Ep. 72 Interview Dr. Jason Hawrelak: The Last Microbiome Episode You Will Ever Need

Hey, guys. Welcome to the show. Now, Today, I have Dr. Jason Horlik on, and he's going to talk about the microbiome. I was really excited to get him on because, you know, as many of you know, I have been looking into the microbiome for most of this year and really just looking for what it can offer to us as a method of treatment. You know, is it a root cause to things that people are dealing with? Now, Dr. Horolak has 20 years of experience as a researcher and a clinician helping people recover from a variety of different conditions using the microbiome. So he's helped kids with autism, he's helped people with chronic gut conditions like ulcerative colitis, he's helped depression, anxiety, autoimmune diseases, and just a lot more things. So this is a guy who really has his feet on the ground and he's helping people in the field. Now, in the interview, I asked a lot of questions, and sometimes those questions were a bit all over the place. But I do think I gained more knowledge about the microbiome from this interview than any other one. But because those questions were kind of all over the place, in the conclusion, I'm going to have a summary of the interview and kind of bring it all together in a way that I think think makes sense, because there were some serious deep insights here, but we might have sped by some of them. Enjoy the interview. Dr. Jason Horlik, welcome to the show, man.

Hey, thanks. I'm glad to be here.

So you are coming all the way from Tanzania, right?

Close. Tasmania, Australia. We're the little island state that hangs down the southern southeast coast of Australia. And Tasmanians didn't really see themselves as being separate from the rest of Australia. So they're the mainlanders and we're Tasmanians.

Wow. All right, so today we're going to talk about the microbiome. And so let's start off by. Why don't you tell the audience about what it is you do and how you became interested in the microbiome?

Yeah, I wear a few different hats, I suppose. I finished my training as a naturopathic clinician in 1999, and at that point I essentially decided to pursue a research path. And that was inspired by a lecture given to me by one of my. Who later became my PhD supervisor at one of my lectures at university around gut dysbiosis and its link to other chronic diseases. This was back in 1999. So, well and truly, before it was a hot topic everyone was talking about, there was naturopaths talking about it and had been for a long time integrative medical practitioners for example, and some very core microbiome researchers, a couple handful around the world at that juncture of time. But the lecture just really inspired me. So I approached him right after the lecture and get, I know my undergraduate degree is coming to an end. I really want to research this area, I really want to expand the knowledge base that's growing. So I went on to do my honours degree which in Australia is a research based degree and then my PhD flowed on from there. So we did monitor, we did my first clinical trial looking at changing the microbiome of patients with irritable bowel syndrome. So we were using prebiotics, probiotics and herbal medicines as a way of changing the gut ecosystem. And we chose IBS because at that time it was probably the best. I had the most evidence for an altered gut ecosystem in a disease state. And now we're linking dysbiosis with everything. But back then there wasn't a huge amount of research around dysbiosis and its role in different disease states. But there was in ibs, so hence why we chose that topic. And then my PhD flowed on from that. So since that time I've essentially tried to maintain a foot in the clinician camp. So I've been a clinician for 20 years and I've been doing research for that whole time too often on at different time points from doing more paper based research like systematic reviews to doing clinical trials and other types of study designs to education as well where I'm educating other health practitioners. And those three hats are still what I wear now, which makes my week very varied in terms of today is my clinician, today is a researcher, today is my educator hat. And they flow together really well. But it means a very, very work week, which actually suits me well.

Yeah. So did you ever have a like personal issue with the microbiome or was it always from like a research and like a doctor's perspective?

Yeah, it's a good question. I mean not, not directly, no. You know, for me my health issues were around asthma and hay fever, you know, and I can look back in time and go, okay, well that, there's obviously a microbiome link there. And you know, my asthma developed after like my third course of antibiotics for viral infection when I was three, so you know, I could like, yes, I can see that now. But it certainly wasn't that straightforward at the time. I was just really inspired by the topic and it wasn't because I had personal gut issues. In fact, I'd say my gut is one of the strong areas of my body. But since my research delving into that area, my clinical practice has been mostly around gut. And for the last decade, I'd say 95% of my patient load is more directly gut related. Because these days you could argue that depression, anxiety, menopause, almost any condition you can list has got a gut health and gut microbiome connection. But most of my patients, ulcerative colitis, ibs, sibo, peptic ulcer disease in that more true gut realm. But there are flow on effects. I'm seeing lots of autistic children more recently, for example, where there's a core microbiome connection.

Yeah, it's pretty amazing how many things are attached to the gut. I mean, when I worked in a health food store, there was this saying, it all starts in the gut. And it was kind of like this belief that if you didn't get your gut fixed, it was really hard to fix anything else. Have you found that to be true?

Yeah, and that is an old, very old concept. You go back to Hippocrates, I think, was saying similar things. And we as naturopaths tend to see ourselves as flow on coming from the teaching of Hippocrates back in the day, and that's always been a core thing for naturopathic clinicians, is the importance of gut health. And even we were talking, I've got some older senior colleagues who have been naturopaths since the 1980s and they were taught about dysbiosis and its role in chronic ill health back then. And that was well and truly before the microbiome boom and well before we had had much research and the access to tools to work on how to define dysbiosis particularly well. But the discussion was still around that point about the importance of gut health for pretty much every other sort of chronic health condition. And I think research, if anything, has really borne that out in the last 20 to 30 years.

So a lot of times the advice you will hear in a health food store is like, take lactobacillus, take bifido. And it's not, it's not that complicated. But it seems like you are someone who has a handle on, at least maybe broadly speaking, of what the good stuff is and what the bad stuff is outside of those really basic categories. So this might be, I don't know, a bit of a broad question, but when you treat someone, where are you trying to get them to, like, where are you trying to move their microbiome to.

Yeah, I mean I would say there's still some debate and discussion amongst researchers on, on what exactly a perfect super healthy microbiome is. For me there's a few aspects that have come through in the literature and I'd say as 20 years of working as a clinician in this area as well, we're looking for diversity. But within that diversity score there's two things we look at. We look at the evenness or the spread of bacteria. We don't want an ecosystem that's too dominated by one species. I like to illustrate this to my patients. I tell them about an example of let's say you've got an acre of rainforest or an acre of, of any sort of forest and you've got, let's say you had 160 species in that forest. It sounds species rich. It is. But if 90% of those trees or 80% of those trees are one type of pine tree, or in Tasmania we go blue gums like one type of eucalyptus, it's going to look like a plantation. It's not going to be really healthy ecosystem. And those are the things we look at. We're looking at the number of species that are present, we're looking at the spread. So you're not too dominated by one or two species. Those are key things I look at. But then I'm also looking at healthy levels of what we generally would refer to as beneficial bacteria and low levels of what we call pathobionts or end pathogens. Now pathobionts are species. I mean people are generally familiar with the word pathogen which is disease causing. But there's a range of bacteria in our gut we call pathobionts that when present in too high amounts are problematic and cause harm. And a lot of ecosystem work, at least that I do, is focusing on decreasing levels of those pathobions that you don't want to eliminate them. They're not bad, they're horrible to have at all. It's just that when their population is too high or in the wrong location they cause harm. And that can be level of inflammation or gut damage releasing pro inflammatory mediators that then impact the whole body functions for example. So a lot of work is on trying to, working within that structural hierarchy of going okay, well how can we improve diversity, how can we improve evenness, how can we increase levels of beneficial bacteria and decrease levels of pathobion?

