EP: 154 The Gut-Brain Axis: Healing The Gut To Improve Your Life With Dr. Erika La Vella

BWW 154 | Healing The Gut


Harnessing the power of managing your stress is essential to our health. But when we fall into the abyss of trauma, pain, and chronic disease, it reshapes our body and brain. In this episode, to lead us into the path to recovery and explain the value of healing the gut, Dr. Erika La Vella sits with Jennifer Pestikas. Dr. Erika brings so much wealth in today’s conversation to further understand how the Body Keeps the Score. Tune in to this episode and be a Brave Woman at Work today.

During my chat with Dr. Erika, we discussed:

  • What led her to her work of helping others heal their guts and take control of their health?
  • What is the gut-brain axis? Why is it bi-directional? And why it’s important?
  • Symptoms of gut dysfunction and what we can do about it
  • Sugar, oh beloved sugar, how it can wreak havoc on our health, and how we can learn to manage our need for it.
  • The role that stress plays in all of this.
  • And how healing our gut helps us be a braver women at work.

Listen to the podcast here


The Gut-Brain Axis: Healing The Gut To Improve Your Life With Dr. Erika La Vella

How are you doing out there? Here’s a secret about me. I am secretly obsessed with reading and studying about all things medical, especially holistic. Maybe I miss my calling. Maybe I was supposed to be a doctor or whatever. I love to dive into studying how what we eat plays a large role in how we feel. I also love to learn about how the body truly does keep the score. There is a famous book with the same name that I highly recommend you check out. It’s called The Body Keeps the Score.

How we manage stress is super important in our health. If we ignore what we eat, how we treat our bodies, and how we manage stress, we know what we’re going to end up with. We’re going to end up with autoimmune conditions, chronic pain, and even more serious and deadly diseases such as cancer, heart disease, and so much more.

When I was introduced to Dr. Erika La Vella, I got super jazzed and I geeked out a little bit. I became a fan girl of Dr. Erika. She is such a wealth of knowledge on functional medicine and gut health, which is so up my alley. We got a little deep into the science but bear with us because it is such a good conversation. During my chat with Dr. Erika, we discussed what led her to do the work she does of helping others heal their guts and take control of their health. What the gut-brain access is, why it is bidirectional, what all of this means, and why it is important.

Symptoms of gut dysfunction like SIBO and Candida, which is a yeast overgrowth, and all of many other things you may have heard, and what we can do about gut dysfunction and gut disease. We also touched on sugar. If I had a drug of choice, it is sugar. I know so many of us have the same addiction. How it can wreak havoc on our health and how we can learn to manage our need for it. I wanted to touch on this not only for myself because sugar is in just about everything that we pick up off the shelves in the grocery store. If you really look, it’s a little scary. Also, how the role of stress plays in all of this and how healing our gut can help us truly be braver women at work.

Here is more about Dr. Erika. Dr. Erika La Vella is a board-certified weight-loss surgeon practicing in Oregon. She attended the University of Idaho where she studied nutrition and psychology. She then went to medical school at Pacific Northwest University. She is also a board-certified metabolic surgeon, wife, and mother who is passionate about health in the most preventative and holistic ways. Through staying up to date with the latest research and healing her own gut, Erika has become an expert in gut-brain access and is passionate about teaching others the impact that they have on their own health.


BWW 154 | Healing The Gut


Before we get started, if you’re enjoying this show, as I always say, please make sure to leave a rating and review on Apple Podcasts and Spotify. Why is this important? By leaving a rating and review, you help the show gain traction and grow which simply means this show and its contents get into the hands of more women worldwide, which is my goal. I want to share these wonderful stories of brave women. I want to share education and inspiration to allow all of you to take braver bolder action in your careers and lives. If you’ve left a rating and review, I thank you so much.

One more reminder. If you have been wondering about what career and leadership coaching is or you’ve been toying around with the idea of making that commitment and giving the gift of coaching to yourself, visit my website at BraveWomenAtWork.com and schedule a 30-minute discovery call. During that call, everything is confidential. We’re going to chat about your current situation and determine if coaching is the right fit for you. Let’s welcome Dr. Erika to the show.

Dr. Erika, welcome to the show. How are you?

I am wonderful. Thank you so much for having me, Jen.

I am so excited to talk about all things gut-related. This is an area of passion for me. I’ve got a sneak peek. I got the intel. Why don’t you tell everybody else about you, your background, and how you’ve gotten where you are now?

My name is Erika La Vella. I am an osteopathic physician. I’m a bariatric surgeon and a self-proclaimed gut microbiome expert. I’ll say briefly but my story started when I was in undergrad. I know I wanted to go into medicine and I started making the link between nutrition. I took my first nutrition class at age nineteen and I was on a fast track to metabolic disease.

My first nutrition class taught me that we had to do a three-day food log or whatever. This is before iPhones and before apps. I had to write it all down and then with a CD-ROM, you put it in your laptop and put it into essentially a food tracking app. It mapped everything out, which is telling and revealing how little whole foods I was eating and how much saturated fat was in my diet.

I was taking biochemistry, organic chemistry, and physics all the same time as I was taking this nutrition class. It made all of that science and all of those details of food as medicine so much sense. Fast forward to osteopathic medical school. The reason I chose the osteopathic route is because the philosophy behind it is that the physician helps find health in an individual and that the body is capable of self-healing.

