Prebiotics, Probiotics and the Gut Microbiome with Dr. Jason Hawrelak

All right, so I am very excited to chat with Dr. Jason Horlack as he was actually my instructor when I went through my master's in nutrition at the University of Western States. And I'm not sure why I haven't invited him to the podcast sooner because I really, I've been following him for so long and again, I just keep on mentioning his name when I'm doing my own courses and talking to patients. So it's an Honor to have Dr. Jason here. And we're going to be chatting about prebiotics, probiotics, and just the gut microbiome as a whole. And I'm going to dive into Dr. Jason's bio and then we're going to just dive into the gut microbiome. So. Dr. Jason Horlack is a researcher, educator, Western herbalist and naturopathic physician with over 20 years of clinical experience. He did his PhD examining the capacity of probiotics, prebiotics and herbal medicines to modify the gastrointestinal tract microbiota and teaches worldwide on the worldwide on the topics of microbiota modification and gastrointestinal health. He has published extensively in these areas, including 20 textbook chapters. And Dr. Horlock is on the Medical Nutrition Council of the American Society for Nutrition and he is a fellow of both the American College of Nutrition and the Naturopaths and Herbalists association of Australia. And Dr. Horlock maintains a busy clinical practice in Hobart, Tasmania, Australia, where he consults with patients from all over the world. And then additionally, Dr. Horlock is Chief Research Officer at ProbioticAdvisor.com which I must say is amazing. And that offers a searchable database that enables easy evidence based prescribing of probiotic products and online resources for clinicians to learn more about the human microbiome and how they can positively influence these ecosystems. And thank you so much for joining us, Dr. Jason.

You're very well. Welcome. Eric, I'm trying to remember how long ago it was that you were a student of mine at tws. I'm using.

Yeah. Quite a while. So I believe I specifically took your course. I think it was in the fall of 2013.

Goodness. Okay. You're definitely one of the early ones, weren't you?

Yeah. And so you no longer teach at Western States, do you, or.

Yeah, no, I'm still there.

Oh, you are still. Okay. Was that in?

Yeah.

Did I go over the buy? I don't. Maybe. I. Maybe that was in the bio and I just wasn't paying attention, but. Okay. So you do still teach I should know this, but again, I, I just follow now you for your. Yeah, I've attended your courses, your online courses, and you know, again, you're listening to your podcast, but yeah, that's. That's cool. So you're still. Still teaching for them?

Yeah, no, that's one of the. My passions is actually I thoroughly love teaching and that. And I love nothing more than teaching gut stuff to practitioners because I just love the. The ripple effects that go out when you can actually improve the way that practitioners are engaging with their patients, improving outcomes. You have the capacity of changing the lives of tens of thousands of people, which I think is just incredible. So it's an honor and privilege, but also a great joy to teach. And coming onto podcasts like this is like that too, because you have a chance of actually reaching so many people that you otherwise wouldn't do and hopefully improving their lives by giving them information that they may have been waiting for. And just that now is the right time to hear it changes the direction of their health. That's what we're hoping for.

Exactly. So why don't you give a little bit of your background as far as how did you start becoming an expert when it comes to gut microbiome and probiotics and what motivated you to create the website probioticadvisor.com well, some of it.

Was probably almost chance in that my final year of my naturopathic training, there is a lecture by one of our senior lecturers around dysbiosis and leaky gut, and it's how it drove so many other chronic diseases. This is back in 1999, and that lecture just really stirred something in me. It was like, this stuff is amazing. I really want to delve into this topic and really dig into it. So I essentially finished off my naturopathy training. But then in Australia, we've got Cassie doing an honors degree, and honors degree is a research base project, and then you flow into that to do a PhD. So that's what I did. So I did a clinical trial from honors degree of looking at prebiotics and probiotics in irritable bowel syndrome to change the gut microbiome. So that was back in 2000, and then I followed up with my PhD. So just one of those things that maybe if I had not showed up to class that day, missed that lecture, my life would have taken a different tack, who knows? But it was just such an exciting area and I still find it immensely exciting. So I sort of float on from doing my honors degree to my PhD in the same topic of, okay, how do we change the microbiome in patients with irritable bowel syndrome using Pearl medicines, prebiotics and probiotics. And then I started teaching clinical applications of pre and probiotics essentially back in probably the latter with my honors degree. So back in 2000, to initially naturopathic students to share kind of what I learned from spending a year devoted solely to that topic, because I learned a lot more in that than what I was certainly taught in my training, which is, you know, we did fair bit of stuff in naturopathic, traditional naturopathic training, but it just was really scratching the surface. And I think there are certain things that around things like strain specificity that we'll probably dig into soon that was not touched upon in my trainings. Like probiotics can be used for this, this and this. Versus when you start looking into the research and really delving in there, you realize, okay, well, yes, some probiotics are good for certain applications and some strains are good for other applications. And it really blows your mind and changes the way that you look at using probiotics. From what I tend to call the old paradigm, which was you do a stool test. Oh, you're low in bifidobacteria. Here, take some bifidobacteria. That was the old paradigm versus the new paradigm is okay. There are human clinical trials showing that bifida strain HN019 speeds up colon transit time and softens stools. Therefore, you use it for people who are constipated who have slow transit time. But you wouldn't use that strain for someone who has diarrhea, for example, or someone who's got a Helicobacter pylori infection. You're not gonna. That strain is not gonna help with that. You know, this very. When as research has really built up around probiotics, we really get to see how much differences there are between different strains, even within the same species. But how important that is in terms of our choices around what we use therapeutically as tools and trying to make sure we're using the ones that actually have the actions required to treat the condition or the patient we're trying to help.

Yeah, I found it fascinating because that's where I learned it from you. And before that, I didn't know about, you know, that you should use probiotic supplements with specific strains, just like a lot of other practitioners still do. I was just recommending probiotics, just really didn't know anything about probiotics until I learned with you about also that we'll talk about prebiotics. You know, how prebiotics are important because a lot of practitioners neglect the prebiotics as well. So. Yeah, so, so the, yeah, so the strain, definitely want to look at the strain. So if like you, you're looking at a probiotic supplement and it has just like lactobacillus acidophilus or lacto rhamnosis, but it's not actually giving the strain, then you just don't really know the therapeutic benefits that it has.

