364. Jason Hawrelak on Probiotic Science & Health: The latest probiotic research findings from the recent global conference.

Alex I'm Alex Stewart, your host and founder of the Lotox Life Movement. Lotox Life is built on empowering tools to help you and me all do our best for our health and the planet. And on the podcast each week I love nothing more than delivering you the brightest minds across all low tox topics, food, body, home, mind and planet so that I can continue to up level for you guys, bring amazing low tox swaps through through our wonderful sponsors and bring you the brightest minds day in, day out. All I will ever ask is that you take the time to like subscribe, follow or add a cheeky review the next time you think to hey, now is a really good time. Boy am I glad you have tuned in with me today because this week we are kicking off 2024 with Dr. Jason Horal and he, for those of you who may not have heard the two shows we've done with him, which I will put in the show notes for you so you can back catalog because they were both fabulous, is one of Australia's brightest minds when it comes to probiotics and gut health. We are going so many places today because Jason was recently at the Global Probiotics Annual Conference, heard lectures from people doing incredible research, incredible thought leaders in the gut health and probiotics space and today's show is basically your crib notes of that conference. What do we know about all of the questions we have about gut health? Where are we at with probiotics? Yay or nay on gluten. We cover it all today, including the estimated time between now and when we may actually be able to go to a poop bank and place an order. If any of that sounds intriguing, I know you're going to like today's show a lot. We have two wonderful sponsor offers and this year what I'm going to do is I'm actually going to elaborate in the show notes about some of the things in the ranges of the sponsors and their wonderful offers that they provide for your low tox swaps to be a little easier on the hip pocket so that you can actually go deeper if this is something of a priority for you right now. Our first one is the Natural Bedding Company. These guys are celebrating 40 years in business this year. They have stunning showrooms that you literally want to move into here in Sydney and over in the Gold coast and they've curated 15% off with the code Lotox Life, a huge range of products on their website or in their showrooms and you have the link to that curated range which includes by the way some wool products which have never been discounted, I, a lot of people find swapping pillows and mattresses and, and things like that a little bit xy. And if it's time for you to do that, I can't recommend this beautiful family business enough. Their integrity and ethics are awesome. So head to the show notes lotoxlife.com podcast and you'll find more information there, including some of my recommendations. Our other sponsor we have guaranteed up until the end of March this year, Oz climate is back. It is a very humid season for us here in Australia and you might want to make the most of that 10% off with the code Lotox Life and that includes on top of any sale prices they have on their website. Again, I have done many shows, many Instagram reels both on humidity, on dehumidifying and on air filtration. So I don't know anyone who's been never had an unexpected leak. I don't know anyone who doesn't have to deal with some sort of environmental effect, whether it's allergies, whether it's bushfires, whether it's pollution. And Oz Climate is a brilliant Australian business providing top notch appliances for us when it comes to dehumidification, air purification and now portable air conditioning. So head to ozclimate.com 10% off with the code low tox life. And again, more information in the show notes with some of my personal recommendations. Enjoy today's show with Jason. It's a cracker. Jason, how are you?

I'm very good actually. It's been a busy year but a pleasant year and it's summer and I'm, I think coming from Canada, you're grateful.

For any sun you can get.

Yeah, yeah. And summer's short, you know, I think it's a, it's beautiful. Thank you. For two, two and a half months where I grew up, it was, it's lovely and sunny. It's just that for the other nine and a half, ten months, it's not.

So one of the reasons I wanted to have you back on the show. You are now officially joining the triple threat club. Jason, as one of the people who've been on three times is because you are always so committed to staying at the absolute forefront of what the gut health conversation is out there. Obviously as a clinician, as a scientist, yourself as well, and you were at a conference and I was following these posts you were doing, thinking, yes, this is so interesting. People need to know it because often you stick with the point of entry of which you learned at a subject as a consumer. So you go, okay, blasto is awful. And you know, like, maybe IBS is peppermint oil or whatever. Like you start somewhere and then that's what you know about that subject. And life is busy. You're not a doctor or a practitioner and so you move on. But science keeps evolving and we know a lot more now. We're a lot clearer on a few things. And we realize a few things aren't perhaps quite as clear as they originally seemed in that black and white sense.

So no, no, I mean, it was a pleasure to go. Like for me, spending like three days at a microbiome conference where the lead researchers in the world are talking gut and microbiome is like a fantasy almost. And even more so because it was, it was in Rome in Italy. So it's like, geez, how could it get figured? I just love. Rome was just a stunning city. So just like combine that together. But it's amazing the conferences that they get like 11 hour days with like a one hour break versus I'm used to Australian conferences where you're like, oh, you have morning tea, having long lunch and afternoon tea and they only go for eight hours. But if you take all the. Yeah, this one's just like, boom. These huge days with like, and all these amazing sessions you have to try to run to get to so you don't miss anything really vital. But so my brain was very packed after those days. But yeah, it was, it was absolutely brilliant in terms of learning capacity, like learning from the people who are at that cutting edge. I think that's the thing and I think it's responsibility for me as a clinician and as an educator. Because, you know, one of the key things I do is educate other health professionals just so they stay up to date. Is like for me, I need to do this and even for my patients too. It's like I want them to get the best care possible, which means I have to stay as updated as possible in this field. And you know, then you have patients who get better on the things you prescribed 20 years ago, which is great. It's lovely. The things have always worked, but there's people that don't. And this is where you always have to expand your, your toolbox to have more, more, more tools to help those patients. I think that's what I love about constantly learning and updating is you are adding more tools to that toolbox, which means you can help a broader number of people.

That I think is wonderful 100%. And as I thought about some of the things I wanted to ask you in our countdown towards number one. The first three are actually related to pregnancy and babies. I remember when my bub was born, who's now almost taller than me. I remember giving him, like a little bifido blend because my naturopath said that was a good idea because I'd had an emergency C section. And I was really grateful to have that support. I'm sure he was as well. He had excellent early brain development. And interestingly, Colleen was mentioned as well, which we're just about to unpack too. So that first point, choline in pregnancy. Then I'd love for you to talk about choline, like, what it is, why it's important to us, and why perhaps until now it might have been underappreciated in that preconception, pregnancy, nutrition, conversation. Because it's not one that kind of floats to the top in. You know, I always think of the mainstream body and soul kind of lift out of a Sunday paper and what they're talking about. That's the float to the top stuff that everybody knows. But I feel like we should all know a lot more about choline.

Yeah. And I think that float the top stuff has changed over time, too, because it wasn't iodine, wasn't necessarily there 10 or 20 years ago nowadays. And folate kind of went up to that point. And I think it's now seen that choline is similarly vital in that during pregnancy and during breastfeeding, too, to ensure the best outcomes. And similarly to things like folate, it's for prevention of neural tube defects, too. But there's also some research suggesting better outcomes in a child in terms of brain development, et cetera, when we have proper doses, that they had a good amount of choline exposure, too. And I think in some ways it's been almost like a forgotten B vitamin because I think people just assumed that, oh, it's ubiquitous in. In foods, therefore we must get enough. And not necessarily looking at actually how much do we need and how much is in our food supply that we usually eat and realizing that, no, there's actually a gap there. Like I think they eventually did with. With folate, too. Oh, no, we need, you know, and I think with folate, it's other day, let's just shove it in flowers and breads and things like that as a way of trying to deal with that. Although obviously they're using, you know, folic acid synthetic form, which has, you know, it is questionable in some ways.

Challenges.

Yeah, it does have some challenges. But I think it's come to the fore more recently and obviously your practitioner was on it years ago when they were talking about choline back at that point. And I do think, like, you know, naturopath, nutritionists, et cetera, who have often been on the ball for well and truly before something becomes mainstream. And this is one of those cases where I think it's the scenario. I think some of the challenges come, though is because it's become. People have more awareness about it and somebody comes go, hey, let's put this in all of our, our prenatal multis. Is that the form that they're using, Choline tartrate, I think is one that's, that's commonly used, has been associated with increasing, I'm trying to say the best way of describing it, but tmao, trimethyl and oxide, trimethy oxide, it's kind of like it starts off as a choline, goes down to the, to the gut, the microbiota interacts with it, converts that to trimethylamine, so tma, and your liver converts that to tmao. So it's a bit of a complex relationship. It's just that if you have too much of tmio, it seems to be problematic from like a metabolic health perspective, type 2 diabetes, cardiovascular disease perspective, which is, you know, one thing about that, we may not be thinking of so much in pregnancy, but there's some suggestion that it may actually be harmful having TMAO build up during pregnancy too. And that is getting people to question about the. Is that the best way we should be taking choline?