And so when you say pathobions, are you talking about E. Coli or.

Yeah, E. Coli would fit that bill. Hydrogen sulfide Gas producers would probably fit that bill too. A classic one would be Methanobrobacter smithii, which is a key methane producing microbe in your gut. And it's an interesting microbe because it eats hydrogen gas and it essentially grabs four big bulky hydrogens and shrinks it down into one little dense methane. And by doing so, it can actually help reduce gas related distension from eating fermentable fibers. That's a good thing. But when there's too much of it, that methane actually slows down gut transit time and slows down and can cause things like constipation and allow that gas to build up. So that's a classic example of pathobiology. And the right amount is very helpful for us because if we don't have that microbe, there's problems. And the research shows that if we're lacking methanobivactor completely, we're very prone to bloating and distension because that hydrogen gas in these people can often just stay as hydrogen gas. And you get this huge amount of volume as gas in your gut that doesn't get processed through it pathway. But when you have too much, it actually slows down. And for many of my patients, it's a key driver of constipation or slow transit time. And slow transit time can often be a bit more hidden because you might still be doing one bowel movement a day, but you might have this huge amount of feces that's loaded up in your colon, despite the fact you're pooing once a day. And that can allow you to one, you get that more gas buildup too. You can get griping, cramping, pain, but on top of that, you're actually reabsorbing compounds from that fecal matter. To put this in the extreme end, one of my patients, I had to do a very simple thing of just having them eat some corn in the cob or some red quinoa. Black quinoa, black rice don't chew that well. Write down when they eat it and then they watch for when it starts coming into the toilet bowl and when it finishes. This gives us a rough idea of bowel transit time. You can do it in hospital settings with radioactive probes and get a much more accurate result. But this is a nice, cheap, easy way of getting feel for how quick or slow that process is. I've had one patient who was doing a bamboo every couple of days, you know, probably three abominable months per week. But it was 26 days before the corn and the cob came out the other end. And that just shows how much fecal backup she was having. And while she was feeling fatigued, depressed, you know, because we know that it's metabolic. 26 days. I know. You wouldn't even think that's possible unless. Until you do tests like this. And there's another patient who did a poo every single day, never missed a day. If that's all you're basing it on, is okay, you never miss a day. You must have good transit time. You're mistaken.

Her.

It was 10 days. 10 days for that corn to come out the other end. Yet she doesn't meet the definition of constipated because she's doing more than three bowel movements per week. She was doing one every single day, but she still had slow transit time. And that slow transit time was essentially causing increased absorption of compounds from her poo that didn't make her feel that well were giving headaches and fatigue. And once we sped up that transit time, she started feeling much better in so many ways. Not just gut, but more broadly.

Wow, that's kind of blowing my mind right now because you always hear, oh, if you're constipated, you're constipated, but if you're going every day, you're fine. But you're saying that basically, even if you're going every day, this one guy had a 26 day transit time. I mean, that's ridiculous. That's nuts.

Yeah, Yeah, I know. It is crazy. And once I started doing this with every single one of my patients, you learn a lot more about how their gut is actually functioning that you don't get solely from just looking at their bowel movement picture. Certainly if they're only pooing once every two or three days, you know that they're constipated, they meet that strict medical definition. But you. It's just that there are people that don't fit that who still have that slow transit time that is impacting on their quality of life dramatically in many cases. But it's not so obvious because their bowels are not constipated from a typical medical definition.

Yeah. So would you say this is the most common problem you deal with, or is there something else that you see quite a bit of?

Listen, this is pretty common in my patients, actually. Yeah. I mean, a lot of my patient load is irritable bowel syndrome, sibo, small intestinal bacterial overgrowth type patients. So having this high level of methane is often a contributor to that slow transit time. So that sort of picture, that level of pathobuoyant that I've flagged before, is pretty common in that patient load. That makes it the bulk of my practice currently.

So how difficult is the microbiome to change in general? I mean, is it very difficult to change or is it kind of easy?

I'd say it's actually easy. We know that there are medications like antibiotics and proton pumptubers that can cause very dramatic shifts in gut ecosystems and massive changes and loss of species richness, for example, and big changes in evenness and spread, as well as actual extinction level events, major changes in beneficial bacteria, pathobiomes, etc. But you can also, the opposite can be the case too in that changes in diet, the use of prebiotics, can actually cause massive shifts to ecosystems as well in a much more beneficial way than what you would tend to get with antibiotic classes. And it can happen relatively quickly as well. One population group that I've been working with more recently with kids on the spectrum, and I've been amazed at how flexible their ecosystem is compared to the typical population where, yeah, it changes, but not nearly as quickly and not nearly as dramatically as what it's been working with some of these kids on the spectrum. But that said, you can make dramatic shifts in ecosystems within one to two months with changes in diet, changes in lifestyle and with prebiotic supplements, absolutely massive. If all you're doing is eating some fermented foods and taking a Lactobacilli based probiotic, the changes are going to be very mild. You might just have a few more species show up on the bottom of your list. When you do a gut microbiome assessment, maybe a small tweak at the top in terms of some things like Bacteroide use, for example, that might come down a little bit when you eat some foods like that, but the changes will be very mild in comparison to making a dramatic change in diet or using prebiotics.

So you mentioned a microbiome test. Does somebody have to do one of those tests to really know what they're doing? Or can they kind of make changes and go by feel?