No, exactly, exactly. You don't. And I think in this day and age, I think it's unforgivable. I think it's the right term for supplement companies to be only providing species level information. I think 20 years ago when I first started it was a bit more forgivable because the concept around strain was newer and yes, it had been known for a while, but it was like newish idea that we can actually have marked differences within the same species just by the strain designations. But I think now if there's any company that doesn't list the strains and just has species name, I would never, I will not use it as a tool because you just don't know what it's useful for. You don't know until you do research. That's the thing. We don't know whether it survives stomach acid, we don't know if it survives bile salt exposure, whether it adheres to the gut, whether it produces an antimicrobial compound that's helpful in the gut or detrimental in the gut, whether it has any therapeutic effect at all. Unless we do research on that specific strain to see what it does in reality, I can't help but think there's a relatively new psychobiotic which is a probiotic that has been shown to help with mental illness, essentially is the definition that's at the marketplace in the last couple years. Lactopilis plantarum P.S. 128. Now that was originally isolated from a traditional Taiwanese ferment, cabbage, mustard, mustard green ferment, you know, of which there's like 500 different types of lacto lactic aciducing bacteria in those kind of naturally found in those ferments. But through like a lot of testing, they isolated that one strain that had what they call psychobotic effects that was able to actually change when you give it to animals, that actually changed the amount of serotonin and dopamine in their brain when you gave it to them, you know, and they took that and said, okay, we'll do the animal Studies, it's pretty consistent. Now let's test in humans. And they gave it to kids with autism spectrum disorder. And lo and behold, the decreased defiance, it decreased sort of repetitive behaviors and decreased anxiety, you know, and they're using the same strain in Parkinson's disease and other Tourette's syndrome and other conditions like that. I just think it's phenomenal, but that you just can't expect any random strain in that fermented food to have the same effect. It's like they isolate that one strain that had the characteristics thereafter and a bunch of strains did not, you know. So I think it really puts that in perspective of that. When scientists do this well and companies do this well, we end up with having this well researched, well characterized agent that has a definitive efficacy in these conditions versus you can go, okay, well let's get some random lplantarm and hope it has some impact. Which is kind of where I think where some way some practitioners practice because they're unaware of the strange stuff. They're just like, oh, let's give some probiotics and see if they help. And it's all hit and miss. And I think they're going to be missing a lot more. And the patients can be essentially suffering as a consequence of not prescribing things based on the best scientific evidence and then with the way that the information has evolved over the last 20, 30 years.

Yeah. So arguably, or maybe not arguably, I mean according to what you mentioned, the strain having specific strains is more important than having a higher potency like the colony forming units. It doesn't really. Not to say it doesn't make a difference. You want to have, I think you said at least 1 billion like CFU as far for most of the probiotic strains. But just because something has like 100 billion CFUs, it doesn't make a difference. Again, if it doesn't have like specific well researched strains.

No, no. And I think I like giving this example of antibiotic associated diarrhea. There's one study that gave lateral retry DSM17938, which is sold around the world as Biogaia and to these elderly people taking antibiotics. And they gave, gave. I think it was 200 million. 200 million. See if you're not billionaires, 200 million CFU per day. Another study looking at elderly people taking antibiotics in hospital settings. The Same population gave 60 billion, two different lactobacilli and two different bifid bacteria strains. Fast forward the results. The 60 billion preparation did nothing, didn't stop antibiotic diarrhea at all. Yet 200 million of that one specific strain worked amazingly well. And I always think that's such a clear example of choosing the right strain with the right actions for versus just going, let's give billions of this stuff that we don't know works or not. And it turns out it didn't work. Now, that same strain combination that didn't work for antibiotic associated diarrhea has got some positive research for improving quality of life in irritable bowel syndrome patients. So it's not as if it's not useful for, in any condition. It's just, it's not useful definitively for antibiotic associated diarrhea. Whereas the reuterized strain that we use in that study is clearly, even if it was given it like 300 times less on daily dosage.

Now also. So when it comes to specific strains, is this also because a question I get from people from time to time is fermented foods. Can't I just take fermented foods instead of taking a probiotic supplement? I guess if it's for therapeutic purposes, it might, it might be more also hit or miss since you don't know what strains are in the fermented foods or.

Yeah, because they're generally wild ferments. Now you can be very directive with your ferments and you could, you know, use, use a probiotic strain with well defined characteristics as your starter. And if there's a way of guaranteeing that's what's there at the end product, which you could probably, sometimes you can do with, with different microbiome analysis labs. You can send your ferment there, you can see what's actually there. It is possible you could make a ferment based on the right strain to make sure you're getting that strain in a food, food base. Sure. But in terms of what most people are having, they're wild ferments, you know, like sauerkraut, kimchi, where we're just kind of just letting the natural bugs that are found on there ferment that cabbage. You just don't know what you're going to get. Like you're, you're going to get. We know the species stuff fine. It's like most likely lactose of plantarum, some sort of strain within that species. But it doesn't necessarily mean that it's going to have any therapeutic quality to it doesn't mean it's going to survive transit to the stomach or bile acid exposure or attach to the gut or produce any selectively acting antimicrobial compound or whether it might produce a antimicrobial compound that kills off your beneficial bacteria. Like you just don't know any of those things in a wild ferment. Now, I eat kombucha, I drink kombucha, I eat kimchi and sauerkraut daily. But for me, they're just ways when I think they taste great. And two, I think it's a way of enhancing your immune reactivity, I would say by interacting with different microbes from the environment, which I think is always part of what humans have done. I think it should be part of what we're still doing. And I think improving diversity of our ecosystem by having these microbes that are generally temporary visitors, but while you're eating them, they're, you're going to get another 15, 20, 30 different species, depending how diverse that ferment is, that they're in your gap for those temporary time periods. But I think I would, there's no way I would rely on it in the same way that I would okay, someone who, a kid on the spectrum. I want to give the PS128 strain that we know actually changes neurotransmitters in the brain because other strains of LPlant Harm cannot. We know clearly from that data that do not have that capacity. So you don't know whether you're like on the, on the sauerkraut lottery and you might end up having what we call a psychobotic strain that randomly happened to be in your sauerkraut. But there's a decent chance you have not. You take a sauerkraut and you feel really happy afterwards and maybe you've lucked out and you've won the sauerkraut lottery and then you can, you know, keep using it as a starter culture. But I think it's just such, it's, it's with wild ferments, they're just that they're wild and they're diverse. And I think there's a strength to that and there's a place for that in Healing Journeys. But I think it's not when we're really trying to target specific issues.