Right. So that's kind of like, kind of like the folic acid issue, right?

Yeah, it's not too dissimilar, actually. That's. Why did we kind of jumping in, going with perhaps with the knowledge that we have at a time, and then as more knowledge comes to the fore, realize actually that's probably not the best approach and maybe we should be doing it otherwise. So, I mean, I think there's other ways of getting choline. Like some of my colleagues will prescribe, you know, lecithin as the way of getting choline, because that's a way of ensuring a couple tablespoons a day you meet your choline needs and you're doing in a way that doesn't seem to increase tmao.

And, and that's like the, the sunflower or soy lecithin that you buy at a health shop, kind of.

That's right. Yeah.

Right.

That's right. And I mean, that used to Be a trendy Soap in the 70s and 80s.

Yeah, it feels like it. Yeah.

Yeah. And then it kind of lost. Lost its. Its enamour, you know, and now it's sort of. I think it'll come Also, you know, egg yolks contain a fair bit of choline to an end as phosphatidylcholine. So it's a more, you know, natural way that doesn't seem to have the same issues with it from the choline supplementation perspective. So there's some that are arguing that we should be doing it via food or food like, things. And I put, you know, the lecithin in that. In that category because it's food derived to sort of concentrate it up. But it means you're. You're getting it in a way that you don't have the TMO concerns. Yeah, that's right.

And so phosphatidylcholine was what you mentioned there as being the good type. Let's call it optimal type.

Optimal type, yeah.

Agreed. And the one that you said, was it tartrate?

Yeah, yeah. BI tartrate is what's often added to supplements.

So that's the one we want to try and avoid if we can. If we've got a choice of two between us. Let's go with the phosphatidyl.

Yes, I think that's the prudent option if we can. And I still think probably the bulk of data is suggestive that having choline in that as. As by tartrates, but none choline, but it's just not the optimal way of. Of having it, you know, and probably similar to the folic acid too, is like, you know that we know that folic acid itself, well, not the optimal form, has prevented neural tube defects from. From occurring. Yeah. It's just that we now know that we can give it in better form and we don't have some of the issues that we're having.

Yeah. And so given we are actually talking about it and there might be someone who's brand new to all this, who's like, so what type of folic acid? I mean, I have a funny pregnancy story later finding out I had a homozygous polymorphism in my MTHFR gene. I was taking a folic acid in a B complex, 400 milligrams micrograms a day, whatever it was that you had to hit. And I remember my pregnancy addiction was the frozen packet spinaches from the supermarket melted into a pan with a ton of butter and salt. And I Just ate that every single day of my pregnancy. It was like a drug. And of course later finding out that I had this polymorphism so I wasn't getting that folic acid.

You needed real folate.

I found a way and I just find the human body amazing like that. So that's a food example. But if someone was looking at supplements, what do you want to see in the ingredient list?

Yeah, and this is totally not my default area, but I. No, no, I know, but it is. It's like the tetrahydrofolate is kind of the one we're after. Like the. And some people argue about flunic acid being helpful, maybe a combination of fluinic acid in the folate. Meaning we cover things the best possible. But I think it's essentially avoiding when you can folic acid. But I think, you know, again, like there's that having none, it's not gonna be helpful either. But having. Just trying to choose supplements contain the right form and. Or dietary sources. I think you can't go wrong because, you know, we find in nature is the right sort. It's just a human made synthetic version that, that can do some of the functions, but in some people, not other aspects of it. Because we're lacking the ability of, you know, pushing that through to what we want it to become.

Yeah, absolutely. Now, one of the posts that you did about the conference was from Professor Ventura's suggestion for bifidobacterium cultivation supplementation and also talking about maybe there being a situation where you should be stool testing babies to decide for supplementation. Right. So yeah, that's new.

It's an interesting area. Yeah. And I think we forget about how unique your microbiome is and I think this feeds into that and how it's been passed down your family line for generation after generation after generation. Your unique family strains of bifidobacteria, for example, that are different from other family strains of bifidobacteria. And the idea here is if you're kind of supplementing with, you know, someone else's bifactory, which you kind of. You are when you're taking a supplemental bifactory, it's come from somebody else or some, usually a person, but sometimes an animal, but typically people and, and often the supplements we're taking are. There's certain bifidobacteria that we see as sort of like baby, infant style bifidobacteria. Then we have sort of more adult style bifidobacteria. And many of our supplements contain the adult style ones. And that's arguably fine and beneficial for adults. But there's some consideration that's coming up about is it interfering with the natural development that would occur if you're actually supplementing with this adult type bifidobacteria. It comes in and some of these, and I should clarify this too, that many of the probiotics that baby on the label still contain adult style bifidobacteria. So you can't go with that. Okay. Because it's just a marketing thing. You know, there's, there are some that are designed with that in mind, but most of this is a marketing thing. Oh, let's put a baby on the label and people will buy it. That's kind of where they come from. And that's problematic. And it may be more problematic than we actually know because the idea here might be that they can outcompete your indigenous populations of that the infant specific bifidobacteria for food sources, which in this case might be human milk oligosaccharides. And therefore actually you don't get the same kind of development of bifidobacteria populations. Because I think the human, I mean my colleague Dawn Whitten, who I work with in Probiotic Advisor, this is her specific area. So I'm like second best to her for sure in this area. But some degree sharing between those infant specific ones where they actually encourage the growth of other bifidobacteria. And that's not the same case with the adult type ones, particularly Biffleacterium subspecies longum infantis or Infantis. Particular strains in that species tend to cross feed other. They encourage the growth of other bifidobacteria. So when they eat they're like, oh, take some of this, take some of that, I'll share it around and everyone grows as much happier. Broader ecosystem. And we're not getting that when we're getting these sort of adult type ones that are coming in and going, you know, and they're kind of gobbling things up and you don't get that sort of bloom of a broader community. Yeah.

So even though, even though they're good in their nature, it's almost kind of like the, the prefect in the schoolyard and they're just too powerful and too bossy.

Yeah, yeah.

No, that's their own good.

Yeah, it's a good, good analogy. And I think if someone has no bifid bacteria, then that's okay. They're better than no bacteria for sure. I think the concern again here is, is nuance is like what's optimal? Optimal is your family's infant specific bifidacteria growing in the way that they have evolutionary always done. You know. And I think this is the thing. Whenever we interfere with, to my mind, whenever we interfere with, with his outlet the way nature set things up, there's problems, you know, and sometimes we've interfered before and caused lack of bifidobacteria. We've killed them all off or. Right.

I was going to ask like in.

Which case fair enough, it's okay. I think supplementation makes sense. Although we might choose our to choose use the infantous bifidobacteria as our supplementation in that scenario. Because it is such an amazing relationship between even the human milk oligosaccharides, which is essentially the prebiotic like sugars found in breast milk. They are individual. Each woman makes a different collection of them. There's some that are similar across border same and then some that are completely unique to feed the Biff factor that you kind of pass down your family line. It's like this amazing lock and key situation, you know. And I always feel like interfering with that is when you don't need to is problematic. Whereas I think again, yeah, there's a time and place and this is the idea is okay, you do a stool says do they have bifectory. Are things growing the way that they should then don't interfere. Yeah. Don't give a baby type probiotic if they don't have it need one and things are growing. It's just. But if they do need one, then yes, you, you, you choose one that's most appropriate for that which is different than the adult type bifidobacteria in general. Although again I would argue that adult type are better than no bifidobacteria because there's a, that development of that ecosystem in the first couple years of life is absolutely pivotal. And we're still really teasing at exactly how pivotal it is. But it trains your immune system to function properly or improperly. It trains your nervous system to function properly or improperly depending on what species are there at different time points. And we get this evolution that's supposed to, you know, the way it's always been is, you know, we're born vaginally, we're given breast milk. Up until very recently this was always the norm. And so we have this evolution of the gut ecosystem that goes along this pattern. Yeah. And the ecosystem changes over the first six months of life and then as food introduced it changes again. But at those different Time points how it interacts with the human cells and our immune system helps train it to function. Hence we know like antibiotic use under, you know, three months of age increases the risk of asthma and eczema and hay fever. Development could be kind of we're interfering with that training by, by killing certain species off, by changing the dynamic and you're increasing these pro inflammatory species at a time we're not supposed to have them there and we're decreasing these anti inflammatory bifidobacteria and then they interact with the immune system a different way and we get like lifelong allergic disease because of an antibody course when we're young. And that, that's pretty clear from the research to an end. As we tease the go and delve into the importance of all those interactions and how we're, we're learning in the early window it can becomes really important not to interfere when we can. Like again there's a time and place for antibiotics where they save lives, they save limbs. It's not a, you know, discuss it but is this like we don't want to use it for viral infection. It's like you wouldn't want to question is this really indicated, Is there evidence to show this will be helpful and then also try to, to do stuff to counterbalance that as best we can.

