Microbiota and SIBO with Dr Jason Hawrelak | Ep 24

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 24 of the Healthy Gut Podcast and today I'm thrilled to be joined by Dr. Jason Horolak, who is a naturopath, a herbalist and a Nutritionist with over 16 years of clinical experience. He currently teaches the Evidence Based Complementary Medicine program in the School of Medicine at the University of Tasmania and is the Gastrointestinal Imbalances Lecturer in the Master of Science in Human Nutrition and Functional Medicine Program at the University of Western states in Portland, Oregon. Jason did his Honours First Class and PhD degree in the areas of gastrointestinal microbiota, irritable bowel syndrome and the clinical applications of and probiotics. He has written extensively in Australian and international textbooks and journals on these topics. And today we talk all about the gut microbiome and the microbiota, why it's so important for us to have diversity and health in our little bacteria that are living with inside of us. We also talk a lot about pre and probiotics because they're often a thing that many people want to know more about when it comes to understanding whether they're right for use in treatment for for their own sibo. So I hope you Enjoy today's episode 24 with Dr. Jason Horolek. Welcome to the show. Dr. Jason Horolek, it is absolutely wonderful to have you here today.

Ah, thanks Rebecca. It's a pleasure to be on. I'm looking forward to it actually. Yeah.

And my listeners are so excited to have you coming onto the Healthy Gut podcast today because we're going to be talking about everything to do with pre and probiotics and sibo and the microbiome. So it's particularly a topic of great interest for myself personally and it definitely is with my listeners as well. And what I'd love for us to start with is for you to tell a little bit about your story, how you came to be who you are today and have such an interest yourself in the microbiome of the gut and also pre and probiotics.

Well, I can start with where I'm at now. I've got a couple of different hats that I wear, I suppose I'm a practitioner so I'm a naturopath and nutritionist that's been in practice for 17 years and my other hat is as an academic. So I lecture at University of Tasmania and also at the University of Western states. And I try to each week will be a balance of different hats on different days. And I suppose my journey started when I was a naturopathic student and it was in the final year of my naturopathic training that there was a lecture by one of the staff members, Dr. Steven Myers, who introduced this idea of dysbiosis from a naturopath medicine perspective, the importance of the gut microbiota. This is back in 1999. It was very early days yet, but it was certainly looking at the ideas that naturopathic physicians had around the importance of the gut ecosystem and what we were doing to it inadvertently with dietary and pharmaceutical interventions, for example. His lecture got me amazingly inspired and excited. So I approached him immediately afterwards and said, hey, I'm about to finish. Can I do post grad studies in this area? And he said, yeah, sure, that sounds great. So then we moved on to my honours degree and then subsequently my PhD in the early 2000s. Some honors started in 2000, which was 17 years ago, which makes me feel a little bit old now. And it was essentially we were trying to find a condition that had dysbiosis as an associated or as a causative or where dysbiosis played a causative role. And irritable bowel syndrome sort of fit that bill. So we said, okay, well, let's see what we can do. Looking at the microbiota and although it was called the microflora back then, and irritable bowel syndrome, and looking at how imbalanced it was and then looking at tools that could readjust that balance. So we started investigating, or I started investigating probiotics and prebiotics, which are something that I was not really familiar with or only on a very surface level for my naturopathic training at that point in time, and also her medicine sec that we could use to alter that ecosystem in different ways to help it rebalance. That was the goal of our research, was seeing how we could use those tools and reviewing the research around all those tools and how they can modify the microbiota, specifically in gut conditions like ibs.

And I think the world is very grateful for the fact that you had such a great interest in it and the work that you do today. And what I think would be great for us to start, and literally starting at the start, is if you can give the listeners a bit of an overview of why we need to have this diversity of bacteria living in our digestive system, what it's there for and what dysbiosis actually is. I know When I first got diagnosed, diagnosed with sibo, I was hearing this term and I thought, I have no idea what that actually means. So if you can also explain what dysbiosis means in simple terms.

Yeah, dysbiosis, I think in simple terms would be just an imbalance of bacteria and primarily bacteria, but it could be other microorganisms within an ecosystem. So that could be the wrong ones growing at the wrong spot, or too many of particular species growing at the wrong spot, or an imbalance of. Of species. So you have too much of one and too few of the other would be probably very simple ways of describing that. And we're now tying dysbiosis in with a whole range of conditions that are well beyond what I originally envisioned. When I started this area back in 2000, we were looking at gut conditions almost exclusively. So inflammatory bowel disease, irritable bowel syndrome, with most of what the research was done on in terms of dysbiosis. Whereas now we're linking in with type 2 diabetes and metabolic syndrome and obesity, depression, anxiety, autism, as well as gut conditions, the ones that I mentioned before, but also diverticular disease and chemotherapy and radiotherapy induced diarrhea. There's a whole bunch of things now that are being tied in with dysbiosis. And I suppose in some respects the pattern of dysbiosis is different between those different disease states and perhaps on an individual level, within patients with those disease states, but you tend to see sort of patterns that occur within specific disease types.

And can the dysbiosis occur at any point in the GI tract, or is it just small intestinal, just large intestine? Where does it occur?

Well, I mean, arguably you could say that anywhere from mouth to anus there could be dysbiosis. And we tend to consider the oral microbiome as being a bit different than gut. And mostly, I suppose, because dentists tend to deal with mouth and teeth stuff and other sort of dental health professionals. So we haven't looked at that so much in the context of gut dysbiosis. But there would be dysbiosis in the oral microbiome, too, that precludes to gum disease and dental caries, for example. And dysbiosis in the stomach really essentially is a bug like Helicobacter pylori, which one could argue is the only indigenous microbe that can happily withstand living in our stomach. It's really when we get to the small bowel and large bowel that you start having a lot of more microbes that are naturally There, but then there's still that spectrum between the beginning bit of the small bowel where you have, you know, 10 to the 3, 10 to the 4 bugs per mil of contents, versus the beginning of the colon, where it's 10 to the 11. So it's far, far more densely packed with microbes when you get to the colon. Whereas the first bit of the small bowel is. There's supposed to be very little bacterial activity in that section. Not none, but. But a lot less than anywhere else along the small bowel.

And given that so many of my listeners have had sibo or are currently dealing with sibo, they're very well versed in what SIBO is and what it does to them. But some of these other conditions that are related to dysbiosis, such as type 2 diabetes or anxiety, depression, do you find that the dysbiosis is occurring in the small intestine or the large intestine? Do you find that the link is that it's coming from one place, or is it that it could be you've got dysbiosis across both your small and large bowel and then that's causing one of these conditions to occur?

It's a good question. And I'd say that essentially we're still learning and this is an area of new research and it's booming area of research, so it means that there's new stuff coming out all the time. So there's certainly been some linkages between SIBO and anxiety and depression, and there's linkages between chronic dysbiosis and anxiety and depression. Just to give you an idea, certainly when it comes to obesity, metabolic syndrome, type 2 diabetes, we're probably thinking more of the colonic ecosystem. But that's not to say that that small bowel ecosystem is not playing some sort of role in that too, and perhaps awaiting more research to tease out some of those things, and it might be partly with different patients that might be playing a more indicative role for that scenario.

