Learn How To Test Your Microbiome & Know How Diverse It Is with Dr Jason Hawrelak | Ep 75

Welcome to the Healthy Gut Podcast with Rebecca Coombs. The place where you can learn how to achieve a happy healthy gut. Here's what's coming up on today's show. Welcome to episode 75 of the Healthy Gut Podcast and today I'm joined by the wonderful Dr. Jason Horolek, who is a researcher, a lecturer, a naturopath and a western herbalist with more than 17 years clinical experience. And he practices at Gould's Natural Medicine, which is a 136-year-old natural medicine clinic located in central Hobart, Australia. Today, Dr. Jason Horolek and I talk all around the microbiome and how having a diverse microbiome is key to optimal health. Jason talks with me about my recent UBioExplorer test results and what it actually means and why having such a diverse microbiome is important. So we talk about why you might consider having your microbiome diversity checked, how we can actually test for it, what these test results actually show us and what we should be looking for and why we should be aiming for at least 40 plant based foods per week. So Dr. Jason Horolek, I'd love us to start off with the concept of more personalised assessment of a person's situation and doing tests like Ubiome, whether we should all be going off and doing these tests that give us a pretty good picture of what's going on in our gut, or whether we should just be doing more generic testing and hoping for the best. What's your approach?

Yeah, I mean for me who's been in this field for a long time, I was extremely excited when testing that was using up to date technology became available and became available at a fairly affordable price. It was just like whoa, this is great. So we don't have to guess as to what's going on and go, okay, well you know, had a course of antibiotics or you've had chemotherapy, radiotherapy. I can read some studies and idea of what happens to the most people, but I also know from reading those studies that there are individual nuances as to what actually happens. Irrespective of what that that sort of gut damaging event may be between antibiotic uses, that there'll be the occasional person that responds very differently than everybody else. And same with other sort of herbal and dietary interventions. So they'll in terms of restricted diets, there'll be slightly differences in terms of how things turn out and how things are modified. So to have the opportunity to actually assess that on an individual level I think has been fantastic because it means that we can don't have to guess anymore. We can actually look and see exactly how things are at and what impact that event has had potentially or importantly where you're actually at now and how to move forward from this time. Because that's really what the key aspect is about is if we can get a clear snapshot of current scenario, we can really individualize dietary approaches and pre wardrotic usage rather than again just guessing and assuming what has actually happened or what your state of your eustacent is definitely.

So this might be a good time for us to show what a ubiomexplorer test result actually looks like. I did this several months ago now actually. And for those of you that are just listening to the audio podcast, head to thehealthygut.com diversity and you can see the link there so that you can watch this video component of the podcast and you can also see the information we're sharing now on UBioExplorer. Yes. So we've got my UBioExplorer tests, test results up here. Now the UBioExplorer test is super easy to do. Unlike those traditional stool samples where you've got to collect stool and send it away and you know, no one loves to do that. This is really easy. You get basically a cotton bud, you wipe the toilet paper once you've wiped your bottom after doing a poo, and you then just send that off in a tube. So it's so much less revolting.

And yeah, it's a very, it's a very small sample. It's true, it is. Although I must say there is a research study that came out fairly recently that suggested that for those who are more keen on poo handling, you can actually collect the whole sample in a Ziploc bag or something and mix and mush it about and then take a swab from the very center of that and you'll get a more accurate representation. But it does take a different sort of person to do that versus the slight touch of a toilet paper.

Yeah, yeah, you want to be really into your body at that point, don't you? So let's talk about how this works, because people will be thinking, oh, so if you're just taking a swab on toilet paper, what are they actually measuring? So what are you Biome Explorer tests actually picking up?

Yeah. So tests like the UBIome, because there's a few that are on the marketplace these days, are essentially looking for bits of bacterial DNA. And some of the newer ones look at Fungi and protozoal DNA as well. And this is quite different from the old style. The old style, we actually had to have a larger stool sample. We had to try to keep the bacteria alive from when they essentially, your house to the lab, and then grow them out in special dishes to see. And then we sort of count and have a look to see what showed up. Whereas now we just do that teeny sample because essentially the bacterial DNA will be there and there'll be the actual amount of DNA that's there will tell us the amount of that species present. And they essentially match a little segment of that DNA to their library and go, okay, well, this belongs to this species, that belongs to that species here. So we get a very clear idea of what's present. And the lovely thing about the change in technology is how much more it allows us to see. Because using the old technology, which was widely in use until probably early 2000s, we could see maybe 70% of or 30% of the species that are present in the gut. We missed about 70% because we can't grow them very well. And with a lot of practice, once we know they exist, we can start growing them. But at that point, you can't. So, you know, arguably, most of what you have in your gut you couldn't see previously until we changed the DNA. And now the cool thing is we need that small amount. And also the liquid is designed to kill all the microbes at that exact time point. So we get this perfect picture. So even if it takes a month to get to the lab, it doesn't matter. Whereas the previous one you've had, if it took more than 24 or 48 hours to get there, there will be changes in bacterial populations, and we don't need to worry about that.

Using the DNA approaches, are we missing any of the bacteria in this new DNA testing?

I'm thinking of the best way of answering that in terms of bacteria that we know that exists. No. Sometimes there'll be some species that are novel that we haven't had a name, put a name to yet. So I suppose those ones will potentially be missed. In a report like the eubiome, other labs can sometimes come up with, you know, taxonomy unavailable. So we know that this, this unidentified species makes up, you know, 1% of what's there, but we don't necessarily know the significance or the name of it at that time point. But in terms of microbes that we know exist, then we. DNA picks them up very well. And as well, as I said, the ones we don't know, don't have a name yet can also get picked up too.

So here we have on the screen. For those of you just listening, do head to the website thehealthygut.com diversity so you can see these slides. So you get this overview where my wellness match score is 99.4%. That sounds great. What does that actually mean?

That's a very good question and I don't think it actually means that much. I would say my patients not it looks impressive but not to pay that much attention. And I think in this case they're looking at people who describe themselves as generally healthy, what their bacteria looks and this is a eubiome derived marker. So I think looking at people who describe themselves as healthy, what their ecosystem looks like and then their matching is how good do you match as other people who describe themselves as healthy? I think that's what they're doing in that case for me and from a more objective researcher perspective, it's the diversity that we see on this first page that is key. We can see that your diversity of your sample is the 62nd percentile. So that means that your sample is more diverse than 62% of those in the Ubiome Poo library. And that Pooh library contains hundreds of thousands of samples now. So it actually gives you a very good indication of where you're at in that spectrum. So that's better than average, but it's still not ideal. And for me I would like to aim high. So I suggest my patients aim to get up to the 85 90th percentile with diversity score. And diversity essentially takes into account two factors. One is the number of different in this case genera present as well as the spread of those two because if your ecosystem is dominated by one or two species dramatically, then even if you have 150 others in teeny tiny amounts, still have a low diversity score even though your richness, species richness is good. So one thing I always do is look at both those aspects of going, okay, are you very much dominated by one species or two or three or do you have a good spread but also how many actual genera are there? And in your case your spread is quite good and your genera richness is quite good too. So how we. I'm a bit old fashioned. I didn't like using papers so I always copy and paste in a particular way into a word document and there were some people whose species or genero copy and paste will cover like down to three and a half pages and other people it's half a page so from that rough, God I can idea of generic richness, and you're sort of, you know, on the better end, a bit above normal in that respect. And diversity is very much impacted by things. So many things are outside our control, like what we were seated with originally at birth, you know, so what ecosystem our mother had, whether we're exposed to antibiotics in that early time period, whether we were born by a C section or vaginal birth, whether we're breastfed or formula fit, all those things impact our diversity from that point onwards. But then every course of antibiotics will decrease diversity a little bit more. And every time we do a combination of antibiotics, where they do two or three antibiotics at the same time, or you take them for longer periods of time or higher doses for bursts, you'll get a more dramatic decrease in diversity. And some species bounce back fine, the big players, but those that are there, the teeny tiny amounts, are the ones that we worry about going extinct from that sort of intervention. And similar things happen with chemotherapy and radiotherapy, for example, is we actually get a loss of diversity. So you obviously can't change what happened in your early years in your birth process. So you sort of have what you had at that point, but you can work from where you're actually at now.