Absolutely. And, and I'm, I'm hearing everything you're saying and then of course my mind goes to this interesting idea then that is our ability to manage crisis and save lives is the trade off of that sometimes then like more insidious chronic repercussions of the way we save. So I'm, I'm not questioning anyone out there, myself included. Like emergency C section, hand up chronic tonsillitis in my 20s, shit ton of antibiotics. Guys. Like honestly we are all in a modern story that has complicated variations to the natural theme of things. However, it really does interest me that we save in one way and our crisis management in health is actually one of the most amazing parts of our, our modern healthcare system. What we can do to save a one week old baby who contracts some hideous infection. That's incredible. That kid gets to live and top this.

Yeah. Or the one who's born two months early. Yeah. Otherwise would have died in the past.

Exactly. So lovely and so amazing and avoids so much heartbreak. And then we also have the reality of how perhaps the way we've become better at saving and crisis has actually somehow inadvertently made us as a whole unhealthier.

Yeah. I would say yes. I think that's, that's very well described and it feels like that's the scenario. You know, it's like there are. Antibiotics are such a double edged sword and I think this is the thing and I think you fast forward 50 years from now and I reckon medicines, you're like, what the hell were they doing giving those agents? What the hell were they thinking? Because we are. And this is the shifting awareness too. Like I've been researching the microbiota for almost 24 years. Essentially when I first started preparing for my honors thesis of delving into the microbiome literature back then there was a handful of researchers saying this stuff, this, this is important, like the microbiome is important. Whereas most people are like, ah, it's just some bacteria in your gut. It doesn't matter if you can kill it, it doesn't matter. You know, it'll, something will grow back, it'll be fine. That's changed a lot over that time. So I lost my track a little bit there in terms of where I was going to go with that.

But it's more sort of just to bring you back. It's, it's about like recognizing almost that the next evolution of medicine is to take into account when there is a crisis, how are we creating scaffolding around that.

Yeah, yeah, thank you.

But then not create an after effect of chronic disaster.

Yeah.

Where we're kind of slightly unwell in a variety of growing ways over the human lifetime.

Yeah.

I can't accept that that's our future.

Yeah. Because I think we'll get it and we'll go, okay, well again, C sections save lives. When they need to be done, we should do them. No, no one's debating that bit. It's just like, can we do anything to help that ecosystem that we've essentially changed develop as per normal? Even like C section born kids, for example, their skin microbiome is the same as the hospital staff that touched them first. It's not like either mom or dad. Whereas in a normal vaginal birth situation the skin flora resembles the parental microbiome. But skin flora for C section kids resembles hospital staff that touch them first. But can we intervene with that process? Yeah, if they, if you have a towel or from home that has parental microbes on that and then that goes onto the bub and they go directly onto the mom right then and there. Yes. That would mitigate those things. So there are ways we can do to try to normalize things after those interventions, but we have to be aware of the fact that they cause harm. And I think What I was leading to before getting with loss before was just the end that awareness of microbes go from they don't really matter to actually these are really important. We should think of these as the new microbe organ. It's the same as the stomach or the small tests on our liver. It plays these really important roles and that's sort of gaining traction at long last. But now there's a shift of thinking of us being these meta organisms or hollow bionts that are composed of human cells and non human cells and that makes us us. And I think this area is really gathering speed and I think yeah, in 20 years time we'd be like, yeah, you are human cells and microbe cells together make you you. And if you're killing the micro parts of you, there are consequences to that. Yeah. And that's kind of what we've been doing inadvertently with the thinking of antibiotics like chemotherapy. But they kind of have been because they're killing parts of you, you know, and there are consequences to that and including, I mean I was reading some studies looking at early child antibody use and cognitive decline and increased risk of Alzheimer's like you know, years years later. Other research looking at again antibiotic use and cognitive decline because I've just been running some lectures in the area. They're looking at women in their 50s and if they had taken cumulative two months of antibiotic use from 50 to 59 in their 60s, they lost four years of sort of cognitive capacity in their brain from that use of antibiotics in that time because of the changes in the microbiome, the pro inflammatory nature of them. Also keeping in mind, I think this is also mind blowing too is that most people have at least some knowledge of mitochondria in our, in our cells. Yeah. So mitochondria are like little battery packs, little energy houses in our cells. But they've actually, they're, they're, they've evolved from bacteria. Yeah, they're like a bacteria within our cells. It's like an interesting process. But they're susceptible to antibiotics too because they are bacterial derived. And antibiotics actually kill damage our mitochondria, which are your energy policing cells. And we damage the mitochondria essentially and it speeds up the, the aging process and leads to, to chronic of neurological diseases that we're, we're seeing around us too. So another connection with, with antibiotics. So as I said, you fast forward 20 years or 50 years probably they'll be like man, you guys are living in the dark ages. What the hell are you doing causing so Much harm. You know, just like we think of things like bloodletting or you know, those are techniques that have like go, no, we've moved on, that's past that, thank you very much. We'll be thinking like that with, with, with probably antibiotics. But we're also doing things to, to try to counterbalance that of things like I call fecal banking where children, before the first course of antibiotics you, you take, you take a poo sample, you have the microbiome ready to reinoculate them after the course of antibiotics. That way it fixes it, the situation super easy. Like could we do this now? Yes. And event Again, fast forward 20 years. This, this will be kind of the norm process of actually we'll be doing these sort of fecal banking so we can reinoculate yourself with the microbiota after a course of antibiotics to get around an issue. It's just we've been really slow with adapting our, you know, procedures that can be life, you know, saving, but harmful as well to see if we can counterbalance the harmful bit because there's been lack of acknowledgment of the fact they cause harm. I think that's been the biggest issue because before antibiotics are, oh, you get some diarrhea for a while, sure, maybe a small percentage to get a C. Diff infection, we give you more antibiotics for that rather than actually you getting long term harm. You know, One of my PhD students was looking at antibiotic use and depression and we looked at every single study had been published to date. All of them show that antibiotics increase the risk of depression. The more antibiotics, the greater your risk of depression development afterwards. And once they actually found even 10 years after course antibiotics, your risk of developing depression was increased versus not taking antibiotics. You know, so this far reaching impact on cognitive capacity, mental health as well as, you know, gut health is generally often just thinking about with anabolics, huge.

And so for parents out there or for people who've had to be on antibiotics lately who are now thinking, okay, can you just give me like a couple of things that help create some scaffolding around antibiotics. So like a swab was done. I'm a big fan of requesting from your GP a swab before you decide to take any antibiotic because A, it might be viral, you might find out, B, you might find out that the one they were going to prescribe was actually not the correct drug for that antibiotic. So you end up needing to take two courses when you could have actually just gone the one if you really needed it. So I think people having this literacy around an empowered conversation with their health professionals is step one, step two, the scaffolding. Can you give us, Jason, just a couple of things that help mitigate damage at the time of taking or directly after while we wait for these beautiful fecal banks to be created. They're not here yet. So what do you find to be the absolute most helpful? Go to.

Yeah, we now know that if you take the right, right robotic during the course of antibiotics, you will limit the degree of damage caused and help it restore more quickly afterwards. And I should say the right probiotic. I'm stressing that bit because there was a study published a couple years ago that had major media coverage because it showed that taking a probiotic supplement during antibiotics actually slowed the restoration and harmed the microbiome. It turns out that it was an Israeli probiotic supplement on the market placed there. And this particular probiotic, the strains used in that supplement did produce compounds that were harmful to our gut microbiota. So it just showed that if you just randomly taking a probiotic, you could actually get a negative outcome rather than the positive outcome you're after. It's really important you choose the ones that have clinical trials showing that they're helpful. In this case we have Lactobacillus rhamnosus strain gg and I'm going to say the strain GG bit is super important. You just can't go with any Lacto's rhamnosus. It's actually the GG bit that's really important. And also Sacramento Mises cervaceae, a Variety Boulardi people just call SB for short for, for obvious reasons. Both those have data showing that they limit the harm to the microbiome, limit side effects to the from antibiotics as well, and restore the ecosystem to a better state afterwards. So I think those are key during and ideally for six weeks afterwards. But I think the other useful addition is what we call prebiotics. So prebiotics, again, probiotics are live bacteria that when you give to people you get health benefits. Now, prebiotics are like the selective fertilizer that encourages the growth of only beneficial bacteria in your gut. Yeah. This is the thing is they're selective. You take them, your good, good bug count goes up and that's exactly what you want after course antibiotics where every antibiotic is different. Yeah. So some will have a dramatic impact, some will have a more mild impact, some can cause extinction level events. Where this study published a couple years ago have had nine species of bacteria went extinct from One course of antibiotics.

