Reviving Your Gut: Dr. Jason Hawrelak on Probiotics, Diet, and Microbiome Care

Foreign.

Welcome to another episode of Le Coin des Experts. Today I'm very honored to have with us Dr. Jason Aurelak. Dr. Jason Aurillac is a researcher, educator, western herbalist and naturopath with 20 years 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 topics of microbiota optimization and gut health. Dr. Orelak is chief research officer@probioticadvisor.com and he also established the Microbiome Restoration center, an online educational center devoted to training health professionals to become microbiome clinicians. In this interview we talk about definition of pro and prebiotics red flags when buying a probiotic, some of the clinical applications of probiotics, reliability of metagenomics tests available today, ketogenic diets and their impact on our microbiome, implications of a long term low FODMAP diet, SIBO and use of probiotics and of course, Jason's take home message. As a reminder, everything that is discussed in this interview does not intend to diagnose or treat a medical condition. So please ask your healthcare practitioner before implementing any new treatment. Good morning to or good evening everyone. And I had the pleasure and honour today to be with Dr. Jason Orillak. Thank you for being with us today, Jason.

Very, very welcome. I'm happy to, happy to be here. I always, always enjoy talking microbiome and gut health and, and probiotics and prebiotics. It's like what I do five days a week, every day. So it's every day, all day. Yeah, yeah, I'm pretty used to enjoy it.

Thank you, Jess. It's a real pleasure because today you are going to talk to your European audience. So this video interview is going to be translated into French and Italian. So we're very happy.

And very, very poor. So I think if I try to be native, native France, it would be, I think your listeners would give up on me. But I can say very basic things. Yeah. Which one? My youngest daughter is like learning Italian now and her Italian is very good in terms of her pronunciation. Next time. Yeah, next time we go to Italy, she'll be, she'll be our designated speaker for our family.

That's awesome. That's awesome news. But so let's, let's get started because I'm interested, I'm curious to know how you got interested at the very beginning into the microbiome and the world of probiotics. What happened?

Yeah, so I was in the last Bit of my naturopathic training. So I trained to be a naturopath here in Australia. It was a four year university degree. And last semester of my fourth year one of my lecturers gave a talk around dysbiosis and the role of dysbiosis in disease. This was back in 1999. And some of you listeners will be surprised that we're talking about the microbiome in dysbiosis back then. Some of you won't because it's actually been discussed for a long time by, by naturopaths and nutritionists and integrative doctors. But I just got so excited by this area of gut bacteria and how they might be related to all these different conditions. And this was back where we didn't actually know nearly as much as what we subsequently have learned. So I went and approached him right after his lecture and said, hey, I really want to do my honors degree in this. And then that started off doing a clinical trial of prebiotics, probiotics and heral medicines to modify the microbiome in patients with irritable bowel syndrome. You know, we chose a condition that at that time we knew that irritable bowel syndrome had a dysposis as a driver. We knew inflammatory bowel disease had dysposis as a driver. There's a few conditions that we were consistent with dysposis as a causative agent and then nowhere near as much as now where we can list like 100 different diseases with dysbiosis as a driver. But back then it was these gut conditions. Right? Okay, we'll choose this condition. We'll do some microbiome testing. As limited as they were back then, we're going to give them a combination of prebiotics, probiotics and herbs and see the impact. And then that grew into my one year honors clinical trial and honors degree flowed into a PhD that I did after that. And I think I just, you know, stay, I still, still, still equally passionate now I would say than what I was back in 1999 when I first started reading my, you know, all these papers from honors thesis and, and I think it just really blew my mind the stuff around probiotics. I had never even really heard of prebiotics. Despite the fact I was, you know, being trained in nutrition and, and naturopathy, prebiotics weren't really on the radar at that juncture. They were, but not really discussed by clinicians and, or my teachers. And it's like, whoa, what these amazing things that can cause you some really phenomenal changes to the microbiome and nobody's talking about them. And, and also learning all this new information about probiotics that was, you know, well and truly beyond what I was taught. Soon after digging into the literature and I was like, okay, I need to start sharing this information. So I started teaching at Southern Cross University where I my on the matter, where I studied and started teaching some undergraduate and students in the, in the nutrition sections around probiotics and prebiotics and the microbiome. And that started probably 2000, 2001 and it kind of grew, grew from there. And I've kept teaching those areas since that time point and kept learning in on those areas since that time point.