Do we know if babies start with 100% diversity or if our mothers, say, had 82% diversity, do we start with what she had? How does it work? Do you know how it works?

It essentially works like that. So you can only pass on what you have as parents. So if you only have 82 species present, you can't pass on 100, you can only pass on that 82. And this is the thing with Westerners, why we've seen with every generation a, a lowering of diversity, because every generation takes more antibiotics and has more interventions that. Including diet, Western diet would be in that category too. And we're having more formula fed and more C section for kids. So as every generation goes down, our diversity scores are getting less. So that means we start off with a lot less species than what we once had.

I think people are quite clear on when you take antibiotics, they kill bacteria. And that's going to impact our diversity. It's going to kill off bacteria that live within us. Can you explain why diversity is reduced when we're not breastfed? What happens in the breastfeeding process to support diversity in an infant?

Yeah, that's a very good question. And I think it's because of the extras that you get with breast milk versus formula. So formula, yeah. You get vitamins and minerals and proteins and sugars, that's all good. But what you don't get is bacteria. This is the key difference. And within breast milk you're getting over a billion bacteria per liter. And there's some research showing there's 100 different species of bacteria that have been found in breast milk at any specific time. And that even changes as the child ages as well. And it's almost as if the. It's a fascinating thing because it's actually there's bacteria that are sampled from the gut, that's our current thinking and then brought up to the, to the breast. And the types of bacteria that are sampled change as the infant gets older as well. So there's actually a different number and different type and different spread of species that gets, get introduced in different time points and obviously with formula, even if they add a probiotic to it, when you get one or two different species which is completely different than what you're getting with breast milk. And on top of that you're getting a range of special sugars called oligosaccharides that are indigestible in breast milk, that are unique to the mum to feed up those sort of species in the infant's gut as well in a very selective way for preferencing microbes that have a healing anti inflammatory effects and that train the immune system to function properly. Because that's one thing we know that the microbiome is extremely important for is training the immune system to behave like it's supposed to. You can see people who are like myself that essentially I've got history of asthma and hay fever and because my immune system wasn't trained to behave properly, it went AWOL at a very young age. Yes, we've got that time point and the bacterial composition at that early window actually dictates how your immune system behaves from that point onwards, which is pretty important to know. And it also changes how you view those early life experiences as well.

And it now makes sense to someone like me who was. I was born vaginally, but I was born two months premature. I wasn't breastfed because the doctors in 1970, 78 thought breast milk was bad, which. And mum was very sick, so she wasn't in a great state. When I was a newborn baby and then I was sick, I reacted very strongly to formula and cow's milk, so got pumped full of antibiotics over my whole childhood because I then had a lot of food intolerances. So when I think about it, when I look back at My history now, I think it's actually amazing I'm at the 62 percentile, given how much damage was. You know, I just had sledgehammer after sledgehammer after sledgehammer going into my poor little gutted immune system with every subsequent round of antibiotics. And I spent years on antibiotics as a child.

Yeah, and your story is more at the extreme end, but there's. There are similarities amongst many Westerners these days, and I think that explains why diversity scores are as well as they are. And then we top that off with Western diet, which, you know, I grew up eating that Western diet and I wasn't. I was born generally, but not, not given any breast milk either. And I was amazed at my diversity score, which was actually quite, quite good. But then, you know, since I was 18 and sort of changed my life around and then changed my diet, etc. That I've really had minimal impact of any interventions that would cause damage. So that's a nice thing. It's knowing that, okay, that, yes, you have what you were born with and you're sort of stuck. And then that's early childhood again, you can't change that. Everyone did the best they could in their circumstances and we know differently now and we could go back in time and change it if we could, but we can't. So we're stuck with where we're at. But you can still move forward from here and prevent any further loss of diversity. And the interesting thing too is that we can improve diversity scores and this both in terms of spread, but also in terms of species that are, that show up on testing. And I suppose what I just said, there is the important bit of what shows up on testing, because there are a number of species that are there in teeny, teeny tiny amounts below detectable thresholds. So they won't show up when you do this test. But if you start feeding those species up, then their populations rise to the point where they can be detectable and then you actually will have a longer species list than what you did before. So it's not like you've actually introduced new species, but you've just regrown ones that are just hanging on at the edge of extinction. So that, that is one of the core aims I have as a clinician, is to improve diversity that way in terms of adding to that diversity from an external source. We know we can do that with fecal transplants and there's a burgeoning amount of research in that area now. And in theory, breast milk will do that too. There Just hasn't been the research there yet. But because breast milk actually contains 100 plus different bacterial species, chances are that would be a way of reseeding or reinoculating as well. And that's a good thing to know with young kids, if they do have to have a course of antibiotics for an infection that otherwise can't be treated. And antibiotics, we know save lives, they save limbs, so they have their place, but they just shouldn't be used flippantly. And sometimes they are, but when they need to, we know if the child at one and a half or two is still breastfed, or even at six months or nine months, whatever that time might be, then that will actually reinoculate that child with those same strains from the moment, so we actually don't have to worry about it the same way. And I think that's the other benefit of breast milk that we don't get with formula.

That's interesting. What about in terms of someone like me? I've come in at the 62 percentile. Will I ever get back to 100% or would I just more likely get back to where I started with whatever my mum gave me? Let's say I started at 85%. Is that more realistic that I would get back to 85% if I did everything right and, and really nourished my gut?

Good question. There will be limitations there because once a species is extinct, is extinct, so once it's actually lost and we can't do anything about, you can't feed it back up to existence or, you know, but we can feed ones that are, that are at the edge of extinction back up to higher amounts of being picked up. So there'll be limitations of where you can actually get to and you won't be able to get back to how you were at that initial time period because of all those interventions in between, is that certain species would have gone extinct, whereas others were just brought down to below that detectable threshold. Those ones we can bring back, but the ones that are extinct without, as I said, doing a fecal transplant or breast milk infusion, there's probably no way of bringing introducing those species back in.