I think it's really exciting, the research that's coming out and the research that will be done in the future around this area of our bodies. And I can't wait to see what we learn in the coming years around this and how much that impacts the way we handle our healthcare.

Yeah, very, very much so. And it's been amazing being in this world since 2000, essentially, to start seeing in 2000, I could read every paper published in the Microbiota that year, and for the first subsequent years after that, I could keep up easily. Whereas now the area is just booming and it's an exciting bit. But also as a clinician researcher, it's not necessarily as easy to keep your head up to date as it once was because there's just so much research that's coming on. But I think one of the biggest shifts that's occurred is perhaps an appreciation for the importance of the microbiota. When I go back to 2000, it was only the rare microbiota head, I'd.

Say.

Term someone who was very passionate, the microbiota, who saw that it was important and that we should be careful about using antibiotics and et cetera, agents that could cause damage to the ecosystem, that there would be complications to that. Whereas now I think that idea of the importance of the microbiota has really seeped through to general public a lot more so and to a greater percentage of health professionals. Sadly, not all of them, in my opinion, not enough of them, but more of them. So there's, there's greater awareness, you know, and I think it goes back and perhaps I'll while I think of it, because you asked before, but you know, what does our microbiota do for us? And I think this is probably a time good link in with that, you know, because we know that it's important for proper immune system function that a balanced gut EcoSystem can do two things. One, it tends to ramp up the arm of the immune system that protects us against infectious agents. But secondly, it sort of down regulates that arm that overreacts to things such as environmental allergens like peanuts or dust that we really shouldn't be overreacting to. But many of us overreact to that. And we know now that that capacity of overreaction has to do with how the microbiota relates to your immune system in your early childhood years, which is harder to shift, sadly, once you're outside those early childhood years. Normal gut motility is related to the microbiota organ as well, or what I call the microbiota organ. They've done lots of funky experiments back in the 60s and 70s where they managed to eradicate the microbiota of mice and rats and just observed what would happen. And certainly one thing that happened was gut motility slowed down pretty dramatically, as well as immune system function decreasing dramatically too. To give you an idea, the microbiota improves our nutritional status by increasing our production of B vitamins. Folate, vitamins B1, 2, 3, 5, 6, are all produced in significant amounts by our microbiota and absorbed. And we also produce a bit of B12 but sadly, at a point that's essentially beyond our absorption, unless you've got Sibo, in which case you can absorb some of that B12, but there's obviously trade offs you get with that, a bit of extra B12, vitamin K also important. And also just even your energy, your daily energy needs are met by your microbiotum. And even westerners will make 10% of their daily energy needs are met by chronic fermentation. And that goes up as a fiber content of your diet goes up too.

What are some of the signs? And I must admit I don't think I hear from many people that have a healthy microbiome living in their system because they're generally, they're people that have sibo, so they're normally experiencing all sorts of. But what would a healthy individual look like? What's their life like?

Oh gosh. Well, I think because of the fact we're connecting that microbiota, healthy microbiota, with healthy everything else. And I think that area of research is just building and building that you would argue that they'd be. What's the right word of describing it in the right zone metabolically. So there are no issues with blood sugar regulation, no issues with weight gain, for example, that the mood would generally be be in a healthy state. They'd be less perturbed by stresses, for example. I think those would be some of the key things that you'd see as well as the lack of autoimmune disease, the lack of gut symptoms that you should be able to eat a big pile of, let's just say legumes for the sake of argument and you just have more flatulence. That would be the normal outcome, the ideal outcome when things are in balance. But when things are not in balance, then you can get bloating, distension, cramping, pain, diarrhea or other symptoms that can go with some of those things. So with lack of food reactions, lack of allergic reactions would be signs of a healthy gut ecosystem and even a healthier gut ecosystem in those early years. I think that seems to be what the research is pointing out is that disruption to that early colonization process or that early immune system microbot interaction seems to have lifelong effects in terms of allergic diseases. The epidemic of receive allergic disease now is being tied by many researchers to that the lack of training that's supposed to occur between birth and age 3 with the microbiota turning down that reactive aspect of your immune response.

And what are some of the symptoms there sort of early warning signs of a microbiota that's starting to be less than optimal.

Well, I would tend to think obviously my lean is along the gastrointestinal disease tract. And I would say that some of the symptoms like bloating, distension, discomfort would be signs that something is perhaps not quite right. And particularly if you tie that in with the acute onset scenario too. Where and you see there's lots in clinical practice where never been well since course of antibiotics, never will since chemotherapy or never will since travelers diarrhea when they went to Bali or Mexico or something like that. And it's like, okay, that's obviously caused an acute dysbiotic event that's had long lasting implications.

And it's funny, I was speaking at an event on last week and I was talking to somebody who said that very thing to me. She said, my partner and I went to Bali last year and I haven't been well since. I've had bloating. I've found that I'm not able to tolerate certain foods that I was able to eat. You know, I think something's happened to me. And I said, well, quite often traveler's diarrhea or picking up a food poisoning event is often a very common precursor or cause for something like SIBO to develop.

Yes, yes. And certainly there's that umbrella term post infectious irritable bowel syndrome of which some of those would have SIBO and some of them would be colonic dysbiosis with inflamed nerves in their gut. And I think to me that's certainly where I'm thinking from is that these infectious agents or even antibiotics we know now cause long lasting gut inflammation and sometimes the nerves just stay hyper, stay inflamed, stay hyper reactive to stimuli. And that's part of the problem as well. It's got integrity that can be affected by the initial infection, in that case like Trilis diarrhea, but then not heal up quite right because of the longer lasting dysbiosis that can occur. And we know that can get worsened when people get traveled diarrhea and then whilst they have it take a course of antibiotics that increases the risk of post infectious irritable bowel syndrome by five times or something like. It's absolutely massive increased risk of long term gut dysfunction. If you take antibiotics when you have the case of traveler's diarrhea, then sadly that information is not out there either. Which means that people inadvertently are causing themselves harm, thinking they're going to help themselves. Wow.

Oh my gosh. I'm just thinking of the many times When I've, I've done some very big trips where I'm traveling for three plus months at a time and you'll go to the doctor to get your jabs, which you need to have in order to get access to certain countries. And they will. Every time I've been given a box of antibiotics and told, if you get traveler's diarrhea, take these. And this was all before I knew about sibo. So I was very uneducated in the world of the health of the gut and what to do. And sure enough, every single time I traveled to a less developed country, I would get some form of food poisoning or traveler's diarrhea. And like a dutiful patient, I would take my antibiotics. And listening to you say that that can often make it worse. I'm just thinking, oh, no wonder I've ended up in such a poor state, my poor little gut.

Yeah, well, it's essentially, it's adding insult on top of another insult that's there. It's just a different sort of ins terms of damaging your bugs that are normally part of that immune response, but also seem to be worsening that inflammation that persists afterwards. Yes, it would be good if that information was more widely known. I concur.