Thank you. You, you are our precursor. Thanks. Thanks for being here and for doing what you're doing because, you know, you're leading the way, you leading the path, really. Thank you so much. Can you give us a quick definition maybe of just reminding what probiot are and maybe what prebiotics are?

Yeah, yeah. You know, probiotics, I think most of us have at least an idea we use the term and most people, ah, yeah, they have some conception of what that is, you know, so it's, you know, live microbes that when administered in adequate amounts confer a health benefit. That's like the medical sort of definition that we, we tend to use. And there's a few bits of that that's live. So the microbes have to be alive, otherwise it can't be really a probiotic. And they have to have a therapeutic effect when given, I think is the other, other aspect. So, you know, some people would refer to some probiotic supplements as microbial mixtures or something rather than using the term probiotics. Some people are really, you know, religious maybe, but things only certain supplements will meet the deficit of probiotic because you have to have human clinical trials showing that they're beneficial to take. That's kind of more the extreme end, but I can understand the rationale behind it. But yeah, essentially live microbes that when you take it, they make, make you healthier in some way. Prebiotics is one of those terms that I think is very misunderstood and misused by the public and by clinicians too. Some people think any fiber is a prebiotic and anything that feeds the microbiome is, is a, it's a prebiotic. And that's totally not true. Prebiotics are selectively fermented and it's the selectivity that makes them unique. Yeah. And different from just fibers or polyphenols that I think are all lovely things that nurture a wide range of microbes in the gut. And I'm totally into all those things. But the prebiotics have this very selective impact on the ecosystem. You can take a person or a group of people in studies and go, hey, they've got low bifidobacteria. We will give them lactulose or inland fructooligosaccharides, and we see bifidobacteria go up. It's this very clear response. And there might be some small changes in other populations, but the really big change is increase of that population or increase of achromansia, increase of faecalibacterium. So they allow us to have a bit more nuanced and targeted approach to altering the ecosystem. Yeah. Whereas just having fibers or pectins and gums and resistant starches feed a wider number of microbes. And that's not at all a bad thing. It's just a different thing than what prebiotics do.

Not all fiber has, of course, an impact on the microbiome. So, yeah, although fiber is.

Yeah, you'd say they would have impact, but they're not. Maybe they might feed 10 or 15 different species or 20 different species, which, again, is not a bad thing. It's just a different, you know, if I want. If I have a patient who's taken antibiotics or even something like. Something like berberine and it's really smashed down their bifidobacteria, I want to feed their bifidobacteria back up. And if I just say take some general fibers, the impact will be relatively small. But if I give lactulose or inulin, phos or galactooligosaccharides, the bifid bacteria will come up really quickly, really directly, and we can restore those populations that may have been hit or hammered by antibiotics or even natural things like berberine.

No, that's awesome. Yeah. And actually, I will think about asking you this question later, but since you're, you know, mentioned, you're bringing it up. So if someone takes antibiotics, let's say for, you know, seven, 10 days, what is the research telling us? Are we killing everything and everyone? Or what's the situation? What's the aftermath?