Part of my osteopathic medical school taught me a lot about the autonomic nervous system and how the autonomic nervous system influences the structure and function of the body. From an osteopathic perspective, whenever somebody has a disease, they wear it in their somatic body experience. It’s very fascinating and you can map out every single nerve pathway. Essentially, from a gut microbiome perspective, everything in the body is bi-directional.

We have brain input coming down to the body, but we also have nutritional input and biochemical input coming from the body back up to the brain. We’re one energetic glob of an ecosystem, microorganisms, our own physiology, our own thoughts, and our own beliefs. That was starting to paint the early picture. When I was in medical school, I found functional medicine. I’ve been a patient of functional medicine. I discovered it because I was having all these GI issues.

I was already eating well. I was exercising, but the stress of medical school, compounded with some other personal things that were coming up for me, I had a GI parasite, and all of these things clustered together. I did a stool test. I did blood work. I did urine tests. I had every single metabolic pathway mapped out and I was a hot mess. Finding the GI parasite was telling because I probably got that from working in a farm environment. I’m from Idaho. My grandparents for cattle ranchers. I grew up around horses. Backyard play was swimming and creek beds and playing with livestock.

This GI parasite in textbooks is found in third-world countries but I grew up in a first-world country, but I had a third-world experience playing in rural Idaho ranch life in and around livestock. This 2-millimeter worm comes in through your feet and bare skin. It gets into your bloodstream and then it lives in your lungs and it causes upper respiratory tract inflammation. When I was in college, I was having frequent sinus infections and upper respiratory infections. It’s easy to blame that on communal living and whatever else might be going on at the time.

Essentially, with every respiratory tract infection, I would cough it up and then you aspirate it. It lives in your small intestine. In all these biochemical tests, I was privy to the biochemistry, but it became obvious that this 2-millimeter worm was stealing amino acids from my diet. I couldn’t digest red meat very well. Granted that red meat is not good for you, in my opinion, all things are in moderation. Variety is the spice of life.

I was 22 or 23. I couldn’t have a glass of wine or a beer without physically aching everywhere in my body for three days afterward. Again, the stress piece. I was having abdominal pain, indigestion, and bloating. In and around test anxiety and different things like that, diarrhea and constipation. I wasn’t feeling like myself. Functional medicine found these things. I treated the parasite. Simultaneously at the time, I was on oral birth control pills. A lot of twenty-something-year-old women are. I had to stop taking that because it had an interaction with the medicine I was taking to get rid of the parasite.

Within a month, the glasses came off. Everything got brighter. Everything got clearer. I fell in love with surgery. I pursued my career in surgery. I became my fearless brave self. Everything fell into place. Since that time, surgery training wasn’t the most conducive to me, exploring all this fun biomedical research, or going on and educating people about all these things, but coming out of residency training and coming into my bariatric surgery practice.

In bariatric surgery, I get to be a dietitian which was part of my undergraduate degree. I get to be part psychologist, just showing up with a human heart and the human experience. I get to use all of my skill sets, which are nutrition, biochemistry, metabolism, and gut health. I help patients or people who experience obesity not only learn how to take care of their bodies from the inside out but also use gut health, surgery, and all these biochemical means as a menu of options to help them achieve the health that they want.

Here I am a bariatric surgeon and I’m networking with people in the community. I got invited to speak about nutrition and chronic pain at a conference. I was inspired by this. Microbiome research was flying off the press. From 2010 to about 2023, there has been this explosion of research, documenting and explaining the experience I had in 2008. The gut microbiome, this bi-directional physiology, and all the things I was starting to pay attention to and start creating my own stories, there’s now amazing basic science research to back it up.

I gave this one-hour lecture to this myriad transdisciplinary conference. There were orthopedic surgeons there. There were physical therapists and chronic pain doctors. It was a whole variety of individuals like social workers, nurses, etc. I got this standing ovation from this crowd because it was the first time that all of those details were mapped out in story form to show how important and how integral digestion is to the human experience.

The overlap with emotional eating, condition, behaviors, beliefs, etc., which is our childhood and beyond. Also, the real physiologic mechanisms and the co-creative relationship we have with these microorganisms that live in our bodies. Sad to say, not everybody who has GI issues can pin it down to a parasite, but there’s a lot going on. Do we have one answer or one quick fix to address it? No, but what I hope to do is inspire people through storytelling and through reflecting on their own relationship to their body, digestion, and food so that they can start to uncover and unravel what they need for themselves in their own self-discovery process.

About three years ago, I founded a company called Art of Bariatrics. Myself and one of my dietitian partners who I work with here clinically started this online. It’s a nutritional education company designed to address common digestive issues and weight regain that we see a lot of times after bariatric surgery. The same co-creative story of self-discovery helps guide people to understand where is health and how health feels for them.

A lot of times, what the diet or the weight loss industry does is they dumb it down to calories and they dumb it down to food replacements. If you can keep calories controlled and you can exercise as much as you want, that’s all you need but the story is so much bigger than that. Whether we’re talking about bloating, abdominal pain, diarrhea, constipation, cancer, and autoimmune disease. A lot of Alzheimer’s and dementia are now linked to gut dysfunction. I feel like what we’re doing is helping people take ownership of their bodies and that co-creative relationship with their own health.

You kept mentioning this whole bi-directional. I’ve heard of gut-brain access but I’ve never heard bi-directional or the gut is the second brain. Do those all mean the same things?

