129 - Preventing Chemotherapy-induced Diarrhoea with Jason Hawrelak & Erin O’Meara

The amount of research that's grown in cancer and a bunch of other areas is just, it's just huge. And that it's really going to be a key component, should be and will be a key component of how we address Alzheimer's disease, you know, obesity, type 2 diabetes, cancer. All these different things we're seeing all around us in Western nations. All have a microbiome driver.

Welcome to the Radical Health Rebel podcast. I'm your host, Lee Brandon. This work started for me several decades ago when I started to see the impact I could make on people, helping them to identify the root cause of their health problems. Problems that no doctor could figure out, including serious back, knee, shoulder and neck injuries, acne and eczema issues, severe gut health problems, even helping couples get pregnant after several IVF treatments had failed. And it really moves me to be able to help people in this way. And that is why I do what I do and why we have this show. In this episode, I'm joined by Erin o' Meara and Jason Horlack to discuss their groundbreaking study titled Preventing Chemotherapy Induced Diarrhea and Microbiota Imbalances with Prebiotics and Probiotics in Breast Cancer Treatment. We explore how strategic use of prebiotics and probiotics can support gut health during chemotherapy, reduce side effects like diarrhea, and maintain microbiota balance during breast cancer treatment. This insightful conversation highlights the power of gut health in cancer care and offers hope for a more holistic approach to managing treatment related challenges. If you or someone you know is navigating cancer treatment, or if you're passionate about the potential microbiota based therapies, this episode is essential listening. Jason Horulek and Erin o', Meara, welcome to the Radical Health Rebel podcast. Thanks for coming on the show.

Thank you. It's a pleasure being here. Yeah.

Now it is a first for the Radical Health Rebel podcast because it's the.

First time I've had two guests to.

Interview at the same time.

So I'm quite excited about that. And not, not only do I have two guests, but two guests on completely different sides of the planet, which is also exciting. One one in Australia, one in the us, one one in hot weather, one in cold weather.

So it's great that we've been able to, you know, manage a time that's convenient for all of us to be able to have this discussion today.

To kick things off, could we perhaps I'll get each of you one at.

A time to share a little bit.

About your background, kind of including your.

Educational and professional background and also what your current position is at the moment.

So should we go. Ladies first. So, Erin, if you want to just.

Give us a little bit of background about you.

Absolutely, yeah. I am a nutritionist in Minneapolis, Minnesota, private practice and I have a master's in nutrition and Functional medicine from University of Western States, where Jason was my GI imbalances professor and where I got turned on to this way of practicing and.

Yeah, awesome, that's great.

And Jason, quick, quick intro from you.

Yeah, I'm a naturopathic physician and educator and microbiome researcher. I started by delving into the microbiome research about essentially 25 years ago now. And I studied my honors. It's a thesis or literal review from honors thesis around disposis and ibs. And I've been actively in the, the juggling the, the clinical practice and research and education really since that. That time. And as much of the passion is, is the gut microbiome and, and gut health. Yeah. So it's been. And these days I'm a, I'm a clinician. I work at the Microbiome Restoration center, which is my sort of educational institute. And I still work University of Western States as well, because I really enjoyed interaction with and educating professionals is one of the passions too, that goes hand in hand with the microbiome.

Yeah, absolutely. And for those that perhaps haven't heard, Jason has previously done an episode with myself a while back talking about small intestinal bacteria overgrowth, which has been the second most downloaded episode out of 120 odd. So it was a very popular episode. So I'm sure this is going to be just as popular. And one, one of the reasons I'm quite interested to speak to both of you, we're going to come on to talk about your research paper in a moment is because, you know, like, like you, Jason, I'm, I'm very interested in, in the gut and the gut microbiome.

But interestingly, I've had a number of.

Women become clients of mine after already having treatment for breast cancer, which is quite interesting. So I guess you know, the reason why I've asked you to come on the show is really to share the results of the study that you guys did together on a treatment modality aimed at treating the gut microbiome and how it can potentially minimize or eliminate the side effects of cancer treatments on women receiving treatment for breast cancer.

But I guess before we get into the nitty gritty of the paper, I guess what I would really like to.

Know is what prompted you guys to do the study.

I reckon you're best answer this one, Aaron.

Yeah, I'll take that. Let's see. Well, full disclosure. I am the patient and authority of this paper. So, yeah, so I was regularly testing my microbiome and working on a dysbiotic gut for a few years prior to breast cancer treatment, which makes one wonder a little bit about was it a contributor. And I had worked with some clients who had been through breast cancer treatment and had seen probiotics, very specific probiotics, work really well for the quote, unquote, diarrhea drugs. So when I was diagnosed In December of 2021, I knew I had to get together a plan. I didn't know right away that I would need chemotherapy, but I knew that I would have surgery and radiation. So I knew I needed to support my microbiome and not slide backwards in my gut health. I had come so far.

Because you had the history of irritable bowel syndrome too.

I did, yes, I did, yep. Years and years.

So.

You mentioned, I think the wording you used was diarrhea drugs. Do you want to be more specific what you mean by that for the listeners?

Yeah, I had a client that called it that. She said that, oh my God, I'm going back on the diarrhea drug. And she was a stage 4 metastatic breast cancer. 10 years, 10 to 15 years she lived with that and she didn't want to do the testing. So we didn't test back then. It was kind of early on in my getting into gut health and specifically the microbiome, so we didn't test. And I think too, that kind of also shows the capacity of women going through this. It's incredibly intense. And so people's capacity for taking another test or seeing another practitioner can be kind of low. But she said, I just need help. And I know you talk about probiotics and particular probiotics and what can we do? And so then she had really good results from that and told her surgical oncologist at the, the University of Minnesota, and he adopted, you know, those two probiotics.

And.

Yeah, so that kind of started it all right there.