Yeah, it depends a bit on the antibiotic is probably the best answer for that. And. And we, in early 2000s, did a systematic of the impact of antibiotics on the microbiome, where we graphed every single study published in the 1960s, 70s, 80s, 90s, early 2000s. It was a Huge document which we never got published because it was just too big. Looking at the impact and I remember creating all these tables, it was like a massive document looking at the impact. And based on old style technology, the impact seemed to be mild to moderate, depending on the antibiotic. Maybe within a week, two weeks, six weeks later, it seemed to be restored with the technology we used back in the 1990s and earlier. But when we, using modern technology, DNA based technology, we saw that the impact of antibiotics was far, far greater and far longer lasting. And we get extinction level events, not uncommonly. You know, there's a study published in Gut, the journal Gut, a couple years ago, nine species extinct from one course of antibiotics, nine gone, permanently finished from the ecosystem. And you see this amazing massive disruption. Initially it's massively different. And then it does settle by about four to six weeks after the antibiotic, it does settle into a new pattern that's different, permanently different than it was beforehand. You'll never get the same microbiome picture back after a course in antibiotics. Not all of them will cause mass extinction events. Some will have a smaller impact, some will have substantively more. If you do antibiotic combinations where you do one, two or three or four antibiotics at once, the impact is huge and you get phenomenal levels of extinction level events that are far greater. And I think it's vital for us as consumers and as clinicians to be aware of the impacts of antibiotics in such a phenomenal way. Because it's imperative that we are judicious users of antibiotics. We don't take antibiotics because we have a viral infection or because the doctor.

Thinks it might help everything under the sun.

Yeah, exactly. Because sometimes they're like, oh, we'll give the antibiotics just in case. It's like, no, it's like these will not just cause short term harm like diarrhea. It's like this is going to be permanently alter my microbiome and that's fine. If it's like a life threatening infection, no, no worries. I'm going to do the antibiotics, you know, but not for viral lung infection. I'm not, you know, so it's, it's, it's imperative that we have that knowledge about the, these more permanent impacts on the microbiome. Get out there so people can be more cautious and just use the antibiotics when they're actually needed. Not, not just randomly for, for things they're not going to work for anyway.

Yeah, and it is of course, very common. You know, the chemist, they give you, you know, a packet of, you know, Probiotics, with your antibiotics and say, okay, at the end of your course on antibiotics, you take this and you'll be. But yeah, what's. Yeah.

And that's better than not for the most part, but. And I'd say that's an advancement to where what they do in Australia, where they generally don't even do that or you know, in the past, no one would have done that on the radar. So I think in Europe they're further ahead that way. But I think it's still a lack of understanding of what the impact is. If, you know, if you think that you can just take some probiotics, eat some sauerkraut and drink some kefir and your gut will go back to normal, we go back to what it was. It's wrong. You know, we know that these microbes that we take as supplements, plants or fermented foods are not permanent colonizers. They are temporary visitors that can be helpful, immensely helpful, but they can't take up the same niche that we may have killed off. So if we take a course in antibiotics that kills off two species of butyrate producing bacteria in our gut, we can't shove some lactobacilli in there and go, hey, it's going to do the same thing. Because it can't, it doesn't have the same metabolic machinery to produce butyrate. So if we kill off our butyrate producers, we can't eat kefir and our way through it, you know, they're gone. Yeah. So I think sometimes that, that conception that we've had kind of cheapens the microbiome that we're like, ah, we can just take a probiotic or eat some sauerkraut and our gut will reseed our gut. And it's just, it's one, it doesn't, it's not real. And two, it just leads to, I think these sort of problematic views that the microbiome is kind of easily replaceable. This thought where that those agents are temporary harmful, it's like, no, they're actually arguably permanently harmful and there are consequences. We know that antibiotic use in childhood leads to increased risk of obesity and diabetes. Antibiotic use anywhere for any age increases the risk of anxiety and depression. Studies showing that women in their 50s, if they took cumulatively two months worth of antibiotics all up in their 50s, their brain aged, they lose like four years of cognitive capacity later on in life. It's like the antibiotics have impacts because they're killing bits of us. And again, it doesn't mean we don't use them when we're our fingers about to fall off from infection or, you know, life threatening. We do, but we just should not use them as flippantly as we do now.

Random. Yeah, yeah, yeah. And so on the other side. So what are the clinical applications of probiotics nowadays? There's a immense study, a lot of research and you, you can, you're contributing to some of this research, of course. So tell us about the clinical applic, medications, how to use, when to use probiotics.