That was the antibiotic. Do you remember death?

Triaxone.

Wow.

And it was given by IV too, so it wasn't taken orally. It's like a dose intravenously. Nine species gone forever from that single thing. And, and this is where you start thinking of, you see, like as somebody works in the microbiome field testing patients, you just see that once you take all the antibiotics, you get this lowering and lowering of ecosystem diversity and richness because every single course will have an impact.

Well, I can definitely vouch as someone who gets a big green tick on my microbial score for very diverse.

Oh, good.

Happy. So, and I would have taken, gosh, chronic tonsillitis lasted about 15 years before I finally kicked it with gluten sensitivity. Something we're going to talk about in a little bit. Probably 20, 25 rounds of antibiotics.

Yeah.

Maybe even 30 if you just count the lifetime and the couple of times either side of that. But it was a very intensive time.

Yeah. And to show that there's a degree of resilience there, thankfully, and even with, with that, I think we have to.

Tell that positive story, right?

Yes, yeah, yeah, we do. I mean, and also, I mean the most and least I've seen with patients is the least number of, of, of sort of genera of stand in people's guts. So genera is like Bifidobacterium or Lactobacillus or Akamansia or genera. Bacteria was 12. The most I've seen is like 450. Yeah. In different samples. And that was someone that grew up in rural Mexico. So they had lots of, you know, interaction with nature and, and other people that were sort of eating more and living a more traditional life. Yeah. Whereas the, the one who had 12 had been on long dose, long term courses of vancomycin, which just decimates the ecosystem, the good bacteria in the ecosystem. But yes, there's a degree of resilience there too, that, that if they survive the onslaught, we can encourage them to come back. And this is where prebiotics come into it because prebiotics selectively feed your good guys and give them this huge growth advantage going, okay, you've just been smashed down by antibiotics. Well, here, here's a selective fertilizer that only you can use so your population will expand and come up relatively rapidly. So, so prebiotics would be things like fructool oligosaccharides or, or inulin galacto oligosaccharides and then lactulose would be probably the three Most well researched prebiotics. But then you also have partially hydrolyzed gum or phcg. Ideal situation is I would generally give two of those prebiotics. Partially hydrolyzed gum is somewhat unique that it feeds a range of a different group of bacteria than typical prebiotics do, those that make a wonderful substance called butyrate. And I'm sure many of your listeners would be aware of obviously some aspects of butyrate. But it's an amazing substance. The more you look at it and the more research being done on it, the more amazing we find it is. So we want to encourage their regrowth in the ecosystem and we give that alongside something like lactulose or inulin phos to encourage the growth of bifidobacteria and achromanity, which are Amphicalobacterium 3, really keystone species that we associate with good health. So we can. By using. And you do that for. Generally, I recommend three months after course of antibiotics to re. Stimulate their growth and get them dominant again. And they do regrow relatively quickly. I think that's the positive thing about bacteria is they grow quick. So if we can give them the right food, create the right circumstances, those populations, as long as they survive the antibiotics, they come back. The challenge is when we get the extinction level event, which.

That'S tricky.

You can't easily fix that. Bar. Bar fecal transplants. And this is where I'm talking about, you know, fecal banking before we need the fecal bank. We do, because that'll fix it immediately. It's like, oh, you take your antibiotics, boom. You take this back, you don't lose anything at that point. And all your good bugs are back reset to way it was before. No losses of species diversity. So that will happen. It's just not now.

How far away do you think fecal banks are? Like, I'm picturing us being able to go to a little receptionist and with our doctor's prescription and say, hi, I'm just here to pick up my, you know, like my, like, what do you. A syringe of my poop sample with this particular thing. And they're like, okay, let me just. Yes, I'll just go grab that. I'll be right back. Like, how far away are we?

Oh, great question. I would like to think 10 years away. I mean, it might be sooner. Someone, someone with. With monies has got to go, hey, this is really key. Let's get the ball rolling. I mean, people freeze their eggs for different reasons, but. But for the pills that Okay, I, I might need these more in the future. And it's the same with a similar way that I think people are going to go, okay, we can freeze it. They'll probably work out ways of separating out the poo bits from the microbes to make it a bit easier to deal with in terms of okay, let's see if we can sit out the brown solids and just, just leave the bacterial bit so it's easier to it a capsule. Capsules versus directly. In fact I had a meeting with some a couple years back with some.

Yeah, sorry. I went straight to the suppository vibe like.

Yeah, yeah, well I think. And that's where we're kind of at now. But I think long term ease of application will probably be, you know, doing what people call crapuls so you know, poo, hence crapsules. But there was.

You had it here folks guys.

Yeah, and I had a meeting with some, some inventories people in the US and they had developed a machine that you, that you kind of put on your toilet and then you would poo into and they would collect it and then you just spin it and then all your poo would just go and fill out these capsules. So you can actually make crapsules at home without touching any poo and then you just put them in your freezer for later use. You know that was like a home, home job way of doing it. So I think that will become more commonplace too. People will lose a bit of their. And those are sort of the center coating on the capsules so they don't release in your stomach because that's the thing that will, will die if they.

Yeah, you don't want to get stomach to just kill it.

No, no, that's right. So release into the small, small bowel. So again that's. I keep waiting for their, their product hit the market. So it's been waiting a couple years. It's still not there. But again that's not too far off. But I think there might be 500 bucks for that. So it might be like, you know, a bit much for some people to have and then they have to a special spot in their freezer for their, for their vehicle matter to be in. But the nice thing about you know, with a self FMT is you don't have to worry about passing on disease or you know, health conditions because that's something that I think the power of the microbiome has really come out in recent studies looking at how we can use poo to treat or give diseases. Yeah, we can give Alzheimer's by taking poo from someone with Alzheimer's and give it to rats and those rats will develop Alzheimer's disease. It's really amazing. And we can conversely take poo from young healthy rats, give it to rats with Alzheimer's and their Alzheimer's goes, and their brain clears away the Alzheimer's of, you know, the plaques and the tangles go just from changing their, their, their gut ecosystem, you know. So yeah, this area is immensely.

That's exciting.

Exciting and interesting. Yeah. And, and there are case studies of people clear getting rid of Alzheimer's from doing poo transplants. And they weren't doing it for that purpose. They're doing it because they had a C. Diff infection and then the life threatening infection that wasn't responding to antibiotics. So like, okay, we'll get a poo transplant. And there are people where their Alzheimer's clears like they, their cognitive scores go up after two months, four months, six months after fmt, they no longer have Alzheimer's. They're cognitive decline. They're cognitively normal. And to me stories like that should be front page news. Front page news. And they should get people going, what the hell? Like how, how is this happening? And yeah, I know FMT is not going to be in that fashion, is not going to be the most easy thing to, to get people to take, but it tells us how important the gut market is and how vital it is and how we can change things. And, and again in the same field there's like reversal of aging process too where we can take poo from young, young animals and give it to old, old ones and it reverses like the aging process, you know, and again we can take poo from old people, giving it to rats and they develop, they get old very quickly. It's, it's really phenomenal. And I think sometimes the fountain of youth is actually going to be poo. Young healthy people's poo is going to be our, our fountain of youth.

I love that the stuff that our three year old world say funny jokes about and just laugh and it's this kind of taboo thing. And even just asking about poo lately has finally become a little bit less taboo. We're checking in on health or not feeling too embarrassed to mention an aspect of your poop to your doctor. Like it's recent, right. That we actually even felt it's comfortable broaching the subject.

