Interview with Dr Jason Hawrelak, Gut & Microbiome Expert

Firstly, thank you, Dr. Horowake, for joining me as a practitioner that has done your healthy gut practitioner and microbiome analyst training. I have learned so much from you, and your teachings have really impacted the results that I get with my clients in a profound way. So thank you for being such a generous teacher and mentor to me and many, many others in our profession. For those of you who I think.

It'S, like, important to share their experience when we learn, you know, I think, you know, my herbal elders that I've learned a lot from because they're willing to share what they learned in years of practice, and it allows you to shortcut through a lot of trial and error. And I think for, you know, my early years was a lot of trial and error to working out what worked, what didn't work. You know, studies said something worked. You tried on people. No, bloody doesn't work, you know, and how long does it take to work? And, you know, so I think we can have some, you know, about moving towards elder eldership now in our profession to be able to share that kind of information to make the journey of other clinicians better and make the patient outcomes better. It's. Yeah, it's an honor to do so, really.

Yeah, that's right. We're very lucky. Thank you. So for those of you who aren't familiar with Dr. Horlac, he's a naturopath, a herbalist and Nutritionist with nearly 25 years of clinical experience in gastrointestinal health and explanation exploring the gastrointestinal microbiota. He's widely considered to be one of the world's leading experts in the treatment of gastrointestinal conditions with natural medicines. He's been teaching and mentoring in this field for more than two decades and has written extensively for Australian and international textbooks and journals and regularly presents to other health professionals at conferences all over the world.

So.

So I'm super excited to pick your brains today, Dr. Horlak, on all things microbiome. Thank you so much.

Favorite, favorite topic areas.

Yes. I think you could talk underwater about this, couldn't you? All day. You kind of do.

Yeah. Well, it's true, actually, between teaching and between patients, it would be five days a week where I would be talking about this all day. Yeah. Yeah.

Well, why don't you start by telling us why the microbiome is so important? Why should we care for it and look after it?

Yeah. And I think for me, it's been an interesting journey, this one too, because as you mentioned before, I would have started my Honors thesis on my literature route, my honors thesis around the gut myrba and its important irritable bowel syndrome back in probably November, December 1999. Yeah, so a long time and even at that time was enough literature that we knew the microbiome was important. And there's only a handful of researchers worldwide, I would say who were literally like pounding the drum on this when it's like these microbes are important. We knew then that they're important for immune system development and for immunity, to function properly, for our sort of gut motility to be normal, enhancing our nutritional status by making B vitamins and vitamin K. We knew some of those things back then and also some conception around that they protect us against getting infections, food based infections too. Those things we knew for a fair while. But to see the boom in research that occurred probably from the early 2000s onwards where we're actually linking the gut microbiota not just for gut conditions or just immunity, which is already good enough reason to care about these microbes. Actually these microbes are tied into everything. It's probably not a system in the body that isn't impacted by the microbes in our gut. We already talked about immunity, but our metabolism, mitochondrial function, cognitive function can all be impacted. And we know we've also moved from that stage where we are seeing disease correlation where we're like, okay, people with this disease have an altered microbiome, but maybe the disease causes the microbiome changes. That was some thinking at the time, it wasn't mine, but some people were putting it out there at the time versus this change in the microbiome causes the disease. And this is where we've seen a huge leap in the last 15 years of going actually we can pass on obesity by doing poo transplants, we can pass on diabetes by doing poo transplants. We can pass on anxiety, we can pass on depression, we pass on high blood pressure, Alzheimer's disease by doing poo transplants. It's really all these conditions that are all ubiquitous in western nations that actually have a microbiome. Cause we can kind of pass on to other other beings by doing poo transplants, which is, you know, fecal microbial transplants, which is pretty crazy. And you even I someone who's a microbiome have passionate person 20 years, 25 years ago would not have thought that it would go the way that it had. You know. And I think also as, as a naturopath, it's like you go back in our history, it's like there was naturopaths again beating the drum about the importance of the gut microbiome. Different terminology obviously back in the early 1900s, you know, the importance of looking at the gut microbe, making sure they had enough fiber, enough sort of plant foods in their diet.