Okay, thanks. Thanks for sharing that. And I think one thing you also mentioned is with fermented foods and the, the species or strains that come with them, you're not sure if it's going to survive. Like, for example, the stomach acid. So when it comes to commercial probiotics are typically all of them resistant to stomach acid because that will, that's a Concern also with some people, if I take it, will it actually reach the desire?

Yeah, and I think this area has been probably over focused on by companies selling other probiotic preparations to try to make you wary about using lactozilli or if the bacteria based ones going, oh, they don't survive stomach acid anyway. So there's no point. I think it's been kind of a selling point for some other types of probiotics in the market and it's taken hold sadly. Again, if you went back 40 years ago or 30 years ago, you'd probably say that there's a decent chance that a number on the market would not meet that criteria of survival through the upper gut. You fast forward to now any, any preparation that has well characterized strains like L rhamnosis, GG or DSM 17938 or laxoplantarum 299D, we know that they survive stomach acid and bile salt exposure and they can show up in your poo because they did those studies before they brought them to the marketplace, you know, and these days scientists are generally doing these preliminary studies of going, okay, well we'll take our 500 strains of lactose to life from this fermented Taiwanese traditional food and we'll put it through an obstacle course to go, does it survive bile acid exposure, stomach acid exposure, does it adhere to the gut? You know, looking at all these different characteristics and they might find, you know, five or 10 out of that, 500 that do, and those ones will then take into animal models and then eventually in human studies because we, we get to see what they actually do beyond just survival. So I think the ones that are actually well defined strains, yes, they will survive transits to the stomach and small bowel very easily. I think again, there's a risk if you're using probiotics that do not define the strain and that you have no idea what you're getting. And I think the reality is that a supplement company can buy well characterized, well researched strains that have got all that sort of background data done on them at a high price point, or they can buy at a low price point where some microbiologists say, I would isolate 500 strains from, you know, a couple strains from the sauerkraut and start selling it because it's cheap and we have no idea whether it actually has those basic characteristics required. So I think there's always a risk in numerous ways for buying supplements that do not define the strain characteristics, but I think we buy the ones that do have the strains and had positive clinical trials showing that they work, then we don't need to worry about whether they survive in the upper gut or not, because they know they work. And we have clinical trials showing that they work.

And then I think it was from, I'm almost sure it was from you where I learned that you're supposed to take probiotics with food just because some sources will say not to take it with food.

Yeah, I know. That's one of those myths I've been trying to bust for 23 years now, Eric. I think the data was relatively clear back then, and it's even more clear now that we have better survival with a meal. The bacteria survive better with a meal. And this matters far more. So for Lactobacilli or Bifidobacteria based probiotics, Saccharomyces doesn't really matter. Bacillus doesn't really matter. And I would say with the new generation probiotics like those based on Akkermansia or Eubacterium or Faecalobacterium, I reckon they'll be better with food too because they're often more impacted by really low ph. And when your stomach is empty, the ph is around two, two and a half. So. So when you're putting bacteria in there, it's really acidic. It's designed to kill bacteria and it does that pretty well. But when you have food, the ph actually goes to four or four and a half. So it's obviously closer towards neutral, still acidic. But it's certainly quite a far cry from a PH of two, two and a half. And we have better survival of the bacteria that go through at a ph of four or four and a half. And the bigger the meal generally the more buffer the ph is. And there's even research showing that dairy, dairy food actually works as a better media to transport bacteria through because I think it buffers the ph even more. So, so it provides a more, you know, neutral ish environment for microbes to pass the stomach intact.

Okay, so Lactobacillus bifido based probiotics take with food the, the newer probiotics as well. But then you mentioned Saccharomyces boulardii, not necessary. And then you said no, also bacillus, if you're taking bacillus based, like spore based.

Yeah, those spore based ones don't matter. I mean, I think that's one of the strengths of the spore based ones. I mean, you can buy some spore based stuff that's mixed into baking, baking kits that you buy and you bake in the oven and other ones, you add hot boiling water to a herbal tea and that doesn't kill them. Like they're quite resilient and then they sort of release when they're in the human gut. So that I think is one of the strengths of those bacillus ones particularly is their environmental, the capacity to, to survive in a wide variety of environmental conditions that, that would otherwise kill. You know, you pour boiling water and your bifid bacteria, they're not going to survive. You put boiling water on your saccharomyces, they're not going to survive. But the bacillus spores, they'll survive and they will come out, release into your gut at a later time point.

Now, sticking to the topic of bacillus spore based probiotics, I know a few years ago, not that you aren't in favor of them, but just the research it sounded like was still behind like the Lactobacillus bacterium. Do you still feel that way where it's still, there's still a lot of research to be done?

Yes. And I happily use some that have clinical trials showing that they do something. Yeah. So for me that's, that's the indicator. If there's evidence showing that something is safe and efficacious and we have clinical trials showing that this bacillocyte probiotic works for this condition, I'll definitely use it. And I think we're certainly seeing that evidence grow. I mean there are some. The Entero germina strain of Bacillus clausii, I think it is, that has been on the Italian market since the 1950s, has a fair bit of research on it, you know, over that time, mostly for immune stuff, but other, other conditions. Antibiotic associated issues too, that's been one of the exceptions that had a higher sort of research base. But I think in other areas the, the products were being overhyped before the research was there. And I think that's the thing that triggered me a bit of going, if we have these bifid bacteria and lactosili based ones with clinical trials showing that they work and then somebody who's selling the product saying don't use them, here's mine, where I've got no data for it. I was like, this doesn't feel right to me. But I have been happy to see that the evidence base has been growing on those and you get ones like the Bacillus coagulans GBI I think 6086, I think from memory that's got an interesting research Repertoire that's useful for rheumatoid arthritis, for example, and functional abdominal pain. So a couple conditions of which there's probably less research data on other probiotic strains from the lactoxellular bifidacteria camp. But still, if you were to compare the total amount of research on lactobacilli bifidobacteria versus some bacilli, the research on the traditional ones far, far, far exceeds what we currently have on biscuits based ones.