I think it depends on the person and what's going on for them. I mean, I think for those people who just want to optimize their health, I mean, if you've got the funds, it's not that expensive these days to do it. And you're very curious. Sure, I think it's worth doing. But the reality is that what we're trying to, if you just implement eating mostly Plants avoiding processed foods, eating like a rainbow of colors, the broadest diversity of plants possible. You will enhance diversity, you will enhance richness, you will improve levels of benefit bacteria and you will decrease pathobiots from that across the board. It's just that certain people with different disease states, we might want to fine tune things or how things work more quickly or they might be in a situation where we have to do preliminary work first before you can do those dietary changes and or prebiotics that will make those beneficial shifts because they'll cause worsening symptoms. That mention of methane overproduction is probably key here too, that sometimes if we just go okay, if we didn't know that their bowel transit time was immensely slow and we go okay, well let's start eating this higher fiber, more plant based diet and take these prebiotic supplements because these things will improve the health of the ecosystem. They will, but they will certainly worsen bloating, worsen distension, and sometimes cases worsen constipation in those people that have an overproduction of methane already to start with. And by doing some either breath testing or in some cases or microbiome assessment, we can actually have a look and we can fine tune how we make the changes. What we start with first or we might decide that we need to bring that methane production down first before we can then make the broader dietary changes that will shift the whole ecosystem in beneficial ways.

What is your go to for the methane producing bacteria?

Yeah, there's a few things. There's a probiotic, Black Pills, Reuteri DSM17938 Catchy name that we know can decrease methane overproduction in the small bowel or the colon. There's partially hydrolyzed guar gum which is a prebiotic fiber which again can decrease methane overproduction in the colon. Then there are often herbal medicines I'll use on top of that to drive that change. And there's a range of herbal medicines that have got the capacity to decrease that methane overproduction. From things like garlic to pomegranate husk to clove oregano, thyme and more.

Which companies do you like for the microbiome tests?

Yeah, I start off with eubiome which don't exist now, but they were great and they were the first one that made it affordable and made it so everybody could access their microbiome data if they wanted to. Then I've moved on to thrive because that was the next similar technology and similar price point. Now I'm leaning towards cosmos id, which is a US based lab in Maryland who uses metagenomic sequencing and you get a truckload of data, strain level stuff like that. I can even show you that if you're taking lactois rhamnosis GG as a probiotic, that will show up as that strain in your test results, which I think is very cool. Plus they tell you about fungi, plus they tell you about protozoa species that are present. So you get a much more comprehensive overview of what's there in fine detail as well, you know. So that I'd say is my preferred lab at the moment.

Is it a little bit pricier than Thrive?

Yeah, you're looking at around $300 per test versus thrive. With that perennial discount code, it's around US$100, so three times the price. So I'm still using Thrive in patients where I don't necessarily think I need that level of extra data and or they're more financially challenged and we want to do lots of follow up. If I want to follow up every month, I'll go with Thrive because it's affordable. Whereas $300 every month or two adds up pretty relatively quickly, particularly because they're already taking medicines and they're often unwell and they're doing lots of other things. I think there's a few things I take into account and I'm preserving the cosmos ID for when I want to look at the protozoa and fungi and look a little bit more deeper level. Looking at species level information versus Thrive, we get a good overview of genus level data, phylal level information. Most of our research around gut health and disease associations is at the species or, sorry, at the genus level and the phyla level. Anyway, I think there's more than enough to work with a company like Thrive's results. Anyway, Biome site in the uk there's a few labs, my micro zoo in Europe that I work with patients, depending on where they are in the world that use 16s techniques which give us accurate genus level data.

I see. So I was actually introduced to your work on a Microbiome website where you put your data in and all that stuff and so it let me see what bacteria I had and, and the balance therein. And there was this section on the site with your name on it and several different bacteria that you had hand selected as important in some way or another. So I want to ask you about how you selected those bacteria. Before that though, I'll just read off this list if I can pronounce these bacteroideia Akkermansia, bacteroides, Bifidobacterium, blautia, disofusion, disulfovibrio.

Well done.

Yeah, you go. Bacterium. Anyway, there's this list. So how did you choose this list of bacteria?

Well, some of it was limited by what we know about the microbiome at any given time point. And someone who's been researching this for 20 years, it's like our knowledge has expanded dramatically. You go back 15 years ago, we didn't know what Akkermansia was, we didn't know what Faecalobacterium was, let alone the fact that they played key roles in our health. So that list was essentially devised on what research we've got, showing certain species in those different categories of those beneficial species of the pathobionts and then the pathogens as well, and looking at the normal amounts in healthy people and then using that as a bit of a framework with some. The newer tests were coming out giving percentages with individual patients and is really trying to devise a framework of going, okay, well what's normal? Where should things be? And then how do we change. Change that as well. And that list, I'd say, will be expanding over the years because we're learning more about the ecosystem, we're finding new species, and we're defining what some of the species that we found five years ago are doing and what role they're playing and how to shift things too, because that's the other aspect too, that sometimes we're finding research going, oh, well, Oscillospora is linked to higher amounts with this disease state. And like, well, how do we adjust that? Some of the stuff we just don't know yet. So as someone who's been in the field for 20 years, it's like, God, we know a lot, but there's still so much more to learn. And we go fast forward 20 years from now and we'll go, we just didn't know much 20 years ago. But it's just that expansion of our knowledge base and because research is accelerating it dramatically now, where as I said before, you go back to the late 90s, early 2000s, there was only a couple of handfuls of, of microbiome focused researchers around the world. And now there are thousands and thousands of them and we're using much better technology. So that's why the knowledge is expanding so much. And as I said, that list will be ever growing as we learn more about different disease associations and learn more about how to modify those specific populations.

Gotcha. So are any of These bacteria would you say are more important than another or that somebody should focus on?

I mean, I think there is some disease specific information there and that we know that Akkermansia mucinophilia, for example, Akkermansia on that list is important for metabolic health. It plays a role with obesity, type 2 diabetes, metabolic syndrome for example, and just gut integrity in general. It's a species that we really focus on. If anyone comes with those background disease states which is common in westerners having metabolic dysfunction, having a leaky small bowel, intestinal hyperpermeability is actually really common when we test for it and as a contributing factor. So if we can focus on those species that promote healing of the gut, that's really a key part of the healing process. Akkermansia is key there, Bifidobacteria is key. Then the range of B tray producing bacteria. The B3 producing bacteria are ones that people are probably less familiar with because they've only come into the limelight more recently. But that would be species like Faecalobacterium, Eubacterium, Blotia, Subdola, Granulum, Anerostypes, Roseburia are a few examples of those that we focus on improving their levels to again promote a normal sort of colonic function or to decrease inflammation in the colon. And that were a condition like inflammatory bowel disease like ulcerative colitis or, or a condition like irritable bowel syndrome where they have a degree of inflammation in the colon that's more low grade than a typical inflammatory bowel disease scenario, we will use those or I will use the butyrate producing bacteria to my advantage as a clinician. I will feed up and nurture those butyrate producing bacteria because they produce butyrate and that butyrate has a healing anti inflammatory effect in the colon. And it's a key part of my approach to treating those diseases.