We will come to FMTs in a little bit, but first I'd love us to actually look at what my diversity was, what I had living in me, what we could see was in good numbers, in perhaps higher than we'd like them and what was lower and how that really shaped what we then did with my. With the next phase of treatment for me.

Yes, we'll do that. I might have to adjust my screen a little bit so I can see this full screen here. They've just recently changed their interface which is still fine. It just takes longer to find things when it used to be a certain old interface. So you click on advanced here and then we get essentially what I generally look at is file Noble data first and from this the file for bacteria to be in the same file it doesn't actually mean that they're that closely related. You know, it's like it's as close related as we might be to lizards and sharks. You know, it's like we have backbones, that's the thing that we have lit and we're in the same phyla or so with bacteria there might be quite distant related, but there are some things like I always look at the Proteobacteria count because all the bacteria within that category, which are actually very diverse grouping contain a just part of their build, their structures like we have, you know, fingernails and hair, they have something called lipopolysaccharide or also known as endotoxin which is very pro inflammatory in this particular group of bacteria. So we know that protobacteria populations can vary between 0.05% to. I've seen them up to 25% of what's there and that's huge, huge variation and that has a huge impact on the inflammatory terrain that that person has to deal with. Because as those bacteria die and turnover in the gut which happens rapidly, they release that endotoxin into the gut. And if 25% of what's there is endotoxin rich and very pro inflammatory endotoxin rich, that's what you're absorbing and that causes, you know, we know now is linked to body wide inflammation, depression, anxiety, changes in blood sugar regulation, increases in weight, even linked to cardiovascular disease in terms of actually getting that sort of chronic plaques build up and even chronic fatigue syndrome have all been linked to endox endotoxins in the gut. So this is an extremely important area to look at. Now yours was very good. So I was happy to see that when I opened that one up, that 1.36% typically in Westerners we're looking at 4, 4 to 5% would be a typical Proteobacteria count in westerners. But that's often a lot less in hunter gather societies. And as I said in some individuals, and I saw one last week that was 25% of that ecosystem. Now one of the highest I've seen a Proteobacteria. Whether it be certain Disease states like cystic fibrosis, where I've read of some people in research studies having 65% of that particular father, which is huge, absolutely huge. And you can see why they have a range of microbiome issues and other issues throughout their system as potentially as partly as a consequence of that. So from there we look at genus level data and this tells us the most about your diversity because here we get an idea of what genera make up the bulk. And some people, particularly those that have recently taken antibiotics, particularly antibiotic cocktails or chemotherapy, their Bacteroides might be at the 60, 70, 75% of that ecosystem. And the reason why is because they tolerate antibiotics and chemotherapy insults fairly well, whereas a lot of our other microbes don't. So they're like, ah, my competition's gone, I've got lots of food, I've got lots of space to like grow into that, that in that scenario. And that's problematic for a few reasons. But one, your diversity score goes down dramatically because just one species is such a dominant player or one genera, such a genus is such a dominant player in that ecosystem. But for you, your spread is actually very good and that Bacteroides is at pretty much what I call the perfect level, around that 20% mark good levels of Faecalobacterium blotti and Roseburia. And for most people, those would be the top four species. For the vast majority of people we see, they'll just be in different orders depending on what their dietary exposure is.

And can we talk about those top four? Do we know what their roles are in the body?

We do, and this is being further refined. I'd say in another five years I'll be able to talk a lot more on these species than what I can. Now we can say that Bloti and Roseburia are two of the key butyrate producing microbes in your gastrointestinal tract. And butyrate is one of the most important and far reaching short chain fatty acids that is produced in the gut. Now all the bacteria here will produce some metabolites that we call short chain fatty acids, but only some can produce butyrate. And butyrate has a healing effect on the colon, a healing effect on the small intestine, helps improve blood sugar regulation, helps improve mitochondrial function, heals up damaged blood brain barrier, decrease inflation in the brain. It's, it's amazing substance. And some people again may only have maybe 50, 60% of their ecosystem will be actually composed of B stray producers and you'll find others that that's 8 to 10% and that has a huge impact on their overall health and well being and has an impact on the disease state that they're often presenting with. And it gives us an in for actually altering that when they're at that sort of 10 or 12% mark because you know that's way below normal, let alone optimal. And, and luckily for you, you're actually in that sort of optimal range. If we add up a number of the B tray producers, including things like pseudobacterial vibrio and Subdella granulum, etc. Your number two is Faecalobacterium prosnitzii. And Faecalobacterium is the dominant species we tend to see in healthy, more diverse gut ecosystems. And those with higher counts of acteroides we tend to see associated with, with lower diversity scores. Now you, as I said was actually that that's probably the perfect or a little bit lower than that's fine too with Bacteroides. But those that have Bacteroides at 30, 40, 50, 60% plus, you'll see generally it'll be a very corresponding low diversity score, almost 100% at the time. And Faecalobacterium is also key B producer but it also produces other anti inflammatory gut healing compounds too. So it's had additional beneficial effects beyond what we currently know with blotty and roseburia.

And there's, there's obviously been a lot of talk in recent times around the presence of particular bacteria that are more commonly associated with people that are overweight and then other bacteria that are more commonly associated with people who are very lean. I was asked by people, you know, should we be looking for these bacteria in our gut? And I'd like us to talk about, about mine, what we saw in my results as well in terms of what those bacteria are called and which ones are associated with which kind of end of the scale in terms of weight.

Okay, now that's probably the thing we should go back to first and I'll see if I can find that because I think it's worth flagging is if we look at the eubiome section on what they call the body weight section. It's worth flagging a couple of things here. One is this idea of the firmicutes bacteroidetes ratio that at one point when this first research hit the headlines back in 2006, I think it was linking gut bacteria and weight and metabolic health. That research suggested that this ratio of firmicutes to Bacteroides was Very important and quite pivotal. And a couple of subsequent studies showed the same in animals and in humans. So people were like, okay, this is a definite rule. And the way science works, sometimes future research tells the complete opposite. Or find that there's no such thing as this relationship being important for that particular scenario. And that's really what's happened, is that there's a lot of subsequent research that's found the opposite than what that original research did or found that there was no relationship between body weight issues and this French bacteroidities ratio. So based on current data, I'd say ignore that section and the apparent importance of that ratio because I don't think that's supported by current data. And there's a lot of people, not just you biome, who are stuck in that sort of 2006, 2009 time period when that research was pivotal. We had that idea. But research has evolved since then. But what is consistent is the data around things like Akkermansia. Akkermansia is one of those species that is sadly, not infrequently extinct. In some of my patients guts due to prolonged, very restricted diets and antibiotic usage has essentially eliminated those in those patients, which is always sad when it's actually properly extinct because it is one of those species that we see as key and pivotal for maintaining good gut integrity. And we know that having the lack of a leaky gut, normal gut integrity is important. And Akkermansia is one of the key drivers of having a normal gut integrity. And we also know that those people that have lower Akkermansia have, have more trouble shifting weight. And those with higher amounts of Akkermansia respond better to weight loss interventions. And there's been some interesting research, both in animals and that's some preliminary research in humans actually administering Akkermansia to help with metabolic health and weight loss with good results as well. So in terms of a probiotic based on Akkermansia, I think we're still a few years away from that, although it will probably pop up in Europe before it ever, if it ever reaches Australia. So watch this space. Australia tends to be slow, adopting to certain things, but that one is definitely one that is supported by research.