So just, just to clarify, when you're talking about diarrhea drugs, you're talking about chemotherapy, right?

Yeah, yeah, yeah, yeah.

So, so obviously you were the, you were the person in the study, as you said, but what was the motivation to actually make that a study?

Yeah, so I had taken a workshop years before on case reports, so that's always been on my radar. And when something kind of interesting or even, dare I say, miraculous happens. I think about writing a case report. So in my own case, I. You would do a follow up. I had four rounds of chemotherapy, and after each round later, you would go in and see a nurse, and she would go ticking boxes down a huge list of symptoms, and she would stare at her computer and say, you know, list all these things. And you'd say, yes, no. Yes, no. And we get to diarrhea. And I'd say, no. And she'd. Every single one of them would turn away from the computer and look at me and say, no, everyone has diarrhea on these drugs. And then I would say, well, do you want to know what I'm doing? And people in conventional medicine sometimes are interested, but usually not really interested what I'm doing. But anyway, so that then working closely with Patricia Kaufman, our co author on the paper on other things, we get together and discussed cases and things like that regularly. She's in California and we mentor regularly under Jason. And so it just kind of came together that, gosh, we should really write this up, because especially when I was able to. Yeah. Just able to avoid diarrhea or any backsliding on ibs, you know.

Yeah, yeah. So again, we'll probably come on to it, but obviously, as you were saying, you had a history of ibs and, you know, what I got from the paper is oftentimes people receive the treatment, I. E. Chemotherapy, and then it's bad enough they're dealing with cancer, they're dealing with chemotherapy, and now I've also got diarrhea to deal with as well, which, you know, has all kinds of issues in its. In its own right. So I'm guessing from what you've said is the major motivation was we need to get this information out there. More people need to know this information. Would that be right?

Absolutely. I think we could help many, many people. And outside of breast cancer as well.

Yeah, absolutely. Absolutely. Okay, so just to kind of overview again for the audience. So the study was you. So you were 57 years old at the time. You don't look 57 now, actually. So hold on. You must be doing something right.

It's my microbiome.

So as you said, you're receiving chemotherapy for breast cancer. Can you or either of you explain to the audience what are the common side effects that you discuss in the.

Paper from the chemotherapy itself?

Erin, I think you're probably best placed here.

You think so? Okay.

Well, you experienced it and you would have delved into potential.

Yeah, well, all kinds of Functional gi, you know, symptoms, but the main one is diarrhea and that's what's expected. And bloating and, and certainly when I, in the day or so following an infusion, I would have mild to moderate GI upset. You know, one of the, one of the drugs I took in the first infusion was an anti, an antibiotic, a tumor antibiotic, you know what I mean? And it's the adriamycin, they call it the red devil. And so that, that's really expected to give you diarrhea. Yeah. So diarrhea, gas, bloating, but the diarrhea can really lead to some really significant problems. And I've met women that have dealt with this. You know, they end up in the hospital because they're, they're dehydrated, their electrolytes are out, you know, they, it's just makes it not possible to tolerate the chemotherapy and sometimes the chemotherapy has to be stopped.

Yeah, I think those are great points, Aaron, because I think sometimes you go, oh, diarrhea, like it's like pooing once or twice more frequently per day. It's like it can be far more intense than that.

Yeah.

Cause significant disability and cessation of treatment, essentially, which is, you know, not what we're wanting in that situation at all. And their, you know, quality of life will go down when they're already dealing with a bunch of other things. And, and I think there's also that, you know, some people do get longer lasting gut symptoms that persist afterwards. So yeah, you get an acute diarrhea episode that, you know, might be manageable at the time when you're juggling a bunch of other things, but also not ideal. But then you might be get stuck with, you know, a dysfunctional gut for, for months afterwards too. And that's certainly something we wanted to prevent as well. That's where I think this approach of trying to protect the microbiome from harm and help encourage the beneficial microbes to regrow after these sort of very, you know, dysbiotic inducing medications is a key strategy there.

Yeah, yeah. So from what you're saying, you know, chemo causes these gastrointestinal issues. How does the chemo actually disrupt the microbiome? Do we know what the mechanism is? Is that understood?

Well, I mean, I think we know each agent will be a little bit different in this regard, but in general, what we see is a overgrowth of more pathogenic bacteria, particularly Proteobacteria, and a reduction of beneficial bacteria that would include butyrate producing species, bifidobacteria and overall diversity. So you'd see it essentially having an antibiotic like effect in terms of this microbiome and selectively for killing good bacteria and increasing levels of bad bacteria, which is not uncommon with antibiotic use as well for that matter. Yeah, so that's kind of the impact on the microbiome is that, and then we will see increased inflammation that occur because some of the proteobacteria we know tend to have very pro inflammatory endotoxin in their, their cell wall which will increase gut inflammation. And at the same time we're taking away sort of the protective anti inflammatory species like bifid bacteria are those that make butyrate which, which essentially will, you know, impact the peeling of the gut cells to heal. Because that's the other thing too is that you know, chemotherapy kills fast growing cells and that and some of the fastest growing cells in the body are obviously cancer cells. But beyond that it's got cells and immune cells and those are the areas that tend to be more, more severely impacted by chemotherapy. And at the same time they're killing, killing the bacter is to heal the damaged gut because I think we sometimes forget this how vital the microbiome and particularly beatrite producing bacteria are for healthy colonocytes. You know, we know that 70% of the energy needs of colonocytes are met from bacterial byproducts, short hats and b made. You know, essentially it's the bacteria that are feeding and nurturing those colon cells. And if we're, we're smashing down those bacteria at the same time killing those cells, it's not a, that's where we get these sort of side effects. So we're, you know, really trying to create an intervention that would limit both those things of going, okay, can we speed up the healing of, of the gut itself and can we you know, protect the mic those protective species in the microbiome and help regenerate them more quickly after the, you know, chemotherapy sort of insult.