It's all the same having time in.

Nature and some of the things that that scientist finding now with stuff that naturopaths were actually been saying for over a hundred years.

Yeah, yeah, yeah. So those little trillions of critters in there are pretty impactful on our health, that's for sure. Yeah. So you've been analyzing microbiomes for so long. I mean how many do you think you've analyzed over the years?

I know it's a good question. Trying to look at. No, I probably couldn't shoulda. I mean even just looking at how many clinicians or patients I've probably seen, it's probably like over conserved as over 15,000 sort of patients in that, in that time. And a lot of that would have been, you know, microbiome work and gut health work. And obviously back in the early days the tests we had available were comparatively poor. Yeah, that was the best we had at the time because we could look at four types of gut bacteria in the stool test.

Wow.

I know we have come so far. And that said you're still able to, you know, as a clinician you can still prescribe dietary protocols, lifestyle protocols, pre and probiotics. And you see the change in disease conditions and the person's condition from that, from treating them. Even if we had that the tools were so crude we couldn't really analyze the microbiome very well. Yeah, yeah. The tools I was using are very similar to what we're using now, although obviously a lot more of them now. And we understand the mechanism a lot more detail. But yes, seeing the stool test evolve that we have access to to remember when the first, the stool test went from having four bacteria to 12, you know, the first GI fix was like 12 bacteria. It's like $800 for the test. But we could tell 12 bacteria as part of that. That was like a major, like oh my God, that's so much better. Yeah. And then we evolved onto the first sort of better DNA based lab that was offering easy access tests with UBIome and they for a hundred bucks, so sometimes on sale for 50 bucks you could actually analyze the entire tree and see that potentially 400 species of people bacteria that's in people's guts and other people far less than that. But you get to see the Entirety that was also a major game changer because all of a sudden we could really see things as clinicians, as research evolved, we started being able to see disease patterns a lot better because before we were relying on again, crude technology to try to see connections. And as technology advanced, we could start making these disease associations in far greater detail and in far greater number and then eventually that trickle down to clinicians or the general public where we can actually look at the microbiome now in a, you know, not overly expensive way and directly see the impact of our diet and lifestyle and medication choices on our microbiome and how we can change our diet and lifestyle or take some prebiotics. And you can see the dramatic change in your microbiome as the consequence, which.

Is so exciting and so motivating I think for people as well, to be able to literally see how, how they change their diet affecting their microbiome and therefore impacting their health, which is just so amazing. So yeah, you've obviously analyzed thousands and thousands of microbiomes. And so what would you say are the three kind of major things that you see people doing that impacts their microbiome in a negative way?

Yeah, number one, that list is probably not going to be too surprising. But antibiotic use and I would argue also include proton pump inhibitor use. So the medication is used for reflux. Yeah, yeah. Overuse. Yeah. I mean antibiotics save lives, they save limbs, but they're way overused. Yeah. And then even proton pump inhibitors I think have got a use, but they are way overprescribed for way longer than they should be. And what people don't know is that PPIs have antibiotic like effects. And I think it's 20% of the, of the, of the species in your gut are negatively impacted by PPIs. Your diversity goes down even after seven days of use of these things. And people are put on them for often life. You know, usually not necessarily intentionally, they're not, they're not necessarily told that, but that's kind of what the outcome is for many people. And these things cause massive, massive disruption. Antibiotics, you know, can cause extinction level events. And I think that's thing that people aren't told about. So we have a viral, viral infection in your lungs and you're offered antibiotics. It's like, no, I'm not going to take something that's going to potentially wipe out, make a number of species, my gut it go extinct, cause massive disruption to the ecosystem that's going to take, you know, four to six weeks before it kind of sails into a new, new pattern that's completely different than it was before. First for, for no benefit. Which is essentially what we're, we're asking in that situation. So I think it's being really aware, do you really need this, this substance, this med, this antibiotic or this proton pump inhibitor? Is it really necessary, can we do something else to, to treat this condition instead? Like, I don't know, change your diet or you know, eat smaller meals. I mean, I mean the reflux is one of those things that as a naturopath is so any tools to use.