Yeah, and that's changed a lot too because again, you go back 25 years, it was like antibiotics, irritable bowel syndrome, ulcerative colitis, candida, thrush, you know, these are the things that we're using probiotics for. You fast forward now it's like, oh, low immunity, recurrent infections, Helicobacter pylori, eradication, reflux, prevention of urinary tract infection, you know, cervical dysplasia, prevention of obesity, postpartum obesity, prevention of eczema, treatment of eczema, treatment of asthma, treatment of hay fever, fatty liver, anxiety, depression, you name it, diabetes, gestational diabetes, endometriosis. It's like sibo, food allergies. It's just like, it's huge. Yeah, it's changed a lot because of the amount of research that, that's, that's essentially been done over the last, you know, 25 years. Predominantly there's, there was research before that time, as I said, mostly looking at gut conditions. And the study and probiotics and IBS happened in 1958, 1956, actually. You know, so some, we have been researching probiotics for a long time, but it's just really boomed from probably 2000 onwards. And moving beyond just gut. Yeah, like the first study was published in the late night 1999, where they found if a woman during pregnancy took L Rhamnosis GG as a probiotic, it prevented eczema in the offspring. That was like a pivotal paper. That was like the first paper that showed probiotics did something besides gut, which actually prevented an allergic disease. That was people. Because that again, like. Yeah, that's right.

Yeah. So, so we know that now probiotics can help in so many conditions. So the way we use them, rather than just, you know, giving random strains and types of probiotics to, you know, anyone. So how do we use them now? So what is the, a better way of prescribing and taking probiotics?

Yeah, and I think that's totally evolved too, because we're kind of using probiotics as a therapeutic agent with a specific action. And just like, I suppose I'm a herbalist too. So if I have, you know, someone who's depression, who has depression or anxiety, I only give a herb that leads depression and improves anxiety. I'm not going to use a herb that decreases blood pressure necessarily, or that that gets rid of your period pain. It's not like. But I'm using the right herb with the right action. We know it's the same with probiotics too, that they have specific actions and attributes. So we kind of match it up of going, okay, this strain has been shown to reduce anxiety. Doesn't mean every probiotic reduces anxiety, because they clearly don't. But some do, and some treat depression and some treat irritable bowel syndrome, But a lot don't work for ibs. So you are actually matching the strains that work for the condition we're trying to treat. And I think this is again, what's evolved over that time period. Because in the old days it was like we didn't have nearly as much research when like, just take a probiotic, you know, whereas now it's like, no, you take the probiotic that has the action that you're after. Yeah. So we, even with antibiotics, we know that if you take the wrong probiotic with antibiotics, it might actually slow down the restoration of your gut ecosystem and actually impair healing of your gut after antibiotics. When you take the right one, it'll actually speed resolution of any inflammation or microbiome harm caused by the antibiotic and prevent the global damage and prevent side effects from the antibiotics. It's a great scenario, but if you just use a random one, there's a chance of actually causing harm that patient. So it's really behooves us as clinicians and consumers of probiotics to make sure we're actually matching the probiotic with the action we're trying to achieve or disease we're trying to treat.

This is awesome. Thank you, Jason, for specific clarifying this concept. And I think it's quite revolutionary. Right. And even within the manufacturing companies, you know, are they following these new kind of guidelines, do you think, or. Because we still see probiotics, you know, with a lot of different, you know, strains, like, you know, 15, 10, 20 types of different probiotics in one, you know, single packet. So where, where are we going? And, you know, what do you think?

I think, I think it's mixed. There'll be certain companies that are all over this and selecting Their if they do a multi strain preparation, they'll do it well. Yeah, they might go, okay, I want to have a metabolic syndrome probiotic. I will choose one that's got research for fatty liver, one that lowers cholesterol, one that improves blood sugar control. So there'll be some people really on it and they can make a really potent multi strain probiotic and there's others who just shove the cheapest robotic strains I can buy.

Shove anything up in the sun.

Promote it for everything. Yeah.

Okay.