Yeah, I mean, you know, I'm sure a lot of people believe that, you know, all health or you could say all disease starts in the gut. Right. So the last thing you want.

I'm in that camp.

Yeah, absolutely. But you know, when you think again, you've got cancer, you've got the chemotherapy, the last thing you want is your gut not performing at its best. Because as you say, you know, that's, that's what's going to help you heal at the end of the day. So if you can negate any of the negative aspects of the treatment, that's only got to be a positive thing, right?

Absolutely.

Yeah. And it is interesting looking at the broader microbiome and cancer field, and I think this area is truly starting to boom now. And I think this will bring the microbiome on the radar of current clinicians who don't. Where it's not. And I think it's. You have to get your head in the sand for it not to be the case. But truly, there's still people out there who don't think acrobatic matters, don't think there's any. It's too early to do anything about it yet. So just. We'll ignore it for 20 years until enough research builds up. But I think some of the research around how, you know, the microbiotic, it's been as like a driver of cancer development, how the composition actually can modulate treatment efficacy. And this is very clear in maybe not so much research yet in breast cancer, but in melanoma like skin cancer. It's immensely clear from the research that the competition of your microbiome at baseline, when you start treatment, can dictate whether you respond or not to immunotherapy approaches. You can get zero efficacy if you've got a Bacteroides dominated ecosystem versus 67% efficacy if you've got a Faecali bacterium dominated. It's dramatic a difference in outcomes. And I think that will. That research is going to spread beyond just like the skin cancer area to looking at, you know, it's already there in the colorectal cancer area too. And. But to move towards breast cancer too, where we're looking. Okay, this microbiotic composition impact how you respond to these agents that we're using. You know, and our focus here was really on twofold, was to protect the microbiome from harm and protect against getting side effects. That would typically be the case and restore the use afterwards, you know, but there's even focus on. On how we can reduce chances of cancer recurrence by altering the microbiome too. Because there's just certain bacterial species that seem to play key roles in cancer progression that we're really delving into in greater detail in the last 10 years.

Yeah, I mean, that sounds like music to my ears. That's being looked at as an approach, you know, for. For treating cancer. Again, if you think all disease starts in the gut, why would you not start there with the. With the treatment protocol? And also if you compare the potential side effects of, you know, what might be called conventional treatment versus that kind of treatment, which I mean, the side effects are normally positive anyway, if there are any. Right. So that makes, that makes a lot of sense to me. So let's fingers crossed that that research is allowed to happen because I know there's some vested interests that might not want that to happen. So yeah, fingers crossed that does continue. So we've mentioned. So people go on chemotherapy, it has a antibiotic like effect, it causes issues like diarrhea. What are some of the standard treatments for things like diarrhea? When someone with breast cancer has diarrhea, you know, because of the chemotherapy, what treatments are normally given and what are the knock on effects of those treatments?

When 35 year old Amanda first scheduled to see me, she'd been suffering for 19 years from severe IBS, diarrhea and faecal incontinence along with abdominal pain and bloating. Her condition had not only made life uncomfortable for Amanda, but, but very inconvenient as she had to walk two hours to work every day along a route that had public toilets. And she'd never been on holiday as an adult because of her condition. The only advice that several doctors and specialists had given Amanda was to take Imodium. And when she first saw me, she was taking five Imodium a day and wasn't getting any better. To help Amanda, I ran tests to find out what foods were right for her metabolic type, to see which foods she was sensitive to and to assess her gut microbiome. Tests showed that Amanda had several food sensitivities and a parasite infection. Over the coming weeks, I coached Amanda to eat right of her type and to replace the food she was sensitive to and a protocol to deal with her parasite infection. And after three months, Amanda was IBS free. And she also reported her skin was much improved and she had lost weight. And she booked a holiday for her and her husband to New York as they'd never been on a proper honeymoon because of her ibs. And if you're suffering like Amanda was and you want to get to the root cause of your problem, you can arrange a consultation with me at www.bodycheck.co.uk and if we're a good fit, I could help you achieve the same kind of results as Amanda. Now back to the podcast.

Yeah, the only thing I was offered was anti diarrheal medicine and that has the side effects of slowing down motility. And with that could, could come a rise in proteobacteria and more dysbiosis. Yeah, so that was the only thing that was offered and I knew I Didn't want to take that because it felt like a band aid. That wasn't getting at. No, yeah. Really? It wasn't supporting me. It was.

Yeah, yeah, yeah. I guess not fixing the underlying dysbotic changes or gut damage that's caused the diarrhea. Stopping, you know, diarrhea.

Yeah.

It can't be a type way.

Yeah. And the other thing, I guess, you know, again, if someone's got cancer, the last thing you want to do is stop toxins being released through. Through the colon. Right. Because obviously, if you're holding on to more stuff and now you're becoming constipated, your body's going to be holding on to toxins, which, you know, I would imagine. I'm no oncologist, but I would imagine that would not be a favorable thing for someone that has cancer or just been treated for cancer.

Yeah, yeah, yeah, yeah, that's right. I think if it. If it actually did have the end result of not pooing at all and really, really slowing down the gut, which is obviously from a symptomatic. Okay, you don't have diarrhea now.

That's.

That's an improvement. But if it stops things from moving at all, you will be reabsorbing, you know, bacterial toxins that are released and potentially, you know, environment toxins, too, that your body's trying to get rid of through that way. And even your hormones might be altered by that process, too, because we know the longer fecal matter sits in the colon, the more it sort of interacts with bacteria and the more sort of, you know, you'd argue, toxins are produced and. Or released in that process just because of. Greater chance of bacterial enzymes like beta glucuronidase to play a role in that, for example, or greater chance for endotoxins to be absorbed, which, again, as you noted, neither of which is particularly going to be helpful overall for that person's health.