Yes.

And lifestyle, dietary factors, her medicines, supplements that can modify that condition, that you don't have to go down a route of taking a proton pop inhibitor, you know, that negative modifies your microbiome, encourages, you know, increases the risk of SIBO development sevenfold. You know, research found even just one week of PPI use caused nearly 8% of people to develop SIBO just after one week of PPI uses. So it's very substantive changes in the small and large industrial environment. And you can start getting molds and yeast growing in the stomach. It's like a really bizarre consequence of that medication class. Never mind the increased risk of Alzheimer's disease and osteoporosis that come with that too, which would be related to the microbiome harm too. Now that we dig into that more detail, it's like, oh, actually osteoporosis is caused by dysbiotic changes in your gut bacteria. Who would have thought? Now many of us are on that bandwagon, but that's relatively new, that information, you know, how the microbiome interacts with bones, you know, the, the microbiot bone axis, the micro lung axis, microt brain axis. We're making all these sort of micro microbiome mitochondria axis. You know, there's all these correlations we're making now about how the composition of your gut ecosystem impacts your risk for so many different diseases that we see commonplace in western nations. Yeah, so, so those, those medication classes I think are particularly problematic. Yeah, ultra processed foods. Yeah, I think is the other thing that, that when you look at the supermarket trolleys around you in this, in this typical city, as a natural, I've always been a bit shocked by what gets in there, but that's what most people eating. And then you're like, no wonder we have so much obesity, type 2 diabetes, because we're eating all this ultra processed food that's devoid of fiber, devoid of, you know, plant polyphenols, but also contains chemicals that, that are harmful. I think that's the other aspect too is we get the dietary emulsifiers that strip away our protective gut lining, you know, and cause leaky gut. And they're commonplace in processed foods, never mind agricultural chemicals. Again, as we delve, more research is being done, it turns out that almost all of them kill good bacteria, encourage the growth of bad bacteria. It's like, great, we're exposed to that too.

Yeah.

Yes. Ultra processed food, I think is one of the other aspects and I think probably also in the dietary aspect is having plant food restricted diets. So there's dietary protocols that are cutting out plant foods. They essentially will result in microbiome harm too, in varying degrees depending on how severe the restriction is. But, but you know, you cut out just legumes, there's consequences to that. You cut out legumes and whole grains, there's consequences to that. And they're not positive from a microbiotum perspective or I'd argue gut health perspective.

Either because those fibers that we get in those plant foods or what are beneficial spec species in our microbiome love to eat.

Yes.

And helps them to proliferate. Yeah.

And helps them produce the anti inflammatory gut healing compounds like butyrate. Yeah. And that comes from us eating legumes and whole grains and root vegetables. We don't get much B rate production from eating leafy greens. I love leafy greens. I eat them daily in large amounts, but they don't feed my B rate producing species. But I love eating fruit daily too. And they're not necessarily going to feed my B rate producers either. But whole grains, legumes are particularly good at that. And root vegetables too.

Yummy. That probably leads into the, the top three things that people can be doing to support a healthy microbiome. So would you say one of those is. Yes, eating lots more plant foods and.

Particularly lots more plant foods. And diversity, diversity, color diversity. You want to have a rainbow on your plate, you know, and having nuts, having seeds, having legumes, having whole grains, fruits and vegetables, you know, because that way you're getting a wide diversity of different fiber types because, you know, not all fiber is one thing. It's like different plants will have different ratios of all different shapes and sizes of fibers that feed different microbes. And that's where the diversity, the importance of diversity comes into it. And the color compounds are often polyphenols and they feed different bacteria too. So by doing that, we're just nurturing the widest number of beneficial microbes in our gut and Encourage emerging an environment that's conducive to good bacteria and less conducive to problematic or pathogenic bacteria. Yeah. We tend to have growth of the more problematic species when our gut becomes more alkaline due to lack of fiber, lack of polyphenol consumption.