All right, let's, let's dive into prebiotics. So can you discuss why prebiotics are so important and perhaps some of the best food and supplement sources of prebiotics?

Yeah. So, I mean, I think the prebiotics, as you kind of alluded to before, are an underutilized tool in most people's clinical toolkit. Not for me. I was enamored by prebiotics when I started doing my honors degree back in 2000, because I don't think I was taught really anything about them in my naturopathic training. And then I started reading the studies or even got up to that point, I'm like, oh, wow. There are these things that dramatically change the microbiota in selective ways far, far beyond what we're going to get with taking a probiotic or eating some fermented food. You know, far, far beyond that. You get dramatic impact and very selective. So I think it's good looking at the what even what is a prebiotic. You know, it's a selectively fermented compound that encourages the growth of one or more beneficial species of bacteria in the gut to produce health benefits. That's how it's defined. So we only have a limited number of compounds that currently meet that criteria. And that would be inulin type fructans, which we typically would call fructosaccharides. Then we have galactooligosaccharides. Then we have leptin lactulose, which will probably surprise many North Americans because lactulose is one of those things that has now been, you know, I think earmarked as like a breath test substrate more than anything else versus it's been used as a prebiotic since the 1960s. It used to be added to infant formula as a way of making it more like breast milk. You know, so things have, is very pigeonholed in the US I think in a kind of negative connotation versus when you look at the science behind it, in fact, its capacity to alter the ecosystem is fantastic. Its capacity to decrease levels of proteobacteria like E. Coli or Klebsiella in the gut is unparalleled as a pre body. It works amazingly well. Overgrowth of Bacteroides populations, it'll bring down very well. And there was a study published in 1997 which was one that really blew my mind. It was recent when I first started my honors degree a couple years ago that showed that we had like a thousand fold decrease in bacteroides populations and 100 fold decrease in E. Coli populations in the gut when people took lactulosis of prelotic. So I mean, so every 100 there was, there's one. Every thousand bacteroides there was, there's one. You know, it's like dramatic impact and you know, 100 fold increase in bifidobacteria and you know, tenfold increase in Lactobacilli. These massive sort of shifts and that got me excited. And then clinically you see results like that with patients where we're actually paying. This is a dyspark picture. We see we can give them lactulose and you see these dramatic, huge, huge shifts in ecosystem composition as a result. Yeah, so those, those three now are. Which we can get in supplemental form for sure. And I tend to use them primarily that way. However, we can also get food sources that contain galactooligosaccharides, which is primarily legumes. So we do get some galactooligosaccharides found in things like, like beets for example, a little bit in. Oh gosh, trying to get anything else that's not. It's scattered around a few things and other sort of vegetables, but the amount is tiny versus legumes. Legumes, like all legumes, you'll get a good amount of galactosaccharides. And that's what makes legumes give you gas. You get gas because of this indigestible compound called galactooligosaccharides which reach the colon, feed specific beneficial members of your gut. But you do get some flatus that comes with that. And inulin type fruit hands we find more broadly across different foods like onions, garlic are, you know, really rich sources that we have commonly. But also, you know, wheat, rye, barley are decent sources as well, particularly when your people eat a lot of it, which they often do with, you know, wheat products. You can get a decent dose of fruitans from, from that for example. But there'll be some foods that are probably less commonly eaten by us as westerners now than our ancestors would have eaten that were Quite high. Like, like burdock root for example. It's like, it's like 10% England Foss, Jicama Root, Yakon, Tubers, I think like 15%, which is a South American vegetable, you know. And there's a number of actually traditionally consumed vegetable crops throughout north and Central and South America that are really high in England type fruit tens. So they were always relatively high part of many people's diets who were traditionally from those areas. Chicory roots, dandelion roots, or things where, you know, people from a European background, our ancestors used to go and collect those things and consume no longer because they taste bitter. But there's, you know, we've lost our capacity to dealing with bitter flavors as a culture. But there are large, large amounts of inland type fructans within those foods and even dandelion leaves have large amounts as well.

And do you personally take prebiotics in supplement form or do you rely more on the food sources?

I do both, but I definitely take my, my inulin type fruit hands daily and often partially hydrolyzed guar gum, which is a prebiotic we haven't talked about so much that is somewhat unique because it's very good at feeding beta A producing species in the gut. So, you know, latulose, galactooligosaccharides, what I say GOSS and foss for frutaligosaccharides, they tend to feed bifidobacteria pretty consistently across the board. They also will increase. Another beneficial group of bacteria called faecalibacterium will often increase too, as well as having decrease in potentially pathogenic bacteria as well. Now, partially hydrolyzed guar gum tends to feed a range of beta A producing species in the gut. It doesn't really lower the levels of potentially pathogenic microbes so much. So that's not a strong point. But feeding B ray producers is and beat rate is just such an amazing substance that, you know, I certainly choose my diet to nurture my microbiome and I choose my foods to feed my beatrite producers in my gut. That's the core thing of what I do. But I also supplement that with, you know, as I said that inulin, inulin, phos and then the partial hydroblastic organ will be part of my daily regime.

And so you mentioned that prebiotics can, I think you mentioned that it could lower opportunistic or potentially pathogenic microbes. Is there concern that it could do the opposite? Because some are also expressed concern while prebiotics maybe it would feed some of the different opportunistic bacteria or some pathogens.

Yeah. And I think some of this comes from. I think there was a study published in the early 2000s that suggested, let's look at fructooligosaccharides. All right. In this particular study, if you took fructoseaccharides or you took klebsiella out of the ecosystem context and just put klebsiella in a petri dish and put some phos in there, it could grow on that phos. All right? And people got really freaked out by this and, oh, my God. Phosphits, klebsiella. What they didn't do is look at the other components of that study, that klebsiella in the ecosystem of poo did not increase when phosph was added to the poo. Fecal slurry fossil. Sorry, clubs. It went down. It didn't go up. It went down. And there's no human studies showing that that kleptil goes up when we actually give false. Yeah. So it's like taking, I think, research out of context, going, oh, my God, this is in vitro study. But we'll ignore all the human studies that show it does the opposite. You know, which I always find a bit strange. And I think it's because FOSS can cause gas and it can cause bloating and distension. So people are like, oh, my God, it's feeding the bad bacteria because I'm farting more when I take it, or I get bloating and distension. Now, bloating and distension is a sign that your gut's not working well. Yeah. And that you need to do something to work out what's going on there. Whether it's slow transit time, a dysphotic environment, sibo, small intestinal bacterial overgrowth that's driving that, that you need to address. But it's not that the FOSS is feeding the bad bacteria. I think that's where people sometimes go, is, okay, we've got this in vitro study, and then I eat this and I get bloated and I'm in pain. Therefore, it must be feeding klebsiella. That's why I'm in pain. That is kind of, I think, spurious logic. And it's ignoring the. The human studies that don't show that. And I can say from giving fos to thousands of patients and doing pre and post poo sampling, microbiome analysis, you do not see these things go up on foss supplementation. It's not reality.