Yeah. One thing I think would be quite useful for the audience is if you could perhaps give an overview of how you actually did the study. If you could just break it down. Now, obviously, we know.

We now know.

I didn't know, but I now know the participant was you, Erin. But if you could just break down, like, almost like a timeline of kind of what you did and what was found.

Okay. Well, so we realized partway into my chemotherapy that maybe we'd want to do a case report. So it's really kind of a retrospective putting together of the past events. Right. Because you've noticed something. Something cool. Has happened. And you want to go back and say, what did we do? And luckily, I keep good notes about, you know, and test my microbiome regularly. So we had that data. Right. And so then I guess we just, you know, we started to dive into the literature to. Well, we knew. We knew as clinicians and researchers that when we chose the different remedies that they took, you know, that they had the evidence behind them to. To support what we were trying to do. But. But we went and compiled all that together and wrote it up.

And so if I could. If I could just take you back. So I'm just thinking back to when I read the paper. The first thing was you did a series of tests at the beginning.

There were three tests over time. Yeah.

So, yeah. And can you explain what you did in between each test and kind of what the results were of each test?

Yeah, yeah. Okay. Yeah. So I had a baseline test that I took in April of 2021, diagnosed again in December. So a little bit before. Before heading into treatment, surgeries that I started with. And what were the results, you want to know? Like, butyrate producers were at like 35%, so a good. A good number. Proteobacteria.

So. So for the. So for the audience, let's just say beneficial bacteria.

Yeah. The short chain fatty acid producers, the butyrate producers were at a good level. And my pathogenic bacteria was well within a healthy range. Bifidobacteria was below kind of like where we like to see it at that point. And I can tell you kind of how that went over time. Diversity was pretty good. Okay. I've had a lot of antibiotics in my lifetime, so my diversity is something that I'm always time to work on, you know, and I'm only. Only able to work with what I've got. Right. But we really wanted to support.

Yeah.

So then kind of timeline. Diagnosed lumpectomy surgery, another surgery to get good margins, a surgery to place the port, the chemotherapy port. And then we retested before I started chemotherapy, but after those surgeries.

So what was the. Sorry, what was. What was the time gap between those.

That was too tough. Almost a year. And this is a limitation of the study. Right. Like, it would be really great if we had started it just before surgery and maybe done one between each surgery and. And not just surgery, but the stress of a cancer diagnosis is huge. And stress, we know, is a huge factor in gut health, Right? Yeah.

Yeah, yeah, yeah.

And I think the reality of trying to implant more, you know, when you're Dealing with. You just got that diagnosis and you're like fast tracking. Exactly, exactly right at this juncture of time. In hindsight, sure. But in the real time, you know, it's just like we're lucky that we just had one that was, you know, not too far apart. You hadn't really changed your diet or lifestyle. So we would expect my hormone to stay pretty similar up until the point where you got the diagnostic label placed and then that's where things are going to change. I agree. Like, geez, that's one of the most stressful things you can ever be.

Yeah.

Here is given the C word diagnosis that, and that inevitably will have impacts, let alone the, you know, the surgeries and antibody exposure during surgery too.

Yeah, for sure.

Yeah.

So In March of 2022, just before chemo, I tested again and those butyrate producing bacteria had cut about in half, less than half, and proteobacteria had about doubled. And bifidobacteria interestingly went way up. But I, I believe that that's because of the lack the bifidogenic effects of. Yeah.

Affects the prebiotics.

Prebiotics on the.

Okay, so can you, can you. So when did you start taking anything like prebiotics and probiotics? At what point?

Yeah, so even in April of 2021 and before diagnosis I was probably taking, you know, a maintenance kind of a dose of some pre and probiotics, probably phgg and yeah, maybe LGG or something like that for probiotic. But then in, in January we were like, oh gosh, you know, let's kick up the lactulose. And because of my IBS in the past, lactulose was a really hard one to ramp up for me, but I pushed through it and it's had really, really good effects on shifting my entire ecosystem, but then also quite a bit. And so that was interesting. Then I tested again in August of 2022, had the four rounds of chemotherapy and radiation therapy by the time I, I did that, that last test and with the pre and probiotics and lifestyle, you know, Mediterranean diet and everything, the butyrate producers really ended about the same place that they had started. And proteobacteria had. Yeah, yeah, which is great. And protobacteria had, is, was lower than, than my baseline and bifidobacteria was up, not as high up as when I had first started the lactulose, but, but higher than baseline and diversity did not quite make it to baseline, but did bounce up again from March to August and I did the testing about. I should have looked at this. I could look at the timeline. I want to say it was about four to six weeks after I finished radiation treatment. I tested again.

Okay.

Yeah, yeah, yeah. So I guess, you know, had you not have been using the prebiotics, you would probably have expected much worse results from the final stool test, right? I don't know. I mean, I've never seen. I've seen a stool test from someone that's just had chemotherapy. Have you guys seen that before?

We cover some of the literature in the paper itself, but you tend to have decreases in bacteria diversity B, reproducing microbes and at the same time blooms of proteobacteria. Yeah, so some of those things were expected, but I do think that we. It was definitely blunted because the increase in Proteobacteria might sound like a lot. It actually was actually relatively small speaking compared to what you would often often see. Yeah, yeah. And that's where I think Lashless has got this amazing capacity to reduce overgrowth of Proteobacteria and prevent the over particularly through its capacity of acidifying the colon. Yeah. And there's nothing, no agent we're aware of that can acidify the colon to the same degree as lactulose. And I think that is really how it works so well at preventing and reducing overgrowth of Proteobacteria. Like, and for those of you who are less familiar with the Protobacteria phylum, and it's a broad phylum, which means that there's like lots of different microbes in there, but you'd be familiar with the ones that are problematic are in the, the Enterobacteraceae grouping. And that's like, you know, E. Coli, Ashwischia Klebsiella, Haemophilus, Citrobacter Clivera, Enterobacter are common ones that kind of bloom in that situation. And they're. Their endotoxin is just that they're growing in this cell wall is immensely pro inflammatory. Many of them also produce colibactin, an actual genotoxic agent that can cause gut damage too. You know, so I think they, they are definitely core contributors to, to that kind of the symptoms we see after, after chemotherapy because they're, they're sort of, you know, pro inflammatory gut damaging potential.