Yeah. And I know that a drug that's commonly used in the treatment of Sibo, which is rifaximin or rifaxin, depending on which brand name you're using, is often given as tool for traveler's diarrhea.

Yeah. And with rifaximin it might be a different case. And certainly the research I was looking at was just looking more generally at the category of antibiotics, or as we know, at least from the data that we currently have in rifaximin, it seems to be pretty selective in how it works and it doesn't seem to have the same collateral damage issues that you have with majority of antibiotics. Plus it seems to have sort of more of an anti inflammatory effect in the gut, whereas most antibiotics seem to have this long lasting pro inflammatory effect in the gut that lasts for months after the antibiotics are actually finished.

And so if, if somebody does pick up some travellers diarrhea for instance, when should they be, if they're going to take antibiotics, when should they be doing it?

Well, it makes it probably quite tricky because often you're going to be in an environment where you don't have your normal health professional who you trust trusted opinion to ask, so you're going to be reliant on physicians in that the country that you're in and their opinions on treatment. And they'll generally try to be on the more conservative side and probably prescribe them at a different point than I personally would or personally use them, perhaps would say. I mean, certainly from my perspective as a naturopath, I would recommend, and I do recommend my patients take pure herbal mixes with antimicrobial effects. But I choose my herbs that are going to have selective activity against the most common pathogens, but don't impact the majority of our beneficial bacteria, going to have a selective influence. And then I get them to take those herbs at the first sign of the tummy being a bit strange or after they've eaten some dodgy food and just feels a little bit quite right, as I'm sure you've experienced. Team Rebecca I've traveled heaps in Southeast Asia and I love the area and I do love experimenting with food, but sometimes you go to a store and you're like, oh, I wish I hadn't eaten there. That's a good time to take a day of those herbs because they're not going to have that sort of the collateral damage that are associated the same way that antibiotics would. And I think in most situations, the research tells us that the traveler's bug, diarrhea bug, will clear up without any help from anything at all anyway. So really comes to duration of time. And a lot of research tells the antibiotics don't actually shorten the duration of the illness, even if you do take them. So I think that's something to keep in mind and perhaps doing a stool culture to find out exactly what's there, if that's possible in that time moment and you've got short enough time window to work out what is there can give you the clearest idea of whether it's worth treatment or not.

And one thing I would like to talk about is how do we find out what is there? But before we do that, I'd like to talk about why we have less bacteria living in our small intestine versus our large intestine. So I guess that going back to basics of why one is one part of the GI tract is different to the other, so we can understand the why. And then talking about, you know, how. How do we even figure out who's living in there with us?

Yeah, fair enough. So I think you can start even with the stomach and the reason why I think we often have 10 or 100 bacteria per mil in the stomach, so it's a lot lessly dense. And most of those are travelers from your spit, essentially, that you swallowed. So they come from the OR or cavity down into the stomach. And essentially the stomach we know is a strong PH that tends to inhibit microbial growth. And it's also a quick transit time, so there's not much chance for bugs to stick around. They're being sloshed around in a pretty strong acid environment, and they move on to the small bowel. And that first bit of the small bowel, you're getting this very acidic gastric contents coming initially. But then there's also pancreatic digestive secretions and bile from the liver I come through all three of which you see as having antimicrobial properties. And the small bowel is also quite highly populated with immune cells and lymphoid tissue as well, which means that we're constantly producing things like defensins and calcinidins secretory IgA, all of which helps maintain a certain low level of microbial growth in that area in addition to this, digestive secretions. But on top of that, we have a relatively quick transit time between food hitting your small intestine to coming out the other end. It's usually on average about 90 minutes from oral cavity through to the first bit of the colon. So it gives you an idea of how quickly things. So it might be 60 minutes or something in the small bowel lap a little bit more on average. And it's a motility that actually helps prevent overgrowth too, or too much growth of bacteria in that environment, in addition to everything else that's going on. But. But that also gives you an idea that if some of those areas are impacted, like if we take a proton pump inhibitor that stops our gastric acid, then that means that we're losing one of those aspects to it. If we have a vitamin D deficiency, that means we're not producing some of the Calcinidins in the way that we should. That might mean we're more prone to getting bacterial overgrowth or low secretory IGA could be problematic. But it's a lack of motility, which is what most researchers are pointing out is the perhaps driver of overgrowth of bacteria in the small bowel. Whereas in the large bowel, the transit time is usually a much longer period of time. It still has a greater contact between food residues and bacteria where they can proliferate and produce heaps of metabolic byproducts that are then of health or consequence to us.

And is there an average time that generally that transit time in the large bowel occurs?

Well, I usually trace it back to a whole gut transit Time or bowel transit time when I'm out talking to my patients. So I'm looking from oral when you swallow the food to when it comes to toilet bowls. I'm out to toilet bowl transit and I'd say, ideally, you want it to be between 16 to 24 hours would be ideal. So I often get patients to experiment with, depending on their food tolerances. But, you know, sesame seeds and you don't chew them well. Corn on the cob, not chewed well. Sunflower seeds, for example, is. You can have those things in your stool and you can see exactly where you're at. And you do find people, because sometimes people think, oh, listen, I poo once a day, therefore my transit time insurer is just 24 hours. But then you get them to do the test and it turns out that whilst they might be pooing once a day, it takes four days for food to go from their mouth to the toilet bowl, which is way, way too long.

And so what do you do? You just try not to chew these items. And let's say sesame seeds. How many sesame seeds would you have to be able to then spot them in your poo sometime later?

I think 1 or 2 tablespoons should be enough. Or eating a corn on the cob, if that's doable too. And out of necessity, you're always not chew your corn to great bits and any bit that's left of is mostly just straight cellulose isn't going to get broken down by you and very little by our sort of Western gut microbiota. So it will come out and your poo pretty much intact.

That's so interesting. And so literally, you time the time that it goes in and then you time the time that it comes out. And that will give you your transit time.

That's right, yeah. And obviously the vast majority of that will be in the colon, but there will be individual differences there because some people's small bowel transit time is obviously impacted too. And the only way of sussing that out more specifically is by using these swallowable probes in a hospital setting where they can sort of look to see when it reaches your colon specifically.

And the other end, which sounds a lot more invasive. And it is, yeah.

Yes. So you usually get some quite significant data, or at least clinically useful data, from doing the corn on the cob or sesame seed biotransit test. You can also use capsules with charcoal, for example, because you'll get this sort of blackness that will come out the other end too.

Yeah, definitely. And I often will have activated charcoal with me when I travel, just to sop up anything if I've had a meal where I feel a little bit iffy after it. I love charcoal. It really does help keep things at bay, it seems, for me anyway. And that is definitely something. You notice that. That your poo becomes very dark.

Yeah, yeah. So that you can use that as a marker if you can't. If you aren't going to go with the seeds of the corn, you know, but charcoal might be able to do it for you in the same way.