In a nutshell, yes. Largely, we’re talking about the vagus nerve. The vagus nerve is the nerve in the brain stem but it’s connected to our eyes, ears, and our vocal box, so even the pitch of our voice. Our ability to assess information from our environment conveys a feeling of safety. This is where there’s a huge overlap in mental health and behavioral health because a lot of people can identify with the experience of anxiety.

Anxiety is your nervous system on high alert assessing the scene around you. It’s assessing your environment for safety, but it is bi-directional because this nerve also goes down. It innervates the thyroid. A lot of people with gut dysfunction will have thyroid issues. It innervates the heart, so it regulates heartbeat and heart tone, which also has an impact on blood pressure through the carotid bodies in our neck. The same little vagus nerve takes a little loop around those.

Anxiety is like your nervous system on high alert, assessing the scene around you for safety. Share on X

It goes below the diaphragm. From below the diaphragm, it branches out into tons of tiny little tributaries that innervate our stomach, liver, and all of our organs of digestion like our adrenal glands. Even our ovaries are touched by this vagus nerve process. I am a very holistic-minded surgeon. What I find so fascinating about the vagus nerve and all its different tributaries is it overlaps with the Ayurvedic chakra model. It’s very fascinating. When we have one nerve fiber going down to all these different tissue sites, there are nine other fibers, part of this eternite cord, carrying information from those organ sites back up to the brain.

I’ve had someone that also specializes in chakra. I love that we’re bringing all this together. I didn’t expect to go there. I can also believe that the emotions are tied in. You’re mentioning that it’s the whole body. It’s not like, “I’m overweight. What are the emotions that go into that? How is the rest of your body feeling?” I love how we’re putting it all together versus people will say, “I want to lose weight,” or, “I just want to do this.” You’re like, “No. You want to get healthy and this is a formula to do it.”

The bi-directional piece overlaps biochemistry. When I went through all that undergraduate basic science training, you’re taught from the perspective of, “This is what the human body does.” When you start learning about the microbiome, you realize that there are more organisms inhabiting your body that also take part in those biochemical processes. That’s where I’m like, “It’s a co-creative relationship.” You are like the Earth planet for these microorganisms and they live in different countries, counties, communities, and populations.

A marker of health is what species diversity you can inhabit or how many different species you can keep healthy and alive in your body at one time. Each one of those different species does different metabolic functions in a co-creative way for your body’s health. That’s why when you look at population studies, there are communities of people that still live in tribal ways that harvest a lot of different things from the planet that aren’t in an agricultural way.

They’re eating upwards of 100 grams of fiber a day and they don’t have any autoimmune disease. They don’t have any chronic disease. It’s very fascinating. Knowing what we know about modern medicine and all these amazing technological advancements, the microbiome basic science stuff that’s coming out of universities right now is going to help shape the next 50 years or the future of this modern medicine era where we can now co-create these developmental relationships to maintain species diversity within our bodies.

Let’s talk about stress. I want to go to stress because I’ve had friends or family members. I’m not going to say they’re healthy because they’re “thin.” That’s also a misnomer too. If we see someone that’s thin, we’re like, “They’re healthy.” That does not mean that they’re healthy. Let’s be clear there. I think that we have more value on appearance rather than overall total body health. I’ve had friends and family members, being an American in the US and how we grew up. One thing that I’ve seen is that they’re eating burgers and fries. They’re not overweight and they don’t seem stressed.

I’m wondering whether some people have better gut function or gut-brain accesses. Can they handle stress better than others? I’ll be the first one to say that I’ve had a long history of gut dysfunction. That’s why I was selfishly excited to talk with you about this. I don’t always handle stress well. I was wondering, do we have individual fingerprint gut-brain accesses where some of us are stronger than others?

Sort of. I think everybody is capable. The word I’m looking for that comes to mind is regulation. By regulating our nervous system, using our eyes, ears, nose, and all of our senses, even touch, we can convey a scene of safety within our bodies. As humans, we are easily programmed to this out-of-body thinking, forward-projecting, and past-projecting. I think women in leadership, you have a lot of fires you are putting out. You are also passively taking on the emotional experiences of others. You are problem-solving all the time.

Developing practices that make you feel more grounded and everybody else’s stuff is back to them and in your sovereign space with your own power vulnerability is important. The basic science mechanism was done in dog studies and this data came out in the ‘90s, but I think because it was done on dogs and we didn’t have the full microbiome picture. I say “we,” meaning humans and scientists. The story wasn’t perfectly mapped out, but under conditions of stress, it releases a hormonal hormone from the brain called corticotropin-releasing hormone.

From the brain, it then circulates through our bloodstream through our nervous system and then has tissue-specific sites where it has an impact. When I was a medical school, we learned that CRH from the brain, that corticotropin-releasing hormone, is what activates cortisol from the adrenal glands. While that is true, the CRH also goes to the gut level. What it does is it stimulates an enzyme which then cuts tight junction proteins that are like the glue and are the gatekeepers of the gut cell wall.

By conditionally, and I say conditionally because nobody is exempted from this. Everybody can experience this response. There’s a certain dose that’s normal and physiologic, but there’s a certain dose that then becomes a little too much for the body to handle. I don’t perfectly have something to analogize why this is evolutionarily beneficial other than I think the microorganisms that inhabit our bodies have been on the planet probably even longer than humans have. It’s probably an evolutionary mechanism for their survival if we want to surmise it down to Darwinian survival of the fittest mechanisms. These are living creatures that live inside us.

