a history of the book. You know, how the written language started to happen and how it was transmitted. And so it's fascinating. It's very, very interesting. And, like, the drive for the human spirit to persevere. And there are several phrases from the spanish author, I can't remember the name of the lady, you know? Yeah, yeah, yeah, yeah, yeah, yeah.

Claudio Morera:
And then she mentioned that the book is one of those things that once is invented. There's nothing better for that. Like their. Like their will. There's nothing better than the will. Once the will was invented, that was it. And then the book is the first time that or they've written, the first time that you were able to capture thoughts, you know? And then, so it was fascinating. The way they.

Claudio Morera:
And I don't read a lot. I have to have the idea that, you know, like, you know. You know. Well, you know, even if I hadn't, I'd rather cook, to be honest with you, you know. Okay. But so, you know, it was, you know. Yeah, yeah, yeah.

Gaby:
Well, so I always end the podcast, and we're gonna have a q and a, but I end the podcast with something that my father used to say, and there's one that came to my mind when I was listening to you, and my father had the same philosophy of life that you just shared with us, and it's. You don't let the forest. Well, I have to say it in Spanish. No. De esque los angeles, I think, is don't let the trees obstruct the forest. I guess it's like, don't let the little things in life don't block the view of the big picture. Yeah. Thank you.

Claudio Morera:
Thank you. No, thank you.

Gaby:
So, what are we open to? Q and A? Do we have a microphone? Okay, don't be shy.

Claudio Morera:
Yes.

Gaby:
What are some foods that tend to trigger irritable bowel syndrome?

Claudio Morera:
So there are more than foods that are diets that help, and then the ones that have been, once again, like a disclaimer, let's put it this way. There are different type of medicine. The medicine that we use in the western world is what is called allopathic medicine, and we are based in the cartesian system, meaning and the scientific method. So all the information that I give is based on those principles. It doesn't mean that it's the only truth. It's the truth that I handle. Okay, so the diet that have been studied are, for example, if you have lactose intolerance, avoid lactose. There are people that have what is called non celiac gluten intolerance.

Claudio Morera:
You can have celiac disease, which is an immunologic condition in which your own body attacks the gluten and attacks the. Their own body. That's one thing. You can be allergic to wheat. This is an allergy. Or you can have these so called. So those people benefit from avoiding gluten. And if your symptoms are diarrhea and bloating, there are certain sugars that can be eliminated.

Claudio Morera:
Is the so called low fodmap diet. Fodmap is for fermentable. So sugars that ferment in the body, the bacteria break them down, like sauerkraut kind of thing. Fermentable oligosaccharides. Disaccharides. Low fodmaps and polyols. These are small sugars, many of the cruciferous vegetables, cabbage, Brussels sprouts, onions, garlic, there are multiple foods. These are tough diets to follow on your own.

Claudio Morera:
So in general, we recommend that if this is what is for you, it should be handled by a dietitian that knows that diet. So these are examples in general, but if you eat red meat and upset your stomach, don't eat red meat.

Gaby:
Okay. The other thing that I have read talk saying is sometimes something works and you're like, oh, I got it, I got it, this is working, and then stop working.

Claudio Morera:
I don't know. That's the true answer. I can speculate what can be. You're not the same person when you started the diet, you know, maybe the diet stopped because you added other things that you didn't realize. Maybe you relaxed in your mind body activities, maybe you many, many things that could be, you know, happening. Okay.

Gaby:
Hello, thanks very much for the podcast, really interesting. Can you speak a little bit about your journey from Venezuela to the US and you can identify two decision points that really made a difference and what were you thinking?

Claudio Morera:
Of course, thank you for the question, which is an important part of what we are. You know, I am the son of immigrants. My parents emigrated to Venezuela with the same prison that many immigrants do, because they want a better life. Pretty much nobody leaves their country because they want to. That is very important. Sometimes I'm asked here, so do you always plan to come here? Like, yeah, you know, you leave your country because you have to, for political reasons, for economical reasons, for social reasons, for multiple reasons. So you have to put in the context of the history. I train in Venezuela, all medical school residency, three years of pediatrics, two years of pediatric gastroenterology.

Claudio Morera:
And at that time, well, you know, I had the opportunity to come abroad to do a subspecialization in pediatric gastroenterology. And I came here to children's hospital because, you know, the main book of pediatric gastroenterology at that time was edited by one the chief of pediatric gastroenterology here. So I came here and I did my fellowship, and I wanted to offer my daughter. At that time, we had only one the opportunity to live abroad. You know, many of us take the chance to have this experience through work because we cannot afford it through our own pocket. So, okay, this is a good opportunity, like the diplomats, that's how they do it. And we were done, so we're going back home, because I want to build, you know, I want to give back to Venezuela. And then we went to Venezuela when Chavez won.