Yeah. So, so you're saying lactulose is, you know, really useful in that situation. Lactulose is prescription only, isn't it?

And it. And in going to conventional medicine practitioners and saying I want lactulose to avoid diarrhea. Might be a little counterintuitive. Right. Because they think of it as this age old remedy for constipation. But I have a lovely primary care doc who's integrative medicine practitioner and she's prescribed it for me.

Yeah, it's interesting because I think it's often prescribed for the treatment of hepatic encephalopathy, like end stage liver disease and conventional medicine too. They're like, why, why would you want that substance? But they never really quite clicked that the reason it worked is it reduces levels of toxic bacteria in the colon and prevents the release of brain inflammatory compounds. That's how it works for antibiotic and cephalopy. So it's like, it's, it's always worked for these gut things but it's just never really clue that this is what, that's why people are taking it for. Yeah. And the dose, dose is very different. You know, we're trying to treat constipation, it's like 30, 40 milliliters in one hit, whereas the prebiotic dose is like, you know, the minimum product dose of 1 teaspoon, so 5 milliliters, so far less than that. And you know, and people are often surprised to know that last year this was, was once added to formula, ancient formula, you know, was the first sort of prebiotic additive formula back in the 1960s I think it was. And it prevented or encouraged a more normal sort of microbiome in those babies compared to normal formula because it's kind of got us a drug kind of feel about it in the US because of the way it's classified. Whereas I think every other country in the world is not a prescription drug. And you can buy it at any sort of drugstore, chemist, pharmacy, but it is offering that in the laxative section. So it does require a bit of an explainer of why before my shop started selling, as I would have to tell my patients, go to the chemist pharmacy to buy it and you have to go to the laxative section but ignore all separate laxatives. You know, this is dose you take, etc. And take a lot of explanation to get their head around why, because they're kind of aspiring sometimes using it off label because the main reason it's promoted in most countries is not as a prebiotic but as a laxative agent. And it's very effective as such as an osmotic laxative in larger doses. But in the smaller doses you just have that really amazing capacity of encouraging bifidobacteria specifically, but also important gut microbes like Faecalibacterium prosnitzii. For most of us, our key B rate producing microbe will go up with lactose ingestion. And you have those reductions in those more problematic species like the Proteobacteria I mentioned before, but also Bacteroides as well. And Bacteroides is one of those genus we consider to be a pathobiont that larger amounts are problematic, small amounts are okay. But we know that there's Bacteroides fragilis, that one specific species in that genus that does seem to have, you know, I would argue pro cancer type type impacts too. And through its production of bacterous toxin, which is clearly tied in with, you know, colorectal cancer and other cancers too. It's a really. And even Alzheimer's disease too. It's a really probatic toxin. So lactose does have that capacity of decreasing Bacteroides populations too, which is an added bonus.

Yeah, interesting. So we've spoken a bit about prebiotics. I don't think we've spoken too much about probiotics yet, have we? Do you want to explain what you used in terms of probiotics?

Sure. So we very carefully chose specific probiotic strains to support my gut through chemotherapy. So lap bacillus, rhamnosis, LGG or gg, I guess. And would you like to know, like, why we chose that? I guess that's supposed to help increase epithelial cell synthesis and to help with gut healing, increase diversity and to keep those pathogenic bugs down. And then we also used Saccharomyces boulardii and a particular strain that Jason can probably rattle off, but I don't have on the tip of my tongue. Anyway, that CNCMI 745 and that one is known to increase antibiotic associated diarrhea, keep pathogenic bacteria down again to keep inflammation down and to also increase the activity of the brush border enzymes.

That one's also pretty cool because its capacity, as it traverses through the gut, it releases these compounds called polyamines, which speed up gut healing and gut regeneration. So that's an added, added bonus. But. And also breaks down bacterial toxins. You know, it's. It's even, even endotoxin too. It creates its own alkaline phosphatase, which breaks down LPS endotoxin to. It's. It's a pretty phenomenal microbe, actually. Yeah. And very well indicated for, you know, well researched antibiotic associated diarrhea where we have, you know, meta analysis level data showing it protects against the development of symptoms and protects the microbiome and helps regenerate more quickly after that kind of insult. There's less research in chemo diarrhea with probiotics at all actually to date, so we're kind of had to extrapolate some of the stuff from the probiotics have the best evidence in antibiotic associated diarrhea. We assume we're going to work similarly with chemo because the overall impact on the microbiome is pretty similar and arguably you get more gut damage obviously with chemo than you do with antibiotics.

Yeah. So is it understood what mechanism is used? If you'd like, for want of a better phrase, by using probiotics how that helps to prevent diarrhea, is the mechanism understood?

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I mean, I suppose there's a few a few ways in which it could occur. I mean, I think, you know, reductions of overreactive pathogens would be one of those. I think in decreasing gut inflammation would be one of those as well. And potentially, as I mentioned before, sort of breaking down bacterial toxins that might be involved. Like you can look at clustered ODs, difficile diarrhea, which is what we typically see after antibiotics. Yeah. More broad, broad acting antibodies like clindamycin, for example. And it's the toxins from the, from the C. Diff that are, that are pretty problematic. And if you take the right saccharomyces, it breaks down those toxins and stops them from causing gut damage, inflammation.