And from there and just on, just for those who are listening, where do my Akkermansia sit? From what we've seen in the results, Am I high, am I low, am I average?

Yeah. So from their perspective, comparing you to their selected samples, you're about half, half of that now for me, that doesn't necessarily mean as much. And we'll go back to, if I can find it, the advanced section and we'll look at the actual amount that's present, which I find far more useful myself. And we can see that your Akermansky is 0.99%. So the average Akkermansky and healthy people we see is between 1 and 3%. So you're essentially just there at that lower end of the normal. But in a situation where we're wanting to, if we want to work on metabolism and weight, etc. Then we put we work on increasing Akkermansia in that scenario. Yes, that would make sense. And what the research also tells us in terms of microbiome markers that are important for, you know, metabolic health and weight health are diversity is one of those two that people with lower diversity scores often have more metabolic health issues. And conversely the opposite higher associated with better metabolic health outcomes. And also the presence of another species that people in your audience will be more familiar with, which is bifidobacteria. Bifidobacteria is also shown in much more of the more recent research as being pretty pivotal for both again gut integrity and for preventing bacterial endotoxins from getting into your system, but also for metabolic health as well as other things like improved mood too, which is always a bonus. And this is where you are below, far more below than where perhaps is ideal in that your is there. Thankfully there again there are people where it's actually extinct. And I think it's far more problematic when it looks it's apparently extinct or actually is. Thankfully most patients I find that who are apparently extinct or that shows up as below detective levels, we're able to bring up again through some nurturing care over a period of two to four months. But about 20% of people, particularly those with higher antibiotic usage, it has actually gone from that ecosystem. And we can see for you it's 0.08%. And you know, ideal for me is between 2 and a half and 5%. So you're a fair bit off that. But if it's there, it's actually pretty easy. If you can do the changes in diet, you can take the right prebiotic supplements to bring that up into a healthy, healthy zone. Yeah. So it's just a challenge when it's not there at all. You can't, you can't do that. If it's there, it's actually pretty easy to modify in most cases. As long as you're able to take. Take the foods of feed it. I think that's the key thing is that if you can't ingest the right foods or prebiotics, then it's pretty hard to bring that species out. But if you can, then that population will get up because you're giving essentially selective fertiliser to nourish that particular species.

We will talk about this next approach in terms of feeding the microbiome, but before we move into that, I just want to check if there's any other sort of key things we should be looking at. When we're looking at this, we're going through myoubiomexplorer results, whether there's anything you want to highlight or call out before we move into that personalised treatment, if fair enough.

And I think that's probably the core aspect, but there are other things we look at too. So at least I look at and we can see where it goes down and that below detectable thresholds, around that 0.01% mark. So when a species is present at less than that amount, it won't necessarily show up on the test results and you go down a bit more than that definitely won't show up. It's just the limits of technology that we have. But once you feed that species up to the point up here, around that 0.01 or 0.02, it'll get picked up by the test. And that's sort of how you bring up diversity. Yes. So the other thing to flag is there are a number of species here that we have no idea what they do, what role they play. We just realized that they're there. And this is really because of that leap in technology has allowed us to see that they exist, but we haven't had the chance to actually define what they do and what role they play and what percentage they should be. So most of these species on this list are like that at this point in time. So again, in 10 years time, we probably will speak for hours on all the different species that show up here that we just don't know much about now. So what I do with my results now is focus on those species that we do know as key players for either improving health associated with better health outcomes, or the opposite, the ones that actually are detrimental to health and produce byproducts that are harmful. And on the latter category we include species like the Sofa Ribrio, which the yours was at 0.33% and then Bilophylla at 0.17%. And both those are key hydrogen sulfide gas producers. Hydrogen sulfide gas is again a Byproduct that only a small number of species in your gut can produce. And a small amount of it is actually fine and normal and your body can deal with it quite well. It's just that when you get above a certain point, it actually causes gut inflammation and importantly visceral hypersensitivity. And for patients who have irritable bowel syndrome, for me this is often a key driver of that or just abnormal sensations in the colon as well to get those patients who can't tolerate gas or even the feeling of feces that build up in that lower left quadrant is often because of that visceral hypersensitivity. And the key driver of that is overproduction of hydrogen sulfide gas. So that tells us, okay, it's not. It's pretty, pretty common for me working with a lot of IBS patients for these levels of those two species to be high and they would be contributing to that ongoing visceral hypersensitivity. That may not have been the main initial driver, which could have been the case of travelers diarrhea or food poisoning, but they will be keeping that bubbling along.

Is it also an indicator that you've got hydrogen sulfide sibo that will probably.

Wait on, on more research. Yeah, because we're that when that test that easy to do test for, you know, small bowel hydrogen sulfide comes comes in, we might be able to start correlating with. With large gut. I would guess probably based on that it would make sense. We see it with methane most of the time too, that those that are have higher amounts of methane producing microbes in the colon also have the small bowel and those that have the small bowel almost always have it in high amounts of their colon. So it wouldn't surprise me if that's the case. But I don't think, at least not that I'm aware, we don't have data correlating those two yet, which are the.

Bacteria that are correlated with higher methane. I know my methane siboers will be like what are those ones?

Yeah, that one actually doesn't show up on this particular finding because it's.

I don't have methane sibo. I have never had it. I'm always hydrogen dominant. So that's why we're not seeing seeing it on my results.

Well, that's one potential reason. But the main issue is you actually have to go find it a different way because it doesn't show up in this interface. You actually have to go to downloads and you have to click on the download the CSV file, which is an Excel file, and then you have to search for it manually, and then you can see whether methano Riverbacter smithii shows up there. And it often does in people that are. That are methane dominant. Sibo.

Wonderful. So should we move on to talking about how we then personalized a treatment protocol for me?

Yeah, yeah. So obviously one of the core aspects is working on diversity, because that is something that pretty much all microbiome researchers around the world will agree, because there's always this debate, discussion, scientific circles, but not amongst that. That is a core marker of good health. So focusing on that is important. So really the way to do that is trying to nourish up those species that are below that detectable threshold, besides introducing other species with feces or breast milk. That's the only way that we've got. So some species in your gut are very flexible with their food. They'll eat some protein, they'll eat some bile, they'll eat some sugar, they'll eat some different ranges of fibers. Those ones tend to survive restricted diets pretty well because there'll always be something there for it to eat. But there are other species that have very selective food requirements, and if we don't feed them, they will eventually go extinct. Not sure quite where that time frame is, but they'll stay there. But their population will diminish and diminish over time. So the idea is that you increase the diversity of your diet with essentially plant foods that will feed those species that have a more niche diet. So, you know, we have this idea of fiber being fiber, but it's not. Fiber comes in all different shapes and sizes, and it's the different shapes and sizes that dictate what microbes can eat it. And we get pectins, we get gums, mucilages, insoluble fibers, soluble fibers, and all those different shapes and sizes. And in plant foods we get polyphenols and of all different shapes and sizes. For between blueberries and raspberries and blackcurrants and pomegranates all have different polyphenols. And. And what they have in common is the lack of digestibility. So none of those polyphenols will get absorbed. They reach the colon where they feed microbes. So that's the idea of having a rainbow of food colors and a wide spectrum of plant fibers on a daily basis so you can nourish and feed the widest spread of bacteria possible. And we know that people that follow that dietary approach have better diversity score. And I can Also say from here is as a clinician now that that is a key way of improving diversity scores.