So yeah, and here we are talking about on this slide podcast with thousands of people gonna be talking, thinking about poo after this I just think the research is, really, is brilliant. As I said, I've had that chance to writing courses to update, to teach health practitioners about these areas. And it's just like even the last five years, this stuff like high blood pressure. Would you have thought that you could pass on high blood pressure from a poo transplant or get rid of high blood pressure from a poo transplant? Yes, it turns out you can, you know, and just like stuff like that, you would never have made that connection that there was a gut leak and this is what's been shifted that last 20 years from, you know, gut bacteria not being important. Oh gut. Very important for some gut conditions to actually. This is absolutely vital for your, your health. You know, and there even there's studies now using poo transplants for skin cancer treatment. People that are not responsive to immunotherapy for skin cancer. If they do a poo transplant from someone, another skin cancer patient who is responsive, they become responsive and they get benefits. Yeah, you know, yeah, it's, it's an amazing area of, of just showing how important the microbiot is. And now they're doing research looking at, okay, if this person with this cancer type has this microbiota picture, they're going to not turn out well from an outcome perspective. If they have this type of ecosystem shape, they're going to actually respond really well to treatments and have better long term survival. There's research in those areas too. So this is what I mean. It's really, we're at this tipping point that it won't be long before we're doing fecal banking for ourselves, that there'll be, I would say, a trade of poo for people, rich people wanting to live forever to, to keep myself young and healthy. Like that's going to evolve under this situation as well as using it for, for you know, skin cancer treatment and Alzheimer's and Parkinson's and multiple sclerosis, these areas that there's already some preliminary positive research in. So watch this space.

I would say, yeah, move over stem cells. There's a new poo on the block.

There is. And I always think there'll be like those people that have that, that unicorn poo. Like I remember having a, a patient's partner who is in his, he was in his 40s, he was home birth in the Netherlands. Never antibiotics. 40 years old, one course of antibiotics. He was breastfed for two years. If you could tick all the boxes for the ideal microbiome, and most of us do, not including myself, he did. It's like home birth. The best microbiome you can get is by home birth, you know, adequate breastfeeding, major tick there, no antibiotics ever. Grew up in sort of a hippie household where they ate like whole food, this diet without food, chemicals, organic food. And he was in his 40s, metabolically super healthy, brain sharp as attack and, and just really happy. Go, lucky guy. And it's like, man, one day people will pay you thousands of dollars for your poo because you are that sort of the unicorn of like, you know, one in a million or something like that that actually grew up in a western culture but managed to actually have a, a intact ecosystem. Intact in every other sort of way. Because it's really tricky, you know, for all of us between, you know, C sections, formula feeding, chemical exposure, antibiotic exposure being, being rife in early childhood, all that stuff impacts the microbiome. So to find someone that, that actually was not exposed to those damaging factors outside of the Amazonian rainforest or you know, highlands of Africa or something like that, or the plains where, you know, the, the had to live is, is pretty. Pretty.

Yeah. Yeah. Wow. And so is there a black market for poo at this point in time? Do we know?

Oh, well, if so, I'm, I'm not aware of it, but I reckon it probably is.

I wonder whether there's some people who, who know the potential and who are experimenting. I mean that could it, it would be better for a rich philanthropist to just step in here and, and create more of a regulated business around it for the, the simple fact that we would then have better data, research and more assuredness.

Yeah. Better matching of donor to recipients. Because I think that's the area where we're not there yet in terms of the best outcomes. Yeah. All these examples I shared, but there's definite improvements. Even the skin cancer one. I think it was only 40% of people that were non responsive became responsive post FMT. So still 60% of people didn't. So we know that. Okay, maybe if we were able to better do the research and match what traits we want, we can actually get people up to 80%, 100% people responding to that sort of immunotherapy treatment for their skin. Skin cancer. So yeah, we need more research still, but it is immensely exciting. And listen, there is, I mean certainly people that are, you know, doing FMTs for things that are outside that sort of the C Diff box because I think for convention medicine it's just often been just C Diff facilitated, so that's all we use it for. And then that stretch to inflammatory bowel disease. But there are, you know, people who are doing, certainly research is doing more cutting edge stuff of trying it for obesity and type 2 diabetes and all these other sort of conditions going, oh, wow, look at it helps not so much with obesity, sadly to date, but certainly with metabolic dysfunction, type 2 diabetes, hypertension, those things have improved post. Post FMT, but we're still early days in terms of finding the, the best ways of matching, you know, donors and recipients yet. Yeah.

Well, that was a wild tangent.

It was, wasn't it?

Yeah. I love that. So good. So my, my fifth point that I want to ask you about is around gluten. Just mentioned it very briefly earlier that it was life changing for me, especially Australian and American gluten. In France, I seem to be just fine in the treaty. Yeah. In the countryside eating beautiful local made things that have flour in them. No problems. It's, it's awesome as a half Frenchie. But one of the doctors that was at the conference that you were recently at, Dr. Fasano, he, you asked him, given the results of his two ex vivo studies, and I will get you to explain that for the 101 people where you found gluten, gliadin could cause temporary changes in intestinal permeation, permeability, even in healthy intestinal cells. Do you agree with the recommendation then that some people have, based on your research, that humans should avoid eating gluten? What did he say?

No.

Okay.

He's like, no, no, no, no, let's break it down.

Yeah. So what is ex vivo?

Ex vivo means we take cells out of human bodies and then growing them in, in test tubes. And then essentially they did that with CVAC cells, gut cells from CVAC patients, gut cells from healthy controls. And they kind of almost like rubbed some gluten on them. And it turns out the CVAC ones had a huge reactivity and the normal ones had a bit of reactivity, but still became like kind of leaky afterwards. So, you know, you go online in some blog circles and be like, everyone on earth has to stop eating gluten. Like, no one on earth, no humans should consume this stuff because of his studies. So I'm like, it's not what he said in his study, but it's what people have interpreted. And I was like, I'm going to ask, here's my chance of meeting the great doctor. I'm going to ask him directly. Is that what you think should be the case? Do you really think that everyone on earth should be doing. Because Normally we would never make recommendations like that based on two in vitro studies. You know, that's such what we call low quality data. You know, it's like. And there's, you know, other in vitro studies not show that did not find that same thing. Two, I should point out too, at least, at least one finding the. Didn't increase permeability in healthy controls. So, you know, it's a bit of lack of clarity there for the one part anyway. But he was like, no, because. Because essentially what. From his perspective, people who are celiac, obviously people that are gluten sensitive. Yes. And probably people with autoimmune disease is the categories that he put in. Those are the ones that should be avoiding gluten, but not everybody else. He eats gluten and he's fine. He said most of us are totally fine with it. It's just that you have those things going on. Then it's definitely celiac, definitely, you know, gluten sensitivity, which we're still defining what that means. You know, there's no great single test for. It just means that you're, you know, reactive to. To gluten essentially, but don't have. Celiac is kind of our current way of. Of defining it. And then autoimmune disease, where it's. There's certainly an overlap between celiac and autoimmune disease as part of the picture and on. And also that we know that, you know, leaky gut is. Is one of the things that's happening seems to precede autoimmune disease. And it even precedes CEC development too. Interesting enough, is having leaky gut first. There's got to be some sort of, you know, trigger that causes gut damage for celiac to eventually kind of evolve onwards. Interesting enough. Yeah.

Wow. Okay. And so the, the next point that I, I want to ask you about is sibo. And a lot of SIBO patients obviously get taken off all the inflammatory foods. Foods. And then they also get taken off anything that might be probiotic because it might upset sibo. But at the conference, this seemed, in terms of what the conversation is currently quite debunkable that you would. That you would just blanket decide that probiotics were bad for SIBO patients.

Yeah. And this has always been an interesting, for me, an interesting area, and partly because my. My PhD and my honors degree, which I started back in 99, was in the gut microbiota in IBS patients and dysbiosis and IBS patients. And so I was like, all over the research with prebiotics. Probiotics, the microbiota and ibs at the time when someone came up and said, hey, you know, SIBO is a driver of ibs, and therefore, you know, probiotics are bad. But I'm like, hold on. We've got studies in the 1950s showing that probiotics are helpful in IBS. And you've just said that IBS is essentially 84% people. 84% of people is what they said at that time. Patients with IBS have sibo, and this is like, this is not fit. And they also said stuff like, the small intestine is supposed to be sterile. And it's like, no, it's not. Never was, never not meant to be. It's just the. Eventually that moves to, okay, no, it's not sterile. It's the amount of bacteria that matters. And, you know, and now that's kind of shifted over the years to. It's not even just the amount of bacteria. It's whether you've got pathogenic bacteria there that actually seem to matter. Like, the people that have symptoms that we call SIBO tend to have lower diversity of the ecosystem and higher levels of more pathogenic bad bacteria like Klebsiella or E. Coli are growing in their small bowel. And that seems to be causing the harm versus and sometimes tryptococci too, for that matter. But it's now being seen, I think, from the more recent research of the last five years as a disease of dysbiosis rather than just any bacteria in there is problematic. And that when you embrace that, it changes your thinking. Because what. What can probiotics do? They can change dysbiosis. You can give a probiotic to alter the ecosystem to one that's actually healthy. And that's what this study that was presented at this conference was doing, is essentially utilized a probiotic to change the composition of the small bowel ecosystem, and it reduced levels of pathogenic bacteria like Klebsielli and E. Coli all went down, the ones that we see as problematic. Diversity improved the ecosystem, and the stability and strength of that ecosystem improved after the probiotic administration, meaning it was more robust to external challenges and more stable. And that was key. So you actually get this benefit. Yeah. So that was interesting to see clearly, because that was one of the few studies that was able to just show the actual impact on the gut ecosystem, the small bowel ecosystem, specifically, because most research we do is because we get poo. So we can look at the colonic ecosystem, not the small bowel stuff. But this was research done on people that had had ileostomies where they had their colon removed. They had essentially a hole in the gut where their stuff came out at the end of the small intestine. So we can actually look at the ecosystem there in the small intestine very easily and see how it is changed by interventions. Yes, it was pretty novel approach in that way. Now you add that on top of all the studies that have been done utilizing probiotics to treat sibo and this very consistent positive results that we see in studies. And again, that stuff was around for the 1990s, early 2000s. But in 2017, researchers did what they call meta analysis, where they grab every single study to see what. Is there a consensus agreement about what results we get when we give probiotics in sibo? And yes, you get improved outcomes, decreased gas production, clearance rates of around 50 some percent just for giving probiotics. And that's not too dissimilar to what you actually achieve with antibiotics, aquatic treatment either these days. So.