Okay. Yeah, it's, it's interesting you mentioned the Akkermansia because I've kind of been on my own personal quest to try and increase those in my own microbiome because I have low levels and I've, I've used cranberry, I've used pomegranate, I actually took an Akkermansia probiotic one made by this company called Pendulum.

Ah yes, that's new.

Yeah.

Exciting. It's like the first new generation probiotics. So it's the first of many exciting products to come.

So I think, and I think doing all that, my levels have gone from like 0 to like 0.05% or something like. I mean, they've gone up, but barely anything. So what do you usually do for your patients for Akkermansia?

Akkermansia is usually immensely responsive to inulin phos and most, most of the time responsive to lactulose. And those are two very key important prebiotic compounds. So inulin phos is a natural indigestible oligosaccharide, which just means like a slightly larger sugar that we find in things like dandelion roots and burdock roots and chicory asparagus, a little bit in wheat and rye and barley as well. Bananas have a small amount. Onions and garlic have got better amounts. But this compound is particularly adept at feeding up Akkermansia. So it's my go to in that case. And lactulose works in about 80% of people, not 100%. I think there's some Akkermansia strains that lack the metabolic capacity to digest lactulose, but most do. But inulin phos works like 99.9% of the time. The only challenge can be that it does produce gas. Inulin phosphate. For people that have slow transit time or inflamed nerves in their gut, that gas production can cause bloating, distension, pain, as well as just flattish. So when your gut's working well, you'll just fart more. Generally, the flattest will be less smelly than normal. More volume is potentially louder, but less smelly. So that's all good. And it's usually just the first one to two weeks that you're taking it that you really experience that. But when people have a degree of dysfunction in their gut or a degree of inflammation in their gut, they can actually get much more symptoms that impact their quality of life far more so than just higher flatus. And in those populations, we sometimes have to use some of the less effective tools, like the cranberry powder, for example, or other red polyphenols that do have an impact, but not nearly as dramatic as what you get with inulin phos.

Wow, that's really interesting. I got to try inulin phos then.

Yeah, in the sense, we call it inulin phos, but the proper name is oligofructose enriched inulin. I just say inulin phos because heat's quicker, but it's essentially a combination of equal parts. Inulin, which is a long chain fructooligosaccharide, and then oligofructose, which is a short chain fruit oligosaccharide and they just put equal parts together and that has the greater capacity to nurture a range of Bifidobacteria species, but also Akkermansia.

Gotcha. So it sounds like you almost have really targeted approaches for certain bacteria to raise certain bacteria, to lower certain bacteria. So what probiotics do you use? And you know which, which strains are you targeting? I mean, this is probably a kind of a broad question, but. Yeah. What probiotics do you really focus on?

Yeah, I think there's a misnomer around probiotics having a huge impact on that gut ecosystem. And they don't. Not when compared to prebiotics or changes in diet or polyphenols. They have a much greater impact on shifting levels of pathobions up or down or feeding a beneficial bacteria up, for example. However, I do use probiotics lots in practice because they do have, again, I'm using them in a very targeted way. It's not just like, oh, here takes this probiotic because it might do something. No. There's ones that specifically enhance immune response and decrease your risk of respiratory tract infections. I'll use those ones when I'm working with someone who works in a daycare center or a teacher at school and they're worried about getting respiratory tract infection. Okay. We have certain strains that clinical trials show enhance immunity and make it less likely for you to get sick. Both gut infections, but importantly respiratory type infections. There's other strains that protect against rotavirus diarrhea. So again, in those similar populations, we'll use those strains. There's other probiotic strains that speed up that colon transit time. So those patients that have slow transit time or constipation, I'll use the strains that speed that along and can actually make a huge difference to how they those patients feel. There's others that can actually enhance mood and decrease anxiety. I really use the clinical trial evidence to guide my probiotic prescribing. So I'm not really just going, I'm going to take this multi strain 500 billion preparation. I don't do that. It's very much targeted going, here's what's wrong, physiologically speaking. Here's a probiotic strain that can impact that specific pathway and improve things. And that's how I'm using probiotics in my practice.

Gotcha. So do you think it's a good idea for, for someone to just go to the store and find one of Those multi strain 100 billion probiotics and start taking it?

I generally advise against that. I mean I think if you're willing to influence the microbiome in a very positive way, which is why many people are doing that, you're better off just changing the way you eat and encouraging the growth of species that you want more of and that their populations are dictated by what you eat. Are you feeding those species that you want? Are you feeding species you don't want? It's getting that sort of knowledge so you can actually make the right decisions. From a dietary perspective, prebiotics are much more happy as a daily supplement because prebiotics like inulin, phos and lactulose, there's research showing that they improve immunity as well. So decrease your risk of developing respiratory tract infections or gut infections. They increase your absorption of things like magnesium and calcium. There's research showing that they could decrease the sort of precursors or creators of compounds that can be created in the gut that lead to things like colorectal cancer. And they generally can have an effect on well being and your stress response. And for me, that makes much more sense of going, okay, well, I take prebiotics daily, for example, and I choose the foods that I eat very much thinking about what species am I feeding with this food? I'm making sure I'm growing my inner garden by my food choices. This is really important when you think of the fact that you as a human are mostly microbes and people are debating about how much microbe you are. You might be 90% microbe, 10% not or 60% microbe, or 50% microbe. There's still discussions around that, but you are mostly microbe. I think it's immensely important that our food choices are based on how we nurture those non human or the microbe cells. Because I think sometimes that has really been neglected in the traditional nutrition dietetic field. We're all focusing on what feeds the human cells, not so much on what nurtures the microbe cells, which we know are absolutely key to our short term and long term health goals, is making sure that we're feeding the right species with our food choices.

Yeah, that's really interesting. So what do you think of the fermented foods out there, like sauerkraut or. I've even heard of, you know, people doing this carnivore diet, eating like rotten meat for a probiotic. So what do you think about that?