Jason, I might just get you to stop sharing your screen so people can look at your faces as we talking. It's always better to look at someone so you just go, yeah, there we go.

Okay, that means I can look more.

A question I often get asked by people is how on earth do I increase the diversity of my plant based food? When I consume, barely tolerate anything, I react to everything. I want to increase the diversity of my gut, but I'm terrified of doing it because it makes me feel so sick. How do you approach that?

Yeah, it's obviously far more challenging and I do work with patients who are in that boat and it's easier for everyone when they're working with a patient that can eat everything. It's pretty simple process of improving that diversity score. But in those that can't, it's more challenging. And I think for me as a clinician, the key point is trying to work out why that is, why are they having trouble with that, those sort of breadth of foods and those types of foods. And from there it's working out okay. What can we do to treat that underlying issue? Because there's often interventions that we can take to improve sulfate intolerance or amine intolerance to improve visceral hypersensitivity, which is why they're not going well with legumes or onions and garlic. You know, it may take three months of work or six months or nine months of specific targeted work on that area. Or obviously if it's SIBO that we have to deal with the sibo, we have to deal with the SIBO first and then work, worry about the large bowel as a consequence afterwards. But with all the patients that I've worked with, I can say I can't think of any failures to date touch with them that we've been able to actually bring that that food count up with care. And sometimes it's slow, you know, in that some people it's a slow process. But I can, I can say from some that I've worked with for a couple years that were people that were living off of, you know, four foods or eight or 10 foods, is that they're actually now eating a much wider diversity foods and their gut is going much better as a ecosystem is doing much better as a consequence and they're tolerating those foods well and obviously their quality of life, it's improved because they aren't just stuck to eating, you know, peeled Pears and chicken, they can actually eat a wide variety of foods. So I think we can get there. It's just trying to work out what the cause is. That's not allowing them to expand that and work on that underlying cause. And once we do that, we can expand the diet.

And what are the types of things that you look for when you're looking for those underlying causes of those quite strong reactions to foods.

So some of that will be around for me. It's looking at gut permeability. It's looking at a new biome itself test similar to that that gives you an idea of what microbes may be contributing to, you know, gut damage. And that could be leaky gut, that could be visceral hypersensitivity and what microbes are absent that might be healing that process. Yeah, so that gives us one way of looking at that as well and really taking a thorough case history too that will give some clues as to that and often have an idea of what food groups are problematic and that can give us some clues, particularly in conjunction with their history of what lined up to create the current situation. And once we do that, it's relatively easy. It takes time, but you can target the treatment at that time point. So if it's leaky gut, that's essentially meant that they now don't deal with slysolytes very well. There are ways of coming in. All right, yes, we have to focus on healing that leaky gut with things that you can take. We can, there's other interventions we can try that can, can help improve your tolerance of sulates in the meantime. So we can again expand your diet and feed some of those microbes that help heal up the leaky gut. So there are ways about doing it. And that's where it gets even more individualized on top of this because yeah, yeah, I can look at that and go, this is what things actually fix that ecosystem, make it much healthier, diversity wise. Increased levels of beneficial microbes and decreased levels of anti pathogenic ones. That part is relatively straightforward. It's just individualizing that to that patient takes another level of practice to do too. Because then, because that's where the fine tuning comes and having ancillary things to help improve their tolerance to the interventions that will help with the underlying issues.

You talk about eating ideally 40 or more different plant based foods. Are we aiming for cupfuls of each thing? Is it teaspoonfuls? How do we start? I think sometimes people get quite fixated on the quantity, size of the food as much as trying to get to 40.

Yeah, I think don't be so fixated on the quantity side. There's a point at which it'll be too low to be much help. So you're having a pinch of coriander is probably. I would count that in my food. But if you took a teaspoon of coriander, I think that would be sufficient to actually add different plant phytochemicals and different fibers to actually really reach your microbiome and then feed something. So I think anything from that point onwards can be included. And sometimes you're going slow. I think even a tablespoon of red lentils, that's counting, that should be counted. That might be the most you can do at that time point. That's totally fine. And that's the way you're helping to build up to the point that you might be able to tolerate eating half a cup, but you start off with a relatively small amount in some of those people. So for me, there's a minimum dose below which I probably wouldn't count, which is probably that sort of teaspoon load. But above that I'm happy to count it, you know. And the other thing I should flag is that there's nothing magical but the 40 mark. It's something that I worked at, I came up with, okay, this will stretch most people, but it's too. Yeah. And we know that and that now I've seen clinically that that seems to make a difference. But there are patients who go beyond above and beyond that up to 50 and 60, which is. Which is great. And that should actually have further benefits beyond that. But I know that that level is far less scary than going, alright, go for 80 foods per week or 60 foods per week. So I think 40 for most people, as I said, bearing other things in the background that are preventing that is actually doable by stretching out. And when you actually go through and count what you have on a week, people are often at that 20 or 30 mark anyway. And it's not that much of a leap upwards. But I know there are other people that are stuck at the 10:10 mark because of their health issues. And as I said, it's a more convoluted and slower process, but we can get there.

When I first counted, I did a week where I just counted rather than just trying to, you know, get to 40 or more. And I was actually really surprised. I thought that I might be at about 20 and I was actually in the mid-30s when I just entered my standard, not trying too hard. Diet. And then when I started really concentrating on it, I would go down to my local fresh fruit and vegetable market and something that I would do. And I'm lucky, I recognize that I'm in a much better position these days than I was when I first got sibo. With my sibo relapsing this time, my gut is in a better state and I can tolerate a lot more foods. And so I would go to my fresh food market and I'd stand there and I'd look around at all the fresh produce and I'd say, well, what haven't I eaten in a long time? What have I never eaten? What would be interesting to try and cook? And I would stop just going and buying carrots, bread, broccoli and squash, because that becomes a pretty staple sibo for me anyway, a vegetable staple. And I'd go and buy different foods. I also started getting a box. Well, I go on and off with this. I have an organic fruit and vegetable home delivery service. And that's a really great way to get different produce in your kitchen, is they send it to you, you. And it's a great way to get diversity in. And I was actually, when I was really concentrating on this, I was hitting anywhere between 70 and 80 different foods per week. But I was also doing fresh herbs and spices. That was a really great way to add different plant based foods into my diet. And also nuts and, and seeds. And I was starting to bring in some different red foods. Now we'll talk about red foods because that was one of the recommendations for me was to increase my red foods. And I have been very conscious about that. And I'd like us to talk a bit about why. For me, red food has been an important factor for me to concentrate on. What is it about red foods that can be beneficial to my gut?

