Meet Your Microbiome, with Dr Jason Hawrelak - A Quirky Journey Podcast #117

The wellnesscouch.com streaming wellness into your lives.

You're listening to A Quirky Journey, the Healthy Family podcast with your hosts, Jo Witten and Fouad Khasab.

Welcome back, guys, to A Quirky Journey. This is your host, Fuad Kesab. And with me from her car, somewhere near the tablelands in far North Queensland, is Joe Whitten. Hi, Jojo.

Hello, Fufu.

Never before has this technology been able to allow us, you know, like, to record from such weird places.

I know. I think the last intro was from a car.

Was it?

I seem to be Josiah Hobo.

She's on the road. Okay, so Dr. Jason Horolak. This guy's incredible. He is a probiotic researcher, he's an educator, and he's also a clinician. So the guy is one of, like, the most incredible. What's the word, Joe? Authorities on the microbiome. He knows so much about it. Like, he actually can probably just, like, they probably know him. He's that good. Like the bacteria.

Here he comes again.

Huh?

Here he comes again.

Yeah, it's like, oh, that's horror. Like, I've heard about this guy, you know, he's that famous. And he knows his stuff and, you know, it's. It's just he's done 16 textbook chapters. He's like, produced medical literature on this and his research has been cited over 800 times. So just an incredible guy with, like a brain that is really, really made for this stuff.

And how many years has he been researching the microbiome? I think it's like 20 something.

Yes. Yeah.

Before most people had even heard what that word about gut health or how it affects.

Back then, it used to be called the biome, and then they called it microbiome. Really? No, I'm just joking.

That was my sketch.

It was a long time ago, you know, Ye oldeam biome, it used to be called back and now. But honestly, we really wanted to get someone who knows so much about this topic so that we can get the best type of advice. And we got more than we expected with this. Right, Jojo?

Yeah, yeah, we learned heaps.

So, look, we won't give it away, but all we're going to say is that you're going to love this podcast. Tune in, send it to your friends. This is an educational one that's not going to overwhelm you at the same time. You know, you're going to learn a lot, but it's not. You're not going to die from overwhelm. You're going To. It's really assimilable. That's a word, isn't it? You can assimilate. Assimilable. I don't know how you say it. I don't know which word. Oh, syllable to emphasize. But yeah, that's. That's the result of 13 minutes in 10 degree water, guys.

Yeah, I was just thinking that. Yeah, he's gonna start making up words now.

No, it's just coming back to me. My brain is just like my memory. I'm remembering a lot. Oh my God. That's where I put that $50. I've got to go. All right, guys. Chat to you later, Joe.

Okay. Enjoy the podcast, everyone.

Doctor Jason Harlak, welcome to the show. Thank you for coming.

It's my pleasure to be here.

Welcome, Jason.

We heard about you through our assistant Dan Sipple, who's an astropath and a huge, huge fan of your. And ever since the day I met him, he kept telling me, have you heard of Dr. Horlack? Have you heard of Dr. Horlak? I'm like, I have to hear about Dr. Horolak. Looking at your work, it's really fantastic work that you're doing in the area of the microbiome. Now this has been a hot topic for the past few years and it's only going to get more and more widespread. The information that's coming out around the microbiome, even though we're really looking at it from the tip of the iceberg. And you've been dedicating so many years of your life to this topic. Can you just give us a bit of background about your professional relationship with the microbiome?

Yeah, I mean, I was lucky enough to discover the microbiome before it was properly discovered by the broader community. So I've been doing research on the gut microbiota and its role in human health since 2000. Essentially. When I finished my naturopathic training in 1999, I flew on to do my honor degree and then subsequently my PhD looking at essentially the role of a gut microbiome in gut dysfunction, but particularly urethral bowel syndrome. So it gave me a wonderful opportunity to delve deep over a period of really between my PhD, my honors were looking at 5 or 6 years where most of my full time job was looking and reading research studies. And at that point there wasn't that many. So it was actually two or three hundred published a year. So it was pretty easy to keep on track. On top of all the research that have been done looking at probiotics and Prebiotics and looking at the fine nuances there, as well as broader impacts of diet on the microbiota. And for me, it's just been amazing to see the rise. You wouldn't have necessarily guessed at that juncture, how big it was going to become. Certainly it's always been an area of interest for naturopaths. And you can go back to the early 1900s and there's naturopaths talking about gut bacteria and how important it was back then. I'd say for my profession, it's always been important. And I can speak to naturopaths who were trained in the 1970s and 80s, and they certainly were talking about gut bacteria as part of their training back then, too. But we just didn't have the right tools at that point to actually probably see what was going on. And I think that's the change in technology that happened in the early 2000s is essentially what has led us to the boom in microbiome research and the connections we're now making between the human microbiota and every disease condition you can think of. It's all because of change in technology that occurred at that time point.

Well, let us define the microbiome for the rest of this show so that we are very, very clear on what we're talking about with the listeners.

Yeah, yeah. Because I suppose when I say microbiota or microbiome, I'm always speaking about the gut. But in fact, there are other microbiomes too. There's the skin microbiome and there's nasal and oral cavity, breast milk and vagina. There's lots of different microbiomes. But for me, my main area of interest in research has always been the gastrointestinal tract microbiota. And with that, we're generally talking about. But essentially the colon when we talk, when we mention that the gut microbiota or gut microbiome, most researchers and people who are discussing it are talking about the chronic microbiota. And there we're looking at a. If we're able to scoop out all those microbes and put them on a scale, you'd be looking at 1-2kg in weight, which makes it a similar size and weight as your liver. And we know that now that the microbiome actually exceeds the liver in terms of the metabolic functions that it performs on our behalf, which is pretty cool, because our liver was considered to be by far our most important metabolically active organ. And that has shifted and certainly led to this idea of the microbiota being a pivotal, important Human organ really taking hold. Whereas back in the early 2000s it was a bit of a far out idea that these microbes were super important to your health. And researchers were saying it then, it just hadn't cottoned on. Whereas now is condoned on.

When we say those microbiome inhabitants, are we referring to bacteria or is there a host of other stuff as well?

Well, the reality is there's a host of other stuff too, but we've really focused mostly on bacteria to date. So most of us again are talking about bacterial components of our ecosystem. And we know that there are, you know, I think about 10 to the 11 bacteria per per ML of contents in our poo. But the reality is now that we've we're using better, we can see that there's actually a fungal inhabitants which we call the mycobiome. And there's also eukaryotes, which are like protozoa organisms that are native inhabitants to. So our definition of what a normal ecosystem is expanding and we're realizing now that it's actually not just bacteria, but it's interaction with different fungi, which are native and healthful for us, as well as protozoa organisms that are native and helpful for us too. And it's the latter organisms that I think that are just coming to the fore and will be a topic of much research and novel discoveries over the next five years. Because we really weren't looking at the fact that there actually are indigenous native commensal protozoa organisms as part of our ecosystem in health, you know. Yes, we looked at that giardia as being pathogenic and we should kill it. But it turns out that we actually do have native inhabitants there that are playing healthful roles for us too. But we're just starting to tease that out.

When we start seeing new actors in the picture, it really increases the complexity of the picture.

Yeah.

And I'm just wondering, with regards to the science, where are we at? Is this still in infancy or is it quite advanced?