What we’ve observed is under states of stress like a traumatic car accident or somebody breaks a femur, a hip, or they’re bleeding out, the stress physiology to the human is super high. What can happen within several hours of an accident like this is certain bacteria in the body can communicate with each other. They pick up on the same hormonal precursors that our bodies are releasing.

Let’s say something like adrenaline. If your adrenaline is soaring high, there’s documentation that something like E. coli, which lives in all colons of most mammals, can then switch gears and in as little as twenty minutes, it can start pumping out genes that then make that E. coli infectious. If those tight junction genes are broken at your gut wall, then E. coli is now getting into your bloodstream. Now you are septic. If that E, coli then leaves the human body, it’s activated to be infectious in whatever else it encounters. I heard a biologist say it’s like the bacteria sees that the host is going down so it tries to increase its virulence and become infectious so that it can jump ship to a new host.

It makes sense because we’re humans and we try to make sense of everything. Whether or not this whole story is perfectly true, I’m just storytelling. I am applying a little fiction to the nonfiction so that we can become caretakers for our environment. That’s where I want to use storytelling to inspire people because the more calming of an environment, the more wholesome of an environment, and the more variety of plant-based foods one can eat in their diet, the more one can take care of their own nervous system regulation through mindfulness.

Exercise is tremendous, by the way. There’s not a study on the planet that says exercise is bad for you. We’re training our nervous system to go in and out of these more activated states and then recover more quickly. I say health isn’t really never experiencing stress, but health is this marker of being able to rebound quickly and recover from stress.

It’s resetting from the stressor rather than your body being constantly in that fight or flight like “the tigers in front of us” state.

You mentioned tiger. Peter Levine wrote a book Waking the Tiger: Healing Trauma. Stephen Porges coined the Polyvagal Theory around the ‘90s or early 2000s. Mammals do this. We’re nursing and we care for our young. That’s when you overlap, “Why are certain people wired for stress differently?” This comes down to how you are parented and how you are brought into the world because as an infant, we are so vulnerable. We rely exclusively on co-regulation from a caregiver.

Certain people are wired for stress differently because of how we are parented and brought into the world. Share on X

There’s been microbiome studies that overlap this. A child born by C-section, there was immediate distress of some sort. There was also microbiome disturbance because of the human and probably all mammals, but based on where you are in your pregnancy, the bacteria of your vagina changed. The ability to go through the birth canal and inoculate which means to swab your face, mouth, and nose with specific types of bacteria through birth determines the immune function of that infant for the next several years. There are a lot of overlaps between neurodevelopment regulation, co-regulation, diet, the environment, and microbiomes starting from even when your mother was pregnant with you.

Let’s say that we do have dysfunction in our guts. Some of them are obvious. You’ve mentioned constipation and diarrhea, but what are some of the other issues that if we’re not feeling optimal we need to pay attention to with gut dysfunction?

I think bloating and heartburn are two easy ones. Bloating paints this picture, and this is where I also bring it back to that autonomic nervous system. In order for a body to digest food at its fullest capacity, we need to be in a more parasympathetic state while we’re eating. If you want to get nitty-gritty with it, I mentioned those tight junction proteins as the glue holding the cell wall together. There’s also a biofilm on top of it that is built up by fiber. Fiber in a diet can do that. Also, on top of that, there’s a biofilm of bacteria that live there.

The epitome of health is we have enough fiber or at least a robust enough mechanism so even under states of stress, that biofilm or that fiber-laden protective lining is not broken. We’re not going to get leaky gut from experiencing stress intermittently as long as those internal mechanisms are restored. What happens is we have over-the-counter medicines like Ibuprofen that don’t allow for that healthy protective lining to grow very well. We also have tons of stress.

I’m of the era where I got an antibiotic for every sniffle I had as a kid. There are a lot of layers here. I think the single best thing a person can take ownership of is that nervous system regulation. They can exercise because exercise is nervous system regulation and training. You can try to eat more whole foods and less artificial sweeteners, but from a microbiome perspective, abundance is the key.

Here’s my take on all the information that I’ve learned, which is different from sometimes the naturopathic or allergen perspective. We can totally develop immunoglobulins to specific foods, but that’s over how much damage has been done, how much those tight junctions have been broken, and how long your body has been reacting at an immune level to undigested particles coming into the bloodstream through the gut.

There is a little bit of that, but diversity. In order to increase your diversity, you have to keep eating a diversity of foods in order to grow this first layer of defense, which is a healthy microbiome population. While at first, you might be more uncomfortable with bloating and whatnot, if you can stick with it for six weeks and beyond, eating 30 different plant species a week. This is what the human gut microbiome project determined. They took samples from tons of healthy volunteers, and the plant diversity was the single best indicator of health

Imagine each different food. Maybe it’s cilantro, parsley, chives, or tarragon. Those are simple herbs that people can add to their food, but they don’t take up a lot of volume. Also in America, we get this one-track mind that more is better, but it’s a little bit. Diversity is better. Maybe it’s five different types of beans a week but maybe you’re only eating a tablespoon or two at a time. Maybe it’s different whole grains. Whole grains are wonderful for your gut microbiome. The same thing with all the different root vegetables and leafy greens. Each different species has a different biochemical profile that then feeds different types of bacteria.

BWW 154 | Healing The Gut
Healing The Gut: Whole grains are wonderful for your gut.


I’m mind blown thinking about I have all these organisms and you have all these organisms living inside of our body. We’re a walking host for millions of other little species.