Yeah, to your gut, the main reason for recommending foods that are rich in red polyphenols was Akkermansia. We know that there's been a number of studies now showing that Akkermansia has quite a liking for red polyphenols from a number of different food sources, whether that be red grapes or cranberries or pomegranates. So it doesn't seem to be that picky as to the exact configuration of, of that red polyphenol, but it seems to like it. So the idea with that recommendation is to just provide that food source. So that commands you like, yeah, I've got one of my preferred food sources always there, because that's really the way that we find will increase populations of that species. So that would include things like red rice as well. You can get them red carrots and red potatoes again, sometimes if you're lucky with your farmers markets, you can get that as well. But luckily, red, red rice these days, gosh, that's relatively easy to come by. Like, I know 10 years ago that I had to special order red rice from the US to actually to get it in. And then eventually quarantine said, no, you're not allowed to bring in any whole grain rice. I was like, no, you can't take my red rice away from me. But yeah, but they've worked around that now. Now you can buy at Woolies and Coles, let alone at that organic version at local greengrocers and organic shops.

Well, I can attest to red rice being quite easy to come by. I have a big bag of it in my pantry. It's really delicious. It's got quite a nutty flavor. I really enjoy cooking with it. And every time, it's funny, every time I eat a red thing, I'm like, there you go, little Akkermansia. Here's some red.

Exactly. Yeah, yeah. I had similar thing too. I was in Southeast Asia, in Sumatra just about a month back and getting these beautiful big dragon fruits which are gorgeous and red on the inside and most amazing floral pinky red. And that feeds Akkermansia. So every time I was eating one, I'm like, yeah, doing it for Akkermansia. Little treats, tropical treat. Because typical Hobart, we don't get dragon fruit very often. So it's very much a treat from Aquamansia.

It's not very tropical down in Tasmania, sadly. No.

We get good berries though, I must say, and black, black currants. So there are pluses. But dragon fruit, now we'll talk about.

So one of the recommendations out of the ubiomexplorer test for me was around, let's look at the nutrition. And red food was a really important part of my puzzle as well as diversity, so I can start to rebuild those populations. But we also looked at pre and probiotics. And this is a question that I get asked all the time. Which is the best prebiotic, which is the best probiotic for Sibo? Now we looked at, we developed or you gave me recommendations based on my ubiomexplorer test because we knew exactly what is in my gut. Should we just be taking any pre and probiotic willy nilly or should we be doing a test like Eubiome Explorer to get a Better picture of what's happening so that we can really personalize the use of these two things.

Yeah, it's good questions. I think it depends a bit on the, on the presentation. So listen, if I have someone who's coming in who's just taking a course of antibiotics or chemotherapy, I'm not going to wait. If I get a one day turnaround time, fine, I would do that and then I could totally fine tune, but I don't. By the time I get the test results, it's going to be two months down the line. It's like, no, this is too long. I will go in with what prebiotic interventions that are going to should do the best job to correct the populations that are usually altered by that intervention. That would be same with antibiotics too, but with more chronic conditions then I think it's ideal to see what's there and to go in because there are nuances in terms of the impact of different prebiotics between galact oligosaccharides versus inulin fructooligosaccharides versus partially hydrolyzed guar gum. So they feed different bacteria. Yes, and sometimes there's some overlap there too, but they sometimes will have a greater impact on decreasing certain populations too. So lactulose, for example, is great at feeding up different bacteria, feeds up fecalibacterium and brings down Bacteroides and Proteobacteria really well, amazingly well better than the other pre products. So if I've got someone's results in front of me that has 60% Bacteroides, then that'll go okay? No, you need lactulose, whereas if their Bacteroides is 20% then I might go with GOS or FOS, you know, all other things being equal. So I think you're able to tailor things far better with a result. So that's the ideal scenario. But I can, as I said, there are obviously cute situations where you're just going to go in with, with with what you think is gonna be helpful because you don't have the time frame of waiting. And there's other ones where I suppose, you know, I think with the cost being so low, it's best if you can to do a test and see where it's actually at. But you will get some like, you know, partially hydrolyzed guar gum that is generally very well tolerated, that increases B tree producing microbes and has a mild impact on things like bifidobacteria. That is, it is a pretty safe one to experiment with. And even most Patients with sibo, not all. Most patients with IBS tolerate it. Well.

That's being partially hydrolyzed gua gum.

Yeah. So sometimes it's just maybe start with a quarter teaspoon and slowly work up for those people that are sensitive, or a tiny pinch a day for a week, or two pinches a day for a week, and then you slowly work up. But you can generally get there even with the most sensitive people.

I think that's really important, and I think because so many people share their protocols on some of the big online forums that other people then just follow them because they're desperate for some answers and some treatment options. And I hear regularly people are having really strong reactions to these things, and I do wonder if it's because they're having a full dose. And I know when I start out, when I started out with my pre and probiotics, I was starting out with the teeny, tiniest little amounts of them and just slowly, slowly, slowly building up. And it took me about a month to build up to a full dose because I just went slowly. I'm not in a. In a sprint race with this. I know this is a lifetime journey, so I don't need to try and have everything at full strength within the day. I can wait a month to slowly increase so that my body and my little bacteria can cope with this sudden influx of these foods.

Yeah, exactly. Because the populations change as a consequence, and the populations that deal with gas change, too. But if you. It's been overwhelming all at once. And that's something I learned from my first clinical trial I did back in 2000 on my poor patient population of irritable bowel syndrome patients. I gave them full doses of lactulose and inulin. So that was like a double, double prebiotic dose at therapeutic doses. And these poor people were, like, farting like crazy. And this is, you know, well, until before the FODMAP stuff came out. So, you know, I'm just basing it on research, and I've got much clinical experience, but. Yeah, and lots of bloating and distension. You sort of realize then that. No, particularly in sensitive populations, you start with low dose and it's sometimes a teeny, tiny dose and work your way up, and it generally will work.

Really, as I.

It's still. Sorry, I was gonna say, it still helps if you. If you know what the ecosystem is like, then it sort of helps you to persist with the one that, you know is gonna be helpful to help bring balance to that ecosystem.

So it really Is the takeaway, as I understand it, is if you're in an acute situation, like you've come off a round of antibiotics or something really impactful, like chemotherapy is to. Is to work with your practitioner to help support the gut repopulation. But if you're dealing with a chronic condition like sibo, like myself, where I've been dealing with this for a lifetime, taking the time to do a test like you biomexplorer, to get a good, clear picture of what's going on your gut, so that you can then really tailor the approach. As I understand it, that's the way you would approach it with your patients.

Yeah, I think that would be right, actually, because I'm thinking of other conditions like depression and anxiety, things that are. That are more chronic. We know that the microbiome plays a pretty key, pivotal role in contributing to being one of the causes, if not the main cause, chronic fatigue would fit in that same picture. So rather than guessing what's going on, have a look. Because, you know, I know that endotoxins, for example, were definitely problematic for chronic fatigue syndrome. But when I do a test, yes, certainly some people have really high proteobacteria, that needs to be addressed and other people don't. So in which case I actually treat it differently. And this is where that getting the test result makes a difference to the final treatment in the end for that patient, even if they have the same disease label or chronic fatigue syndrome or depression, come up with a different treatment approach based on a different microbiota picture.