I think the thing about those food ferments is that they're wild ferments. You don't know what species or what strains you're getting. Sometimes you generally have an idea that like with sauerkraut, generally, the end species, the sort of trying to think of the right word for it, my brain is slipping in terms of the right term for it from an ecological perspective. But the end species there is usually Lactobacillus plantarum, but there's a range of different strains of Al plantarum and how much is actually there can differ. And I was giving a lecture just a few days back, talking around Kefir and kombucha, and if you grow it at 20 degrees Celsius, you get different species growing than if you go to 30 degrees Celsius. If you grow it on green tea versus black tea, you get different species composition, different fungal composition. It's just so variable that I don't think we can rely on it as a therapeutic tool. I'm quite happy to consume it and suggest people can, yes, fine, have some. And you'll get a temporary boost in species richness because you're going to be. You might be consuming 10 or 12 different species in that glass of computer kombucha or that bowl of sauerkraut, but they're certainly not permanently colonizing your gut. They're having minimal impact on species populations when consumed, but they are adding to your total whilst you consume them. In terms of how many species are present in your gut, they do make food taste good and that diversity of flavor and improve nutritional content. So I think there's good reasons to use fermentative microbes to do some work for us and to consume them as well. And at the very least, we tend to research shows that even if they die in the stomach, the sort of dead bacterial bits tend to enhance immune response. You could argue from our evolutionary perspective, we've always been eating dead microbes, probably in far greater amounts, or live or dead, but the microbes in far greater amounts than what we do now. So it might more match our evolutionary biology to have some microbes on a daily basis, because our food supply tends to be much more sterile now. We're not having dirt on our foods, for example, we're washing within chlorinated water. And our produce is often sprayed with chlorinated water in the supermarkets too. So we're missing the microbes that would often be on those foods in a much more natural environment. But I think there's been far too much focus on the importance of fermented foods and far less on fermentable foods. And I would say that what the research shows us is you get far more dramatic shifts in your gut ecosystem from Having more fermentable foods.

Gotcha. Yeah. It is kind of nuts, the trend towards fermenting things. I was just talking with a store manager, I was in a store today, and she was saying that one of these vitamin companies, basically, they're just fermenting everything now. Everything is fermented. Garlic is fermented, vitamins are fermented. And so what you're saying is it's not as important that you're eating something that is fermented, but that it's a food for the right bacteria in your gut?

Yeah, for me. And I think the research is clear on this. If you really want to make big shifts, beneficial shifts in the ecosystem, eat fermentable foods, eat lots of a range of different fibers, a range of different plant polyphenols, and that will have that effect of increasing diversity, improving evenness, increasing levels of beneficial bacteria in the gut, and decreasing levels of pathobiomes, which is really what we're aiming for when we're shifting an ecosystem. There's things we had to tweak that for individual people. But that dietary approach will be far more effective than drinking some kombucha, drinking some kefir, eating some sauerkraut.

Yeah. So if you had to make up a protocol for your average person just to maintain gut health or maintain a microbiome in a healthy state, what would that look like? Would it be the inulin fos every day? Would it be, you know, maybe pulsed uses of fibers or what would that look like?

I think, you know, I've touched on this already, but I'll. I'll say more explicitly here. But it's eating mostly plant, and it's. It's avoiding all processed foods, and it's having a diversity of different plant foods and a rainbow of colors. And I usually suggest my patients aim for about 40 different whole plant foods per week as just something that's achievable, that makes sure they're having diversity, different fiber types. Because we often get in our head that fiber is fiber. It's not. There's all these different. Hundreds of different shapes and sizes of fibers which feed different microbes. We know that diversity is key. And how do we get a more diverse ecosystem? We feed different species. The best way of doing that is with a range of different dietary fiber types. I suggest patients have black rice, red rice, brown rice. Rather than just focusing on brown rice, for example, it had red quinoa, black quinoa. Rather than just having white quinoa, they use a variety of different apples, variety of different foodstuffs altogether because the different color compounds, slightly different fiber shapes in those different foods will essentially feed a wider range of microbes in the gut. So to me that's the core aspect of it. But we'll complement that by taking things like inulin phos, because even just one teaspoon a day, which is around three grams, that's a minimum therapeutic dose. And that will help make sure that your Akkermansie and bifida bacteria are at a healthy population, that your faecalibacterium, a key butyrate producing bacteria in the gut, is in a healthy population. And also, as I said, you get the added benefit of increased absorption of calcium magnesium, so enhanced nutritional status as well as improved immune response on top of that. So that's a nice addition to that general aspect of eating. Mostly plants, wide diversity and a rainbow of colors. And because the colors are important, because it's the polyphenols in black rice, on eggplant skin, in raspberries, blueberry skins, that tend to nurture a wide range of beneficial bacteria in the gut as well.

Gotcha. So humans have these two large groups of bacteria in their gut, the firmicutes and the bacteroides. And there's been a lot of studies that look at different ratios of those and say one is better than the other. Do you think that ratio is important?

No, I'd say not. And I think there's been some papers at certain time points, like there was a really pivotal publication, I think it was 2005, 2006, that was the first one that linked microbiota to metabolic health and obesity. It was absolutely mind blowing publication because it really blew our minds about the importance of the gut ecosystem and that it was far more than just gut disease that was impacted. In that paper they talked about a higher bacteroidetes to firmicutes ratio being important. I think that's where a lot of this information came from. Was that pivotal paper that made headlines around the world for good reason, because it was a very pivotal paper. However, there's just been a number of studies done even in that obesity metabolic field that have found different results since then, finding that maybe actually no, it's more important to have more firmicutes than it is bacteroides or that the ratio is completely irrelevant. That has really cast shade, I suppose, on the importance of that particular ratio. So it's certainly something I keep in mind. More so in terms of the level of firmicutes because almost all of our butyrate producing Bacteria are in the Firmicutes phyla and there's a lot of pro inflammatory species in the Bacteroides phyla. And in some patient populations, levels of Bacteroides or Prevotella, which are the two key genera found in that Bacteroidetes phyla are really high and are problematic. So it's certainly something I look at, but I don't think that exact ratio is nearly as important. And I think it's with the composition of those phyla that actually is more important in terms of. But as I said, if you have like 80% Bacteroides in your gut ecosystem, that's going to make your bacteroidetes at least 80%, probably more, slightly more than that. And that's problematic having 80% of a single species dominating particularly things like Bacteroides or, or Prevotella at such high amounts. And those are the two genera I've only ever seen that dominate so dramatically in certain people's ecosystems. In which case we do certainly want to change that ratio, but we're looking more at the genus level rather than at the phyla level. I think perhaps a phyla that I think is actually really key for a range of disease states is Proteobacteria. And it doesn't get nearly talked about as much as it should, but Proteobacteria is usually the number third or fourth highest phyla in people's guts. But it can be number one in certain dysbotic states. But one thing that all Proteobacteria have in common is their production of a compound called endotoxin or lipopolysaccharide and a much more potent version of it. In all gram negative bacteria produce endotoxin, but Proteobacteria produce a much more potent pro inflammatory endotoxin. And there's a growing body of literature linking this production of endotoxin the gut to things like chronic kidney disease, fatty liver depression, anxiety, Alzheimer's disease, multiple sclerosis, Parkinson's, a whole wide range of autoimmune diseases, gut damage more specifically as well in terms of causing more increased intestinal permeability, all being linked into this over release of endotoxin the gut by having different high levels of Proteobacteria in the gut. And I think we'll find in the coming years there's going to be more and more discussion around that particular phylum.