Yeah, that's great. So I'm going to. I haven't done it for a while. I'm going to. As a result of this podcast, I'm going to go and test my transit time, just see how things are going.

It was probably different now than, I mean, if you did. Did yours years ago when you had more gut issues, it would probably be quite different now, I'm going to guess.

Yeah, well, let's hope so. I mean, everything feels a lot better. But, you know, I haven't done the test for a while. I'm going to go and do it. So how do we find out what's living within our GI tract and what should be there? Like, are there certain groups of bacteria that we should definitely have and then those that we should be making sure that we don't have?

Yeah, well, I'll answer your first, first part of the question first, which is how do we find out? And I'd say that up until the year 2000, we were using relatively old technology called culturing, where you get a bit of a stool sample and we played a little bit out into a different sort of petri dish with different media in it, and then we see what grew and we change conditions, put some in an anaerobic chamber and some exposed to oxygen. And that was the best technology we had up until the probably late 90s. And that was able to provide limited information about what was actually there because. And limited information about the impacts of what we did, even back using the culturing techniques that seem to make very little difference what food you ate and what impact it would have on your microbiota. And people were surprised at the time. They're doing these studies going, I reckon this should be changing your microbiota, but it's not based on culturing techniques. But when we moved over to using culture independent molecular techniques, where we're looking for a particular type of bacterial DNA, the 16S RRNA fragment, it's essentially opened up a whole new world and the reason why everyone's excited about Microbotto is because we've essentially changed technologies and can now see what's there. And some people have argued that maybe 10% of what's actually in our gut we can culture in terms of 10% of the species that are there. 90% of the species that are present, we don't have the right skills to culture at this point in time. So using only culturing gives us a very incomplete idea about what's there. So since we've moved over to using molecular techniques, it's like, wow, there's actually a lot more species present and a whole bunch of bugs in large numbers that we didn't even know existed before. And I can give the idea the name of one bug, Faecalobacterium prosnitzii, very important gut microbe. That's usually one of the top two species in your gut and for some people makes up 25% of what was there. But it can't be cultured, or at least it couldn't until very recently. So we didn't even know it existed, despite the fact it made up a quarter of your poo until in the last 10 or 15 years. And you're like, wow, that certainly gives you an idea of how far we've come. There's a number of other species too, like Akkermansia, that also plays a very important role in your health, as does Fecalibacterium. That again, we can't culture, so they don't get picked up on traditional older stool tests. And the CDSA types that most alternatives are integrated practitioners tend to use. If they're using culturing, they won't pick up those species, nor will they tell us about the diversity, the ecosystem or the genera richness, which is what the research is telling us are extremely important. So we'll get quite different answers depending on what tools that we use. But I think it's important that we use tools that are based on molecular techniques to get a clearer picture of what's there. Much more complete picture. Faecalobacterium, Acha, mandia are two of the species that I think are very important, but less known members of the Microbita. And then you've got species like Bifidobacteria. Everyone knows Bifidobacteria or Lactobacilli, again, because these bugs have been isolated. They were isolated back in the late 1800s. So they've been around for a long time. Our knowledge of them has been around for a long time. Whereas the other bugs Less so. And also a range of butyrate producing bacteria like Eubacterium and Roseburia that also make up a decent proportion of what's in your gut, but generally don't get picked up with traditional culturing in any significant way.

And what tests should people who are listening be looking for or should they be asking their practitioners to conduct? Are there particular laboratories that are doing these tests better than others?

Well, I think there's different laboratories using different technology might be the better way of putting it. And there's still a number that are using the old culturing techniques which rely on live bugs reaching, you know, going from your, essentially your anus to the lab, lots of different environmental conditions intact. They're relying on that scenario and then they're only able to pick up a certain percentage of what's there. And it can also provide some useful data too about whether potential pathogens are there or not there in culturing and whether those pathogens are sensitive to certain natural or synthetic antibiotics. So there's still a role for that sort of aspect, but you're certainly not going to get a comprehensive picture of what the ecosystem is actually like or the, what most species are actually like. I was looking at one of my culture independent molecular test results the other day and there's 78 species that were actually picked up and a whole range of different percentages and it gives me a much bigger picture of what's there than just looking at 12 species or 24 species. Yeah. So I think it's a matter of perhaps working because I suppose the issue with the this time point is you're going to need someone to guide you through the interpretation of molecular techniques. And I'd say it's an area that less practitioners are upskilled in compared to the culturing because it's a new technology that's only recently become essentially available to practitioners or the general public. But certainly you need professional advice to interpret it and walk through it, in my opinion, and understand what it's actually mean.

And if we think about what we should be seeing, are there particular strains or species that, you know, just categorically we, we should have these and, and we should be looking for them in our samples.

Yeah, well, I would go with Faecalobacterium, Prosnitiae, Akkermansia, Mucinophila and Bifidobacteria and some rope and some butyrate producing bugs like Rose, Beria, subdola, granulum, anurastypes, etc. Which are probably very foreign terms for a lot of people because they're important bugs that are recently discovered. So it just again, all of us know Bifidobacteria, all of us know Bacteroides or E. Coli. Even though E. Coli makes up 0.01% of what's actually in your colon, it's actually a really small player. But we discovered it 1885 or something like that. So it's been around and people are familiar with it for a very long period of time. Whereas Akkermansia mucinophila makes up it's probably 30 times the population of what E. Coli is, but it's only been recently discovered. So most of us don't know that it actually exists, let alone the important role it plays in gut integrity, keeping your metabolism functioning properly. And even it seems to be very. People that have high levels of Akkermansia, for example, tend to respond to weight loss interventions better compared to those who have low levels. Just give you an idea of the research that's come out Acromans in the last five years or so.

And talking about weight loss, it is something that people with SIBO seem to fall into one of two categories. They're either very underweight and losing weight rapidly, or they're in the category I fell into, which was gaining weight despite eating incredibly healthily and unable to then lose the weight once gained.

Yeah, yeah. And I think that is not uncommon. And we know now that the importance of the microbiota with body metabolism and weight issues. And there's a very amazing study done by Turnbaugh and colleagues, I think in 2006, where they had these germ free mice that were really thin, metabolically, really healthy, and they actually just introduced some poo from an obese mouse. And then that mouse model, they became obese despite no change in caloric intake, no change in caloric output. So they weren't exercising more or less and they weren't eating more, but they gained huge amounts of weight and became obese and had type 2 diabetes and a whole range of things, all from just getting a fecal transplant from an obese mouse. So we know that actually the ecosystem of the gut is hugely important in terms of the role it plays with metabolism. And we're still teasing at all the nuances there, but there are certain species like Akkermansia, faecalobacterium and Bifidobacteria that do seem to play protective roles. So those would be things that you'd certainly want to be looked at on a stool test if you're wanting to look at potential Microbiota relationships to troubles with shifting weight, for example.

Yeah, definitely that's something. Now that I've got through my SIBO treatment and the SIBO to this point in time thankfully has not returned. I now look at these other things of going, okay, clearly there are still things going wrong, so let's look at next steps.