I think this really depends on who you ask. If you ask someone like me who's been in this field for 18 years, I don't think we're in infancy anymore. When we're looking at bacterial members of the ecosystem, we've learned a lot. Is there more to go? Yes. Whenever I look at a molecular analysis of someone's stool that there might be 90 species on that list of what's in their gut and we might know a lot about or some about Meliska, we might know a lot about 10 of those species, some about another 10 of those species, and almost nothing on another 70 species found in that gut. So in that respect, I can see, yeah, we've got a lot to learn. But then I compare that to the microbiome research where this has only come out the last five years, and we're still trying to find what name these species and find out what role they might be playing. That's in its infancy. Looking at protozoa organisms, I'd say that's in its infancy. Yeah. But if you just spoke to someone who just discovered that the microbot exists two years ago, they'll say it's in its infancy. You know, from watching a catalyst special for them, it's new, but it's actually been ongoing for ages. I mean, there's been people researching it from the 1960s. It's just that it's, as I said, because of the evolution of tools, we can see more of what's going on. And that's led to the Boolean research that happened from the early 2000s onwards.

So I guess for me, I'm looking at these various species that are in the gut and our understanding of them and their interrelations and also how they relate to various bodies. So a human being with certain health or whatever characteristics they have, we probably don't understand the individual responses. They'll have individuals. So just. Can you maybe clarify to us the interaction between the bacteria or the microbiome and the human being and what kind of relationship there is and what does it do for us?

Yeah, I mean, I liked. There's a researcher in Sweden back in the early 2000s called Professor Stig Begmark, and he likened the microbes at that point to the microbiota organ, or microflora organ, as he probably called it then. And I very much like that idea and it's totally stuck with me since then. And. Because when you sort of delineate all the important functions that this organ has for us, you start seeing it as. Yeah, it's equally as important as our stomach or liver or other function. It plays vital roles. Yes, we could live without those microbes. You could absolutely sterilize your gut and you'd still live, but you wouldn't live healthily. I think that's the key thing that we know that the microbiota is important for our normal immune system function. And that's both two arms of that immune response in terms of protecting us against infectious agents, but also helping us develop oral tolerance to food, for example. And I think the current scenario where we have high rates of food allergies is totally related to disrupted microbiome because we used to have tolerance to peanuts and kiwi fruit and fish and a range of other nuts that we don't seem to have now. And that's very much to do with how bacteria interact with our immune system. There was funky research done in the 1960s and 70s where they were able to completely eradicate the gut ecosystem of mice and rats and put them in little sterile cages and give them sterile food so they couldn't regrow bugs. And they found that their ability of their white blood cells to sort of eat invading pathogens decreased by 90%. Their spleen shrank, their thymus gland shrank, which are key immune organs. And even the number of antibody generating cells in the gut decreased by about 90% as well. So massive shift. All they had to do to correct it was introduce some poo from normal rats and boom, their thymus grew, their spleen grew again, and their white blood cells started functioning properly. So we can see this very clear relations from early days of research in the microbiome and motility. Also in terms of gut motility, we know is very much dependent on microbes. If we again use those same mouse or animal models where they eradicate out those gut bacteria, everything slows right down dramatically. Other things we know is that the microbiome improves our nutritional status. So certainly by making B vitamins, we know now that makes B vitamins, vitamins B1, B2, B3, B5, B6, folate, and even vitamin B12. It's just that we don't have transporters for vitamin B12 in our colon. But we do, however, have transporters for the other B vitamins. So the microbes that are making the B vitamins, we actually benefit from that. And the B vitamins are often in active forms and very well absorbed in that environment. Vitamin K, also made by gut bacteria and even helps with absorption of things like calcium and magnesium, because a fair bit of those minerals get absorbed in our colon too. When we've got the right sort of micro environment that's there.

The old view of bacteria is good bacteria, bad bacteria, which is very typical of humanity where we try to put things in certain boxes. One is good, one is bad. But as the science has emerged, now we're seeing that that is not the case. Can you give us an idea now of what the new view is?

Yeah, I mean, I think it's more about maybe therapeutic windows or having the right. It's about balance. Might be taking it a step Back of having too much of certain microbes will cause problems and too little can be problematic as well. And having microbes in the right zone, I think is perhaps arguably ideal. I think that's certainly the way that I look at and that's what I think the research is dictating. We have some that have a narrow window in which they're healthful and a greater window in which they're harmful, in which case scientists would refer to them as pathobionts. So species that in the right balance are healthy, helpful, but in overgrowth stage can cause harm. And there are other microbes that we put lactobacilli and bifidobacteria in that category that it's really exceptional circumstances where we'd see them as causing harm. From a drug analogy, they have a wide, great big window that you've got a wide range of populations that are going to be helpful. It's only when you get above a certain point, which is really, really hard to do, bar unusual circumstances, will they actually cause harm.

So these are the ones that we see in ferments.

Yeah, yeah. That's where we certainly see lactobacilli as being key drivers of most of our traditional fermented foods.

I'll zoom out a little bit because I'm looking now, as you know, people are getting more and more health conscious. There are so many diets out there that are promising health. So people are going on diets for a long time. It's no longer interventional diets. They're just trying to find the diet that suits them. And I'm just wondering, let's take a healthy individual, which is very rare to find these days. Yeah.

And I don't treat many of them. It's true. My clinical practice is not full of healthy individuals.

It's full of, well, individuals.

Is there a universally accepted healthy diet that is actually gut friendly and healthy for the microbiome?

I mean, I think there's obviously going to be individual nuances to suit the person, but I think broadly speaking, it is high plant food and high fiber and high diversity. I think those things come through in looking at microbiota specifically, but probably more broadly literature as well.

Okay, so the fiber and the plant food are the major element in your view, that will be beneficial to the gut?

Yeah. We know from a gut bacterial perspective that the higher fiber, higher diversity of diet results in a higher and more diverse colonic ecosystem. And that is one of the markers that I think almost everybody, not almost every scientist and gut microbiotic world agrees on that a more diverse colonic ecosystem is equated to health in numerous different research studies. And essentially the best way of doing that, achieving that is one, avoiding factors that cause harm to your gut. But two, eating a diet that feeds up a wide number of microbes. And remember, what reaches the colon is essentially food components that we don't. The human cells don't extract and absorb. So that means we've got polyphenols, and it means we've got fibers for the most part. You know, a whole mixture of insoluble and soluble fibers and pectins and gums and mucilages. And this is why a diverse variety of plant foods provides a diverse type and shape of fiber, because that's the key thing are some species in your gut that are pretty selective and they'll only eat like one or two different shapes of fiber. And there are others that will eat a wide diversity of different fibers and resistant starches, et cetera. So if we have a wide diversity of plant foods means we're having a wide diversity of dietary fibers you're consuming. And those fibers all reach the colon to feed microbes, because we as humans don't have the right machinery to break down fibers. Whereas eat a steak or lamb or something like that, then we're absorbing pretty much almost all of that. Yeah, small precipitation amount of the amino acids or proteins escape digestion everybody to reach the colon, but very little. Whereas if we're eating a big leafy green salad or a bowl of black and red rice with those salady greens in it, that there's a whole matter of fibers and polyphenols, which are the color compounds in the red rice or black rice, for example, that reach the colon to feed microbes.

Right, that's super interesting. So apart from the hermetic effect on the body in terms of stressing the body, they're also provide various substrates to the bacteria and the gut so that they can thrive as well.

Yeah. Because we have to remember that the colon bacteria are mostly some that can eat a bit of your mucus in your gut when we are all secreting mucin. But otherwise they're dependent upon the foods that we eat to feed them. So diet has got the huge capacity to alter one's ecosystem, far more so than any sort of intervention like a probiotic or even eating fermented foods will have minimal impact compared to changing one's diet in terms of reducing food substrates in terms of fibers and polyphenols, or increasing one's intake of fibers and polyphenols you'll, you'll see dramatic shifts in a really short period of time.

The fiber issue is. Sorry, Joe, I keep asking questions because.

I'm like, you're on a roll.