And would it. Are we talking about those same stars that we talked about with the antibiotic treatment scaffolding?

Well, interesting. I mean, the saccharomyces.

Yeah, there's lots of probiotics there is that.

Yeah. So saccharomyces, yes, there's certainly some research on, on saccharomyces for decreasing sibo. And Wednesday they're comparing it to antibiotics and had better outcomes than, than the antibiotics did. Then there is the. In terms of what's commercially available, there's another bug called from Biogaia, which is Lactobacillus re dry DSM17938. Catchy name, I know, but this thing is Bio Gaia.

He needs a new marketing campaign.

Well, I think they just call Bio Gaia. That's probably the marketing now. But yeah, that one has been shown to reduce methane levels like some people that like arguably three different types of sibo, but most people have hydrogen or methane and this reduces methane, this bug. And there's even studies using that particular biogaia preparation to prevent SIBO from developing in people who took proton pump inhibitors. So Proton pump inhibitors, PPIs are classic drug that is so widely used in Australia and America and Canada in the western world. It's massive because they use it to treat heartburn. So when people get heartburn reflux, they give PPIs and they give them for not just weeks, but for months to years or forever. You know, you're 40, you get, you get a PP Diag of reflux. Oh, take this for the Rest of your life is kind of how it's often done. But one of the things that, that one of the many negative outcomes from, from PPI use is it actually causes sibo. Yeah. And, and, and there's study published just a few weeks back that one week, seven days of PPI use caused SIBO in 7.8% of people who took it. And the authors were like, ah, it's only 7.8% of people. That's not bad. After I was like, that's a week.

It's an over the counter drug often in the pharmacy. Like if you think of your Gaviscons and all those sorts of brands, this is, there's, there's millions and millions and millions.

That's right.

Taking these things and that's, that's after one week.

And there's a study done in kids, it was 56% of them developed SIBO after six weeks or 12 weeks, weeks of PPI. So there's a spectrum, you know, 8% after week to 56% after 12 weeks. But in that study of the 12 week one they gave the Biogaia prep robotic preparation and only 6% developed SIBO after 12 weeks versus 56% in the placebo group. So it actually prevented SIBO from, from developing very markedly. And this is where the, the strain matters because the, the re strain into the biogaia produces a substance called reuterin, not, you know, that's what it's name, reuterin. Reuterin is a selectively acting antibacterial product and that kills off bad bacteria. So when it's traversing its way through the small bowel, it's just releasing some RIN as it goes, which kills off competing bugs and hence you stop getting SIBO from developing. But not all strains of lactose re produce reuterine. Only some do. So if you just go, I'll just take a random retry, you can't guarantee getting that result because if it doesn't produce R, you're not going to get that same sort of result. And this is where the strains really, really matter. And this is one of those clear case in points. Yeah, but yeah, PPIs are another class of medications that, you know, essentially when they were first developed they were clearly shown to have antibiotic effects. So they, they kill bacteria and, and some research showed that they, they can kill. Up to about 20% of your ecosystem is susceptible to damage from PPIs. And people are long term PPIs. Their ecosystem richness gets worse and worse. And after a few years on it it's no different than taking antibod courses for years in terms of the microbiome composition. Increased risk of osteoporosis, increased risk of Alzheimer's too. And that's just because of the change in the microbiome. Both we now know that osteoporosis and Alzheimer's are microbiome linked conditions. We can change bone, how much bone breakdown creation there is by changing the microbiome. We can sort of alter the prognosis or path of Alzheimer's moving forward or going back by changing the microbiome. So and PPIs are just really problematic. Again there's a time and place but they research also shows that I think some 50 to 70% of people taking PPIs are doing so inappropriately, not based on the evidence. So it's another class medications that you really want to be on for the minimal time possible and limit your exposure. If you can do anything else to.

Protect yourself and you want to work with practitioners who understand and have compassion for SOS Us picture however, are also working on the day to day picture of what needs to change for you to not need that thing anymore.

Yeah, that's right. Because I've worked with reflux patients for 20 years in my practice and often it's diet. We can change diet and we can stop reflux. We can change eating patterns, what they're eating. Sometimes there'll be underlying sibo. We treat that reflux go sometimes underlying constipation and high methane. You treat that, the reflux goes. A lot of times it's just they're eating too big and large meals and having too much alcohol. Again, you can, you can intervene in those areas and, and never mind the fact there are some natural agents that can, can effectively treat the reflux symptoms in that moderate medium term while you're trying to treat the underlying cause that don't have the same effects of PPIs. You know, I think that, and yeah, working with clinicians who are aware of those bits and aware of the fact that PPIs cause harm besides just, just I don't know, I think they're often seen as a pretty benign agent. I think that's part of the, the trick with why they're so widely prescribed is good people go, they're well tolerated in the short term. Yeah, they probably are. But if you understand that they actually are antibacterials, you're giving someone an antibiotic to take for life essentially and that it does have long term harm. It changes when you prescribe this agent, changes how long you prescribe it for. Never mind the stuff that, you know. 7.8% people SIBO. Developing SIBO after a week might mean that you're less inclined to just like, let's give it a try. I don't know what's wrong with you. I'm going to give you a PPI and see what the impact is which occurs. Like I see my patients not infrequently just prescribed a PPI because the doctors aren't sure what's going on. They're like, let's try it, see if it makes a difference. And that's okay if that medication is harmless or essentially harmless for short term bursts. But with this research going okay, well, 7.8% of people developed after just one week. That's like a trial period. Developed, developed a chronic condition that can be really hard to treat in some people. You know, take months to years of treatment in some people, depending on how they're responsive. They are. Placebo can be very quite variable in terms of response is like you might be causing a chronic disease to, to, you know, as, as a trial, when you're trialing something to see if it actually helps her treat a different condition.

Yeah, I always say maybe trial like ditching the burger, buns, rice and pasta for a week and see if you feel different. Different, you know, and I'm not anti any of those things. We often have an Asian meal in the mix over the month or two and there's rice in that meal and my family adores spaghetti bolognese. So we have that once or twice a month. But the rest of the time, I, I often find, I don't know if you found this, but this is just my life. I find if I mix a high carb and a high protein meal together. So high carb, high animal protein, that would be the heartburn meal. I can do carbs and veggies. Yeah, I can do protein and veggies. But there's something about mixing the high carb, high protein together. That for me is a no. And my husband's found the same.

Interesting. I, to be honest, I, I felt that I had, I haven't had reflux since I was a teen. But when I did have reflux, then it was when I had meals like, like that. Exactly like that. But I don't necessarily see that super common as in my patient population. Yes, in some, but, but others it is alcohol or there's certain things that make the sphincter lose its, its strength and tone. Yeah, yeah. Alcohol is one of those things that's It's a common driver, just eating larger meals and drinking fluid with meals. Sometimes there's just very simple things that, you know, you eat till you're full and then you drink a couple glasses of water on top of that, you, your stomach expands out and then the pressure is, is, is goes up and you get, you get it coming up. So that way too. So sometimes it's not even what they're eating so much, it's the quantity of food they're consuming and reducing food intake with their meals that makes a world of difference. Other times it's more complex than that. But, but it's interesting, that observation because I, I could think back when I was a kid when I had reflux. It was always after actually spaghetti Bolognese was probably cool that it was actually.