Yeah, well, I suppose there's multiple things because you can have SIBO and colonic dysbiosis or even treatment of SIBO can actually worsen colonic dysbiosis too. So. Yeah, yeah. So I think for a lot of people it should be looked at as a post SIBO treatment or during SIBO treatment, but certainly should be considered too. But what impact have we had on the clonic microbiota and how is that impacting the rest of our health?

And it's interesting you say that, Jason, around how SIBO treatment can often have a negative impact because I do hear from quite a lot of people saying, you know, I had SIBO and my symptoms were not great, but they were bearable. I've gone through treatment and now I'm so much worse. How is this possible? Why am I sicker than before? Can you talk through how that can occur with people with SIBO when they're making things worse?

I've seen that happen too, sadly, in terms of patients that have come to me before and they're like actually worse after treatment than what they were before. And I think it depends a bit on the treatments that we know that some, like antibiotics, do cause collateral damage to the clonic ecosystem and gut inflammation, which can actually worsen situations like visceral hypersensitivity. And I think some of your listeners will be familiar with the concept of visceral hypersensitivity. Some may not, but essentially it means the nerves in your gut are hypersensitive. And we know this can happen with antibiotics. We can have it happens with traveler's diarrhea, for example, and a few other things like high periods of stress can actually worsen that too. But it's not unusual for course of antibiotics to flare that up, which means that people become less tolerant to colonic gas production than what they were before. So SIBO might have been dealt with now, but they're actually more reactive to gas forming foods because their nerves and their colon are now hydrogen hyper responsive to gas. And I think that can be part of it. And sometimes the dysbiosis caused by some types of antimicrobial treatments can cause an overgrowth of gram negative proteobacteria. They tend to respond well with overgrowth to some types of antibiotics. Gram negative bacteria contain lipopolysaccharides, also known as endotoxins. And endotoxins actually cause leaky gut, but they also cause systemic inflammation and visceral hypersensitivity. So that can be secondary antibiotics can cause the inflammation, but they can also cause the increase of lipopolysaccharide containing bacteria in the gut. But so can dietary changes that people actually can sometimes implement too. So if you put on or if you go onto a high fat, low fiber diet, for example, we know that encourages the growth of gram negative endotoxin rich bacteria, but also the absorption of those endotoxins which which then can cause a whole have been linked to obesity and type 2 diabetes and depression for example. Two just give you a small picture of the endotoxin research and there's a whole theme of people who are really interested in looking at this concept of metabolic endotoxemia. And it hasn't reached in any degree of fervor the blogosphere. But it is certainly a lot of excitement in the research worlds because it certainly links in the western type dietary changes or different types of diet that are essentially low in fiber and negative alterations to the gut ecosystem. On top of that increase with growth of lipopolysaccharide containing bacteria, you tend to have a decreased concentration of butyrate producing bacteria too. And butyrate is an anti inflammatory short chain fatty acid that decreases inflammation in the gut, it promotes healing of gut cells, both colon and small intestinal cells. It decreases inflammation of the nerves in the gut. So it actually helps deal with visceral hypersens, improves insulin sensitivity, improves mitochondrial function. There's a whole bunch of wonderful things that butyrate actually does, including improving the blood brain barrier in terms of its integrity. But we know that certain dietary types like high protein, low carb, low fiber, high fat, low fiber diets will decrease levels of butyrate producing bugs in the gut and decrease butyrate production. That has other impact over the longer term too. So I think that sometimes a dietary dietary approaches that people follow can sadly have a negative consequence on clonic microbiota.

That's fascinating. And I'm just thinking of all of the various diets that even I myself have followed. I think of the ketogenic diet which is very much high fat, low and protein and low carbohydrate, low fiber. Even many of the sibo diets that people follow are very much in that realm. What, what do you do when you're working with people with sibo in terms of their dietary, the dietary guidelines, and because diet is something that is so it is such a topic of emotion and passion for people because it is something that they feel that they can control. And also generally people can see that they'll eat something and they have an immediate reaction to it. So there's. They can, I think for many people, they feel that they're very linked in with nutrition or diet and how they're feeling. So they want to be very much in control of that. What do you do with your patients around, what they eat when you're treating them with sibo?

Okay. I mean, I would say that probably in the spectrum of practitioners, I would be one of the least restrictive diets or prescriber of diets. I'm pretty, I think because of my research, doing my PhD and all that year of research, those years of research looking at the wonders of the colonic microbiota and the colonic ecosystem, I'm pretty hesitant to use any intervention that's going to significantly harm that ecosystem unless it's really needed. Like antibiotics save lives, they save limbs. There's times where they're by far the most needed intervention. And even with dietary things too, there can be times for more extreme dietary, what I would perhaps call more extreme dietary approaches that have collateral impacts on the ecosystem. But I'm pretty loath to use them, at least if at all, or at least not for the first long while of treatment. And probably the most extreme I would go, which is probably not that extreme, is a low fodmap diet. When I do testing for sibo, I generally test for three sugars. I do glucose, fructose and lactulose. And we can add whether people are actually reacting to fructose or not from that, because you'll be surprised a number of times where people actually don't actually fructose isn't actually feeding their sibo bugs, for example, whereas other times it is. So that can help give you a bit more fine tuning with dietary suggestions and fine tune the restrictions that you're actually implementing dietary wise. But I'm also aware that a low fodmap diet we know decreases levels of faecalobacterium, Akkermansia, bifidobacteria, lactobacilli over time too, is what the research is suggesting too. So I'm aware that the short term that's not such a big concern. I eat just for like six weeks or I use prebiotics or selective prebiotics to actually help offset that. Because I know that those species are going to be whacked around by this diet. I'm going to supplement with specific fibers that are generally well tolerated that feed those specific bacterial species that are knocked around by a low fodmap diet, for example. And you could do a similar thing with the ketogenic type diet, although it might take a bit more work at working around. I mean, there's an animal study just published a few months back that described the ketogenic diet as an antimicrobial treatment for gut dysbiosis. Because it had such a huge impact on the ecosystem, I thought that's not necessarily a positive thing for a lot of patients.

That's so interesting. And I'm thinking of the people that I have contact with who will often say to me, I've been following this diet for three years, five years, long periods of time. And I do have often thought, gosh, what impact long term are we having on the health of our gut and the species living within it by restricting our foods? And I hear also from many people who are down to five foods. They're eating chicken, some carrots, maybe some plain white rice, and that's all that they're doing. So for those people that are, that perhaps have been on something long term or a right back to just a handful of foods, what's your advice on how to start to expand the diet that they're following and obviously what can they do to assess the health of their gut?