You know, we're coming out of the grain based era, I guess, where the food pyramid was telling people to eat nine series of whole grains, which actually ended up being pastas and breads and you know, genetically modified grains and all sorts of stuff that, with that, with the preservatives and the additives. And then we've had a shift in the culture now where people are either going down the paleo route where they're eliminating all the grains and then seeing a lot of health benefits as well because they're starting to focus more on plant based foods and fresh meats and getting the preservatives out of the diet. And then people think, hey, that I found the holy grail of food. And then on the other hand there's like the vegetarian and vegan movement as well, which is focusing on eating more fresh leafy greens and brassicas and things like that. And there's the low carb, high fat approach, which is the key. Keto is getting really, really big. It's one of the biggest diet trends at the moment. And we also have like Joe and I have personally healed from doing an intervention diet called the GAPS diet, which I'm sure you're aware of. And for that one initially it is very, very low fiber and the fiber increases as the gut heals. In terms of the view of that diet that people who, well in their gut, they should avoid fiber to begin with and then introduce it slowly as they got heals. And it's kind of confusing for people because a lot of people don't know where they are in terms of their health and what kind of foods they can tolerate and where to begin with this, I'm interested in two things. One is your approach in terms of determining where human beings should be starting with their diet, whether they should be eliminating fibers for a short period of time, then reintroducing them. That's one thing. And then the other thing is I'd really love to hear about the long term microbial effects from diets like paleo, vegan, high fat, low carb.

Okay, for the latter question, I think we'll have to wait for more research to tease some of that out. I can certainly share some experiences as a clinician because I do see patients and I have seen patients for 18 years. So I'm one of those people that straddles a couple different worlds of academia, research and being a clinician. So I still see patients and I do a lot of microbiological analysis for my patients too, you know, but I suppose one aspect of that is I do see sick patients, healthy people. So, so for me, when I'm doing analysis and looking at the microbiome and I'm looking at the dietary fact and the research around that, you can, you can start making these links because I, I do think that there, I certainly see them in practice and the research is there that, that dietary patterns that restrict plant foods and fiber sources do negatively impact the ecosystem and there's the short term impact of that. But for me it's more worrying. It's a long term aspect of that. This is something I see frequently in practice now of people and this I think is compounded when they're taking herbal antibiotics for long periods of time or antibiotics for long periods of time on top of very restricted diets and where you start seeing really huge negative shifts in the ecosystem because you're losing diversity, you're losing levels of species that generally microbiotic research and see as key marker species of good health, which would be things like faecalobacterium, achromansia, bifidobacteria and other butyrate producers often go down as a consequence of such diets. And for me, I'm often seeing people that used to be able to tolerate a wide range of food, a whole range of foods, but they had some bloating or distension and they were diagnosed with sibo. So then they were put on or small intestinal bacteria overgrowth for those that aren't familiar with placebo. But I imagine most of your listeners are, and they're put on a very restricted diet. Some course of antibiotics, some course of herbal antimicrobials. 12 months down the road is that now they can eat only five foods and they can't tolerate much at all in terms of fiber, because essentially, and you look at their gut ecosystem, you're like, oh gosh, okay, now you starve off your butyrate producers, you starved off your bifidobacteria and your Akkermans and Faecalobacterium, which are key players for keeping your gut not inflamed, for helping promote healing and for decreasing even systemic inflammation, let alone even gut inflammation. And there are also as a consequence feeding often groups of bacteria called Proteobacteria and more specifically ones that are called hydrogen sulfide gas producers, which actually actively cause leaky gut and Damage, but you don't get bloating or distension by eating those foods. That sort of dietary process. You don't get any obvious signs in the short term that the ecosystem is actually going wrong. But you noticed after six or nine or twelve or year and a half or two years following, like, hey, their ecosystem is actually actually gone backwards in many ways. And maybe the bloating, distension, you're not getting that. Well, you're eating that sort of dietary approach. But now you try to introduce these foods back in, you're far worse off than what you were before. And this is a pattern that I see commonly in practice.

What about when people are taking foods out because they're not coping with them and working on healing the gut with something like GAPS and then bringing foods back in?

Yeah, sorry.

No, that's okay. I was just gonna say because that was, that was very successful for us. And my son had his gut bacteria tested after two years on gaps and with Dr. Igor, Igor, sorry, Trevisian. And he was saying that he was, he said this is a GAP success story because he really had a healthy gut afterwards. But I think we did do. What you're saying is make sure there was a really wide variety of vegetables. Would that be something that really helped?

I think that the continued fiber ingestion is a core aspect of that. I mean, there's a few things that twist in there. One is the stool test that they did at the end of the two, assess what the ecosystem look like. If we're using old technology like culturing, we're pretty limited on what we can see. So we're looking at 12 different species that we've known about for 150 years that actually play pretty small roles. We don't see the changes, and this is one of my concerns is if we're still using that old technology, you don't see the increase in Proteobacteria, you don't see the increase in hydrogen sulfide producers, and you don't see the decrease in butyrate producers or Akkermansia because the test can't see them.

So what kind of tests do you usually do?

You need to do molecular assessment of the microbiota. And this is why the microbiome is what it is. It's because we changed technology to use in DNA to see what's there. And research has shown since the early 2000s that for some people, 90% of their gut bacteria, we can't grow in petri dishes and see that they even exist using the Old approaches. So you really can't see very much of what's going on.

He did have the DNA test as well.

Okay, cool. Because my concern is I see people who do a traditional stool kit thing that looks at four species of bacteria to 12 and go, hey, look, it's all good. And like. Well, I can see those changes and some of them you can artificially raise. Like if you're, if you're low in bifidobacteria or lactobacilli, then you give them heaps of friendly foods and the probiotic supplement pool. Yeah, they're going to go up while you're taking the supplements. It's just whether you've actually healed your indigenous or nurtured your indigenous populations up to the point where they're promoting your health is another question. Yeah, and that's something I suppose I've seen a few. And again, I see mostly people that are unwell. But I also run workshops for the general public where we look at the cognitive microbiome sessions. So I do have a number of healthy people who go in there. And there has been a pattern that I've seen in gaps and you know, granted it's not a full on research study, so it's just a pattern that I've observed as a clinician teacher which has been interesting because their diversity score has actually been very good. Yeah. And that's one factor that's probably associated with good health is diversity score. But what has showed up was high proteobacteria, which are a class of bacteria that essentially contain endotoxin just as part of their structure. It's like they're releasing toxins. It's just part of who they are. They just contain endotoxin. And that endotoxin is really pro inflammatory from Proteobacter. Really pro inflammatory causes gut damage and causes issues with blood sugar regulation over time, even damage the blood brain barrier and even research showing it's a trigger for depression, anxiety as well. There's a whole bunch of research studies showing up looking at, well, this is the interesting thing because some of them actually eat bile that we produce when we have more fat. So they actually often thrive on a high fat, low fiber sort of diet and high fat, high protein diet because some of them eat amino acids and protein, but they don't eat fibers. So there's this thing of. And this thing you wouldn't notice. If you're only looking at that old culturing approach of assessing the ecosystem, you'd have no idea that your dietary approach is actually Feeding those species, we don't see that they're there. And you also wouldn't see that the beetroot producing microbe population decreases because you're not feeding them either. If you're eating just mostly, this is extreme example, but mostly fat and mostly meat, you're not going to feed those beetrate.

What is. If you can explain and tell us why it's beneficial.