So if someone, let's say if someone, a practitioner was to do a stool test and it showed a few opportunistic bacteria, which is common, let's say there was like some streptococcus, staphylococcus klebsiella. So some practitioners might say, oh, let's give him some antimicrobials, such as oregano, or, you know, there's so many different ones out there. But would a better approach maybe to give him some prebiotics, maybe even some probiotics do things to increase stomach acid? Or is there justification for, like, the antimicrobials, even if they're just opportunistic and not necessarily pathogenic?

Good question. I think it depends on what's there and how far off of normal it is too. Because I do see some people that look at the result and like, oh, the streptococcus in the red, but it's like a tiny bit above, like the normal range. I'm like, that's not problematic, you know, really? Whereas sometimes you might have E. Coli that's, you know, tenfold higher than the normal range. Yeah, that's problematic. And I might decide to use a combination effect. I might use probiotic, like, I think either saccharomyces cerevaceae variety boulardii or lactose rutoride DSM17938 that produces a compound called reuterin that can target E. Coli. And I'll use lactulose, which will bring down E. Coli, you know, and then I might use a herb too. But I. But I'm very selective, and I think this is something that came out of my research with my PhD is that we were curious what impact different herbal antimicrobials might have on the gut ecosystem. And this is back in 2001, 2002. So we did some in vitro research at that time going, okay, well, let's see, let's grab some bacteria that were like usual representatives of the keystone species that we knew about at that time that we could grow in petri dishes. And then we will expose them to different herbal antimicrobials and we'll get to see whether two do they only kill pathogens and leave good guys intact, or do they kill everything, or do they kill good guys at lower concentrations and bad guys? We were really curious, and it turns out that some of those ones did do that. Some things, like citrus seed extract just killed everything. And if anything was more effective at killing the good bacteria than it was the pathogens. We use clindamycin as our positive control, which is pretty full on antibiotic. This wiped out clindamycin in terms of at the concentration, which it worked in a. Just killed everything across the board. But then we had things like garlic that actually only targeted things like candida E. Coli, but left lactoacillide bifidobacteria alone. And we had oregano essential oil that was good at killing bifidobacteria, sadly. But lactobacilli were fine. And it did kill some pathogens, too, like a wide number of pathogens. And then we had berberine containing herbs that were also good at killing bifidobacteria. Lactose flavor a bit more tolerable to it and could kill some of the pathogens. It was an interesting project because it kind of really changed the way for me. It became integral to how I viewed the way, even the choice of herbs. So rather than going, okay, antibiotics kill, you know, cause vital damage. But herbs are fine. They're natural. They won't kill any of the good guys. Was like, hold on, that's not true. You know, depending on what herb we use, what form we give it, in, what concentration we're giving, what dose, we can kill lots of beneficial bacteria with our herbs, too. Yeah. And that really changed the way that I practiced from that point onwards. Like, I want to choose things that work selectively as much as I can, which, thankfully is most of the time. We can choose something that will target the E. Coli, but leave bifidobacteria and berate producers alone or lacto sili alone. And I think there's been more research that's come out along that vein in the. Over the last 20 years since I did mine. That around how we can. There's certain herbs that we know that are more selective and how they work and certain ones that are not, you know, So I think. And I think we shouldn't underestimate the impact of the right prebiotic and the right probiotic for shifting things in the gut too. Yeah. And if it's only a minor imbalance, that's where I'll often just use dietary changes pre and probiotic to shift things. Now, you do get situations like I had some patients with crohn's disease, and 50% of their ecosystem was E. Coli. 50%. And some context here, normal levels of E. Coli are like 0.01% or 0.1%. That's the normal range of E. Coli. And in these kids, I had two people. It's like 50% of the ecosystem. So in that case I'm not just using prebiotics and probiotics. I am too but I'm also using her medicines like pomegranate husk. And what I love about pomegranate husk is that capacity to target Krebsiella, streptococci, E. Coli but leave butyrate producers alone and bifida 3 alone. In fact they go up when we utilize it. It's like, you know, there are some herbs that are just amazing in their selectivity and they really, when you get on board about you know, really targeting things, trying to do things in a selective way and putting the microbiome first, I think we, we end up with better results long term for our patients. And you can look at things like berberine which we know has got that yeah, it does kill a range of different pathogens but but there's some interesting research that's come out about longer term use of berberine. Actually causes decreases in diversity of the ecosystem. It reduces beta producing species with longer term use, reduces bifidobacteria populations with longer term use but importantly actually increase levels of E. Coli and Klebsiella and a bunch of nasty Proteobacteria with long term use. You know, which I think is one of those things that should be on our clinicians radars when we're talking about because Berwine has become one of the new, it's used for everything type supplements. But you know, when we're starting to do research about the impact on the microbiome there are some definite negative impacts with long term use of berberine that really should be on our radar. Particularly if you're starting thinking about using it for cholesterol or metabolic health where you're giving it daily for long periods of time. Need to be aware of the significant dysbiotic effects that it actually has in the gut.

That's interesting because I know oregano oil could be kind of harsh and the citrus seed extract like you mentioned, but there is a lot and maybe I need to just dive deeper into the berberine because they're even in the like the PubMed research. If you do a search with berberine and gut microbiome a lot of it seems to be positive. So but again I guess you can't argue with the research as far as you know if it does affect some of the good bacteria like the bifidobacteria.