When I think about, yeah, 100%. And my husband was traveling to New Orleans for work last year. And so it was a week of like, there was chips and burgers or there was like a slider or like very sandwichy kind of situations. You know, hospitality conferences. It's not known for like leading with really healthful foods at the breaks. But he was like, oh my gosh, gosh, I just, can I just have a steak and salad? Can I just like really simplify, Just have. Because he knows now and then it's just, it's sorted in two days. He just doesn't have those problems anymore. So I think it's also about just tuning in.

Right.

We're so disconnected. We externalize health so much that we hardly have the conversation with ourselves about what's working.

Yeah. And I think convention, conventional medicine, medical model that we have gives clinicians so little time with their patients and it means that do they discuss diet much or lifestyle? No. And the end result of that is often. Okay, I've got seven minutes with you. You okay? You've got reflux. Okay. Here, take this medication. And will that help in the short term? Yeah. And that's. Sometimes we're off to these like short term fixes and people, patients aren't even necessarily told that there's a dietary connection. And some I think are, should be aware of it if they're paying any attention at all. And so some, I think do pay attention. They can't see pattern that occurs too. Don't get me wrong. But I think for many there, there's a clear pattern there from if they were paying attention to, to how the body was responding to what they're putting in, they would, they could work out what's, what's Healthful and health enriching for them. And which ones are actually causing them harm and symptoms?

100%. Now I have two more things to ask you about. One is blastoise. So blasto. Blastocystis.

Blastocystis, yes.

Yes. I didn't want to get it wrong. Do we have to go all out to war on this microbe, it sounds like? Not so much.

No. I think, I think the research has shifted here. And I can say as a clinician, I put my hand up here 20 years ago, if someone presented with symptoms and blasts on a stooled head, I would target that. That must be the cause. Let me try to kill it for you. I was there myself, like, you know, in the early 2000s when I first graduated as, as a naturopathic clinician. I wasn't using antibiotics to target it, but I was still using, you know, I would say pretty strong herbs that can cause, you know, broader microbiome damage trying to kill this thing, because the research at that point was strongly suggested that it was problematic. Okay. And all in all clarity, that's where the research was in the 90s and was.

Was really around that everyone was just doing the best with what they knew.

Exactly. Yeah. It's just that knowledge has evolved since then and, and I think it's important that we evolve with that change of knowledge because now, because I think part of the studies initially were like, okay, this person has symptoms. We check if they have blastocystis. Oh look, they do, therefore that must be the cause. Yeah, they didn't bother checking if healthy people had blastocystis either. And when there's greater proportion of blastocystis in people that had symptoms versus not. And when they started doing studies like that of what's the prevalence in healthy populations are like, oh my God, it's actually immensely prevalent. And, and like, I think there's some studies showing that 55% of Australians have got blastocystis in their guts, you know, and there'll be some people out there and, and I would say in the old paradigm, you be like, they be willing to give them like three different antibiotics orally and three antibiotics intraclonally to try to kill it, even if they're probably asymptomatic, because blast showed up on a stool test, you know, on the extreme things. And I've seen those patients afterwards when they're far worse off after the antibiotic decimation of their microbiome. And yeah, the BL is gone, but geez, they're, they're far worse off than they were before. Yeah. There's just been that, that shifting of actually, it's really actually associated with people who eat the healthiest diets. And those that have the most diverse and healthy ecosystems have got lots of sisters there. And those that have the most sort of decimated, you know, harm impacted, less diverse ecosystems have lower risk, lower rates of blastocystis. So we're seeing patterns like that. We're seeing, okay, like in one of the studies public presented, the data presented at the conference was they're linking, okay, the people that had blast had lower weight, better blood sugar control, better blood lipids. You know, they were generally metabolically much healthier than people that actually didn't have blastocystis. Yeah. And even its role in the gut has changed because it eats bacteria. That's what it eats. And it turns out that people are possibly now it performs the apex predator role in the gut. So like the great white shark or the wolf in Yellowstone that keeps deer populations in check, that if you take away the apex predator, there are consequences to that in terms of some bacterial populations that were kept in check, that were harmful, go out of. Out of balance because there's nothing that in check anymore.

Yeah. Wow. We removed the wolf.

Yes, that's right. Yeah. And that's where the current thinking is, is going with. With that. And I think in the vast, vast majority of people with blastocyst is present on a stool test. It's harmless. All right. I'm in that category. I've got blasted scissors in my stool. My. My gut health is touchwood. Been exemplary. I've got other health issues, but not my guts.

Don't want to better be dog.

Yeah, yeah. And I've got blastocyst there. I showed up on a sample, nurses doing a bunch of stool tests to compare what the different studies, the different labs found. And like, oh, look at that. I've got it. My family have got it all asymptomatic and going great. And you, the more you delve into the research, the more you go, oh, no, it's not a problem. And I think also when you start doing a more thorough workup of patients, like the patients I saw 20 years ago that said, I've got symptoms and blasto, I wouldn't do any more testing. I would just treat it that way. Point now it's like, I have patients who come to me, I've got blasto. I've got symptoms. I'm like, okay, let's test to see what else is going on. And it works. Oh, well, you've actually got sibo, or you're chronically constipated, and it's got nothing to do with blasto, and we can. And you fix the other things and blasto is still there and their life is going great. You know, I think it's only a very, very minority of patients that were blasto as actually a cause of their problems. I wouldn't say nobody, but I would say I had not treated someone in my clinical practice to target the blasto in the last eight years for somebody to give you an idea yet it shows up on stool tests frequently. And we get good results because we're treating the actual cause, which is not the blasto. You know, and there, I mean, I think there are some arguments that maybe the wrong diet, if you're eating a typical western diet, a crappy diet and lots of emulsifiers and, you know, and you've got blasto, maybe there's a greater chance of harm being caused from that interaction action. Yes. But that also means that you can change the diet and improve the healthy ecosystem and turn that maybe pathogenic blasto into actually a healthful variant just by changing the environment around it. Yeah. Which to me seems like a much better approach than, let's see if we can give you six different antibiotics at once and try to kill the thing as well as decimate your entire ecosystem as part of that process too. Yeah.

Wow. So many parallels. I'm sort of thinking almost about, like, mental health or like the bad boy who's misunderstood and actually just needed to be loved as a child. And like, that's interesting.

I hadn't thought of it that way.

But yes, I always, you know, because I always. I. I did a lot of kid education on gut health, like many years ago when we ran our thrive course and as a live course, and it was about helping parents, like describe. So I often use Star wars and the lightsabers and all the things to just, you know, good guys, bad guys. Little kids understand that. But it's almost like we also have to recognize that in the wrong context, a good guy can become a bad guy, and we want to help it become a good guy again.

Yeah. And that's very much the case with certain microbes in our gut. We call them pathobionts is our technical term. But bugs that are in the right amount do lots of healthful, great things for us. But when there's too much much, they can cause harm. Yeah. Or too little. I would argue there's harm comes from that too. And. And sometimes It's a matter of changing the environment. Like, like Bacteroides is a good case point. It's, it's a common genera and genus in the guts of humans. And it's really common in Westerners. Okay. People that eat live in Canada, Australia, America, UK tend to be dominated by Bacteroides because it likes living on a typical western diet. And, and it's, and it generally tolerates antibiotics well. So we're kind of given it killing off its competition. It survives and we're giving it the dietary protocol that it likes. And in that context, it produces harmful metabolites. Okay. And you know, and it's not when the PH in the environment of the colon is more towards neutral, it we're kind of getting the bad traits of the bacteria or these bad metabolic byproducts. It re releases toxins we're trying to get rid of, or drugs we're trying to get rid of. It re releases it. So you get a second go at biopic path, like a beta glucuronidase. But if we change the ph, I. E. We eat more fiber, we eat more polyphenols, we, we end up changing the PH of the environment and then bacteria is still there, but it isn't able to actually produce the same harmful metabolites anymore, and it produces healthful metabolites for us. So it is, sometimes it is a matter of just shifting proportion or shifting that what's around it. By our diet, we actually can bring out the positive trace traits versus the negative traits as well.

Very, very good clarifications there. I really, I really like that and I like where it's heading in terms of. I feel like we're in 2.0 with gut health. Right. And understanding. We're a lot more flexible in our thinking and understanding of science and recognizing gray area and, and that environment is king. And what we feed that environment is kingdom king. So the final question I have is very much speaking to that which is on glyphosate, glyphosate and its effect on the microbiome. There have been a few nascent studies over the last sort of couple of decades where alarms have been sounded. I had a wonderful practice, Professor Michael Antonio on the show a few years ago to talk about the effect of glyphosate on proteins in the gut and the genetic expression, which was kind of cool. But this new study in November has revealed something clearer for us about how we really should pay attention to where we're getting our food from. And if it's, if glyphosates around up is being used in our, in our food chain.