We’re a galaxy.

It’s a science project. It’s a little uncomfortable, but we have to take that responsibility if we’re going to feel well.

If anything, it inspires you to be a little more environmentally conscious. Compost and a little garden are better. Also, soil mitigation practices. Probiotics come from the soil, food, and air. Paint the picture. What’s your role in it?

It’s a big role. Even before you have your baby, what you put in your body and how you’re regulating your stress, I guess it’s a cliché, but it’s a cycle of life. We are our own environment and we are responsible for furthering the health of ourselves, our families, and things like that. One thing I wanted to comment specifically on because I’ve had a history with these.

Selfishly, I wanted you to comment on SIBO, candida, and sugar addiction. Let’s talk about sugar addiction because sugar is in everything in the US diet. I will tell you and everyone listening, this is nemesis. I think I’ve heard and read that sugar may be more addictive than heroin. I don’t know if that is true or not but when I’m off sugar, I go off for long periods of time and then I feel amazing. You can be literally like someone’s like, “You have some sugarless gum,” and then I’m off the wagon. I have to literally find ways to get rid of sugar. Can you talk about SIBO, candida, and sugar addiction for us?

SIBO is separate from candida. Candida is a yeast that loves sugar. Kombucha, for example, is a probiotic food that uses SCOBY. SCOBY is the name for the big mother mushroom that lives at the top of the jar. You have to feed it cane sugar in order for the SCOBY to live. That’s food for the SCOBY. A lot of kombucha is fermented sugar. The species of the Saccharomyces boulardii is proven to be a beneficial organism to be consumed in a drinkable way. It’s highly regulative for our co-creative regulation. It’s beneficial for our immune system to be consuming probiotic foods as part of our life.

SIBO is Small Intestinal Bacterial Overgrowth, and that is a couple of things. The digestive environment in the stomach should be acidic. I have a hard time buying into any major health benefit from drinking alkaline. Water typically is pretty alkaline, but when they make it a pH of nine, I think that probably isn’t doing your body any justice because you want an acidic environment in the stomach. Stomach acid regulates the growth of bacteria from your stomach into your upper small intestine. It needs to be acidic because you don’t need colon bugs growing in your small bowel. That’s what SIBO is.

There are different ways to test for SIBO. Usually, it’s a breath test or things like that, but essentially, it’s bacteria that normally wouldn’t grow in the upper gut. It’s growing in high enough volumes when you eat something like carbohydrates or sugar. Not all carbs are bad. Carrots are a type of carbohydrate. A sweet potato is a type of carbohydrate, but what happens is so many people eat the same thing every day. I see it a lot. We’re conditioned. We’re all creatures of habit, but you can get this bloating.

Whenever the bowel stretches, that’s when you get belly pain. If you were to cut the intestine, you wouldn’t feel it, but if it bloats and stretches, you feel it significantly. That’s what SIBO is. You can take antibiotics but antibiotics have a negative effect, which is they also hurt other beneficial species in the gut of the same type. I don’t think antibiotics are always wise unless you’re correcting the underlying conditions. You need an acid in the stomach.

You also need healthy peristalsis. These are all general surgery terms or gastroenterology terms. Peristalsis is the forward propelling mechanism from mouth to anus. It’s hormonally regulated as well. We have a circadian rhythm. It’s conditioned on fiber. It’s conditioned on water and hydration. It’s also conditional on minerals like magnesium. It is one of the simplest. You can get it over the counter, but it’s a mineral that helps the bowels empty and contract.

If we have a forward-flowing river with a healthy enough acid in the stomach, the likelihood of you getting SIBO is pretty low. You want to make sure that those underlying conditions are corrected before you start considering treatments. In my line of work, we often prescribe people pain medicine after surgery. Narcotic pain medicine dramatically slows down the rate at which your bowels empty. There have been studies suggesting that two weeks on a chronic opiate can cause SIBO.

There’s also been evidence that two weeks on an antacid can cause SIBO. The acid and the forward flow, you want to restore those mechanisms. It comes down to being in a parasympathetic state just by sitting down and smelling our food, orienting yourself with your eyes to your environment that it is safe to eat. Not everybody has to be this dialed in, but you want to make sure that you’re not eating while you’re all stressed and ramped up, late to work, running around, or whatever it might be. By getting your body in a state where it’s ready to receive food, chewing your food well enough, and letting your spit in your digestive enzymes and your mouth start mixing with the food, you’re going to prime your body for getting enough blood flow and hormonal stimulus to make digestion work for you.

Make sure you're not eating while you're all stressed and ramped up. Share on X

That’s helpful. A lot of working women, moms, not moms, caregivers, or whatever, I can’t tell you how many times I have been eating in my car or eating standing up or eating on the run because I’m starving. I haven’t eaten and I’m stressed. I was asking about this because I’ve had all of these. Everybody, you’re not alone if you have had SIBO or if you’ve had constipation, diarrhea, or anything.

Who knew that we were going to talk about all these digestive things on our show? I think it’s important because how can we be brave women at work or how can we take bolder action if we don’t feel good or if we’re not feeling well? I think this is important to talk about. Before we move off of these, can you talk to me about sugar addiction? I’m going to be vulnerable here. How can I break this more long-term because it is so addictive?

It’s very addictive. I’ll be vulnerable with you, Jen. Sugar is one of those things where especially the more I start to understand about nutrition and I know it’s terrible for you, but there’s also so much joy that you get from eating it. I noticed myself, I don’t know if I was trying to be a good example or trying to make it off limits, but there was this part of me that would then eat it in secret or make sure that nobody could see me. I would then feel such shame and guilt.