Yeah, I think cases like that are a perfect time to use a molecular stool analysis to see what's actually there. And I wouldn't recommend an old fashioned culture because they're not going to be sensitive enough to pick up what we're actually looking for or normally even look at the species that we're particularly keen on, like Akkermansia and Faecalobacterium as main ones. So I think that would be prime time to look at that and then you could see what that ecosystem is like and then how look at tools that we know can adjust that. Now the challenge is if I have a patient that can take the prebiotics I recommend and implement the dietary changes I recommend within two months, you can make massive shifts to one ecosystem in terms of improved richness, improved diversity, improved levels of beneficial bugs and lower levels of pathobion. Pathobion to bugs that they're okay to have around. They do some good things for us, but in the wrong amounts they actually cause us harm. But the challenge is if we're working with patients who can't implement a lot of those things, then it's much slower going and it's really trying to go work with them on a one on one basis. Okay, well your fecalobacterium is low. I would normally give this and this prebiotic, but chances are you're going to bloat to HIV or have diarrhea when you take those or feel just absolutely rotten. So it's much slower progress and it's trying to work out what tools work with that individual patient whilst perhaps seeing if we can work on the underlying reason why they're being so reactive to foods too. Because I think you're right that the longer they're on diets like that, the more chances there are of actual species lost in a gut ecosystem. And we know from mouse models, which is the best data we have at this point in time, that if we starve them of fiber for long enough, that ecosystem, certain species go extinct and then we can introduce fiber back in. It doesn't matter, the species are gone. Now how long it takes for humans to starve out species, we've got no idea really. It could be a year, it could be two years, could be five years, could be 10 years, we don't know. But certainly doing testing with molecular techniques that actually will tell you the number of species that are present as well, we get an idea of what your diversity score is like. I certainly have seen people, people who were on more the extreme end of sibo treatments, both in terms of antibiotics and herbal antimicrobials for a 12 month period and very restricted diet. I've seen their stool tests afterwards and their diversity is very low. The levels of beneficial bugs is very low and the pro inflammatory bugs are actually quite high because some of the foods that we're eating in those diets, like higher protein or higher fat fat, inadvertently feed a bunch of pro inflammatory species in our gut that don't. You don't get overt obvious symptoms, you don't get the bloating, distension, et cetera, but you are getting the metabolic byproducts that are not healthy for you long term and can worsen things like visceral hypersensitivity, for example.

And so you've said that whilst studies aren't, we don't have a clear definitive answer on how long does it take to see the extinction of these species. Do you personally have a time frame that you would prefer not to go over when it comes to having a patient follow a restricted diet?

Well, yeah, and I might have my aim of three months or something like that before we start introducing back things back in. And that really depends on how severe people's symptoms are and how severe their gut is. When I get to see them earlier on in the piece, it's usually much easier to get those FODMAP foods back in after three months of treatment and a lot more after six months. That's pretty consistent. But when people are. When I see these people that have been treated for the last 10 years with a whole range of different things and they're down to five foods, it's much harder going. But I do try to get them to at least take some of the prebiotics that tend to be well tolerated by that group as a way of. And I do that with my patients if I'm going to put them on a low fodmap diet for a period of time to offset any potential harmful effects that can occur with such a diet.

We've talked a little bit about pre and probiotics, so let's just dive into them now. And if you can start off by explaining what are pre and probiotics just for any listeners that don't know much about them.

Okay, well, probiotics are live microorganisms which when consumed, have a health benefit to the host. I think it's a very simple definition. I think that's a definition that the World Health Organization uses. And prebiotics are selectively fermented, tend to be fibers that increase levels of certain bacterial species, again to benefit host health. And I think that most people have some idea about probiotics in terms of what they are. But the term prebiotic is over casually used and people refer to all sort of dietary fibers as prebiotics, which they don't actually meet the definition of selectivity that you can actually get with prebiotics. Like if I have a patient who shows on a stool test with low fecalobacterium and low bifidobacteria, I can give them lactulose and it will increase fecalobacterium and bifidobacteria pretty consistently. And it's like, ah, so it's having very. And research tells us that too, they have fairly selective effects, at least in the shorter term. Long term they tend to improve overall diversity in a very beneficial way.

And so do people need to. Would you. Would the first step be to determine what is in their gut through analysis before prescribing what pre and probiotics that they should be taking?

You Obviously have a chance to be more specific and more targeted in your approach when you know exactly what's there, what percentage they are and how we can, what tools we can use to then modify that, I don't know. And I think it depends on the background of the person. The average Joe blow off the street, or Jane Blow in this case most likely be women who will be interested in this sort of information and actually making their relevant dietary changes, et cetera. Then I think it's actually quite fun to. I mean if with the. I think, suppose it depends because I'm going around in circles a bit here. But the price and costings of these tests have actually come down considerably, at least for the microbiome bought up molecular techniques that can be under $150 to find out exactly what's there. So that makes it actually much more achievable to assess where you're at now and also do follow up to see how things have changed back when you're paying 4 or 500 or $700 for a stool test made it much more challenging for people that had a lot going on with them to even pay for the tests. And two, follow up testing was much more challenge to deal with. Whereas with the molecular techniques being a much more cost effective way of seeing what's going on, then it can be a useful tool for even just the average person who's interested in their health to do and then get a chance to see what's there. But people that don't have issues with their health can obviously, or have, I should say, don't have Sibo. And irritable bowel syndrome can often play around with prebiotic supplements to their heart's content with no real risk of symptom flare ups, which you're probably going to get. So most people who are listening to, to this, I'm going to guess, have got placebo from what you're saying, or irritable bowel syndrome type symptoms. And you've got to be a bit more cautious with prebiotics because some of them are more prone to causing gas than others. So you have to tailor things a bit more specifically for your gut. So therefore it can be useful to see what's there beforehand as well.

And that's something that I hear from people saying that they're trying pre and probiotics and then they're having flares and it's making them feel worse and what should they do? And so my question is at what point should we be looking at pre and probiotics in Our treatment of sibo, should we be doing it at the beginning, in the middle stages, once we've cleared the sibo? How do you approach it?

Well, my approach will probably be different from many others, but I use probiotics from day one. I tend to use prebiotics from day one too, but it's very individualized as well. We know there's a couple of prebiotics that tend to be well tolerated and not increase gasolated symptoms and can actually decrease gasolated symptoms and bloating and distension scores and improve bowel pattern, for example, or decrease methane production in methane producers. So I will use those as my primary tools. And there's a prebiotic like lactulose which is I'm going to be much more selective with because depending on what the test breath test results come back and tell me because it can work as a prokinetic age agent, which is great. I like using prokinetics that also enhance the health of the colonic ecosystem, that also helps heal up a damaged gut. So in the right person, lactulose can be a wonderful therapeutic tool. But in the wrong patient or the patient that's not matched with well, it'll worsen a lot of their symptoms. So it has to be a bit more tailored. So for me, I definitely use probiotics and prebiotics initially as part of treatment and I use use my probiotics very selectively too in that for desired aim. So I have someone who's constipation type IBS or methane predominant SIBO who've got very slow gut transit time, which is what we find out from doing that corn or sesame seed test. Then I'll use a probiotic that speeds up gut transit time. Not all of them do that, but there's a handful of strains that do do that. So I'll use those ones. And sometimes just that simple thing will make a massive, massive difference to that person's state of health. So I, I think when probiotics are chosen well to match the patient and their health condition, the chances of having flare ups or worsening symptoms are dramatically reduced. They still occasionally happen with very sensitive patients, but most of my patients actually tolerate both the pre and probiotics that I recommend. And it starts getting more complicated when you get to those patients that you mentioned before who are eating five foods that have been unwell for a long time. We sometimes have to work, it's a bit more touch and go with some of those agents. But the majority of my SIBO patients or IBS patients would tolerate the right probiotic and the right prebiotic without issues.