Yeah. And I think this is where we've had that shift in technology from. Because I agree there's been stuff around maybe glyphs that causes harm, microbiota harm studies published years ago. But we were using old microbiology techniques, we couldn't necessarily see the degree of perhaps harm that was done because. Not because it turns out that the whole reason that glyphosate stressor is used is because it actually blocks a particular pathway that plants have that human cells don't have. So they're like, oh, here we go, great. Something that won't harm humans, quotation mark, you know, that will harm plants. Therefore it'll be fine for us to ingest. But it just turns out that our bacteria, many of them share, actually have that same pathway that the plants have, the schemic pathway. So if we, we inhibit that, we're inhibiting their growth and we can actually work out to kill them. And it turns out that actually a lot of our good bacteria utilize that pathway. So when we ingest glyphosate, it actually inhibits the growth of our good bacteria. Whereas some of the bad guys actually can tolerate higher amounts of glyphosate. So glyphosate might actually have a selective antibacterial effect in a bad way that we're actually. And we need to ingest more of it. We actually selecting for more harmful species are going up. And the healthful species like Faecali bacterium, which is really a keystone health species for humans and Bifidobacterium we've talked a bit about already, their populations go down because they're sensitive to that agent, whereas things like Pseudomonas or Salmonella, they're like, oh, we tolerate this thing quite fine. So they'll keep going. Yeah, that's right. So it's kind of selectively having negative impacts. And some people were estimating that maybe 50% of the factor in your gut might actually have that pathway, that we might be impacted negatively by glyphosate. And when you start taking on one, at the very least, the importance of the gut microbiome to human health, or two, that bigger leap is that we actually are beings composed of human cells and microbe cells that make us. We should not be ingesting something that poisons the microbes component of us and that we can't imagine. There's not going to be consequences to that. I think that's because of that broader shift in consciousness of bacteria that Matter. Therefore we kill limit of who cares to actually know. Actually, actually, no, we are, we are beings that are like maybe equal parts, you know, maybe 90% microbes. There's some discussion about that, but we are mostly microbes, arguably. And if we're doing something that kills the microbial cells, how could there not be a consequence to that? Yeah.

How could that not?

Yeah. So when you start reading that and you know, again, and this is not something like antibiotics that are life saving, you know, it's life like, we do not need to be ingesting this substance as many people in the world who don't farm with glyphosate and we've grown food for millennia without this substance. We do not need to be exposed to it, let alone like spraying it all over our bloody driveways and stuff, because we've been told it's, it's, it's safe.

And would the respiratory impact of using glyphosate in a home setting be. Can, can that.

It would still get in that pure system that way? For sure. Yeah. Yeah. You wouldn't be negated just by. Because you're not actually ingesting in your food. You'd still come into your, get into your gut from that pathway for sure. It's interesting substance because even the impact it has on plants, like, it actually stops. I was reading that it actually limits the production of certain amino acids like tryptophan, because that pathway is important for the plants to make amino acids. So it actually, when you spray that on the plant, as the plant survives, it actually produces a lot less of those essential amino acids that we've relied on before and other plant metabolites that are based on that. So there's certain plant compounds that we'd see as medicinally active from a herbal medicine perspective that aren't produced if that plant is exposed to glyphosate. And it's just like, oh, God, what are the consequence of that? When it's bloody ubiquitous in our rainfall, in our water supply, it's everywhere. And it's actually maybe impacting the protein content and the amino acid profile of the foods that we're consuming, but also the medicinal constituents that are, that we've relied on plants producing for us, including things in potentially like polyphenols and other compounds that might be impacted because we're disturbing that particular pathway. It's scary when you delve into it in greater detail. And again, you just question why we allow this substance to be in our food supply and in our environment. You know, when we don't need it. I think that's the thing. I mean antibiotics, proton pump, tubers, they've got a use, they've got a time of need. This thing is not needed.

And it makes me think like if we're not, then could this be one of the reasons that plants aren't as satisfying from a protein perspective as they perhaps once were?

Interesting thought. Yeah. Because it is, it does seem to impact the tryptophan, I think phenylalanine, another amino acid that is not there. And nearly as much plants exposed to glyphosate. And the challenge is now it's not just the plants sprayed by the farmers. It's like it's become ubiquitous in our, in our water, water supply chain. It's like they're finding in rain, rainfall like everywhere.

It's just like, yeah, gosh, that just opens up a whole can of worms right at the end of our time. But suffice it to say that if you can do anything to change just a few items a week, to just make a start on organic or straight from a farmer where you can have that conversation and ask if they're spraying because, because sometimes really small farms can't afford the organic certification. So knowing your farmer is actually a really important piece of being able to afford spray free, glyphosate free produce.

Yeah, I'm a huge supporter of farmers markets and obviously organic produce too. But you know, every week I go down to my farmer's market and come back with baskets full of amazingly good, yummy, fresh, spray free, sometimes sort of organic, sometimes just spray free, but, but produce that just feels so nurturing, you know, And I think it's this and it's just such a good way of actually giving money directly to people who make the food for us to grow the food and showing that how important that is. It's such a, it's a vital thing that we just don't give them, they don't get the respect that they need given that they're the ones who are keeping us all alive essentially.

You know, it's 100%. And what a lovely place to end, support your farm farmer. I mean at the end of the day we can have these extremely technical conversations about groundbreaking science, studying little microbes in guts and poop, but at the end of the day, what it actually all comes back to and what makes it a heck ton easier to thrive is support your farmer and go buy produce or start growing if you have the capacity. So you know, know where a lot of your food is Coming from.

Yeah. And even from a microbiome perspective, one of the best ways we can diversify or add richness to our ecosystem is grow your own food and being in nature and, and even just diversifying your garden. Like, there's research showing that people that have a wider variety. Diversity of plants growing in the garden have a wider variety of microbes in their gut. Yeah. So it's like, diversify your garden. Don't have a green lawn. Like, my front yard is full of hundreds of different plants. It's like not just green grass, it's like, you know, and, and even if it's growing one thing, you know, that itself, that exposure to soil makes a difference. Even going and weeding their garden makes a difference from your microbiome perspective. So. So get out into nature, grow your own food and support your farmers. Those are simple, relatively simple things. You can do that. You've got control over that. That will make the, the world a better place, but make your gut a better place too.

It absolutely will. And I'm going to add worm farm because for the city people who maybe you've just got a balcony and you can grow a few pots of herbs, but a worm farm is such a brilliant way to tap into nature's cycle and be exposed to rich soil.

Yeah. And growing plants on the veranda, even if they're not edible plants, but just having exposure to plants because they've got their microbes. And if we're interacting with those plants, we get exposed and inhale and ingest those microbes too, which interact with us. And humans have always been, you know, exposed to microbes up until relatively recently in our, you know, city lifestyle where we might be no longer getting that exposure. And I think we missed. There'll be again, negative consequences when we kind of change what we've always been exposed to.

Yeah, absolutely. And it kind of, kind of. We're ending with let's all strive for unicorn poo. That's where we're ending.

And we can do our best with where we're at. You know, I have someone that's. I was, I was. No breastfed just this formula because that's what they did in the 70s. Or like, yeah, don't even bother breastfeeding. Just give formula that's better. That's what the doctors told my parents. They did. They're trying to do their best and that's just what they were told. Grew up eating a horrible American. I grew up in Canada, but, you know, we had American food.

Same, same, you know, really crap kind of diet.

Yeah. Yet at 18, I was like, I discovered health. It's like you could do a lot, you change. You can actually change a lot from that point, whether that be 18 or that's 20 or that's 60, but that's 70. You can actually make a huge difference by changing at that point, you know, no matter what went on beforehand. Because all these things happened to us before we had any say in the matter, you know, and, or knew better combination of those sort of things. But we just work from where we're at now and, and the gut does have a great degree of resiliency there. And I think if we can do some of those things of being out in nature wilder spots, you know, exposure to nature like that, as well as guarding those simple things will actually get start feeding new species into your gut. Maybe not in any permanent way, but if you're constantly exposed, it's no different because they're constantly there because you're constantly exposed to those microbes.

Yeah. Brilliant. Thank you so much for all your amazing work and for sharing what is happening at the forefront today. I really, really appreciate it.

Ah, you're welcome. It's been a great conversation. I enjoyed it too.

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