Yeah.

So there's a, there's a few ways there. And potentially through their secretion of short chain fatty acids and encouraging an environment more conducive to the growth of beneficial microbes who then produce their short chain fatty acids, which again, help regulate motility.

Two. Yeah. Awesome.

Lee. Excuse me just a second. There were four other, there were four other probiotic strains we also used. And we used those just right around the infusion time and chose. Chose those for. Yeah. For their chemotherapy induced diarrhea, lowering capacity and then also bloating and diversity and again, keeping pathogenic bacteria low.

Yeah. So if I was to summarize the paper so you can, you can check my homework to make sure I've understood everything. So. And again, this is to summarize for the audience as well, just to again, make sure I've got it right, but make sure the audience understand. So basically, when women have breast cancer, they go for chemotherapy. It has an antibiotic effect on the gut microbiome that leads to a lowering of the good bacteria that allows overgrowth of the more pathogenic bacteria that creates the diarrhea. And by using prebiotics like phdg and lactulose and supplementing with specific strains of probiotics that almost negates the effects of the chemotherapy and helps to, I mean, in this case, in this study, prevent diarrhea. Would that be correct? And something that you mentioned, you mentioned it in the paper and you've mentioned one of these already today, but what limitations were there in the study and what further research would you like to see performed in this field or indeed like to perform yourself?

Do you want to take that, Jason, or. Okay, let me just take me a second to refresh my.

Well, you can, you can, you can both take a turn each.

Okay. I mean, I think, you know, again, in hindsight, like if we had kind of come up with beforehand, okay, let's put this as a case study. And they didn't have all the stress and everything else going on. You might go cable. It's do more and more frequent stool sampling at different time points to gauge impacts, you know, in more sort of smaller small time windows. That's something that I think would be interesting to do. Yeah. And I mean, I think, you know, you could argue about using a test that using shotgun metropic sequencing to go deeper into like species level changes, where we chose a inexpensive, easy to come by 16s RRNA testing because the cost points is low. Yeah. And we see accurate level at the genus level, you know, accurate data. Genus level, not so much at the species level, but genus level is very accurate. And we, and we get, you know, good picture of diversity from that tool too.

Yeah, yeah, yeah. I guess, you know, money being no object, I would guess that it would be. I mean, you don't, you don't wish that anyone gets breast cancer, but for the study, I guess a larger number would be useful, I guess. And even having a placebo control group as well would be quite good to compare the two. Would that make sense?

Yeah, yeah, I totally hear that. And I think whether, I mean, there's ethics around using placebos in certain conditions, and I would argue that this would be one of them. I mean, some other people would argue differently, but yeah, you know, where you have something that can, you know, reduce harm, reduce side effects. That is placebo ethical in that. In that situation?

Yeah.

You know. Yeah. I mean, obviously the best data that we come up that we accept as evidence comes from, you know, placebo controlled studies. But I do think there are times where we don't think that placebos are ethical. And so. Yeah, so I think the next step would be doing like a larger case series of the same sort of protocol. Um, and then you can, you can kind of go from there in terms of, you know, how much evidence is enough evidence, what sort of study designs are acceptable for. For making clinical decisions on, like, those are broad, broader questions. But if you had like, you know, 30, 40, 50 women doing the same protocol, all getting great results, then I think, okay, many clinicians will be satisfied with that. That, you know, particularly with. For me, there's. When there's no risk of harm.

Yeah.

From interventions or the risk of harm is. So it's minuscule that, that the quality evidence required showing efficacy to me can be less. Yeah. So you've got a novel agent that's never been ingested by humans before. I have no idea what the side effect profiles are like, you know, I want really good evidence that it's both safe and efficacious. Yeah. Whereas when we're like, eat a Mediterranean diet, take these prebiotics that we know are immensely safe, that I think that for me, like, a lower standard of Evidence is required for efficacy for me to implement on my patients because there's just not much risk.

Yeah, yeah.

Whereas I think when the risk level goes up, you want much higher levels of, of, of evidence of efficacy, et cetera.

Yeah, that makes sense. Yeah. I hadn't thought of the ethical point of view, but yeah, I completely agree with that.

Yeah.

There was another limitation, I guess is that the confounding factors. Right. There was a lot going on here. I took a lot of different prebiotics, I took a lot of different probiotics. I was eating a good Mediterranean diet. I was myself to exercise through most of it. When you're really hit hard with chemo, that's pretty difficult. But even walking can help with how you feel and probably motility and things like that. And I was getting a whole bunch of integrative therapies too. I was getting shiatsu and acupuncture. So there were all these different lifestyle things too that you know, in nutrition research is, can be difficult because there's just so many different. Yeah. Confounding factors.

Yeah. And how do you control for that? Do you go, hey, well you go eat a standard western diet while going on this. So we can take that adventurous out of the equation. No, of course not. Because that we know will cause harm and worsen outcomes from, from the, out from. From chemo and worsen outcomes for cancer and just overall health perspectives, you know, so some of those things are like we want all patients to do anyway, eat a, you know, a probably plant based Mediterranean diet, eating the rainbow of colors, variety of foods because that's the best arguably diet for numerous factors, you know, metabolic health and even cancer risk too, I would say. And cognitive health, but also, but microbiome health too. Yeah. So I think you're right. So that was one of the things of this paper took so long to actually get through peer review. They kept sending to more and more peer reviewers because they just couldn't understand like you just didn't do one thing. You did multiple things, like what the.

Hell.

Not just one agent. It was just like mind blowing to them that people could do this because I think they're really stuck in that model of you don't. The only thing you change is one thing. Nothing else changes. There's one thing. And you see, for us it was not about that. I was trying to get the best outcome.

Yeah.