And possibly and diversity in beta rape producers. But what I think was more surprising was this research and this is so look at the research that humans on long term use of berberine because I think there's a short term things which might be one thing and I don't mind using berberine for short periods of time, a couple weeks, no issue. But you start giving it daily for months. I think this is where you see the more substantive negative impacts from its use. And I think also we have to, for me it's important that we respect traditional wisdom and that berberine containing herbs were never given to people long term in any traditional medicine system they're always seen as short term use. Like Coptis tenensis using traditional Chinese medicine, really high in berberine. It was always seen as short term use. Short term use, don't use long term. You know, Golden Seal was always seen as a short term use, don't use it long term which is, you know, more from North American Western medicine tradition. So I think that there's this wisdom that was there around these things and then we've like pulled out this really potent antimicrobial compound and got oh look, it improves blood sugar control. Let's give it to everybody long term for years. Let's not fix the diet or lifestyle, don't do that. Let's just give them this one magic pill. But I think we'll see that there are negative consequences to that magic pill whether it comes from the herb or comes from pharmaceutical lab if we're not treating the underlying diet and lifestyle factors that actually led to that occur. And again I think Berben short term is fine but I think the data is clearly showing that there are long term negative consequences for microbiotic perspective unexpected like the growth of E. Coli, Klebsiella strains and other sort of Citrobacter bloomed with long term berberine use. And I can't help but think that maybe you get this initial suppression and then the bacteria become resistant to it and then they end up growing up as a consequence with continued use.

All right, well, very interesting and thanks, thanks for sharing that Dr. Jason. And what are your thoughts about speaking of just randomly killing? Not that well, just antimicrobials. What do you think about like practitioners who treat everybody for parasites and, and as you know I, I interviewed Dr. Neurologic Kobe. I asked her the same question. I'm sure I know what your answer will be as well. But if you could talk about just like randomly treating like putting everybody on anti parasitic protocol, you know, even if it's without berberine. Let's, let's, let's take Berberine out of the equation and other antimicrobials. And also if you could expand even with like, blastocystis. Blastocyst. Blastocystis hominis, is it more commensal, Is it pathogenic? Because there's also some controversy on that as well.

There definitely is controversy around it. And I think there's also how the evidence has changed over 20 years. If you would have asked me this 20 years ago as a clinician, if I had someone who had presented with gut symptoms and a stool test that said blastocystis, I would have gone, okay, well, let's treat the blastocystis. You fast forward 20 years. No, I will not. I will work this patient up really thoroughly. And seriously, 95, even higher percentage of the time, we find something else that's causing their symptoms. Generally with sibo, I would say in most of these patients, they haven't been adequately breath tested for sibo. They just have gut symptoms. They have someone does a stool test saying, oh, look, you've got blasto. This is the cause. And they stop their diagnostic work up there. I think this is the biggest mistake because it's like, then we're going, okay, and all that focus is on this microbe that if you start looking at recent data, you'll start seeing that it's being viewed in a different light. It's being seen to be associated with better, higher quality, more diverse gut ecosystems. People are now arguing it has a apex predator role in the gut. So just like the wolves in Yellowstone national park or great white sharks out in the ocean, the. They actually get the apex predator. And their job is to keep other populations in check. And if we wipe out that population, there are consequences to the broader ecosystem, allowing other species, bacterial species, in this case, to become dominant. Because blastocyst is a bacteria eater, and some people argue it helps keep bacteroides from becoming overwhelming, which is what we tend to see in western cultures, is overabundance of bacteroides, for example. And the lack of blastocyst may be one of those reasons why I think the crappy western diet is probably the core reason. But I would say that there's also the connection with the lack of the species. Because many people in North America take enough antibiotics, it's not there anymore. Whereas there's, I think, a billion people worldwide with blastocystis in their gut. And there's a lot of super duper healthy people with blasts in their gut. And I'm putting my hand up here as someone that I was doing stool test experiments and it turns out I've got blastocystis and dientamoeba in my gut. Do I ever have gut symptoms? No. You know, do I have fatigue? No. Do you have brain fog? All these things that people attribute to that I don't have. And you'll find it's not just me. There's a lot of healthy people that end up having this in the gut, and it's not a problem. And I think sometimes the issue is, is if we stop our diagnostic workup at, okay, you've got this stool test at this, and you've got symptoms, therefore, that must be the cause. That, I think is the issue. Now, I do think that. That there is enough data out there to suggest to me that there'll be, in rare cases, the potential that blastocystis is a problem for this patient. And I think we just have to rule out everything else first. And then I still think we focus on, you have to do that and go, okay, we rule everything else. You don't have sibo. You don't have this, don't have that, but you do have this bug. And maybe it came from a case of traveler diarrhea. You didn't have the bug before. Now you got symptoms. Like, there'll be some stuff in the history that might make us think that this is more likely caused. I would still focus on microbiome optimization, improving the health of the gut and then seeing how symptoms go from that point over just trying to kill this thing. And if it was as simple as if we can't see magic tweezers that went out there and pulled it out, it wouldn't really be this discussion. But like here in Australia, there's people that. There's centers that do triple antibiotic cocktails, three different antibiotics orally, sometimes at the same time that they do three antibiotics in, you know, sprayed by colonoscopy as a way of trying to get rid of this. This bug, because it's been blamed as the cause of this person's fatigue or brain fog or gut symptoms. And then I'm often stuck with trying to mop up, you know, these people. Yeah, the blaster is gone, but geez, they're a hell lot worse than what they were before because they've completely decimated their ecosystem trying to get rid of this thing. Decimated. And I have massive loss of diversity, you know, So I think it's always weighing up the potential risk versus benefit with treatments. And I think when there's lack of definitive evidence showing this is a problem, then I Think we've got to be very cautious about using really big guns to target it. Whereas I think if you go, okay, well let's make your system healthier, let's make you healthier and let's see how you feel as a consequence. It's a different way of looking at it. If you can go, can we potentially induce better behavior? Like we know with certain microbes, it hasn't been shown with blastocyst, but we do with certain microbes that if we make the environment more safe. Acidic. Yeah. By essentially having them have more fiber or prebiotics, we actually bring up the better behavior in potentially pathogenic microbes. We can turn different genes off and on. They're, you know, really to produce beta glucuronidase or toxic metabolites. Goes down, you know, candida, we know we can change the ph and it makes it not grow a little hyphae that can burrow into your tissue, but it stays in that bud form, you know. So we've got enough data showing that if we can change the environment to a healthier one, we can bring out the best behavior in certain microbes and the suppress the negative behavior. So that way the bug might still be there, but it's not a problem in terms of the context of the environment.