Okay, yeah. So the microbiome I talked about some of its health benefits, a lot of its health benefits come from sort of metabolites that it produces. And I'll talk a little bit about B vitamins and vitamin K, but one of the main things they produce are things called short chain fatty acids. And there's three main ones that are produced. There's acetate or we know as vinegar, you know, they produce. And that's pretty similar to what's happening in traditional ferments as well. We get that vinegar being produced, but they also produce propionate and butyrate. And most microbes in your gut produce acetate. So that's not so hard to come by. Although we obviously produce more of it when we, when we're eating more, more sort of dietary fibers, because that's the main driver in terms of fibers and resistant starches and oligosaccharides and polyphenols are the main drivers of short chain fatty acid production in the gut. But what's somewhat unique is that only a handful or a couple handfuls of species in your gut can produce butyrate. And they only produce that butyrate is when you feed them. You don't feed them, you don't get the butyrate. Butyrate has a number of important roles. Perhaps the most well known is the fact that it's the main food source for your colon cells. So I think up to 70% of your colon cells energy needs are met through butyrate production in the colon. So we evolved in this relationship where our cells are actually totally dependent on this bacterial byproduct to grow and thrive and function properly. And if we deprive them of that, then there are negative consequences. And when we have more butyrate, we make sure the colon cells are functioning properly and heal properly. But it also has a healing effect on the small intestine as well. And there's good research on this. But importantly, when we reproduce more butyrate than what our colon cells can use and eat as a food source, it reaches our circulation. And this is where it gets really funky because this is where we start Getting the body wide benefits of butyrate. And butyrate is now being touted as something to help heal the blood brain barrier because even getting decreased inflation in the brain and having a role with Alzheimer's, anxiety and depression, for example, improves insulin sensitivity, helps your insulin actually work, work better and decreases inflammation in your fat cells and muscle cells and in your liver as well. So it has a whole body wide anti inflammatory effect to just name a few benefits of butyrate. But there are and even it's one of the main tools for improving mitochondrial function as well and for helping regulate appetite. There's whole conferences that can be beautiful. You can spend days learning about the wonders of Bajray. It's a pretty amazing substance. And essentially we've evolved with these little butyrate producing factories in our gut. And I am cautious about dietary approaches that do not feed those Bajray producing bacteria because we've got research showing that there are negative consequences gut wise from such approaches in terms of the increased risk of ulcerative colitis and Crohn's disease for example. But it's more of the systemic things that we're starting to see now of Alzheimer's disease and depression, anxiety, those things that we're linking in with with the lack of certain bacterial products in the gut like butyrate, as well as an overabundance of some endotoxin.

So butyrate comes from the fermentation of fibers by the bacteria. Is there any other source? I remember reading that it is actually contained in dairy products like butter or something like that.

Yeah, there is a trace. There is some in butter. Like I think you'd have to eat probably like a giant block of it to produce this. Get what you would gut. So I'm always hesitant to have people go hey, you can get two butter. Well yeah, but there's two problems with that. One is the quantity you have to consume to equal what your colon bacteria produce. But two is the fact that if you, you orally ingest it then you're, you absorb the butyrate and you get some of the body wide benefits. Sure. But you don't get the colon sort of benefits in that case. So.

So again it's up the fibers, more veggies, more variety.

And it's certain types of fibers that feed the beef ray producing microbes. And this is the thing, it's resistant starches are very important and, and oligosaccharides also play roles. Oligosaccharides we find in grain late legumes often contain oligosaccharides. Some grains do as well. And then some vegetables like Jerusalem artichoke and asparagus and burdock root and dandelion root and Chicago, some roots that, that traditionally were always part of our diet but are seldom consumed now. And even drew some artichok we seldom consume because they're very often, they make us fart. And that in our current society is like, whoa, I don't want to eat that. But traditionally we wouldn't have really cared.

Much about farting to start digging up the dandelions.

Yeah, yeah. Because they've always been a part of our diet and they're pretty.

You know, my mum always ate them when we were. Before we were born. Cheers to that. Was their greens.

Yeah, yeah.

And there's even some of those same oligosaccharide compounds in the greens of dandelions.

Yeah.

And it's also in onions and garlic as well. So essentially you probably see a pattern if you're familiar with the low fodmap diet. That dietary approach is designed to cut out category of foods. And as a consequence we see decreases in microbes that eat those compounds, like faecalobacterium, which is for most of us. Our main butyrate producing microbe in our gut goes down. On a low fodmap diet, we also lower our bifidobacteria counts. And another species called Akkermansia, that is one of the key players for metabolic health and integrity of your gut cells too.

Where's problem? If people are so sick and reacting to these foods, what do you do? Because you've got to take them out for a while.

Yeah. And I work with people with IBS for a long, long time. And with SIBO would probably make up the bulk of my practice these days. So I certainly have lots of people that I do use a low fodmap diet with initially whilst I heal the underlying issue. And that's. I think the key thing is that a low fodmap diet for three months is not a concern.

Yeah, exactly.

Two, three, four years. Yeah, it's a concern. And also on top of that, I'll supplement with prebiotic fibers that actually feed those same bugs that are being starved off in that diet to make sure that they're still being fed and nourished. And that often works very well. And sometimes you might have to tweak to get the right fiber at the right dose, depending on the person. But I think it's important that we maintain those healthful bug populations on different sort of dietary. Dietary approaches because I think it's often a neglected. It's often neglected currently by practitioners and people who are self imposing certain dietary patterns and not knowing that there's an impact on their gut. And if they follow dietary patterns for long enough, there seems to be, I'd actually argue extinction events that occur. You starve something up for long enough, it will die out as well.

I want to remove the confusion for our listeners because a lot of them are on the GAPS diet and just want to get some really good clear thinking for them here so that they don't go here feeling super confused because they're on the side that they're trying to heal their gut. And the idea, as you know with GAPS is initially to reduce the fibrous foods because if the gut is so far gone that it can't really handle the fibers initially. So what we try to do with GAPS to up the nourishment and make the digestion as easy as possible.

Yeah, my always concern is just the role because again this from evolutionary perspective we've evolved with gut bacteria playing specific roles that are important for gut integrity. You know, and that would be things like the butyrate producers and Bifidobacteria akkermansia that do we know from research play key roles in keeping our or healing our gut when it's damaged and promoting good gut integrity. And if we're starving off those species, and I'd say that there's, I'm sure there's ways of doing such a diet so it doesn't do that. But always my concern is if we're neglecting to feed those up, then it actually makes healing the up more challenging because you're sort of trying to do with one hand tied behind your back rather than there's other ways of doing it that actually speed up the process so we can actually nourish the species that we do want there. And I think sometimes the challenge can be, is teasing out something that's causing gut damage versus something that causes gut symptoms. And I think this can be very challenging for the general public because your gut is inflamed. You eat a bowl of legumes, I can tell you now that you're going to get not only just farting, you'll get distension and possibly pain and bloating with that. And it's not because the legumes are harming your gut or causing damage, it's because the oligosaccharide legumes, which is not digested by anybody is feeding microbes that are increasing gas. And when your gut is inflamed, you do not tolerate that amount of gas being produced. Whereas if you decrease the gut inflammation, then you will be able to tolerate that amount of gas with just farting more and not getting bloating, pain or distension. So I think there's that aspect. So sometimes we cut out things thinking that they're causing harm or they're causing symptoms, which is a completely different thing. Unlike gluten, for example, where gluten for someone who's celiac or arguably in people with gluten sensitivity not only causes symptoms but causes physical harm and damage. While you might get similar symptoms from eating a bowl of lentils as you do some bread, you're actually going backwards when you eat that bread. Whereas legumes will cause symptoms but not actually damage your gut or inflame your gut in any significant way.

GAPS does contain fiber foods, but sort of later on in the, you know, the more advanced stages. And the idea is to progress towards those stages and, you know, get the fiber back into your body. And in the same way, like we look at, as you mentioned, just the low fodmap diet.

Yeah, that's what I was thinking.

You know, a three month intervention with low fodmap and then maybe supporting the microbiome with fiber that the gut can tolerate and feeds the bacteria as a good approach. Would that sound like a reasonable approach for you?

Yeah, because it might be just some tweaks like as I said for my patients that I'm working with that do have inflamed guts and don't tolerate gas forming things very well. For the most part, that you can use a fiber like partially hydrolyzed guar gum, which is essentially broken down in a certain way and only feeds certain bacteria in the gut and for most people actually decreases gas production and is well tolerated. But it feeds us B trait producing microbes and feeds bifidobacteria. So you've got a supplemental dietary source that tends to that also will promote healing and speed up the healing process that's well tolerated and will feed those microbes that could otherwise be starved out.