For this person. And that requires really as a clinician you do multiple things. You know, we're doing the diet, we're doing exercise, you're Doing stuff to help manage stress movements and it's like a bunch of different things to get the best outcome for this person. So you can't say that. Okay, the outcome we had was due to specifically pre and probiotics. Sure. You know, it's due to the, the entirety of things. But I think we know that from the microbiome perspective we would argue that the key interventions there were the pre and probiotics. And it was just really important to get that information out there so that other patients don't have to suffer. The diarrhea drug can get the gut in months of, you know, IBS like symptoms afterwards if they can be prevented. And that was a good first step because that's the lovely thing about case reports is they get that information out there, they stimulate thinking, stimulate researchers, stimulate clinicians to go, ah, okay, I can implant these things. Or they're stuff we chose for stuff that were commercially available. You know, it's like stuff that everyone can access is commercially available. That's, I think the strength of our study too is we didn't use this like full on, you know, novel probiotics or novel, novel prebiotics or novel testing that no one can access. It's like every patient can access all these things we used here and achieve, you know, loose microbiome support and protective qualities of those agents.

Yeah. I guess the other thing that I'm thinking as well is that what might be really useful as well is to have some long term follow up as well. Because as we know, sadly there is a lot of reoccurrence of cancer. And if, let's say, I don't know what the figures are, but let's say on average someone might go six years cancer free, and after six years, on average the same cancer or another cancer comes back. But if continuing these protocols, 5, 10, 15, 20 years and there's no reoccurrence, it's like, well, okay, now we're onto something, right? So I think maybe that kind of long term follow up would be really.

Useful actually in talking to a surgical oncologist who's interested in doing both intervention and long term studies.

Julie, a 47 year old who works in computer sales, came to see me.

Complaining of lifelong irritable bowel syndrome which included severe abdominal pain and bloating, loose and very frequent stalls, along with hot flushes, menstrual brain fog and low energy.

Which affected her work performance.

After taking comprehensive history plus running some labs, I discovered that Julie had a parasite infection which may have been causing the Loose stools, a methane producing bacterial overgrowth that was almost certainly causing the abdominal bloating and pain, a leaky gut, low levels of digestive enzymes, as well as eating too many high oxalate foods on her vegetarian diet. So Julie reduced the high oxalate foods from her diet. Plus she took a broad spectrum antimicrobial supplement to help with the parasites and the bacteria in her gut, probiotics to increase her good bacteria and help repair her gut lining. She also took prebiotics to help feed the commensal bacteria, digestive enzymes to improve her digestion, and herbs to help clear the toxic lipopolysaccharides from her system produced by the overgrowth of gram negative bacteria. At the end of the program, Julie reported that her health had never been better. In her own words, the improvement is staggering. The abdominal pain and bloating was gone, her stools were back to normal, her energy was up, she no longer had brain fog or hot flashes, and her immune system had improved as she no longer suffered from frequent bugs and colds. If you're suffering like Julie was and you want to get to the root cause of your problem, you can arrange a consultation with me@bodycheck.co.uk that's B O D Y C H E K and if we're a good fit, I could help you achieve the same kind of results as Julie. Now back to the podcast.

Yeah, that's fantastic.

Yeah. And I love it when there's a conventional physician who's curious and sees the benefits and actually is happy to chat about it. Because my observation with many clinicians in the conventional world is a lack of curiosity that like, yeah, great, oh, you didn't get diarrhea.

Okay.

And they don't care what you did. Have no interest in like finding out what you're doing differently than the 95 people who are getting diarrhea, you know, so when you have someone who actually is like, whoa, my God, that's like different, what are you doing? And dudes and go look at the research on it. Because it's not these things that have studies on them. They're not like made up things, you know, the research is there. Just people are generally ignorant of them because they haven't spent the time to look at it, you know, as yet. So it's, it's, I always find it so harping to find those curious clinicians are like, who want to go learn more.

And this particular doc is also interested in not just crossing our fingers and hoping that it doesn't Recur. Right. She's, she's interested in how could this affect future outcomes.

Yeah, yeah, that's, that's good to hear. I'm, I'm sure both you guys have found the same experience as me, you know, after many years. And you know, you work with a client and they've, or a patient and they've been seeing a doctor about a certain condition, the doctor hasn't really helped them. They work with you for, you know, a few months, they've solved their problem and they go back to the doctor and the doctor said, oh, what do you mean, what do you mean you've got rid of that? It's impossible.

And they say, well, I changed my.

Diet and I did it in this, that. And the doctor normally says now that wouldn't have done it. Right.

Yeah, yeah.

There are certainly occasions like that, you.

Know, or, or at best they might, they might say, well just keep doing what you were doing.

Yeah.

Rather than asking more questions. And I guess to be fair, most doctors haven't got time to even ask what. Okay, so what was you actually doing?

No, no, fair point. I think they spend the average of seven minutes.

Yeah.

With people and it's just like how, how can you cover lifestyle? Can you cover diet? You know, what can you cover in seven minutes? Besides.

Yeah.

You know, pharmacological interventions. That's. Yeah. And which is a major problem with the current medical model for sure.

Yeah, absolutely. And I think I was extremely lucky. This is a, is a hub of, you know, progressive practitioners and the system that I was working in, which was the public health system. Many, many really curious, fabulous doctors, open minded enough to maybe not curious enough to go the next, you know, what they do or whatever, but at least open minded enough to, you know, oversee and allow me to do these things along the way. Although I think they all sort of saw me coming and were like, oh no, here she comes again. Which, what study is she bringing and what kind of remedy does she want to go on? But yeah, yeah, but they were fabulous.

Yeah, yeah, no, that's good, that's good. And it, you know, and you know, as I said earlier, you're looking fantastic, Aaron. So you know, whatever you've been doing is obviously, it's obviously doing something.