Do you recommend that people go and try pre and probiotics on their own or should they be working with a practitioner to tailor the treatment?

Yeah, I would actually say that you want to get the most out of taking probiotics. Work with a practitioner that understands how to use them and what I would perhaps say appropriately in terms of matching the actions of the specific probiotic strain to the condition that you're trying to treat. And I think that's the key thing. I think there's sometimes this idea out there that just, I don't know that a probiotic is just like a placeholder or that they have this whole range of actions. And actually one therapeutic strain might have a couple different actions there. Like I mentioned, that one strain that actually speeds up your colon transit time. Now, if you took that strain inadvertently when you were a diarrhea type IBS patient or diarrhea placebo patient, is that going to be helpful to speeding up your gut transit time? Obviously not. And if you don't know that and you're just random buying random products off the shelf, then I think that can be problematic and there's greater chance of choosing one that one, the strain doesn't actually match your indication well at all or could exacerbate your scenario. Two, two, we know from market basket surveys done around the world, although none have been done in Australia specifically, but around the world, that some supplements don't contain the strains that they're even supposed to contain and there's perhaps differences within brands. So if you're going with getting expertise from someone who's got the training, they might be able to point you to the products that use well researched, well characterized strains that use those strains are far less likely to have contaminants, for example, and actually meet their label claims. That's what we do know from research around the world.

What's your advice to people? And sadly there are many out there that just don't have a practitioner in their local area that knows anything about SIBO or knows much about things like pre and probiotics. Do you have any advice on what these people can do in terms of if they're really eager to try and use a preference and probiotic on how they can approach taking something?

That's a good question. And I would still think trying to make contact with practitioners who do have that knowledge would be the good first step. And that might mean doing Skype consults or phone consults or traveling for the consult, sadly, to actually find the people with the right background and right knowledge to help guide you through that, because as I'm sure you said many times, is that SIBO is a relatively new diagnosis. It wasn't part of my naturopathic training training in the late 90s that this condition even really existed, bar in people that had their small bowel removed. That was all we knew about sibo up until the early 2000s, essentially. So there'll be a lot of people that just. It wasn't part of the training or they've heard little tidbits of it. So I think you're better off trying to find people that have the expertise to help you through what you're going through and who have the knowledge to know what you're going through.

It's interesting you say that. I had an. An email from somebody just very recently at her wits end, and I just wanted to reach through the email and give her a big hug. She's based in the UK and she was told in writing by her doctor that sibo does not exist. It is not a recognized medical condition and therefore she will not be treated for it. And the poor. I just felt for her because, you know, we know it's a real thing. And do you have any advice for people that perhaps are facing those kind of challenges where they've got practitioners who are saying it does not exist, this is not a known condition, on how they can just get through that phase and finding someone that can care for them?

Well, I'd say contacting someone like you, it's probably the support group that might come with a healthy gut, would probably help that you realize that you're not necessarily alone. And it's funny you'd say that story and it reminds me me or it's not probably sad, but it reminds me of what was going on when I was doing my irritable bowel syndrome research back in 2000. I interviewed probably a couple hundred people with IBS as part of my research. And the number of people that said that their doctors told them it wasn't real, it was all in their head, was still quite significant. And that had improved dramatically for the last 10 years. And you think, okay, well, sibo is probably at that point now too. Give it another 10 years and this will be far less of a. It won't happen nearly as often as what it still is. So first step is trying to find a, perhaps a community that someone can actually relate to what's going on for you. And secondly, trying to find a practitioner who's got the expertise and training to be able to help you and listen to YouTube. I mean, this is the fact that if you can speak to someone who actually listens and has an understanding of what's going on for you, that makes a huge difference to people. It really does. And when they have practitioners who don't do that and say, oh, no, it's all in your head, it's not real. It's a horrible experience.

And, you know, my gorgeous naturopath, Natalie, and one of the very first things she said to me when I walked through her door and burst into tears and just said, I don't know what's wrong. I'm sick. And I'm sick of being of no one believing me. And one of the first things she said was, I believe you and we'll get to the bottom of this. And that in itself was just so comforting. And it gave me the emotional permission to. To believe in myself and to think that I wasn't going mad because I'd had multiple doctors say to me that there was nothing wrong because it didn't show up on a blood test. And so I think the emotional support that comes with finding people like what we have with the healthy gut, and there are plenty of other platforms out there where you can find people that know about SIBO and can be there emotionally for you is really powerful. It's a really powerful support to the recovery of this condition.

Agreed.

Yeah. One of my last questions is if somebody is just using pre and probiotics, let's say that because I do see this a lot with people that they've gone and bought some supplements or pre and probiotics. They're just giving them a shot because they're desperate to try and find something that works, and it's causing a big flare. What's your advice on what to do if they're really flaring up from it?

Well, I mean, the first thing I think is cessation, cessation of use. So stop using it and see how things respond from that time point. That happens as a clinician who's been in practice for 17 years too, that you'll get people that react to a whole range of things that 95% of people don't react to as well. But the first thing you do is get them to stop taking what they are, and then you're trying to look for cause is that the only thing that's changed is that the only thing you've introduced at that time point? And again, they might want to get more Advice from someone who might have more expertise in that situation too, of going, okay, well, was that the right thing for me? As I said, if they happen to take a probiotic that speeds up colon transit time and gut transit time when they've got diarrhea, then that's not going to be a wise thing. And it's probably not an easy way of determining that from just looking at blogs or looking at websites, for example, because the information on probiotic labels won't necessarily be specific to help you with that either, for that matter. So you can't necessarily trust that information on labels, which tends to be pretty generic rather than specific to the research done on that strain contained in that supplement.

Yeah, and I know that my listeners will be wanting a full list of every pre and probiotic that they should take. But I think that the important thing that you've mentioned here is to really work with a qualified and experienced practitioner that can work with your individual scenario, rather than us giving a list of pre and probiotics that people then may take, which may inadvertently not be the right ones for them.

I think with probiotics that's definitely the case. And even in the broader category of prebiotics, there will be some that are not going to be helpful and some that are helpful in the majority of people, but still they might be more helpful for methane type placebos. So I still think you'll get the best out of your experimentation if you don't experiment so much and you can get advice, advice and feedback from people that have guided others through it.

Ideally, yeah. And just in terms of how they come, should we be having our pre and probiotics in foods? Things like you said fibrous foods, or things like sauerkraut or kimchi or those other fermented foods or cultured yogurt that you make yourself? Or should we be having these in capsule form or powdered form? Form? What's the best way of actually taking them?