So it is quite varying but I think there's a lot of companies doing great research on their strains and showing that their efficacy, what's perhaps lagging is ability to make label claims. You know, so sometimes they won't be on the label, it can't even be on their company's website. But we'll have clinical trials showing that this product is good for these applications. And they're saying, and I think it's sometimes how much evidence is enough evidence to show efficacy, you know, for some people who do label claims or you know, government regulators about what to lack on labels. And like we want 20 clinical trials with 10,000 people each before we're going to say you're allowed to make a label claim. It's a bit of an exaggeration, but it's pretty similar. Whereas if you have, you know, five clinical trials on a few hundred people, they might go, that's not enough. But for us that's enough for me, you know, man, I need it on my patient, it works, you know, but they may not be allowed to make that label claim. So just keep in mind that what's on the label of the probiotic may not actually match the evidence base in either direction. You know, there might be a great robotic strain with preparation made with great care, intelligence thought using well researched strains and they can't even put on the label what it's actually good at doing due to government regulations. And then you have some really crap robotic preparations that might put a lot of misinformation on their, their labeling and on their website that they make bigger claims when, when it's got actually no evidence for doing anything. Yeah, so it is quite variable in that regard.

Yeah, so some, yeah, some red flags when buying a probiotic. Right. So what there should be at least on, on a label. For instance, if we, we're talking about, let's say Lactobacillus rhamnosus, is there something that should be specified or something that shouldn't be missing? This is for the general public, but also for some practitioners, I think it's good.

Yeah. And, and I think it's, it's the strain designation that's really vital to see on labels and in materials from the company. And to me, it's always a red flag if that's not there. So the term strain is one of those terms that's also misused by people in the blogosphere, by companies selling products either knowingly or unknowingly.

I'm not sure what is the strain? Tell us, Jason.

So you might go lactose rhamnosus is the species. Yeah. So black is the genus. Rhamnosis is the species name. There's no strain there yet. The strain is what comes after that. So it'd be lack resilce, ribnosis, GG or lack resilience ribnosis, GR1 or LR34 or something like that. It's that strain designation that actually tells us what that strain is capable of doing, because then we can look at the research on that strain and go, ah, okay. There's studies showing this strain does this application, this strain does that, you know, and this can make it a massive difference. Like there's a couple of different strains of lactose R, you know, one is very good for constipation and, and preventing antibiotic associated diarrhea. Okay. And then another one is good for osteoporosis. Yeah, but the same species.

Very different.

Yeah, but very different applications. Yeah. And we know that strains matter. We have enough studies now and we have in vitro studies, animal studies, even a few human clinical trials showing that the strain designate like strains matter. They're closely, genetically speaking related, you know, left with rhamnosis is still left with rhamnosis. They're going to have a certain amount of qualities in common, but there's enough differences that can determine whether something works or not for the condition we're trying to treat. That's, that's the other key thing, too. So if a company is like, oh, we're using a different strain of electrical rhamnosis, but it does the same thing as LMSTG or GR1. That's a red flag. No, you can't say that.

We need to know.

Yeah, we need the research. I'm just going to stick with the ones that actually use the real product that has the research on it. Yeah.

Okay. And is the, the quantity important? How many millions? Billions? Trillions?

Yeah, it is to a certain, certain extent. But I think you're, you're spot on in kind of your, what you're leading to here is that for Some people and what some companies say is like, all that matters is quantity. Like, like 2500 billion is better than 1 billion. It can be. But what matters more is using the right strain for the job. Yeah. So, and there's studies looking at this, like there was, you know, study that, looking at probiotics for antibiotic associated diarrhea in elder population. And you know, one trial they gave 60 billion bacteria per day of four different strains. Did nothing, did not work. Another study, they gave 100 million bacteria one strain. It worked beautifully. So it's not all about number of species there, it's not all about numbers of bacteria. It's about minimum dose and being above the minimum dose for that strain. That's what matters. And in general we see that about 1 billion CFU for some things there is a dose response, some things there's not, you know, for some people, some conditions we found out that actually a lower dose seems to work better than a higher dose. And other studies it's like, okay, no higher dose will work better, but it's key to, we just use the, use the right. Again the right strain for the job and the minimum dose is achieved. Yeah, in general that's 1 billion CFU of each strain per dose. There are exceptions to this like the lactose reuteride. DSM17938. Sorry about the weird naming, but that's from the Bioguy company from Sweden that's all over the world. That one we know works because we've got dozens of clinical trials showing it works at 100 million CFU per day. So it works at a lower, you know, tenfold lower dose than what we typically would see. So that one is fine to use at that dose because we have all these studies showing it works at that dose, but in general we're after that 1 billion or above. And just because a product contains 10 strains and 100 billion CFU of microbes does not mean it's going to work better then a product contains the right strain at 1 billion CFU.