And do you take a similar approach with H. Pylori? If someone has H. Pylori in the absence of symptoms, would you also say to leave it alone?

I think it would depend on the test that I did, yeah. And I think when I'm testing for H. Pylori, I'm specifically doing it because I think it's causing symptoms in that patient. But I think there are a couple of stool tests out there that test it and everybody that find it in, I reckon like 80% of the stool test. I can get one lab that finds H. Polarizing to be present, which isn't correlated. When I do any other sort of follow up analysis in most of those cases that I'm more cautious around those things of going, okay, well if you have H. Polar that shows up on a random stool test that isn't backed up by other testing technologies like breath testing or scoping and looking around or a blood test for antibodies or normal fecal antigen, those show up clear, then no, I would not treat it based on that. But if I do have patients who show up with a positive ur breath test, generally I would because they'd be doing that because they had symptoms consistent with H Pyrite causing a problem. So I would treat it, but I Think you bring up a point in that, that are people out there who argue, and I agree that there are likely benign strains of H. Pylori that are completely not problematic. And there are some that are definitely are problematic. And there are certain things we can test for like CAG or a few other those sort of things. We go, okay, these are virulence factors that we know about now, but we don't know about all virulence factors. So I don't think we could necessarily go, okay, well it doesn't have these two virulence factors, therefore it must be benign. I don't think we're there at that point yet. I think another 15, 20 years we'll have a better, better picture of this about when it's appropriate to treat it, when it's not. But I do think when people have upper gut symptoms consistent with this and it's present, then I will treat. But I'm also able to use selectively acting herbal medicines and dietary interventions to target it without causing major microbiome damage. So I think again, to me that puts in a different perspective. If every patients had to take triple cocktail of antibiotics or quadruple therapy to get rid of it, then I would really want much more distinctive evidence that was harmful versus, okay, you take this whole medicine for six weeks, eat some broccoli sprouts and drink some cranberry juice and take this probiotic and we get like 90% sort of efficacy rate doing that, then I've got no qualms about actually going, well, let's take out the H. Plori, leaving everything else intact. And that, that to me is close to that. Selective tweezering out and pulling up the microbe but leaving everything else in a good state that we can kind of get with some things like H. Pyri.

All right, well, thanks. Thank you for sharing that. And the final question I have for you is leaky gut testing. I attended one of your online courses where you discuss some of the different testing and I think you mentioned again, I don't want to put words in your mouth, but zonulin I think you said is still not. I'll let you talk about zonulin and some of the leaky guts. Again, I don't want to put words in your mouth, but I think you said zonulin is not completely accurate as a marker.

No. Well, I think it's been interesting watching the research in this area and some people will poo poo the lashless mannitol test because, oh, it's old, old technology. It's accurate technology. We've been using it for a long time. It's still considered the gold standard by people who specialize in this area who don't work for a lab trying to promote something else. And I think when you start looking around the data around, okay, does things like blood zonulin, like taking blood sampling for zonulin, does that correlate with the gold standard? And it looks like most research suggests it does not. You know, and then more importantly, there's researchers now in the last number, last handful of years that have looked to go, what is the test even looking for? And it turns out that the tests that are looking for zonulin aren't even finding zonulin. They're finding something else. You know, they're finding there was like some studies show it might be haptoglobulin or coffee complement C3 or another zoning like compound, but it's not actually finding zonulin anyway, you know, so it brings up like one, the correlation between that and the gold standard is pretty consistently poor. And two, it's not even finding what it's purported to find, which is zonulin. And some people think that we should really be tossing at every single study that's done using bloodstream zonulin. And it's associated with leaky gut because of its, its poor, poor accuracy, because anybody's telling us that. And never mind the fact I think maybe 10% of people don't produce zonulin at all. So they will always show up as, you know, having really bad leaky gut, but they won't have any zoning show up. So I think it's, it's a problematic thing, fecal zonulin also similar situations. Are we actually finding zonulin or some other compound that may be similar enough to zoning to make an assumption with. But it doesn't seem to correlate with bloodstream zonulin in most studies. It doesn't correlate with lactose. Manitol simply do sugar probes, which we see as the gold standard, although the occasional study with fecal zonin suggested it may correlate. So it's a bit, it's really mixed but mostly negative with fecal zonulin. But blood zonulin I think is really questionable as a marker and I would rely on it as a way of assessing leaky gut. And I think it's probably pushed more so in the States because lactulose is a prescription item. So it means that nutritionists, dietitians, etc can't prescribe a lactose manitol test because it's got a drug in it, you know, from their regulatory potential. Whereas here in pretty much every other country in the world, relaxer dose is just a common over the counter thing that everyone has access to that we can all prescribe this test really easily. Whereas over there you can't. Listen, you can if you're a medical practitioner or naturopathic in certain states, etc. But I think it, it means that there's more of a push to go. Okay, well we can't use this test. Let's see if we can find something else. But I think people have jumped on that one way, way before the data was actually supportive of being accurate. And I think the tests were developed and they can't even see that without even finding Zoidlin. I think that's a major issue. It has poised to find it. It's not, it's finding something else.

All right, now that's really good to know, so thank you. I'm glad I asked you that question. I know I said that was my last one. Do you have time for one more?

Yep.

In 2018, when I took one of your courses, I think you mentioned that you used to use Ubiome for microbiome testing, but since then they've gone out of business. Do you, you currently use any, any companies for gut microbiome testing?