Claudio Morera:
So that year, 1999. And we spent the best five years that we could have because their grandparents were alive and healthy and their uncles were there. So it was great. Five years. But then things started to get bad, particularly I didn't see a good future for my daughters there. So even I discussed, and I think it's time to start looking abroad. I tried to look. To look into Spain was too complicated.

Claudio Morera:
I wasn't planning on leaving just to see what to do. No, we have to be thoughtful about it. And then I have a career that took me a lot of time to get. I want to work in my career. So we started looking, looking, and then they offered me to come here to my current position. And then I came. And in order to practice here, you need to have what is called the boards of the subspecialization. So at 40, I had to do pediatrics again.

Gaby:
So.

Claudio Morera:
And I was working one month as the pediatric gastroenterologist at postal medical and one month as a resident. And I would see a patient and I would refer to myself to the next month kind of thing. And then I did it. And then that's when people ask me, so you planning to do that again? Like, yeah, twice. I really was looking forward to that. Once again, you do what you do. You do what you need to do, and you don't think too much about it because you don't have too much of an option. And then I've grown there and I, you know, we've made a life.

Gaby:
Yeah. Your story is so fascinating that I would want to have a question about.

Claudio Morera:
That.

Gaby:
Coming back to ib's. I'm sorry.

Claudio Morera:
That's okay.

Gaby:
So I'm just fascinated with the situation of how emotions affect the gut, you know, and I wanted to understand how that. How that happens. And you have talked about the brain and the nerves, but I still don't get it, you know, when I'm stressed. And I could pinpoint two situations, like when I was. I got very angry, which I usually don't put it back in, or I'm frustrated. And then all of a sudden I felt it, you know, and it started. And I said, how does this work, that an emotion triggers an episode? So that's my question. And not, you know, like, oh, you feel bad and.

Gaby:
No, no, no. Like the actual chemistry or physical aspect.

Claudio Morera:
Yeah, perfect. Very, very good question. And there are multiple studies about that. I don't think they have all the answers there, but I can give you several things. One, we all have heard people that, you know, before they have a test, they get diarrhea. That's not psychological. You have diarrhea. I mean, it's very clear.

Claudio Morera:
Okay? There are nerves that come from the brain down, like the vagus nerve that communicate all the way down and then can trigger the release of hormones in the gut that make the gut move faster. Okay? One, chronic stress affects the, when you have stress or anxiety in the brain, there are certain hormones that are released that has to do with the cortisol metabolism. And that hormones also affect the permeability of the gut. So you can have more interaction with bacteria and bacteria and substances from the God. And then when you're not stressed out, you don't release that hormone. Once again, this is not all of it, okay? And also, once again, how your brain manage your brain. There's so much that your brain can do, okay? And then if you're stress out, the stress out is a genetically determined function of our brain to protect us from the tiger that want to eat us out there. In the 100,000 years that we were homo sapiens living in the woods, we are what we are.

Claudio Morera:
For the last five, 6000 years before that, we were naked walking around, you know, so we are more prepared. That's why, for example, we accumulate fat when we eat a little bit more than we want. And that's why it's so hard to lose weight because we're genetically, you know, primed through all these many, many years of evolution. The same with that is the fight or flight response. So the fight or flight is you have the high adrenaline, you hyperfocus in the stressing so you don't pay attention to the other stuff. So other stuff that, like the filters in your brain regarding the information, I always use the example, you are in an airplane and you don't know anything about flying and you are right behind the door of the cockpit and then the door is open for whatever. And then you hear the pilot, alpha Delta Gamma 33,000. You know, you get kind of nervous, like, oh, my God, what is he talking? Nothing.

Claudio Morera:
It's a normal talk, but you shouldn't be listening to that. And that makes you nervous. So something, this is an oversimplification regarding how the brain interprets the sensation from the God. Okay? That's why we. Cognitive behavioral therapy. God direct immunotherapy works with some patients with irritable bowel syndrome. Symptoms is the other side of the microphone. Migraine.

Claudio Morera:
Yeah. But maybe for the podcast to record the podcast. Yeah, on, good. Yeah, that's good. Yeah. How young are you readable? I have patients with gut brain disorders of the gut brain interaction. School age, preschool age, six, seven years old. It's rare in small infants.

Claudio Morera:
I haven't seen. I've seen small infant with reflux, for example, or with constipation that are babies, and two, three, but more with pain. And this type of pain is more older patients. There you go.

Gaby:
It's most likely to happen to women, and I grew up before Sam's all the time, and she just mentioned it. So is there a huge correlation, or is it.