However, I’ll tell you, every time I eat a little bit, there’s this automatic feeling I get in my brain, which is almost on autopilot telling me to go have more. I think it’s that mechanism of the addiction. The sugar thing is interesting and it creates a lot of negative feelings in my body. Not only from the actual sugar perspective but also from that emotional weight and that logic. There’s a belief, a mindset, and a logic of what I should be doing or what I shouldn’t be doing. There’s too much going on there.

It came across the word assisis and it’s what people do in Lent. I’m not particularly a religious person but I find this overlapping of ancient old cultural religious practices like fasting. I find the context of those things refreshing. The assisis is a spiritual commitment to go without something, hoping that spiritually you’re going to invite something bigger and bolder to come in.

A little while ago, I did that with sugar. I’ll tell you what, it was the first time in my life that I went above myself to ask for support in getting rid of something. As I was experiencing this detachment from sugar, I was still experiencing like, “I’m having a craving for sugar.” I’d have to sit down and be like, “What is missing?”

Oftentimes for me, what would come up, and this is what comes back to the whole me eating sugar in private anyway or me eating more than I knew that my body needed, but I was being too strict with myself. I wasn’t giving myself enough self-love. I was being too judgmental of myself. By me being too judgmental on myself, it was detrimental and others around me would feel judged by me just by me not even eating the sugar. I’m like, “Damn it. I can’t win.”

My husband had a birthday. My daughter had a birthday. There’s a certain cultural expectation that when birthdays come, you celebrate with something sweet. I went about 2 or 3 months before I had my first bite and I’ll tell you, there was something so genuinely sweet about that conscious choice to celebrate that moment with the presence of my family and to do it. My husband had a birthday and he watched the Chef’s Table. We were in Bali and he wanted to go to the chef’s restaurant. He’s a dessert pastry chef from New York who moved to Bali. Everything is farmed there on-site. It was a sixteen-course dinner and eight of those courses were desserts.

It’s not like you’re eating candy bars. You’re eating it vanilla, passion fruit, mango, and banana. It was very tastefully done and everything was very small. The meal went on for four hours. It was a classic experience and Balinese prices too, which was great. We did that and reflecting on this thing, I realized that there’s this internal dialogue of being too strict and not allowing yourself to feel self-loved and self-worth. Also, this addiction thing that comes up with sugar.

I came full circle and now, I’m at the point where I’m trying to be conscious of when, why, and how I say yes. I allow myself to feel enough self-love and lack of perfectionism because I find that in a lot of the obese population, and this has been well-documented, healthcare has a way of labeling and creating sociocultural norms of lack of self-discipline, which we all have that, but it imprints on us.

As soon as we tell ourselves that we can’t have something, there’s an inner rebellion just like our children do against us as parents which is, “They told me not to do that. I’m going to do it.” In the realm of sugar, we can understand that it promotes yeast overgrowth. Yes, it promotes such a strong dopamine release that we want more, but how do we learn to live in balance with it? I agree. Halloween just came up. There’s candy in our house. It’s something that we need to learn and navigate for ourselves.

Where do we have peace? Do we have enough self-love and compassion? Are we saying yes when yes works for us? Can we stop when stopping works for us? At the end of the day, we also need to trust our own intuition and the vulnerability of emotional eating. If you want a bunch of sugar, but you keep telling yourself no, at some point, you’re going to cave and do it anyway. What’s the harm in leaning in, going to the depth of your deep dark cave, feeling that, and then coming out?

It’s okay, but I think if we don’t allow ourselves the full depth of that emotional experience because sugar is also one of those emotional things. It’s a soul food. It’s a comfort food. It’s a treat. It’s associated with so many emotions. Sugar is tricky and there’s no right or wrong way to do it. It’s something you have to lean in. It’s a little bit of shadow work. It definitely has been a shadow-work piece for me.

Sugar is a soul food. It's a comfort food. It's a treat associated with so many emotions. Share on X

What was the spiritual practice you did to go into sugar?

It’s assisis. It means going without. You can do it with anything. You can do with your social media addiction. You can do it with anything but it’s a gentle practice of going without so that you can spiritually attract something else. It’s what you do with lent. I’m not a Catholic but I’ve always found that practice of like, “For six weeks, can we go without something?” It’s a self-reflective process. As I said, I went longer than six weeks without it, but then it became these other things. That’s where I was like, “Self-love. I’m critical of myself. I’m my own worst critic. Here we go.”

I appreciate you jumping in the vulnerable pool with me on this because I struggle with it, but you taught me something, and for so many of us at Brave Women at Work, we could be black-and-white thinkers, perfectionists, or recovering perfectionists. I’m here thinking as I’ve eaten too much post-Halloween candy, I’m like, “I have to go completely off.”

What you’re saying is, “No. You have to find what works for you.” You have to go into the why of why you’re looking towards sugar. As you said, maybe I’m being too hard on myself or I’m being too perfectionistic or I need to give myself more love. I like that. You’re tying it full circle to everything from self-love to compassion for ourselves and to how we feel. It’s not just about what we eat. Thank you for talking to me about some sugar.