And it's selective as well at the bacteria.

Exactly. Yeah, because that's the thing for me, it's about we can choose tools that are selectively fermented in the gut. And that's what we term prebiotics. And I think the term prebiotic is overused and misused in the blogosphere and by many clinicians.

Same thing.

Well, it's something that feeds back bacteria and it's like, no, that's not what a prebiotic is. A prebiotic is a selectively fermented substrate that by its, by its fermentation promotes your health. That, that's how it's defined and it's a. Selectivity is the key aspect there. So with something like partially hydrolyzed guar gum, what we feed is butyrate producing microbes and bifidobacteria. Boom. That's it. That's all it eats.

So that would be the supplement form, is that what you're saying?

Yeah, that's right. Because it's different from normal guar gum. That's what I wonder, as binders to stick it in. That's right. Because that actually feeds different bacteria. The partially hydrolyzed bits broken up. Hydrolysis means chopped up. It's chopped up into small bits and it works selectively and it's well tolerated and it doesn't sticky and bind stuff up. You can mix it with the water beautifully and swish it down. Whereas you couldn't do that with normal guar gum, right?

Yes.

So it's quite different. It's actually a supplemental dietary fiber, not something you would typically add to your diet.

This is not something you would sort of recommend anyone adds to their diet, would you? Because I know a lot of people might be just going now online looking for it.

Listen, I think partially hydrolyzed guar gum is a great, generally extremely well tolerated supplement. You know, we've got very good research on it for irritable bowel syndrome and for constipated type patients. But importantly, it also works for people who've got the diarrhea, functional diarrhea or diarrhea type IBS side of things. And part of how it's working is by changing that ecosystem in a beneficial way.

How much would you take for generally.

It'D be 5 grams a day is the therapeutic day dose. Occasionally more than that, but that would be a standard therapeutic dose. And for some people, and again, I'm working with a pretty sensitive dynamic or group of people that I might start off with half a teaspoon and slowly work up to 5 grams, which is essentially 1 metric tablespoon. But it has to be the partially hydrolyzed. The normal guar gum ferments very differently and reacts differently in your gut and will often not be tolerated. Whereas partially hydrolyzed feeds different bacteria. And 9 out of 10 people doesn't increase gas but actually decrease intestine gas.

So you're working with people who really, if you're working with people with ibs, I guess at first they can't handle much in the way of fiber.

Some people, yes. And for me, I'm working mostly ibs, SIBO patients and people with ulcera colitis and Crohn's would make up bulk and some Helicobacter pylori tossed in for good measure, but those ones would make up the bulk of it. So I'm working with people with pretty inflamed guts on every sort of day basis.

So what's the first steps for these people that are so far are having so much trouble with their bowel?

Yeah. The trickiest ones are the ones that have already gone through two years of very restricted diets and herbal antimicrobials and antibiotics. Treat their condition because their ecosystem, their gut, is extremely inflamed and sensitive. So much so that I've got some patients that can feel every single gas bubble that floats through their colon. Others that have to have a nightly enema to eliminate the feces from the their rectum because I can't sleep because of the pain associated with having poo in their gut overnight. So the extreme end of things. And those people are the harder ones to treat because to heal that gut, you need to nurture those bacterial species that are there. I look at their ecosystems and it's like, oh gosh, that approach you've been taking has certainly fed up your proteobacteria and your hydrogen sulfide gas producers, which explains your extreme gut inflammation sensitivity. To fix that, we need to have more polyphenols and more fiber. And it's really for very sensitive people. It's a painstaking, slow process of doing one thing at a time and slowly increasing dosages. We might start with something like partially hydrolyzed guar gum and start with polyphenol rich foods and then slowly expand from there as well as doing other things to really focus on healing up that gut damage. But the challenge is until you change that ecosystem, you've got contributors to that gut damage right there. It's not the food that's causing, not directly the food causing damage. It's the microbes that are present, the probiobacteria and the hydrogen sulfide gas producers that are causing the problem. And they're being fed by their current diet. So it's this catch 22 that if we change the diet a lot, we would, those populations would decrease dramatically, but they're so inflamed they can't handle much in the way of gas. So it's, it can be a slow process in those people and we try to work on decreasing that inflammation at the same time decreasing those bacterial populations and encouraging the ones we do want that promote gut healing and tolerance to foods.

In terms of the ratio between say leafy green, non starchy vegetables and legumes, what does that look like for normal person on their plate?

It's a good question. And for me, I still eat grains and I eat gluten containing grains, but I still think rices and black rice and red rice and colored quinoa can play a, and buckwheat can play, and millet can play a role and then people's health as well as legumes. And for me it's trying to have a mixture of all those different things. And the cool thing is you can actually do stool analyses and it's becoming cheaper and more readily available. To see how your current dietary approach is impacting your gut microbiome. I think that's the cool thing too. So we don't have to rely on because everyone is unique. We know that everyone's gut bacteria ecosystem is unique. You're more similar to your siblings and your mom, but otherwise it can be very different from anyone else in the entire world. So how it reacts to food will be a little bit different than anybody else's as well. So this would be the cool thing is you can actually do the testing and see how your current dietary approach is impacting your ecosystem and from there make changes. And this is what I'm often doing with patients is we do that the test and go, okay, don't change your diet to the test results in. And then we go, ah, okay. And I can now see that here current approaches negatively impacting you because you're feeding these species and you're not feeding enough these species. So we get an idea of how we can actually change things. And then most people respond in a pretty typical way to those sort of changes. You do get the odd outlier who you know, as we all know, reacts idiosyncratically to different substances. But most people fit the pattern of increasing fiber, increasing polyphenols, increasing prebiotics, with certain bacteria populations increasing and certain populations going down.

I was asking the previous question sort of from a selfish basis because I was 128 kilos at my heaviest and I've lost 30 kilos since 2011. And that was, I had to go on like a low carb paleo style diet early on. But then I opened it up more, you Know, eating soaked grains and white rice and things like that and I tolerate them fine. But I find that I'm really healthy as well. When I am just eating lots of non starchy vegetables with plenty of fat like olive oil or tahini and meat and eggs. And at the same time I kind of have this concern that hey, am I, should I be worrying about eating the legumes? But when I do eat the legumes I kind of do feel less sharp in my head, less clarity, less ability to articulate myself. I feel more bloated and I have more water retention in my body and maybe that's from the, you know, remnants of insulin resistance that I had. I was pre diabetic as well at that weight, you know, back in 2011 and maybe my carbohydrate tolerance isn't as high. I'm just wondering, for people like me, which there's plenty of, what kind of approach would you take?

Yeah, interesting. I just couldn't help but think of some research that was, that was done on legumes and blood sugar regulation. And, and they essentially compared two breakfasts, one was a bowl of lentils, one was a big beef steak. And I said, okay, let's look at your blood sugar levels the next 24 hours. Do you know which one had the best impact on blood sugar regulation over.

The 24 hour period?

Yeah, and I think almost all time points was actually the, I'd have to double check that. It's been a couple of years since I read the study, but the legumes did and essentially it's because they feed the beetray producing microbes and beetrate actually.

Improves whether the person was fat adapted or not. So if they've been eating, that's a.