Yeah, that's really interesting about the endotoxin because that's been something I've read about quite a bit and it's one of the only things, I think that if you actually inject it into people, it can give them type 2 diabetes. It just causes a cascade of. Of bad things that can happen to you.

Yep. Yeah. And you can give it, you can give an injection to someone who's healthy and happy and they get depressed and anxious for about five hours afterwards.

Yeah. Well, that's one thing I heard about the firmicutes and bacteroides is that the Bacteroides have a lot more endotoxin than the firmicutes.

Correct. Firmicutes have got none. But Bacteroides are all gram negative and they all are releasing that endotoxin all the time. And that's where I think the overall amount, not necessarily the ratio of firmicutes to bacteroides, but the overall amount of Bacteroides. Bacteroide, sorry, can be problematic and certainly an inflammatory driver. And I do see that quite commonly in patients.

Yeah. I mean, my own personal testimony is I tested my microbiome back in January and I did some different protocols and I went from maybe 65 to 70% Bacteroides down to 30 to 35%. And I've had a lot of health benefits from that.

Yeah, I reckon you would, because that's high. Because you're getting a lot of endotoxin being released. If you're like seven out of every 10 bacteria in your gut is gram negative, they're constantly dying and releasing the endotoxin into your gut. And that is a dramatic pro inflammatory driver, both in the gut, but body wise as well.

Yeah. How does somebody get to that state? Like how does somebody get to that state where they have such an inflammatory gut? I mean, is it a diet thing that they're doing? Is it influenced by their lifestyle?

Diet, lifestyle and medications. Those are the core drivers of those changes in the gut ecosystem. Bacteroides, which is often the key genus in those situations, is I like to think of as the omnivorous pig of the gut ecosystem. Eats a bit of protein, it eats a bit of bile, eats a bit of sugar, eats a bit of fiber, pretty much anything. And hence why it tends to be common in humans worldwide. But it's very dominant in people in western countries eating a western diet because they're having no fiber in general and they're having lots of protein and lots of fatty things which increase bile flow. So there's not much competition for protein putrefaction the gut, not much competition for bile compared to fiber. There's a dramatic competition for fiber in the gut. And Bacteroides is not great at eating fiber. It is okay at it, but there's other species that are better at doing so. So when we're having more plant based diets, we tend not to be very high in Bacteroides. But if we're mostly animal based processed food, low fiber, we tend to be very much dominated by Bacteroides. And that can be dramatic where they're up to 60, 70% of what's there. But also is key to keep in mind that antibiotics can often be a big driver of that too. That in terms of bacteria in the gut and their antibiotic resistance, Bacteroides have got the greatest repertoire of antibiotic resistant genes of all the bacteria in your gut. So it can often thrive after courses of antibiotics because the competition doesn't. The competition's been smashed. Bacteroides is like, yeah, I'm handling this. I've got no trouble with this antibiotic and now I've got more food and I've got more space. I'm just going to grow into that because my competition's gone. And you can get people that are 60, 70, 80% bacteroides post antibiotics where that was a core driver independent of what the diet was like before. If they're able to eat a prominently plant based whole food diet, you'll see Bacteroides will come down relatively rapidly because even after the antibiotics, because we're starting to feed out the competition who are more adept at eating those plant based compounds and fibers.

So do you, I'm guessing you probably don't use many antibiotics. Are there any that are, you know, useful?

Personally, I don't use them, no. But obviously there's a time and place where antibiotics save lives, they save limbs, they save organs. You know, in those cases, I guess it's no brainer that we actually use these things.

I mean like for the microbiota, they are way overused.

Yeah, no, yeah, okay. I don't think that antibiotics are often needed for microbiome related shifts. I'd say extremely, seldomly needed for things like small intestinal bacterial overgrowth or irritable bowel syndrome or inflammatory bowel disease. We can often end autistic spectrum disorder and conditions where we're really wanting to shift that ecosystem. I think antibiotics really shouldn't play a big role and should be reserved for cases where all the things that are more healthful haven't worked. And I think that they seldom need to be used. If we're aware and capable of using the other tools that we have that I have in my toolkit that will Generally be able to shift the ecosystem pretty dramatically without the use in a positive ways, without the use of agents like antibiotics.

Okay, so we only got about 10 minutes left or so. So I just had a couple questions that are kind of broad, but what do you believe about the microbiome that you know, maybe other people in your field would call controversial or you know, maybe even, maybe even dangerous?

I would like to see nothing. As someone that's like been researching this area and is a researcher in this area for 20 years, I'd like to think that, and I also, you know, teach evidence based medicine here at the University of Tasmania, that my approach is very much based on research. I would like to say probably not much, I'm certainly not dangerous so much. There's going to be some, as I mentioned before, there's some people that are still happy arguing about what the healthy ecosystem is. And those people are seldom clinicians. We don't know enough about the ecosystem. Yeah, we don't know enough to change anything. But those of us in the ground are like, well, I think we know enough to start making some positive changes. And you can see it, you know, when you bring down that 80% bacter, what he's down to like 15, 20% and you bring up bacteria and you see the difference in your patients and their metabolic parameters or their mood, anxiety, depression goes away, it's just like, yeah, I mean we need more research and you know, I'm totally for that. But I think for things that are actually safe, have extremely low side effect profile with any, I'm quite happy to use them in practice. I think when agents have high risk of causing harm and side effects, we need really good evidence beyond any shadow of a doubt that this is super effective. But when it's like, okay, eat more Mediterranean style diet, eat more plant foods, things like that, you're not going to cause, as I said, bar the exceptional person, that you have to go a bit more slowly with it because it's going to cause symptomatic changes that are problematic for them. But broadly speaking, that approach is not going to cause harm and actually going to improve so many aspects of their life that I don't think we need to be cautious and worry that there aren't quite enough clinical trials yet showing that that is because I think there is. But there's always going to be that, that spread of how much evidence is enough evidence for people to be happy with any intervention. And that's an ongoing discussion. How long is a piece of string? It's like there's going to be differing opinions about how much evidence is required before certain recommendations are made. For me, when it comes to use of probiotics, a couple human clinical trials is enough. But for someone else, they might want 20 clinical trials with 20,000 people enrolled with every study before they're ever going to. To implement that in their practice for their patients. So I think there's that in the background.