Sugar is a slippery slope. You have one bite and you’re like, “I need more.” Something else I reflected on my sugar thing is I grew up with two brothers. If something sweet was in the house, you were racing them to make sure you had your share to make sure it was fair. I was like, “That’s interesting.” I think we have programmed ourselves to think that sugar is a scarce resource or at least, I did. It’s so good and everybody wants it.

However, what I’ve realized too is I have two young children. I work in a collaborative work environment and sugar is everywhere. Even if I choose not to bring in the house and get away with it, it is in my face almost every single day in some capacity. That’s because everybody loves it. The actual act of me saying I’m not eating sugar right now and then realizing that all of the people around me felt ashamed by me saying I had the willpower to say no, even that was annoying.

It makes you feel bad. For me as a people pleaser or a recovering people pleaser, I’m like, “I’m not a joiner now. I’m making them feel bad.” It’s terrible.

You want everybody to live free and live in harmony with their own choices and feel good about what they’re doing. Also, realizing my influential role in this space and the leadership role I have in it, I’m happy to get vulnerable with you. Nobody is exempt from these feelings. Sugar is what it is. It’s a choice. Sometimes we have the choice to say no. Other times we have the choice to say, “I want more.”

I hope you’re okay going here. The popular diabetes shots, I want you to comment on them because they’re so popular right now. We talk about shame. Even stars are like, “I just did with traditional diet and exercise. I’ve lost 80 pounds.” It’s hilarious. I’m wondering what are your thoughts on that? I’ve been also wondering about long-term ramifications. I’m not here to judge anyone who’s going on that drug to lose weight, but I’m also like, “What’s going to happen to you long term? Any thoughts on those drugs?

I do bariatric surgery so the weight loss operations that I do, the common public misconception is you failed it on your own. There’s this finger-pointing and almost this tabloid ramification of separatism and celebrating people who can do it on their own. What I get excited about it’s just this one more menu item. I would love to be holistic. I would love everybody to get deep down and vulnerable with their relationships just like we talked about with sugar.

What’s our real relationship with food, with soda, or with our lifestyle choices? Do you exercise? Do you not exercise? Are you not loving yourself enough that you hold food away from you like this? You restrict yourself all day and then at night time, you go hog wild because nobody is watching. I’ve seen it all, and all I can say is we’re all vulnerable to the human life experience. Food and our lifestyle choices, there are a lot of genetic components to obesity or being overweight.

There are also some simple things. Ten pounds of weight gain per year over ten years, now you’re 100 pounds overweight, but because there’s this body weight or almost what we call a body weight set-point. This is a philosophical talking point. How true it is or not can be debated but it’s like for every amount of weight gain a person has above their physiologic normal, healthy, or where they move the easiest, where they don’t have high blood pressure, where they don’t have diabetes, or where they don’t have metabolic dysfunction.

Whatever that weight is for you, the heavier we get the body, and the longer we’re at that body weight, the harder it is to lose it just around the board. There’s a weight loss resistance that builds in. It’s definitely easier to gain than it is to lose. Medicines like the GLP-1 agonist operate on the same hormonal mechanism that my bariatric surgery does. Does it work? Yes. What it does is it helps your body feel satisfied.

When your body feels fed and granted, you can do this by eating the right kinds of food. Eating enough protein regularly throughout the day helps women not reach a certain stress response. It’s beneficial for women to eat protein regularly throughout the day. It helps stabilize our blood sugar. We’re not chasing these other quick fixes like more coffee and sugar.

Eating protein consistently throughout the day naturally helps us have this satisfied, not hungry, and not stressed feeling in the body, but that’s what these medicines do. They also slow down the rate at which the stomach empties. This is one potential. This has not been looked at yet. Are these medicines going to promote SIBO because they’re slowing down the rate at which the river empties? Maybe. That’s a question mark for me.

BWW 154 | Healing The Gut
Healing The Gut: Eating protein consistently throughout the day naturally helps us feel satisfied, not hungry nor stressed, but it’s what these horrific medicines also do. They slow down the rate at which the stomach empties.


I’ve heard so many success stories without even needing much dietary education. Because people feel less hungry and more satisfied, they’re naturally eating less. Here is where medicine is being a quick fix. This is where a lot of times too bariatric surgery gets mistyped or mischaracterized as a quick fix. That is because the hormonal effect of these surgeries right after surgery lets a person feel satisfied with much less food.

There we go. Calories in and calories out on much less dietary intake, yes, you’re going to have rapid weight loss. The long-term side effects of these medicines are still questionable. We’ve had people with delayed stomach emptying, nausea, and constipation. It depends and it’s very individual. How long a person can take medicines is questionable as well.

Type 2 diabetes patients take a slightly lower dose. They seem to be doing fine. These medicines have been on the market for at least 5 or 7 years for them. We’re at the tip of the iceberg. Where I come at it from is it’s one more thing on the menu of options to help people maintain a healthy body weight. We also have to take into consideration why we shame or judge people for not being at a healthy body weight anyway. What is the psychological, emotional, and behavioral impact of those beliefs? Is it a quick cure-all for everything? No, but it is a good tool just like bariatric surgery is a good tool.

It’s a couple of tools. You have your toolbox of how you can maintain health and it’s just one other. I like that you’re also cautioning that we don’t know what the long-term ramifications are because it’s pretty new for this purpose of weight loss.