Very good question and that's something that would have to be teased out and whether if you kept eating legumes consistently rather than maybe once on a blue moon, that your system would actually adapt quite differently, your gut bacteria would adapt as well. So there's a few things that weren't teased out in that research. There's been a few research studies comparing legumes to just meat meal showing improved blood sugar regulation, but that's obviously for a certain population which may not fit that population. Yeah. So I mean I would think that if you were potentially worried, you could look at your microbiota picture and go, okay, how does it actually fit? And yes, there are some questions about what an ideal ecosystem looks like, but there are some traits that we see as important like diversity, scoring and levels of certain microbes that I said can cause harm in larger amounts and certain species that we know are playing important, key, pivotal roles in promoting health and can only do so when they're there at a certain amount. So we look at that and see, okay, where does he occur and dietary approach fit in that category. Because sometimes he would worry about the longer term consequences, not the short term consequence. You might feel great now, and I'm not saying you as in you probably more broadly is sometimes we can choose a dietary approach that works really well for us right now, but if we continue with that approach long term, that's when the consequences occur. And particularly because we're looking at, talking to me, we're looking at microbiota changes that can occur with certain dietary approaches. So that's the thing that I'm curious about and would like to look more into and that would allow you to make some tweaks to that potentially that dietary approach. And you might start off with smaller amounts of legumes. And we're introducing legumes back in the diet and of a tablespoon five days a week or something like that, rather than one bowl once a week. And then you slowly increase the actual dose and that helps one decrease the bloating, distension and even gas type issue. Because for most people, if you consistently do it, it's a short lasting impact because the ecosystem adapts to the new food source. And the microbes that eat gas, adap, there's a whole bunch of microbes that need hydrogen gas. So you eat more legumes, once in a blue moon, you produce a lot more hydrogen gas. And that can result in some of us just more farting. But other people will get bloating, distension and discomfort, not feel all that great because of that. But if they did that consistently for a week to 10 days, the microbes eat the gas, their population goes up and then the gas actually goes down to almost what it was at baseline, which is, which is interesting. And this is what happens for most people now. There are people who don't fit the typical pattern, but thankfully most do. And this is where I think the people that have cause the most damage to their ecosystem are the ones that are least likely to fit the typical pattern.

Yeah, I've had a history of antibiotics for, I don't know, more than 20 years of my life. And so I don't think I fit any.

He's unique.

Yeah.

Dan, who's a naturopath, who has actually studied with you, done some courses with you, he got me to do the eubiome testing, which I'm waiting on the results. So we'll try to get into it and understand. Understand where I am and what's best to do.

Yeah, It's a great test because it's extremely affordable. The only downside is the time frame. It takes longer than you'd wish to get the results, but it means that you can see where it's at and you can also make changes and do follow up testing. So I like the fact that it's such a relatively inexpensive test, whereas you're paying 4, 5, $600 for a test. Follow up testing to see, for your curiosity's sake, to see what's changed with your diet becomes more problematic by looking at.

Can you tell us more about. Yeah, like this new method of testing. You kind of mentioned it really briefly, but you said now they're doing different types of testing. Can you just give us an idea of what the new kind of testing looks like and what kind of improved accuracy it has and people do it.

Yeah, I can certainly do that. So the old style we called culturing, which essentially they'd get some fecal specimen and then they would take a little scoop and they'd put it out in different sort of petri dishes with different sort of growth media or food for different bacteria, and they'd sort of grow it and see what would grow. That's technology we've been using since the late 1800s when we first isolate bacteria from poo. And there was a bit of a shift in the late 1960s that they worked out they could grow some microbes without oxygen because most of the bacteria in our gut die very quickly when exposed to oxygen. So we didn't know they existed then from 1970 onwards we realized there's a whole bunch of new species in there that we didn't know existed. But there's a huge leap in in the 2000s because essentially we changed the DNA. So now they're looking for a specific component called 16S RRNA that all bacteria have and it's different in all different bacteria. So essentially you can take a fecal specimen and what they do now is you put into a tube that kills everything right away. Yes. That way it can sit at your shelf for two weeks or three weeks or not and then you send it away to the lab. That's fine. Whereas the old technology you had to hope and pray that your populations didn't change from when you avoided the stool and when it reached the lab. And this is one of the major problems with the Old technology as well. Not only can you not see most of what's there, but there were often changes, particularly if you lived in Darwin or far north Queensland. You send your lab down to Melbourne, it's going to have a lot of temperature variation. And that meant the population shifted or died in transport. And I certainly saw that a lot in practice in the old days when we had to rely on these old techniques. Now, as I said, because they're using bits of DNA is essentially they can look to find that DNA and, and then they match it to the library and go, okay, this belongs to some Lactobacillus species. Boom. And they can match it to that library. They work out how much is there and they can actually tell you, okay, well, 50% of your ecosystem is composed of this species or this genus, and 40% this one, 30% this. And we get this very lovely picture of the ecosystem with much, much greater accuracy. And we can see a whole bunch of species, as I said, that we didn't even know exist, existed 20 years ago because of that. And that's really thrown everything on its head. And we can also see with greater sensitivity changes that occur. I wrote a review article looking at the impact of diet and the gut bacteria back in the early 2000s, essentially reviewing the data that was done in the 60s, 70s, 80s and 90s using old technology. We could almost not see any change in gut bacterial populations, even with big changes in diet. And it was confusing because we know that there should be a change. Our technology just couldn't see it. I'm like, what the hell is going on? And there were researchers at the time that said, I think we're just using insensitive tools. And I think in the future we're going to start seeing these shifts. And for me, I was just lovely to be around in that time to see that shift going. We used to think that antibiotics impacted your ecosystem for two weeks or four weeks. That was. Now we're using DNA. It's like actually two years afterwards, your ecosystem doesn't look the same, or you're doing antibiotic cocktails. Four years afterwards, the ecosystem does not look the same. And you could actually argue that every single course you take has some impact on that ecosystem. And similar. We can see big impacts from diet even. There was one study where they put people on a, what they called an all animal diet, which is just dairy and meat for a week, and they could see giant changes in that ecosystem within just two days in terms of populations of some bacteria going up, the ones that eat bile and protein, not surprisingly, went up and the ones that eat resistant starches and fibers went down. We now know with the right tools there are changes that we induce with our diet. Just with the old tools. We couldn't see them. This is why I've got major issues with relying on the old tech to see what's going on with the gut, because it's not what's done in research world anymore. And there's even microbiology journals that refuse to publish research that's based on the old.

Fair enough.

It's 21st century. Let's move on using the tools that actually show us what's there and what impact our lifestyle and diet has on those microbes.

You talked so much about feeding the bacteria with fiber, which is really kind of makes sense because you kind of try to look after what you've already got and feed them. And you know, if I've got kids and they're sick, I'm not going to go get new kids and look after them. I'm gonna try to feed those ones I've got. But probiotics is a big, big business now. I see a lot of money being asked for these little pills and I'm not sure whether they are beneficial or not. Would they be beneficial for me, but not someone else or the other way around? And it's just so confusing. What are your views on probiotics? Is there really solid science now where you can just go into the chemist and grab that bottle of whatever it is that they have in that fridge, or sometimes it's shelf stable and then take it home and expect some benefit from it, or is it more nuanced than that?