Yeah.

As well.

I always think when people need that much evidence, I think, have you ever really been sick? Have you ever been desperate? You just kind of take a chance sometimes when you have a little bit of evidence.

Yeah. And I do think that often those people that are. I'm still shocked when I read stuff that comes from gastroenterology cough is primarily U.S. based, that there's no evidence that probiotics work. And I'm like, just like shocked because someone can actually say that. Because I've got a database that's got like hundreds of clinical trials showing that they work for certain conditions. And it's just like, man, you have really selectively chosen your evidence or you've got this standard of evidence so high that almost nothing would meet it. But you're probably prescribing pharmaceutical medications that don't meet that standard that you have for probiotics quite fine. There's often this double standard that comes from some people who are in that sort of not enough evidence is there currently that they're quite happy to prescribe pharmaceuticals with a much lower level of evidence than they are for prescribing probiotics or prebiotics or a change in diet that has much because their bar is quite different.

So do you ever hear any advice about the microbiome out there from social media or other practitioners that you think, man, that's just bad advice?

I've got a lot of caution around some of the trends towards a carnivore diet or ketogenic diet, more broadly speaking, because I see the impact of the ecosystem from people following those sort of dietary approaches. And it's not beneficial shifts that we're seeing, we're seeing. And you'd expect if you understand the workings of the microbiome, you stop feeding species, they stop living and their population goes down. And that's what happens if we stop eating grains, we stop eating legumes, we stop eating fruit, we stop eating fiber. You starve off the species that actually produce short chain fatty acids for the most part, and you starve off your butyrate producing bacteria. And our guts have evolved alongside these species and eating 100 grams of fiber plus per day for thousands of years. And we've got this pivotal relationship, particularly with those beta producers bacteria, many people don't know, but your colon cells, your large intestinal cells, like 70, 80% of their energy needs are met through the production of butyrate by your colonic bacteria and other short chain fatty acids, but primarily butyrate, you take that away, your colonocytes do not function properly. We've evolved this relationship there. So those sort of extreme diets, and not to say that there maybe will be a time and place for ketogenic type diets in epilepsy, for example, but I think in those cases, how can we support that ecosystem and the bugs we want to survive while they go through that, follow that diet? So like a non responsive epileptic child, maybe the ketogenic diet is something that's going to be very helpful for their quality of life and improve their epilepsy. But how can we use prebiotics, dietary fiber supplements, to prevent the short term and long term damage that's going to occur to that ecosystem from following that diet long term? So I think you need to have knowledge and awareness of the negative repercussions of those interventions to be aware of how we can try to prevent that from occurring. And there's plenty of research done by the Sonnenbergs in California showing that fiber depleted diet causes extinctions. And then those extinctions essentially get passed on to the next generation. And then giving them fiber, it doesn't fix it because those bugs are gone. Once they're extinct, they're extinct unless you're willing to ingest some poo or some breast milk to get some species back. And those are the things that you see as outcomes for people that follow those diets for longer periods of time. Not just a short term dip in populations, but actually extinction level events that are not easy to come back from. Wow, those are my worries.

Yeah. So last question I have is, are there any patient recovery stories that you have that you think are worth sharing?

Oh goodness, potentially a few. I mean, you can think of a case of a young lad, probably around 12. It's been a little while since I've seen them, so that the age might be a little bit off, but around that age, presented with acute ulcerative colitis that was not responsive to all the medications they were on. They were already on biologics and they were on steroids and they were on. And vancomycin and everything that could be thrown at them was being thrown at this child. And he was still having 10 bloody bowel movements a day. And they said, surgery, we have to remove his colon. That was where it's at. And the mom parents came to me wanting one last chance. Is there a way we can stop? We don't want to have the colon removed at this point in time. Is there anything else we can do? And I started working with that, that patient and then just see that it completely changes. And all of a sudden they're doing two biomons per day and no blood and no mucus. And their calprotectin, which is a marker of colonic inflammation, has gone from 2000 down 200. It's been this massive, massive shift. And that was through essentially more plant foods, more plant fibers, prebiotic supplements and some hero medicines too that were decreasing inflammation more directly. But that shift in the ecosystem was important. And even though it was slightly harder in this case because they were constantly taking vancomycin, which is an antibiotic, which has a pretty dramatic impact on the gut, this was actually fascinating case because having a look at this child's gut on vancomycin, normally there might be 100, 160 species present in the gut and this one had 20. And there was no firmicutes, no bacteroidetease, most of it was proteobacteria what was surviving the vancomycin. And it was the worst ecosystem I've ever seen. But even in that situation, implementing the diet and supplementary regime actually made a dramatic difference to their state of health and their ulcera colitis. And they're not needing to get the colon to move now. And I think, I think that's a lovely example of the power of microbiome modification even in a severe disease state.

Wow, that is a great story to end on. So if people want to access your content or work with you, how can they do that?

Yeah, so I've got a website called Probiotic Advisor and we've got an evidence based database which is around how to use probiotics well, and evidence based manner easily. And then I've got a range of courses on there, mostly for health professionals, because I've been training health professionals for about 19 years, so that's one of my passions. But there's also some lectures on there for the general public too about learning more about the microbiome. Like we have a meet your microbiome course, for example, a chance to teach people about how to make their ecosystem healthier. What are the good benefit bacteria, what are the pathobiomets where the pathogens and how do we can modify that? Through choices with prebiotics and dietary factors, for example. And then I'm also a clinician at my clinic here in Hobart called Gould's Natural Medicine. And these days I'm seeing exclusively gut conditions, which is good because it's that thing that maybe I was lucky that my first few years were half gut, half general. So you get a lot of experience treating a wide range of conditions, but certainly the last decade has been predominantly gut related conditions.

Do you work with people over Zoom or Skype?

Yes. Yeah, I'd say 95% of my patient load is distant from Hobart, all over the world.

Gotcha. And so if people want to work with you, they just go to your website and they can find you there.

Yeah, Gould's Natural Medicine in Hobart is my clinic website. And then Probiotic Advisor is my more educational website.

Okay. Is there anything new coming up for you, like a new book or anything like that?

Much of the same, actually. I'm keeping working, doing some interesting research studies and seeing patients and still educating practitioners. So I'm working on releasing a course on modifying the microbiota in kids on the autistic spectrum. That's probably going to be my next course. That's going to come up on my website. So that's probably the next new thing that will be occurring.

All right, well, thank you so much, Doctor. I really appreciate you coming on. I totally got a lot out of this interview, so I really appreciate you making the time.

You're very welcome, Lucas. Yeah, it was a great chat. Happy to be here.