What’s nice about a medication like that is it’s a once-weekly injection. If somebody were to feel side effects from it where they didn’t want to continue it, they just stopped it. Whereas bariatric surgery is a more permanent thing. What I get excited about is bariatric surgery, while almost everybody has a wonderful result in the first 1 to 2 years, weight regain if they haven’t mastered these lifestyle aspects of exercise and portion control or saying no to all the easy-to-consume sugars, drinks, and coffees, weight regain after bariatric surgery is very possible in this environment of America that we live in.

Now, we have one more tool. It’s so much safer and far more effective to put somebody who’s already had bariatric surgery on one of these medications to help them maintain a lower body weight than it is to offer them a more drastic weight loss surgery. You only get one good shot at a weight loss operation. I like these medications. I’m here to promote them. It’s all a tool but I think whenever somebody wants to take that leap, hopefully, what comes first the chicken or the egg?

Do they want to start losing weight and feeling good about themselves from that perspective to then have more of a foundation of, “This is what healthy eating looks like,” or do they want to start healthy eating first? A lot of times what happens is the black-and-white thinker. We like success and we want to feel it. Sometimes we can be doing all the right things, but it’s harder to get in that calorie deficit and still feel satisfied. By using the medication and the nutritional counseling, I understand the psychology of humans, but let’s try our best as people not to poo-poo one way or the other but support people for the choices that they make.

Let's try our best as people to support people for the choices that they make. Share on X

I could talk to you for days. I have to have you back on as you keep expanding your work. It’s so good. I love to ask every one of my guests and you will be no different. I want to know what you believe are 1 to 2 ways that women can be braver at work now.

Let’s go back to the chakra language. I think women have an uncanny ability to be empathic with one another and with their teams. There comes the ability to tune into the power of your own heart and then also be the vocal connector of heart-centered leadership. I would say heart and throat linking the two together in some regard, but with that comes, and this is where I’m like, “I’m such a shadow work person,” releasing our false masculinity.

Women have an uncanny ability to be empathic with one another. Women can tune into the power of their hearts. Share on X

Everyone, just hang with us. We’re going a little long but yes. I’ve shared this many times, but I think it’s appropriate to reshare it here. I grew up in my career in the investment services industry and that’s a very male-dominated industry. I had a colleague mainly with men and a couple of female financial advisors, but there was one in particular that I was always so proud of because I could hang with the boys. He said, “Pestikas, working with you is so awesome. It’s like working with a dude.”

I was so proud of it. When I started getting into this work with women and women’s empowerment and all the stuff that I do, I was like, “I was contorting myself into what you’re calling that false masculinity so much so that I confused my own sex. Other people were confused about how I moved through the world.” I’ve had to decondition myself. How’s that for an example, Dr. Erika?

That’s absolutely perfect. In your position of promoting female executive leadership, the more that I think women can decondition what is men or a masculine way. It doesn’t mean that we’re not masculine and feminine within ourselves but there becomes a chasing or a conditioning. I notice that for me, it comes up as aggressive communication. I can be direct and I don’t need to apologize for my directness, but there are also different expectations on women and different expectations on women as leaders. I’m doing all the same things.

You keep expanding your work and I’ll be like, “Part two.” You keep going. How can women find you and all of your great work online?

I have exclusively dialed myself back. I’m such a multi-passionate person that I had to get more focused in order to feel productive at the end of the day. ArtOfBariatrics.com is my online business for serving people with obesity before and after bariatric surgery. I know there are plenty of female executives who have either considered bariatric surgery or have done it. It’s a very growing field. I am podcasting like crazy to try to show the kindness and compassion that my brand has, but know that we are here to support anyone who needs this catered holistic approach.

There’s the surgery which is great, and in my male-dominated field, if somebody has “failed” weight loss surgery, there are plenty of doctors out there that will sign you up to make everything tighter, but there is zero ounce of literature that suggests that it’s been beneficial. That’s why I’m excited about the menu options. Yes, to these medications, but we’re here to help develop this co-creative internal feminine-inspired relationship between you and your microorganisms and between you and your nervous system so that you can feel healthy.

We believe in health at every size but at the same time, we have a lot of smart and well-educated people who know how to help you lose weight as well. Whether you’re trying to cure gut problems after bariatric surgery or get back on track or you want to collaborative supportive environment that maybe you didn’t get in your clinic, we are the program for you. Anybody who listens to our podcast gets a discount code of PODCAST20 off of any of our services. We do one-on-one coaching programs. We also do group-based nutrition programs. Nutrition is a part of everything because when we’re taking good care of ourselves, nutrition matters as well.

Thank you so much for that generous offer. I love what you’re doing in the world. I think it’s so empowering and inspiring. Thank you so much for being on. We’ll keep in touch and I’ll have you on again.

Sounds good. Thank you so much, Jen. You have a wonderful day.

That does it for my discussion with Dr. Erika. I hope you found our conversation both valuable and inspiring. As a reminder, please rate, review, and subscribe to the podcast on Apple Podcasts and Spotify. The show is also available on Google Podcasts or any other platform you enjoy. Until next time, show up, heal your gut, and be brave.


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About Dr. Erika La Vella

BWW 154 | Healing The GutDr. Erika La Vella, DO, FASMBS is a board-certified weight loss surgeon practicing in Oregon. She attended the University of Idaho where she studied nutrition and psychology and then went to medical school at Pacific Northwest University.

Dr. Erika a board-certified metabolic surgeon, wife, and mother who is passionate about health in the most preventative and holistic ways.

Through staying up to date with the latest research and healing her own gut, Erika has become an expert in the Gut-Brain-Axis and am passionate about teaching others the impact they have over their own health.

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