It is more nuanced, but at the same time, there is great evidence for certain probiotics, for certain disease conditions, tremendous amounts of evidence. And again, for me, it's been fantastic seeing that grow in the 18 years, years I've been in this field, because I've always produced resources for, because I've always taught clinicians and student clinicians how to use probiotics for over that whole time period. And so it's been interesting for me seeing that I used to have two pages of a Word document talking about which probiotics had good research on them at this time point. And that's grown out now. I've got a searchable database that's got all the evidence on different probiotic strains and some specific probiotic strains, have got dozens of systematic reviews and meta analyses which are like the highest level medical evidence you can actually have on a therapeutic substance showing that they work. I think the issue is around nuanced use. It's not just a matter of one probiotic fits all. It's like. And the other aspect is the strange specificity. And this is something I've been teaching people about for really 18 years, since I first found about it in the probiotic literature. But I think the best analogy here is looking at breeds of dog. All dogs are the same species, Canis spinoliarus, but you've got Great Danes, then you've got Chihuahua. They're dogs, they can in theory mate. We may not want to watch it occur, but it can in theory occur. And they're within the same species. And within Lactopilis acidophilus or Lactopilis plantarum, you get a huge variety of what we call strains which are just different, with a few genes turned off or on, or sometimes a lot of genes that differ between strains within that same species. But that totally dictates whether they're therapeutic or not. And this is, I think, the key thing to one of the key messages of I love to get across today, but more broadly, the last 18 years I've been trying to teach this message because it's not a matter of going, okay, take some Lactopus plantarum. It's like, okay, the research used one specific genetically unique strain called the 299B strain, which reacts differently. In fact, I can think of one clear example where the 299V strain of Laskers plantarum. A number of clinical trials showing it helps people with irritable bowel syndrome, decreases bloating scores, distension and helps normalize their bowel pattern, improves their quality, quality of life. That's pretty clear. But there's another strain of Latipher's plantarum called the MF1928 from memory that when given people with IBS, worsened bloating, distension and people preferred being on the placebo than over on taking that particular probiotic strain. So you can get huge differences in terms of therapeutic effectiveness within species based on the differences in strains and what genes are turned off or on. And that's the nuance about using probiotics, that using the right probiotic for at the right time and can condition you can have. They're wonderful therapeutic agents. And I think we have to shift how we consider probiotics similar to how we use herbal medicine or we'd use pharmaceuticals that you've got a disease state or condition you want to treat, you match that to the agent that's going to fix that condition, if you know what I mean. So it's the idea that you can recolonize or reseed with probiotics has really been tossed out over the last 20 or 30 years. Based on the research that we've got on current generation probiotics, that will change in five or ten years, I'm sure. But at the moment, the data we have shows that Bifidobacteria lactobacilli as probiotic supplements, don't permanently stick in your gut after ingestion. If you're lucky, they'll stay there for a week or two if you've got a good strain. Otherwise they'll pass straight through. But what they will have potentially is a therapeutic action to match what you're wanting. Yeah. So there are strains that decrease blood pressure. This is a clear example. So you take that probiotic strain, it'll decrease your blood pressure. It means you don't need to take medications. It means that you couldn't in general not change your life, your diet and just take that probiotic daily as your medication for your blood pressure. But when you stop about a week later, your blood pressure is going to go back up. And that's one of the clearest examples I can give. Whereas what we should be doing is changing their lifestyle and their diet so they don't have high blood pressure and using the probiotic as a tool in the short term term because it's much safer and better profile than the medication until they can change their diet and lifestyle. But I think it's the key thing is the right probiotic has got the right action to treat the condition at hand. I think I've got more issue with just using them. If someone who's generally really healthy, I don't think you need a probiotic supplement. I think you're better off having fermented foods or something rather than going up a multi strain, multi CFE probiotic supplements.

Multivitamin.

Yeah. Yeah. I don't think the data shows that that's particularly helpful approach where using it the right time, right place, fantastic therapeutic agent. But if you're just after interaction with bacteria, for your gut cells or for your own gut bacteria, you're better off having fermented foods. That way you're getting the nourishment that comes with the food and the taste and the loveliness of it as well as that bacterial interaction. So I think it's a much better approach if that's all you're after with.

The specific action bacteria we Have a lot of our listeners who have children who begin their symptoms with things like asthma and eczema. Are there any good probiotics that are on the market that sort of are very well, very much proven to act on that and to help?

Yeah, there are certainly some and I think that list is expanding not so much with asthma yet, but there are some strains that help with hay fever, for example, and there are some strains of bacteria that have been shown to prevent eczema very well. So if the mum takes them during. So if a mom has a high risk of having because she's got asthma or hay fever or eczema or has other children that does if she takes the right probiotic. In this case, you could use something like Lacticlus rhamnosus gg, the GG strain of rhamnosis during the last trimester and over the first six months of breastfeeding that the risk of eczema is reduced by 50, which is a pretty marked. And that persists long term.

So that's a very child that already has eczema.

Yeah, there are some strains, but there's less. There's the lactose fermentum. Vrio 3 has got some good research for the treatment of atopic eczema and our noses GG has got some. I found it clinically a bit more hit and miss. It works in some kids, not others for eczema. And there's also another one that's available in Europe, but not here, called Latval Salivarius LSO1 from memory with really good research in eczema. It's just not, sadly not available to your Australian listeners. If you have any listeners in Italy, it's easy to get there in other parts of Europe, but not here at this time point. Although you could buy it online for your child if so desired. But there's good research on those ones for the treatment of eczema. Personally, I found that prebiotics play a pretty pivotal role there too. So feeding up, nurturing your bifidobacteria and at the same time decreasing microbes that in studies to date seem to be problematic in the gut with kids who end up developing hexane.

Is that with the guar gum, like that kind of thing.

I would actually be using fructooligosaccharides in that instance because there's research essentially adding fructooligosaccharides to formula, decreasing the risk of eczema developed in the offspring or the child. Sorry. And also clinically, I found it to be helpful and it's shifting that balance in the gut of increasing microbes like bifidobacteria bacteria and faecala bacteria that have sort of healing gut anti inflammatory effects. At the same time decreasing levels of Bacteroides and E. Coli which have been linked with increased risk of developing.

I feel like I'm talking to like an encyclopedia at the moment. Jason, how are you doing for your time? Do we have time for just a few more questions?

Yeah, that's fine.

All right. You mentioned the fermented foods. These of course like sauerkraut now is a huge, huge thing. Everyone's eating sauerkraut breakfast to dinner. They have a sauerkraut dip next to them in bed or something. It's that big a deal. I'd love to hear about your thoughts on the fermented foods and also the histamine containing ones. And how does someone with poor health introduce these ferments and are there any dangers in doing so?

I mean I think the instance of people with, with I think food histamine issues I've seen as a condition skyrocket in the last 10 years of my practice life. And I do really think it's got to do with really dysfunctional gut and gut ecosystem because I usually see it as a consequence of lots of antibiotics, lots of herbal antimicrobials and restricted diets over time that's actually made them sensitive where they used to tolerate those things fine. So in which case you wouldn't necessarily include sauerkraut or kimchi or something as part of their. Until you get their gut healed up and then they will tend to tolerate those things again. But that's often a slow process and there's people at the far end of the extreme scenario. But I think for most people that there's really little risk of harm associated with things and general benefit from doing so. Not only just from a taste and nutritional perspective, but I think that sort of daily interaction with microbes is probably something that's always been part of humankind's exposure to the world world that, that we're sadly missing in modern days. So I do think that having that, that contact is going to be helpful even if it's not working in the way that people often say. It's not like you're reseeding your gut bacteria with when you drink kefir or you're drinking, you're eating your sauerkraut. It's not like the plantarum that's in there stays in your gut for years afterwards. It doesn't it's going to go within a week or two of ceasing ingestion in the vast majority of people. But you are getting that interaction at the time. And I think for some people the ecosystems are very disrupted. Having, having those bacteria who come through just doing what they do, which could be just secreting some acids, some short chain fatty acids and lactic acid can be enough to start promoting changes and shifts to that ecosystem for the better.

Do you have any more specific questions or should we finish up like a big picture question? Where are you at?

Hello, I am here.

Jo's gone on mute. She's back. All right, yeah. Joanne, any more questions?

Oh, so many. I probably, I always want to bring it back to the practical, everyday stuff for people like me who just want to know, okay, but what do I do? So can you just maybe give us an idea of like Fouad did touch on it earlier before. I know it's different for everyone, but how much vegetable should we be eating a day? I've heard five servings a day and just getting the variety in there as much as possible. Maybe a little bit of legumes if you can cope with it, and a little bit of meat and animal products. Is that what you would suggest to your patients?