Claudio Morera:
There is some correlation. There is some hormonal correlation, definitely. And there are certain DGBI. That's how we call them. They're more prevalent in women. Well, you know, this is a different hormone, you know, but, you know, there is definitely, and there isn't stability, association. For example, in the winter time, we have more than in the summertime, and we don't know if it. Because of the light.

Claudio Morera:
Is this because of the. Because we're happier, but why are we happier because of the light? We don't know. You understand what I mean? You know? So, for example, you see the vitamin D. So we don't know what is it, you know, but there's definitely a cycling thing in it, in DGBI symptoms.

Gaby:
And I think you have another. So a question goes, Claudio, these diseases that you're explaining are very human centered. So do you think that this is only a human disease? Are there any animal models?

Claudio Morera:
There are animal models with. Yes, there are animal models. There are mouse. As far as I'm aware, this is not a big area of my expertise, the basic science of that, where they distend the rectum of the rats, and then they release certain chemicals, and then they have ways to trigger ivas, like symptoms or manifestations, and then they see that there is a difference between one or the other. So there's. There is a what? I hate to use that word, but there is an organic component, and there is a, let's use psychological component, but the psychological is organic, too, because there are neurotransmitters that get, you know, variable. So that's why I don't like the word organic or psychological. There is a mental component and there is a GI component.

Gaby:
How do you know without it? Because perhaps you have IBD all your life, and you don't know that you have it or you will know it.

Claudio Morera:
Yeah, well, IBD is different than ib's. Yeah, yeah, yeah. So that's irritable bowel syndrome, is the old nerves in the stomach. When people say, no, they have nerves in the stomach, you know, they get nerves and then they get belly pain. Or, you know, my typical thing is, no, my mom has always suffered from the colon. You know, that this is irritable bowel syndrome because, you know, they have, like, you know, 65 years having gas and pain, you know. So the best way, if you have gastrointestinal symptoms, you need to speak with someone that knows about gastrointestinal symptoms, and that person is not Google. Okay.

Claudio Morera:
Okay. Yeah. Oh, there's a question here. I'm sorry.

Gaby:
So how does transplanting, the microbiome, will that work, too?

Claudio Morera:
There are. It's a nice, interesting concept, and there are some attempts to study that. And they saw that people without irritable bowel syndrome, that they get transplanted. The poop of people with irritable bowels. You don't get it. So there's the other way around. It's not that clear. But this is all studies in the microbiome, and this is all experimental.

Claudio Morera:
Nobody's going to give you poop. So you can. Okay. For that reason. You know, they might give you for other reasons, but not for that one. Yeah. Yeah.

Gaby:
Okay. So, Gabby, you're out in the world doing your podcast to introduce all of us to the people that are under gray, right? So here we are with you. And I just want to say, like, it's clear how you fit into this model. Before my question, I just say that in that, you know, the role that you're playing, especially with younger kids, and actually validating that there is a gut brain thing where otherwise the other parent, people might just think like, it's just a thing, just like the latest thing on Instagram, whatever. But that you're out there just demonstrating it's actually a thing and giving a language to it. And this order thing is not yours. It's an interesting thing, but just that you're. It's clear you're making such an impact, and it's amazing.

Claudio Morera:
Thank you. Thank you. Thank you. Thank you.

Gaby:
Thank you.

Claudio Morera:
Thank you.

Gaby:
Sorry. You can clap again after lots of questions. My question is this. Have you seen a connection between a lactose intolerance and a sleep situation? Whether it's a disorder, whether exhaustion or sleepiness or anything that. Have you seen a connection with people that have left intolerance? All.

Claudio Morera:
I haven't seen it per se because the people don't come to me because I have lactose intolerance. They come to me because I have belly pain, diarrhea. They don't come to me because I can't sleep well. So I don't see those patients. Having said that, I have patients with DGBI disorders, disorder of the gut brain interaction, that I improve their symptoms significantly just by making them sleep better. The typical one is the adolescence. You know, the teenagers, they go to bed very, very late, you know, and then they have to wake up early to go to school. And then, you know, I have nausea and I have belly pain, and then I may know you need to go to bed at ten and then wake up.

Claudio Morera:
And just by doing that, the nausea is gone and the belly pain is gone, you know. So if, regarding the lactose intolerance per se, I have not seen it. By taking the lactose intolerance, the lactose making you more sleepy? I haven't seen it. But once again, this is more like in the sleep thing. I see a group of patients, as I told you, the patient don't come to me for lactose intolerance. They come to me because they have the other stuff and they might have lactose intolerance to explain their symptoms. But there are people that are very sensitive to milk. Not necessarily the lactose, but the other components of milk, the protein.

Claudio Morera:
And maybe that's the reason that is having those issues there. It's an easy answer. Just eliminate lactose.