That's a big question. I think it depends on what you're trying to do too, in that if you're just, again, a person with nothing wrong with you who just wants to have some sort of probiotic as a daily thing, then I think it makes sense as having probiotic foods that you can make yourself. Because wild ferments are exactly that. They're wild. I eat kimchi or sauerkraut daily. Not because I think it's going to have any specific type of targeted benefit, but just by having some of that, those microbes tend to improve my immune Response, for example. So you get some benefit from having any sort of fermented food. But if you're after a specific targeted action, then I think you're better off using probiotic strains that have research showing that they're useful for that action. And I think that's clear because you can have a whole range of studies being done showing that probiotic A, B and C don't work for this condition, but probiotic D does. So and sometimes you can have variation even within the same species that you've got different strains that will work. There's lactobacillus rhamnosis, GG doesn't prevent urinary tract infections, but lactois rhamnosus GR1 does. Just small differences in genes turned off or on can dictate whether the strain is helpful or not for treating a specific condition. So when it comes to treating conditions, I think you should be using well characterized, well researched research probiotic supplements. But if you're after just general health improvements, then I think having probiotic rich foods or microbe rich foods might be a bit more accurate way of describing it is a great approach. And same with prebiotics that if you choose your foods really well, assuming you've got a broad range of dietary options that you can withstand, then obviously having onions and garlic and druse artichokes and yacon tubers and a few other things that are high in fruit and, and having legumes for example, can actually make a huge difference for feeding up members of your microbiota that are health promoting. But it becomes more problematic if you react to those things. So for me, I tend not to take, I certainly don't take a probiotic supplement daily, but I eat fermented foods daily and I would eat prebiotic rich foods daily as a general thing in food high and resistant starch, for example, to try to make sure that a wide spectrum of my bugs are well fed. But if my little girl comes back from daycare with rotavirus and vomiting and diarrhea, I'm going to take the probiotic strain Al Rhamnosis gg that's got clinical trials showing that it that prevents rotavirus diarrhea and or shortens its duration by two days and give it to her, not play around with sauerkraut which may or may not contain a strain that has an impact on rotavirus. Whereas I know that genetically unique strain has got the actions that I'm after to both bind to rotavirus, enhance secretory IgA production, both of which shorten the duration of the disease significantly.

Yeah, and I think that's great advice. Really being targeted for the specific actions or outcomes that you want and then having things like fermented foods or lac sauerkraut or kimchi or kefir or whatever is part of just kind of general health. If you're in a place where you can be tolerating that, which many of my listeners are not yet they're on their journey.

And when you start looking at the microbiota, it's the fermentable foods and prebiotics that really shift the microbiota in terms of diversity, in terms of richness, in terms of increasing levels of bacteria dramatically. You don't get that from fermented foods and from probiotic supplements. You do get it from prebiotics and dietary genes changes. But yeah, and that's interesting thing is when you start using molecular techniques to assess microbiotols and seeing what's there and then seeing what shifts, you can see massive shifts when people can use those tools. And you also see the lack of effect of just having some fermented food daily because that doesn't impact your levels of anerostypes or blotia or subdilogranulum, for example, because they're not in that fermented food and they're not eating anything from that ferment, fermented food. But they do eat resistant starches and prebiotic like compounds in legumes and onions and garlic, for example.

Yeah, yeah. Wonderful. And really I think the takeaway is that it's, it's a process. So even the people that are on five foods and they're, they're quite unwell, it's a, it's a process to return back to health. It may not be a quick fix, it may be a longer term journey, but that it's about, you know, taking the appropriate steps, doing the appropriate testing to understand what is going on within your system specifically for you, and tailoring an approach that's unique to your unique needs at that point in your journey. Because your journey will change depending on where you are in your treatment and your recovery as well.

Well said, well said.

Thank you. I've been listening. Dr. Jason Horror, it's been an absolute joy to have you on the Healthy Gut podcast today. Now, I know you are an incredibly busy man. Is there any way that people can reach out and connect with you if they would like to know more or perhaps even be treated by you?

I do practice at Gould's Natural Medicine in Hobart. Is my clinical practice base and I do see patients via Skype and phone, although I believe there's a bit of a waiting list currently. And I do have some basic information on probiotics and advanced information on probiotics on my website called the probiotic advisor.com and the surgical database is you can have a 24 hour trial and have a bit of a play around but you'll probably find some of the information in the freely available lectures on there of interest in terms of some of the background of the probiotics type information we've been talking about today. And I suppose maybe keep an ear out if you sign up for my newsletter on Probiotic Advisor. And to be honest I've been very slack and probably one newsletter in the last couple years so don't worry if you don't get one soon. I won't bombard you with email junk I can assure you. But I'm going to try to organize some webinars for meeting your I run these workshops on meeting your microbiome locally in Hobart and I'm trying to convert those workshops through to online settings. So I work with groups to a group setting to interpret people's microbiota results for example and we look at the good, the bad and the ugly of one's ecosystem and how we can change that. So if you're on that email list then I'll be able to keep you informed when I eventually develop this into an online platform.

Wonderful. And I've got all of those links in the show notes so that anyone listening can just go to the show notes and click those links. Jason, it's been great having you on the show today. I know I've learned lots and I'm sure my listeners have too. So thanks so much for coming on the Healthy Gut podcast.

Oh you're very welcome to chatting about Gut Probiotics. It's always a pleasure. So thanks.

I hope you enjoyed Today's episode with Dr. Jason Horolek as much as I did. I know I have learned so much and he's just an absolute joy to have on the show. If you would like to receive the full transcription or the show notes from today's show or any links that were mentioned, simply head to thehealthygut co Jason and if you know anybody that might benefit from listening to this podcast, don't forget to share it with them. And I absolutely love hearing your feedback. So do write us a rating and review in itunes or the app you use to listen to this podcast. Not only do I love to hear your feedback, but it does does really help other people know that this is the right kind of podcast for them when it comes to learning more about gut health. You can also connect with us on Facebook, Instagram, YouTube, Pinterest, Twitter and Google. Just look for us under the Healthy Gut. Coming up on next week's show, we're joined by Larry and Belinda Wern from Clear Passage Therapies and we talk all about adhesions. And I had a real light bulb moment when it came to understanding or even hearing about adhesions last year and realizing that they could have been a missing link in understanding what had been going wrong in my abdominal cavity for so long. So I look forward to sharing that episode with you next week. You've been listening to the Healthy Gut Podcast with your host host Rebecca Coombs to learn more about the Healthy Gut or our podcast head to thehealthygut.co podcast. And as we are fully funding this podcast, if you would like to help support the continuation of this podcast so that we can continue to bring you future episodes, all you need to do is make a contribution at the Healthy Gut Podcast. We would like to thank Belinda Coombs for the production, editing and original music score of this podcast. To hear more of Belinda's music, head to soundcloud.com belindacombs the Healthy Gut Podcast is a production of the Healthy Gut. Thanks for listening.