And I really see this is where our medical journey is going more and more in the future, which is exciting that it's more personalized, tailored treatment protocols rather than this carte blanche, one size fits all approach, which, you know, it just, it only works for a percentage of the population because we are all different, we're all unique. And I think that one of the challenges amongst the SIBO community is we're all looking for that quick fix because we don't want to feel sick any longer. And it can be frustrating that it can take time to uncover all of your pieces that have led to this overgrowth and your system not working optimally. And that can be a real challenge mentally to come to terms with that, because we have been conditioned in the Western world to take a few pills and be fine. And that just isn't often the case with sibo. How do you work with your patients? Just around the emotional and mental component of pulling together a full picture to really get good quality treatment. And outcomes.

I think it's often about chatting to around expectations and timeframes. You know, I think that's something I do better now than I did when I was more of a junior practitioner. Probably because it's based on so many people's experiences that you get a rough idea of how it usually takes things like, I know how long it usually takes to treat the acute phase of sibo. Now, does it always take that long? No, occasionally shorter, occasionally it's longer, but how much it usually takes. And then I know how long it usually takes for the secondary stages, you know, so I tend to walk people through that at that first, if I'm lucky enough to get them at that first time point of diagnosis, then we will talk about what that actually means in the duration, treatment and what they can expect and at what time points. We'd expect things to be able to broaden the diet, for example, and start including these other sort of foods.

Let's just finish up on repopulating the gut through things like fecal microbial transplant. You were talking about breast milk inoculation, which is interesting. And also things like fermented foods or cultured foods. Let's start with fmt. So fecal microbial transplant, obviously there's a lot of interest in this. People often wonder, could they do this and rid their sibo? Is it a treatment option for sibo or is it more that we're looking at diversity in the large bowel and that's why we would use it. What's your thoughts on that?

Yeah, I mean, I personally wouldn't see it as a SIBO treatment. I would see it as a way of improving the microbiome in someone post sibo, for example, where their ecosystem may well have been damaged from long time with restricted diets, lots of herbal antimicrobials, biofuel investing products and mixture of antibiotics thrown in. I've seen some very disturbed ecosystems as a consequence of that sort of combination of effects, in which case a fecal transplant could be a way of reinoculating into it. So, I mean, I could see it as a component of that, but I certainly wouldn't see it as a cure all for it. And you would see that, you know, I think that often in SIBO patients that there's a degree of large bowel inflammation, visceral hypersensitivity, that is part of the picture as well. And if we just treat the placebo bit, we can decrease bug counts and the SIBO is gone. But they're still getting gut symptoms from legumes or something. It just may be happening at three or four hours now instead of it half an hour after eating it. And to me it's like, okay, well we haven't dealt with the underlying issue there. And, and again the composition, the ecosystem may well be playing a role in persistence of symptoms in that large bowel and the lack of healing. And in some cases you might go, okay, God, if your diversity score is 1%. And I will often try as the first protocol to actually restore an ecosystem before I'll just go, no, you need an fmt. I'd suggest talking to someone about getting an fmt. I'd often more my first protocol is always trying to restore an ecosystem as best we can and see what shows up. And so there might be a time where, you know, FMT is the only way of providing the right bacteria in that colon that will actually help improve healing, decrease inflammation, decrease visceral hypersensitivity.

That's really interesting. And I know there's a lot of discussion around FMTs. One thing I often wonder is how do we know that the poo sample we're getting from somebody else is actually healthy? Do we know enough yet around our gut to know that we're giving the right sample to somebody that needs it?

Good question. And I think there'll be some people's point of view will be we certainly don't have enough evidence at this time point to work that out. I mean I think that'd be the more conservative side of the picture who like having a tremendous amount of studies up before they'll accept an intervention. And I'm not in that category. I'm much more over in the few studies category for intervention that's safe. But I think it does come back to the health of the donor and screening. And this is something I think could be done better by a number of places that offer FMTs is that they often won't do something as simple as you buy them or something similar tests using DNA technology to see what's there. And for me that would be the most pivotal thing is I want to know what that ecosystem is of that donor. Is it better? I've seen people post FMT who actually didn't have a very good one week afterwards. Their ecosystem wasn't very good, 70% Bacteroides and it was really out of whack. And yes, after two and four months of treatment we're able to bring it into a beautiful balanced ecosystem with higher levels of, you know, our anti inflammatory species and lower levels of those pro inflammatory species. So we got there because the other bugs were there in small amounts so it could be corrected. But I had another patient who, the one that had the 25% Proteobacteria that was probably given over by an FMT because it wasn't there before. They had a series of eubiomes. It's like, ah, so that FMT introduced and it was 22% streptococci. It was just like a radio really imbalanced ecosystem from, from probably just one, one donor that wasn't a very good donor. So I'm, I think that the screening process could be better. I think that the history of the donors should be better. Like I want someone who is, who was born vaginally, who was breastfed, who did not take antibiotics or minimal, but hopefully not under 2 years of age and hopefully minimal for when they were young, when that sort of. There's much easier to cause permanent extinctions at a younger age than older. And I want someone that not just has an antibiotics in the last three months or six months. I want someone has an antibiotics for five years as a donor and who eats a really healthy diet and physiologically well, healthy, fit, good mind, meditates daily. I want a lot. But those people's poo should be a bit like gold. It should be, you know, they should be the through donating stools for FMTs. And I don't think we're necessarily choosing enough people like that and I know there'd be not that many of them out there, but we should do our best to try to isolate and find those ones who actually fit that criteria.

I have thought the same thing myself and I've thought, oh my gosh, if I was going to do an FMT with somebody, I would want to know everything about them before I put their Microsoft microbiome into me. Now you talked about breast milk. Is that something that you could see that as adults that we could be perhaps drinking, or is it more for children?

I think this is talking theoretical because we haven't had the research to look at it yet. And for some reason we find it easier to deal with poo transplants than ingesting breast milk from other humans. That's just often the way it is that will change. But I think in terms of bacterial composition and richness, there's no reason why something like breast milk couldn't be used as a way of reinoculating or reseeding the gut in a way that contains a number and a wide breadth of human bacterial species. Because what we don't get in cultured food and fermented foods is we don't find Faecalobacteria, akkermansia, subdilla granule anerostypes. They're not, they're human gut species. They're not found in cabbage or any other sort of fermented food. So you can't reseed those species from a medium that doesn't contain them. Whereas something like breast milk or feces does contain those same species. Hence why we can reseed and repopulate that way.

And then it's around the cultured foods, fermented foods. Obviously there's huge amounts of promotion of things like sauerkraut and kombucha and kimchi. At the moment it just feels like every second I'm looking at someone else posting a post about oh look at my kefir that I've made at home. How important is it for us to be eating these fermented and cultured foods for diversity and good gut health?