Yeah.

And I'd say also time in nature. Yeah. And I think that's something that we probably don't prescribe as much as we should. Kind of something the old naturopathic thing was like have my time in nature and nature cure all came from, you know, in part with the idea of being in nature is, is, is a healing process. And I think for a microbiome it totally is too. I mean, there's a number of reasons why I think we get healing, healing going on from going from a bushwalk or going for a run, swim on the beach, for example. But microbes are, is part of that. You know, like when we're able to go into, to, you know, more intact nature. But at worst even a, you know, a rural, a park in an urban center, you'll pick up more microbes from that and you can enhance your diversity from that process too. Yeah. So I think never neglect the importance of just being, spending time in nature as well. It heals us in so many different ways. But also from a microbiome perspective, it definitely does too. I'm trying to think of other things that kind of flow from that, but I think farmers markets, I'm just going to go with that because I think that's something that we get numerous benefits society in numerous ways. We support our local farmers markets. But from a microbiome perspective, we get huge leaps and bounds improvements in microbiome diversity if we're able to source some, if not most of our food from the farmer's market too. Because what some people don't know is that an eggplant, a tomato, apple, all have their own microbiomes. They're covered with different microbes. If we buy those same foods from a supermarket, they have the same number of bacteria on them, but they're completely lacking in diversity. In fact, there's a supermarket microbiome, which means that your apples, your eggplants and broccoli all have the same microbes on them, the same number versus they're all supposed to have different microbes on them. So as a way of interacting your ecosystem, interacting with more microbes is like you grow your food, you buy it from a farmer's market. You get so much more diversity, exposure from that. And that I think is Key, you know that there's a number of markers by which we judge a healthy ecosystem and diversity is certainly one of those key ones. And if we're able to grow some road food to buy some of most or at least some of our food from the farmers market, we will improve the diversity of our ecosystems. And I suppose flowing from that too, you know, buying as much organic as we can and I know cost wise it can be hard to get 100% organic. And I've certainly had times where you're prioritizing some, some things organic and some things you just can't buy locale, but even a bit of that's going to be helpful. And if again, from microbiome perspective, organic food has got far more diverse microbes on them and we spray them with chemicals, we tend to select for more bad bacteria on those foods and less good bacteria and less diversity altogether. And those, those chemicals that we spray them on food is, are likely to cause our gut harm to our micro, our microbiome and harm too. So another reason to, to choose organic.

Yeah, plus it just tastes better and has more flavor as well.

Yeah, and more, and more body chemicals too generally as well. So it's more nutritional value in general and usually more phytochemicals because the plants are a bit more stressed. And when plants are a bit more stressed, they, they make more of the phytochemicals which are the antioxidants, the anti cancer, anti inflammatory compounds that we open to get for our plant foods.

Yeah, makes sense. So let's shift a little bit now and talk briefly about menopause. I see lots of clients who are in perimenop or going through that menopausal transition. And we know that during that time, due to the loss of estrogen, the microbiome can become, starts to become less diverse. And as you've already said, a more diverse microbiome is a healthy microbiome. So why is it important not to let this happen at this stage of life in particular, would you say?