Yeah, my patient base is, is pretty much spread around the world, which means I have different labs, different continents that I work with and utilizing different technologies. And I would say there's, broadly speaking, there's probably two types of tests that I would use in practice, tests that use 16S RRNA technology to look at the microbiome. You biome did that in the States. Ombre does that now. We're called thrive. There are limitations with it, but you do get a beautiful snapshot of the entirety of the ecosystem at a low price point, around the $100 mark, which I think is fantastic. And you can track changes in the key species, you know, Bifidobacteria, Lactobacilli, the Calabactrium Akkermansia, butyrate producing species will all get targeted there that we can see, and we can see the impact of our dietary changes and prebiotics really relatively quickly and inexpensively. For follow up, there's a test in the UK called BioMEsite, which also uses 16s, which has a better microbe library. And it fills in some of the gaps that we currently have with thrive. Because thrive ombre isn't particularly Good Italian, but proteobacteria populations. So each of those tests has got strong and weak points. So ombre knocked with Proteobacteria for example can't see Bilophila which is a bio loving organism that produces hydrogen sulfide gas. But if we take their data and we put it through the biome site library we can see protobacteria and we can see. So there's ways of trying to work around some of that issue. And then there are labs that use shotgun metagentic sequencing which is really cool because it can go down to the species level accurately and even down to the strain level. You can tell people are taking lacto rhamnosis. GG is a probiotic because I can see it show up in their poo when they take it really clearly, which I think is pretty cool. Again you can look at the entirety. But the cool thing about shotgun and genomics is we get to see fungi and protozoa, bugs and bacteria and even genetic pathways too for the production of certain compounds like hydrogen sulfide gas or methane. There's a lab here in Australia called Microba that, that uses shotgun that I do a lot of. I'd say that the major downside is the cost point. It's you know, 300, 350 per test, which is a lot more than the 100 for, for the ombre for example. And then I also use Nirvana Biome or Cosmos ID in the States who also does shotgun as well. But again the price point's a bit higher. But we do get more data to work with down to this because I think when the biggest issue with 16s which is like eubiome and ombre and biome site is their species level, the differentiation is not so good that we can't go okay, what bifidobacteria species are in there. But we can, we're using shotgun techniques so we can get that, that species level detail in fine nuanced ways.

Does, does Viome use 16s?

Viome uses shotgun managernomic. So they, they, they use like the best, arguably the best technology to look at the ecosystem. But as, as a clinician I don't get much out of the reports. So you know, they're more designed for the general public. You order this, it tells you to eat this food less of that food food but in terms of telling you what the ecosystem looks like. So I could advise that patient how to modify it. I don't get the data that I need from a biome but the technology they're using is good.

All Right. Well, thank you so much for sharing your knowledge. Dr. Jason, is there, I'm sure there's a lot more you could talk about, but is there anything that I didn't ask you that you have a burning desire to share? Or if not, can you just like give kind of a, like a, just a brief summary of where, you know, where people could, you know, what direction they should go as far as, you know, just looking more into taking care of the gut microbiome?

Yeah, no, I think we've covered a lot of some controversial topics and a lot of good topics, which has been great. Yeah. I can't overestimate the importance of looking after your microbiome and essentially changing the way you look at it is being a custodian. I guess you've got to be the custodian of this ecosystem for, not only for yourself, but for future generations too. Particularly if you haven't had kids yet and you're going to be passing on those microbes to your next generation. You want the ecosystem to be as diverse as possible. And I think to me that involves eating some general tips that have to be. It's not always that straightforward to eat the way that I'm going to mention here because sometimes you've got sibo or irritable bowel syndrome or family bowel disease, other things that may complicate things. But, but in general we're wanting to eat predominantly plants and not completely plants necessarily. You can if you want, but predominantly plants, whole foods, high fiber, avoiding all processed foods, anything with weird food chemicals, emulsifiers, completely avoid olive oil, bright colors, choosing, you know, purple potatoes, purple sweet potatoes, choosing lots of like bright colored berries, having as wide variety of rainbow of colors as you can in your diet. The widest diversity of different plant foods in your diet. Lots of spices in your plant foods like cumin and coriander. Get a whole mixture of different things. I think that's the key is diversity of foodstuffs, diversity of plant foods, whole plant foods, I think, and not to be neglected, be poor being to neglect lifestyle stuff too. So get out in nature, you know, go bushwalking, hiking, out in natural environments, garden. We know that actually people who are out their garden, organic gardening, actually pick up more microbes, have a diverse ecosystem. People that have the more diverse, the widest variety of plants growing in their garden have more diverse ecosystems in their gut, which I think is also a fascinating correlation. Since I've read that study, I've been planting out my garden like mad with this wide variety of different species. As possible. So I can actually make sure I'm interacting with different plants and getting different microbes on a regular basis as well.

Do you still recommend. I think I forgot if it was when I went through my. The master's in nutrition, your class, or the online course where I think you said 40 different types of plant based foods per week.

Yes, I still recommend that because I think to me that's not that 40 is a magic number, but because the 50 is arguably better. But I think that 40 is achievable for most people in terms of. Okay, how many different types of plant foods are you having over that week? And to make this easier too, it's like, you know, Granny Smith apple, Red Delicious apple, Fuji apple are three different foods. Red quinoa, black quinoa, white quinoa would be three different foods. So when you look at it that way, it becomes easier to achieve that 40. But by doing so we do see a improvement of diversity of the ecosystem. The richness of the ecosystem will improve when we're able to eat that way.

Yeah. So not just vegetables and fruits, nuts and seeds with those also nuts, seeds, legumes.

Yeah. Because I think legumes have been demonized more recently, yet they are absolutely fantastic for feeding the microbiome. They really are. They contain galactooligosaccharides. You eat adzuki beans or black beans, you're getting the beautiful polyphenols which feed other beneficial bacteria, soluble fibers which feed butyrate producing species. So as a, as a food group that actually provides a lot of nurture and nourishment for your gut beneficial members of your gut microbiome. Those are the ones. Ones. Legumes are fantastic. I think they've just been unfairly demonized in the last 10 years, sadly.

All right, well, where can people find out more about you? Obviously this probioticadvisor.com Yep.

And that's where like my probiotic databases, which is really trying to make evidence based prescribing a probiotic easy for busy, busy clinicians and obviously people in the general Republican to access the data too. And then I've got a range of courses on there too, mostly geared for practitioners because my probably main passion is actually educating clinicians to then reach more patients. But there are some courses there for the general public that are very up on health, which is in proportion of people these days. That's one thing that's changed a lot in the last 20 years is people's general knowledge who have a health interest is just way beyond where it was 20 years ago. So we do have courses for those. Those people, too.

All right, well, thank you again, Dr. Jason, for your time. I appreciate you sharing your knowledge with regards to prebiotics, probiotics, and the gut microbiome.

You're very welcome. Nice chatting with you, Eric.