Ah, now that's a big question. I'm trying to think of the best way of approaching it. You know, I love fermented foods and I eat them daily and I have for, you know, since I first started in series 18 years ago I was making my first batches of sauerkraut, you know, so it's been ongoing thing for me and I come from Ukrainian and German background. Both my parents grew up with big vats of sauerkraut in their basements. So you know, it's part of my familial passing on as well. But I think it's, there's a over statement of the impact that they have and particularly around this reseeding and re inoculating aspect. Because when you look at a gut ecosystem you can do that pretty easily. With eubiome you can look at an ecosystem that's found in sauerkraut or kefir or kimchi. They do not look the same. They do not share almost any species in common bar Lactobacilli. They might one genera that they might be both guts and there. So I think this idea of reseeding, using those things is nonsensical because you can't, you're not putting in species that are, that are lacking and you're putting in species that are good at fermenting cabbage. Does that mean that they grow well in your gut? That's another big question. And generally no. And two, you can do follow up testing, eat some sauerkraut for two weeks and then wait two weeks and do another you bomb test, the species aren't going to show up anymore because they don't produce colonized. So you do get a temporary improvement of diversity. There's no doubt when you eat fermented foods, same with eating, you know, some soil on your carrots. Same with eating, you know, more raw fruits, vegetables, nuts, you get this bacteria on them, you know, and they will be temporary visitors to your gut and they will temporarily improve the diversity score whilst you take them. But a couple weeks afterwards, no longer, they aren't permanent members of your ecosystem, they're temporary visitors. And I think that's what sometimes forgot. Now, for an ecosystem that is severely low in diversity, adding in another 10 species from sauerkraut, another 10 from kefir probably is going to be very helpful because there's just such a lack of diversity. The ability of some of these microbes to interact with our immune system while the temporary visitors is a different story. You can have different effects from these microbes, from that temporary interaction. But it's just, I think that a misnomer to think that you're reseeding or recolonizing.

Thank you for answering that question because it does provide a lot of debate online amongst the SIBO community. Now you've got a really fantastic meet your microbiome course that anybody that's really interested in learning more about the basics around the microbiome could do. And I do have a link for that on the show notes page. So do head to the healthcare diversity but in, you know, in 30 seconds, what's the course all about? Why would somebody do your online course?

Yeah, it's essentially the name. Does it? Well, meet your microbiome. The idea of the course is to teach members of the general public that are, you know, not just for the health professionals. I've got a different level course for health professionals to be. Familiarize yourself with that ecosystem to a far better degree. Meet the key, the key players, both the ones that are key helpful players and the ones that might be causing you harm. And it works. Ideally, if you go alongside something like a UBI result, it's not needed, but if you got your own, it makes it more interesting because you can go, okay, where am I at? Where should I be at? What can I do to diagwise to actually change that? And I think it gives a lot of empowering information to sort of make those changes and to really understand why. And I think I've had sort of my own patients who end up doing the course and I do course here in Hobart, locally As well. It just really changes the way people view their gut. It changes the way they view food because they're now looking at, okay, what am I feeding my microbes when I eat this? And it really changes your perspective. And I think it's important we remember that we are super organisms or holobionts, that we are mostly microbe and partly non microbe in terms of our whole makeup. And it's important that we learn more about that non microbes, you know, the microbe component of our cells and how to nurture certain components of that. So there's a whole bunch of flow on benefits. And I think that's the key thing. The more research that's done on the microbiome, the more important we actually see it being for not just gut health, but mental health and other aspects, cardiovascular health, etc. So I think if you, once you learn those, those important aspects of how to feed and nurture certain species and how to, you know, do less feeding the ones you don't want, it puts you in quite a good state to actually make the changes and change your microbiome.

One of the great things about doing the Meet yout Microbiome course and the link is in the show notes thehealthygut.com diversity is that it really helps you to know what's going on in from just a basic bacteria level. And I find it great when I sit down to eat my very plant based food meals now. I get so excited about the food that's going into my bacteria. I'm all like, there you go, little bacteria. Have a wonderful time with that. And it's also really helped make the decision making process around food easier because I know many people get really guilty about eating junk food or highly processed food. Now it's not even a question because I just go, I'm not doing that. I'm not putting that holocaust of food into my gut. I am giving my bacteria good quality nutrition because I really want to get my diversity score up. And that's something that hopefully in the coming months, Jason, you and I can come back and do a bit of a wrap up on how my gut has gone. Did my diversity improve? And I look forward to sharing those results with everybody. So hopefully you'll come back with me and we'll do a wrap up in the coming months around did Rebecca's diversity go from 62 to could I get it into the 70s or maybe even 8? That would be amazing.

Let's hope so. Let's hope so. I always find you buy them A bit like Christmas presents because it's like I don't know what I find, I open it up. It's like even the returning ones are even more exciting in some ways because you get a chance to see what's actually changed from the interventions that the patient has implemented in the changes that they've made. It's always super exciting.

It's so exciting. Dr. Jason Horlick, thank you so much for coming back on the Healthy Gut Podcast and sharing your amazing knowledge on the microbiome with us and talking about building diversity back into the gut. As I've said a few times in the podcast, if you'd like to get the show notes from today's episode, all you need to do is head to thehealthygut.com diversity and don't forget, if you would like to get the full transcription from today's show, you can do so by becoming a member of the Healthy Gut Podcast. It's absolutely free to join. You just need to pop your name and email address down in the membership box and then you'll get the full transcription from today's episode. Which is great because we've used some pretty big names for some of these bacterias and it will help you to know what we were talking about. And don't forget, guys, come say hi to myself and the team at the Healthy Gut on Facebook, Instagram, YouTube, Pinterest, Google and Twitter. We're under the Healthy Gut and we love hearing your stories and you can get my Food Plant Based Food Tracker as a free download. So head to thehealthygut.com diversity to download that and I'd love to hear how many different plant based foods you're eating today and how you go at reintroducing foods. We'll be really excited to see what people's numbers are. So thanks for tuning in to the Healthy Gut Podcast and and thank you once again Dr. Jason Horlick for joining us on the show. It's been an absolute pleasure to have you with us again.

Thanks for the invitation, Rebecca.

If you would like to access the show notes from today's episode, make sure you head to the Healthy Podcast and don't forget that you can join as a member of the Healthy Gut Podcast. It's absolutely free to join up and it means you get the full transcription from every single episode in season two. It's a great way to listen and read along to the podcasts, particularly when bright rain fog is bad. And it's a bit of a challenge to take all of the information in. So head to thehealthygut.com podcast so you can sign up as a member today. And if you would like to watch the video that accompanies today's interview, make sure you head over to YouTube and search for the Healthy Gut YouTube channel where you will see my interview with Dr. Jason Horolek. And you'll also be able to see the images from my YouBiome Explorer results pages. You've been listening to the Healthy Gut Podcast with your host Rebecca Coombs. To learn more about the Healthy Gut or our podcast, head to thehealthygut.co forward slash podcast. We would like to thank Red Lemon Productions for the production and original music score of this podcast. To find out more about their services, head to redlemonproductions.com the Healthy Gut Podcast is a production of the Healthy Gut. Thanks for listening.