Yeah, and I think it's also relevant to males of a similar age. But we link in like the microbiota tends to change as we age, particularly in Western nations. And that actually speeds up the aging process depending on how quickly or slowly that microbiome change occurs. So essentially what we're trying to do is prevent and slow that change of microbiome to an aged sort of microbiome. And we know that people that live really well, healthy lives, their microbiomes are akin to people much younger than them. So, so it's going to be. We want to support diversity. We want to make sure we support the level of beneficial bacteria by, by encouraging eating the right foods, avoiding medications that cause those microbes harm to encourage the properties to stay high during that. Those times of transition. Yeah. And we know it is important for, you know, we know postmenopause women are far greater risk of osteoporosis, you know, becomes much more of a thing at that point. And we know that microbiome at this point is one of the key drivers of that. Depending on the composition and that, you know, that that aging microbiome, it would be seen as a driver of osteoporosis, a driver of, you know, more metabolic dysfunction and hard time, you know, easier time gaining weight, harder time losing weight would fit into that sort of the changes we see during that, that time. Yeah. So it really does need to be on our radar as, as clinicians to, as a part of that strategy of working with, with your, your question, working with women in that scenario is making sure that the microbiome is considered when looking at osteoporosis, looking at excess weight gain or cardiovascular. Cardiovascular risk risk factors, metabolic risk factors that would, you know, tend to increase after that, that time point, because microbiome influences all those things quite considerably. Which means we also have amazing power to, to alter that one area and have all these ripple effects that go out, you know, because if we can change the microbiome, we can reduce the risk from that one inter. That one sort of interventional focus, reduce risk of osteoporosis and cognitive decline and Alzheimer's disease and heart disease and also argue cancers too. Yeah. It's a pretty amazing opportunity we have of influencing a wide range of disease processes in that one focus area.

Yeah. And I think, yes, coming into that life stage where those risk factors go, they all go up for women during that life stage. Yeah. It's the perfect time to really get in there and try and improve that microbiome health to mitigate against those. That future risk of chronic disease. I mean, why wouldn't you?

Yeah, probably just lack of, lack of knowledge.

That's probably the reason why, because I think all the talk is around the symptoms and the hot flushes and the insomnia and, and that side of things. But without. Yeah, I think the discussion including gut health and the microbiome is almost more important as important because we do know that women are, you know, at higher risk during that time and. Yeah, great. So would you. Is there any specific gut health advice that you would give to that, to women in that life stage in particular.

I mean, some of that stuff is going to be considered what we've already talked about. In reality, those truly are the best ways of making your microbiome the healthiest possible. We've touched on already, irrespective of age group or disease state. You know, I think things can be tailored from that point because there'll be certain conditions where actually I can't just have them go and start gorging on legumes. Three meals a day, five days, seven days a week is like not appropriate. We have to fine tune things and individualize it. And again, and this is where I love that the capacity we now have of microbiome assessment is we can go, okay, well, let's look at this woman's microbiome. How can we best modify that microbiome at that point to get the best outcomes from them? Yeah, because everyone, their ecosystems are unique and can respond a bit differently too. Even though most people will respond very similarly to the main interventions we've talked about here. But you might need a bit of a helping hand with a prebiotic supplement to really encourage the growth of certain beneficial bacteria. Or you might have, oh, you're osteopenic and you have this very high levels of, let's say, problematic proteobacteria. We know that they're byproducts called endotoxin with a core driver of osteoporosis. We need to address that aggressively now rather than doing it more slowly through dietary means. Over the next six months, we're like, okay, let's take a herbal product to smash those putty bacteria down or the right prebiotic so we can get a change occurring more quickly. Yeah. So I think that the broader stuff I discussed is totally relevant. But if you get a microbiota assessment done, that means you can fine tune and tailor the treatment protocols within that to your specific ecosystem so you get the better, best results possible for you.

It's really personalized, which I love. Yeah. Well, I think that's it for me. From Quest for Questions. Thank you so much again, Jason, for chatting with me today and taking time out of your day to really just shine a light on our microbiome and why we should be taking as best care of it as we can, especially as we're aging.

Yes. No, no. I mean, I think you get to that age, like I'm 51, it's just like, I want to age well, you know, have a little lovely health span and that that means a bunch of different things. Exercising and a bunch of things that were probably less so in your radar than 20 years ago as a necessity. But it also means, you know, imper the imperative of keeping your microbiome in a healthy state, too. And that should be part of our sort of aging regime is. Is care of the microbiome.

Yeah. Couldn't agree more. Yeah. Thank you, Jason.

All right. You're welcome, bro.