You know, I bounced back really nicely and I attribute that to what I did to support that as well.

Yeah.

So, you know, the reason I asked you guys on is because I think this is really important information to share and you know, I'm going to invite, you know, anyone, whoever's got to this, got to the end of this, this interview. I'm going to put a link to the study in the show notes and you know, I just want people to share not only this episode but also potentially share, share the paper as well with people that are perhaps going through that experience because it might be really useful information. And you know, like we've kind of alluded to, not only might it create a better experience if you know, if you're going through that modality of treatment, but it may well, I mean, again, we don't know yet because as we say, there's no long term information on this, but it might well create a much better long term outcome as well. So I think it's really important if people could, could share this information.

Yes, agreed.

Absolutely agreed.

So this is my kind of normal, normal kind of signature question and it's interesting. I'm going to have to ask two people, but it's fine. Erin, what's next for you?

What's next for me? The beginnings of thinking about an intervention study and actually Napa listening to Jason, thinking, yeah, it might make sense to do a case study series first. I'm working on building my practice back up after going through cancer. My cancer journey got extended a little bit because of a medical mistake that was made. I'm just finished now and yeah, so I'm hoping to help a lot more people prevent cancer, get through cancer treatment and mop up after cancer treatment if they haven't got the information while they were going through it.

Yeah, I mean your skill set and knowledge in this area now just means you're so well placed to help so many women going through a similar hurry. And we know it's a frequent diagnosis. Yeah, there's so many women that benefit from what you've been through and that's sometimes the silver lining and horrible of diagnostic events, the horrible disease events that occur when we as clinicians work through them is that it means we're better placed to help others going through similar situations.

Yeah, for sure. And what's next for you, Jason?

I'm still focusing, these are focusing a lot on training clinicians through the Microbiome Restoration center. And I'm really passionate about creating, we might call microbiome literate clinicians of, of micro analysts of really lifting the standard there because I think we can't ignore the microbiome anymore and most of the people listening to this podcast will know this already. But the amount of research that's grown in cancer and a bunch of other areas is huge and that it's really going to be a key component, should be and will be a key component of how we address Alzheimer's disease, obesity, type 2 diabetes, cancer. All these different things we're seeing all around us in Western nations all have a microbiome driver. And it's really important that clinicians are really substantially upskilled in this area. And that's kind of my passion, is trying to upskill them so they're gonna be better placed to move into this new world, you know, because I think, you know, conventional medicine can no longer ignore the microbiome and no longer ignore its role in cancer, for example. That to me is one of the more areas that I know will drive acceptance of microbiome medicine in conventional medicine is because the difference in outcomes we get with cancer treatments, that is going to be one of those big leverage agents there. But, you know, so, yeah, so that's my current main focus and passion as well as well, seeing patients too, because, you know, I've been doing this for nearly 25 years now. So you bring a lot of experience to the table and helping people that have had a hard time getting help with others today and certainly with that microbiome focus.

Yeah, yeah. I mean, it's interesting. You know, you are one of the kind of the leaders in education when it comes to the microbiome. And, you know, someone like myself, I'm a clinician. I mean, you know, I've got a real passion for learning more about the, the gut microbiome, but it seems like it's a. It's moving so fast, the amount of information that's coming out, it's almost like trying to nail a piece of jelly to the wall, you know, because you think you've got information and then there's new information comes out, which is a good thing. You know, it's a good thing.

But you're spot on. Like, like these days there are like nearly 30,000 papers are published a year talking about microbiome. Now When I started 25 years ago, it was 100 per year. I could read every single paper on the microbiome that was published in my early parts of my journey. And that's like, it's impossible now. But I think there are themes that run through. And once you understand those themes about, like proteobacteria B produces bifact. Like, there's certain things that you see common commonalities between all the different disease states. You often see the same bloody despotic state, you know, and it's like the western diet causes this Exposure to, to, you know, pesticides cause the same sort of dysbiotic state. Like it's, it's, it's interesting. The more you get into it, the more commonalities you actually see between disease states from a microbiome perspective.

Yeah, interesting. So Erin, where can, where can people find you online? How can people get in contact with you?

Yeah, at Functional Nutrition MN from Minnesota and. Yeah.

Awesome, good.

That would be a great place to email me.

You work online with patients too, correct?

I do, I work online with patients and yeah.

Cool. And I'll make sure your details are in the show notes. And Jason.

Oh great.

And Jason, where can people find you?

Yeah, the Microbiome Restoration center is sort of my teaching hub. Then I've got the Horlac Gut Microbiome Clinic where myself and a few chosen physician naturopaths, nutritionists that work with patients in a one on one capacity. And then the Probiotic Advisor, which is my probiotic evidence based database as well. There's probably three areas to find me.

Awesome, awesome. Erin and Jason, thank you so much. I've really enjoyed having you on the show. It's been great having two guests at one time. I felt, I feel like it's different, isn't it? I feel like I've been a juggler for the last hour, but it's been fun. Yeah. But yeah, thanks for coming on. Thanks for sharing, you know, your information from, from your paper. And as I say, I think it's potentially really important information for people to share because, you know, sadly there is a lot of cancer around these days. I mean, there was pre2021, but it seems like that's gone up a hell of a lot more since 2021, sadly. So, you know, this is really vital information. So again, I'm just going to ask.

Anyone if you've got to this stage.

Of the episode, please do make sure that you share it with relevant people that are going to really benefit from this great information.

Thank you, Lee. It's really been a pleasure to be here.

Yes, thanks Lee.

My pleasure, my pleasure.

So that's all from Erin, Jason and.

Me for this week, but don't forget to join me same time, same place next week on the Radical Health Rebel podcast.

Thanks for tuning in. Remember to give the show a rating and a review and I'll see you next time.