Yeah, I mean, I generally see suggest and I mean, I'm probably less specific when I think about it. When you ask me those questions, I'm like, oh, maybe I should just give an idea of what a dinner plate looks like.

Yes, that would be great.

You know, have, have the, the meat as the small little section there and the rest be plant food. And for me that can be whole grains and that can be legumes and leafy greens, but also some root vegetables too, because I do think that root vegetables are something that the humans are, have always generally consumed and we're getting things like resistant starches out of them. That, that can be hard. Hard you don't get from leafy greens. You get other sort of fibers and lots of amazing compounds, but not resistant starches and not so much the oligosaccharides. So I think that's what can be lacking if we depend solely upon leafy greens and issue consuming legumes or grains or root vegetables. I think that's where there's more, more problems with dietary approaches. Whereas if you're including those ones and I think and a wide variety and on a daily basis and over a week. And I suppose one of the things I do tell my patients is to do what my colleagues now said, the 40 food challenge of having 40 plus different plant foods in a given week. Whole plant foods.

40 types.

Sorry, I missed that.

Was it 40 different types or 40 servings?

40 different types.

Right. Okay. So that includes things like herbal teas and that kind of stuff as well.

I generally suggest don't count those, but by all means have them, because we're looking. And then don't count like, you know, a pinch of cumin or a pinch of coriander. But if you had a tablespoon of cumin, sure, you can count the tablespoon of cumin. That's enough to have fiber and polyphenol content that's going to contribute to.

There's hardly 40 different types of vegetables in the supermarket, actually.

Yeah, well, this is. Yeah. So this is. My challenge is going. Okay. And it's how you count things, too. And I think this is. I always tell my patients, too, that if you're having a Red Delicious apple is different from a John Gold apple. They're two different foods. Red rice and black rice are two different foods. Red quinoa, black quinoa. Two different foods.

Yeah, yeah.

So you start breaking that up more. And even different types of potato you could count as different foods. Different types of lettuce. Arguably, you'd say it's different foods, too, because each of those different foods will have a slightly different ratio of different fibers and different polyphenols. So which means.

And then you've got your different fermented foods as well.

Yeah. You would include them, too, so. Yes. So if you're looking at that.

So it's not that hard, then.

No, if you're looking at over the week, not on a daily basis, but 40 plus over a week, I find most patients can get up.

That's a really good challenge for people to maybe stick a piece of paper on the fridge and see what they can figure out that they're having. Because I really noticed with my kids, when they're getting slack and they're, you know, they're busy with work and they're rushing home and they're tired and they're just sort of not eating the variety, I really noticed their immunity and their energy levels going down, I'm always saying you've got to eat more vegetables.

Yeah.

So that's a good thing.

Thank you.

I guess when you try that supermarket and you're buying apples instead of buying like 2 kilos of the same apples, just, you know.

Exactly. Yeah. And you're going different. Different colors. So there's many rainbow things, so purple carrots. Orange carrots, red carrots, purple potatoes, white potatoes. So you can just get that. That rainbow effect. And I think that's helpful for a number of reasons. One, because their antioxidant properties. But two, you know, things like polyphenols, like the. In blueberries and purple potatoes, they feed your gut bacteria, and that's the reason why we get their health benefit, is because they're feeding you your gut bacteria, and they change that polyphenol into one that you absorb, and that's where you get the benefit. Your physical human cells get the benefit because of that microbial conversion that's going on in the gut.

A big picture question. To finish the podcast, we can keep going for hours and probably have you back again to talk more and more in depth about these things, because it's been really fascinating so far. But one of the things that Joe and I do is we travel around the country and we teach people how to eat whole foods. Basically, it's a very simple message for us. And, you know, it's kind of Sad that in 2018 someone has to be doing that, but I'm glad you are.

We need more people teaching people to eat whole foods, unprocessed foods, once again.

And one of the things that worry us is that, you know, you were at the mind forum, the statistics that they quoted was one in four kids is going to be autistic by 2033. And we're feeling that the system is continually producing more and more sick people. And, you know, we're doing our best to help and to educate and to help heal people or help people heal themselves. How do you manage your emotional side of your work when you're dealing with individuals? But then you look at the larger system and you see that's producing sicker people at a higher rate that you can manage. And if you had a magic wand to sort of change one thing in our culture, what would it be?

Tough question.

It is.

Yeah, I think probably as my focus, I'd actually go with antibiotic overuse. I just see this every single day in practice of it being, yeah, they're great for saving lives and saving limbs, and we should save them for saving lives and saving limbs, in which case we'll have them for a long time to come. But their overuse and experimental use on a whole bunch of populations, including kids, that I see causing harm on a daily basis, I find very challenging. So that's something I wish I could change here and now. And because we're looking at. And I think part of the reason why that we're seeing this rise in certain conditions is really loss of ancestral microbiome I think is one way of looking at the missing microbes. Hypothesis is what Martin Blaser from New York Union States called it, is that our ancestors had a far more diverse ecosystem than us in every single one of our generations because of antibiotic usage and proton pump inhibitor use in non sterile anti inflation inflammatory use, let alone diet. Standard Australian diet is starving off species and every single generation gets born with less and less and less bacteria than the one before. And we're just, and this is where I think we're in our infancy teasing out what the consequences of this are of being born with lacking a number of species that were present in previous generations. And I think it's those things that I worry about and that I think are feeding into the sort of western disease epidemics that, that we're seeing. Do you have easily fixed for the.

Future as things are?

Sorry, I missed that question.

Do you have hope for the future as things are going?

I have hope that we're improving our tools and we're improving our ability to measure the gut ecosystem and we're improving our tools to fix it. So I think yes and I think we'll be doing things like fecal banking in the future where we, before we give our kids a dose of antibiotics, we'll be storing a bit of their poo and then we'll give them antibiotics, then they'll reintroduce those same microbes back in. So there'll be no loss of diversity from that, you know, so I think we'll be doing that and I think we'll have probiotics that, that contain 50 different strains from, that are gut inhabitants that we can use to sort of recolonize. So I think those things will improve and we may well even be sourcing some of those supplements from indigenous cultures that haven't had the crafts diets, horrible lifestyle and all the antibiotic and medication exposure that we have. So you can look at people from the Peruvian Amazon and I think some researchers did just that. They looked at their poo. Anyway, I always find it fascinating to think of that first contact was hey, nice to meet you, we want some of your poo. Showing us some food. No contact with westerners before. What are they thinking? You have really diverse, far more diverse ecosystems than us. And that's how we all would have had, you know, 100, 200 years ago. I mean even pre antibiotics we would have had a huge, hugely different ecosystem. What we've got now. So there may well be developing probiotic products or reinoculation products from people that have, you know, undamaged ecosystems. But wait, wait, see we start seeing.

People saying, ah, mine is from the African tribe. And that one second drives much better.

And I could imagine that happening.

Wow, Jason. Yeah, fecal transplants and all these kinds of things are, you know, a topic on their own. Maybe we'll have you come back and talk about these and get also a bit more in depth. This has been fascinating. Thank you so much. We've taken an hour and 20 minutes of your time, so better get you let you go back and help heal some people.

Thank you. It's always a pleasure to talk about all things God and it was very good. The topics we went on today were I loved.

Thank you. Thank you so much.

Thank you.

This has been a production of thewellnesscouch.com check us out on Facebook and join in the conversation on facebook.com thewellnesscouch subscribe to each show on itunes and check us out on Twitter the WellnessCouch Streaming wellness into youo Lives Whilst the Wellness Couch presenter endeavor to provide accurate and helpful information to their listeners, these podcasts cannot take into account individual circumstances and are not intended to be a substitute for health and medical advice from a qualified health professional. You should always seek the advice of a qualified health professional before acting on any of the information provided by any of the Wells Couch Podcast.