So what an interview. I just got so much out of this interview. I really feel like, you know, after what he said, I'm at the point where I understand the microbiome enough now that I know the general direction that the microbiome should go. Now, obviously there's always caveats and everybody's a little different, but I think I have a good handle on that. So let me explain. Most of the software used to evaluate your microbiome, it's always looking at averages versus the population. So, you know, if a bacteria is below average, they give you recommendations to bring it up, and if it's above average, they give you recommendations to bring it down. But this interview gave what I think is a really solid foundation for. For how to treat and manipulate the microbiome. So the first part of that is when I asked him about the firmicutes versus Bacteroides ratio, it was actually kind of strange because when I asked him, you know, if the ratio of Those two mattered. He said, not really. But then he went on to say that, you know, having too many Bacteroides can be problematic. If you remember, I said I had lowered my bacteroides from 70% to 35%, which is not actually accurate. I went back and looked at my microbiome tests and it was actually from around 60% to 35%. So not as extreme as what I was saying. Now the reason that the Bacteroides were problematic was because of the lipopolysaccharide or endotoxin that they release when they die or they make or whatnot. Now, now, very, very smart people, and quite a few of them will say that endotoxin is one of the reasons that your health takes a turn for the worst. It's just one of the worst things for you. And like I said in the interview, it's one of the only things that you can inject into somebody and just straight give them diabetes or I think he mentioned depression or something like that for six hours after it's injected into somebody. And not only that, like a big part of Ray Peet's work is devoted to talking about how bad endotoxin is. So lowering this stuff is really on the radar for just a lot of cutting edge nutritionists and doctors and health bloggers. It's kind of one of those things that didn't get enough attention back when it was discovered and now people are saying, wait, maybe this is really bad. So endotoxin is just one of the bad guys in aging and that is just being rediscovered over and over again. But anyway, at one point in the interview, Dr. Horolek, he says that getting his patients down to around 15% Bacteroides was part of what he did. On the other side of the ratio, the firmicutes, they're not gram negative bacteria and they don't have any endotoxin. So it seems to me that skewing the firmicutes to bacteroides ratio towards firmicutes will lower the amount of endotoxin you are exposed to. That just makes sense. Now this is a huge deal because there are tons of people who, you know, poo poo on the probiotics and gut bacteria because they say, you know, all of that stuff just raises endotoxin. And so you should just try and have as few bacteria as possible, possible. But if firmicutes doesn't even have endotoxin and you can skew your gut bacteria in a way that minimizes this endotoxin, I mean, that should help all kinds of inflammatory conditions, diabetes, you know, you name it. This is just, you know, my conjecture, and there is the caveat that Bacteroides has some helpful bacteria. So you don't want to eliminate them completely. You know, maybe just have them around 10 to 20%, like he said. Now, something else he said that I personally experienced when I was using antibiotics earlier this year, you might remember, I experimented with three different ones. Azithromycin and a couple others. So my Bacteroides went from around 45% to 60% while on the antibiotics, and then it went down to 35%, which is what we were talking about in the interview. So when he said that antibiotics tend to raise Bacteroides, that's definitely true from my experience. Now, this also puts a lot of question marks around people who use antibiotics to lower endotoxin. I mean, it may be beneficial in the short term by lowering just the sheer amount of bacteria, but in the long term, you're promoting Bacteroides over firmicutes, and theoretically, that could raise endotoxin. And this also explains why some people feel so much better on antibiotics while on them, but then when they get off them, they just. They feel so much worse, you know. So what this tells me is if you are on antibiotics, you want to do several things. So after you go on them, you know, you want to take some inulin fos or other prebiotics. You may also want to take things that specifically target and inhibit Bacteroides, like pomegranate garlic, chitosan, the probiotic Lactobacillus reuteri. However you say that. Actually, I went on Ken's site and I looked up, you know, what would lower Bacteroides, and those were just a few of the top ones that popped up. Now, Dr. Horlick also mentioned Proteobacteria as giving off a quite potent form of endotoxin, even stronger than Bacteroides. It was really hard to find substances that inhibited Proteobacteria, but one I did find was the herb burdock root. So, you know, that might be worth experimenting with. A couple other things I thought were interesting. Inulin fos raises Akkermansia 99.9% of the time. You know, akkermansia is important because usually people who have adequate levels of Akkermansia have less leaky gut and they tend to be thinner. This is something that everybody with any kind of chronic condition or just, you know, looking to lose weight, this is what they want to achieve. So anything that raises Akkermansia is a good thing. Now, you know, assuming they don't have overgrowth levels. Now, nowhere on the net does it say that taking inulin fos really helps Akkermansia. Which is why, you know, talking to a guy like Jason, it's just so useful. You know, somebody who's in the clinical setting and he's use these things. I mean, everything online says on Akkermansia, you know, take cranberry, take pomegranate, and those kind of work, like you said, they're okay. But this inulin fos is apparently, you know, magic. I also thought it was interesting when he said that he did not find probiotics and fermented foods really all that helpful, broadly speaking, at influencing the microbiome. You know, he said he would, he would use targeted probiotics for certain things, certainly, but that he found prebiotics and polyphenols from different fruits and veggies more important. I thought that was really, really interesting. What else? I will put the list of bacteria that he says is important. I will put that in the show notes. That list where I started to read it and then I realized that the words were way too difficult, so I just kind of stopped and skipped it. Yeah, I'm going to put that list in the show notes so you can look. And it says what the bacteria's name is and it says the range that you should have on your microbiome. So it's pretty useful. So really, to sum up, his usual protocol is to bring Bacteroides down to around 15 to 20%, to bring bifidobacteria up, and to increase diversity with different polyphenols found in a variety of different foods. So listening to the whole interview, that's, that's basically the sum up that I got. He has that list of bacteria and their optimal levels if you want to really dive deep. And I know many of you have not really taken the step of actually having your microbiome tested. And I get that. I mean, it's a lot of money and, you know, who knows whether manipulating it is actually helpful or not. But, you know, thrive, they often have sales where you can buy a kit for 80 bucks. So it might be worth it if you are struggling in some way. And given how this direction seems very clear now of where you want to get to, it might, it might be worth it. So anyways, that's it for me. I'm also just to let you know, I'm working on getting the episodes up on YouTube for easier listening. I think I found a very good solution that will make that very easily and not very expensive. So that should hopefully be up here soon. For anybody who wants to listen on that, it's not going to be a video of me talking or anything like that, but, you know, whatever. Some people like to listen to things on YouTube. If you do want to support the show and, you know, you get useful information from it, you. You enjoy it, all I ask is that you share the show with others. That would be great. Thank you so much for listen.