Thank you. This is super important because, you know, people think, oh, the more the better, you know, quantity.

Exactly. And some, some companies have gone, that's their marketing. They're like, let's buy cheap strains so we can put more in there. And, and, and people will be bamboozled by the, by its multi strain in such high numbers. But they don't care about the, the research pedigree and whether the strains they've chosen have any efficacy for anything. Yeah, that's the trade off because Often, you know, if you're a company designing a probiotic supplement, you can choose to buy really well researched strains that are going to cost more or you can buy strains that have no research doing to do anything, even surviving in the gut to any length of time for very dirt cheap, you know, and if, and if you're trying to put, if what you think people care about is just the more the better. Some people just choose to the cheap route because that will, you know, still, they'll still make, they'll make more money off that. Yeah, because people still bamboozled by the, the more strain, the higher numbers, the better concept.

And so the delivery system is important, I guess. And I remember, you know, in, in the old times, you know, we were thinking, okay, it has to be refrigerated so that it know they keep being alive. So nowadays we find quite a lot of probiotics on the market which do not need refrigeration.

Right.

You were talking about buying diet, you know, so how does it work? And are we making sure that they heat, I mean, they get delivered to the right spots in the digestive system? What do you think about that?

Essentially the changes have kind of occurred for probably a couple of reasons. One is changes in technology and our capacity to store things in bottles or package blister packs that have evolved since 20, 30 years ago. But more importantly, it's been changes in our criteria for selection. So when researchers are like, ok, I want to develop a new probiotic strain or new probiotic product, they might go to. This is often the case, go to some healthy people's poo. They'll isolate out the lactobacilli or the bifid bacteria from that poo. Then they will put them through what I call a probiotic obstacle course. And that's going okay. Does it survive gastric acid? Does it survive bile salts? Does it adhere to the gut? Does it produce antimicrobial compounds that are selectively acting? Does it interact with the immune system in some ways? And is it shelf stable? That's a criteria that was added probably in the mid-90s. It's like, let's see if we can find one that meet all those other criteria. But also our shelf stable so we don't have to worry about refrigeration, that they will survive in variable conditions. So it makes it easier to get to people rather than having to refrigerate the entire journey from where it's manufactured to the shop, to the home. And that's what's going to change things now Because a lot of the probiotics that have come since the 1990s have got that as a basic criteria that before they do any other research on it, it meets those basic criteria. Then they do animal studies with it, in vitro studies and human trials and then it eventually becomes commercialized. But at that point we know it actually survives at room temperature quite okay. Or if the occasional strain doesn't, at least we clearly know that. And they will package it in such a way that, and let us know that that particular strain does need to be kept. But that's relatively rare for modern probiotic strains. That would be the exception these days.

Okay, so that's awesome. Okay, so, so we make, we can be reassured that, you know, we're buying the, we need to buy the right type of probiotics, the right strains for the right, you know, for the different conditions and of course buy a reputable company as well.

I think.

Yeah.

And I think that's the other thing that goes into the importance of strain on the labels. Yeah, yeah. When, when there's been market basket surveys done all around the world where some scientists will go out and they'll buy all the probiotic products in that country and they will grow in them, out to see what's in them and see whether they meet their label claims in terms of species and in terms of counts. What they've consistently found over the last 20 plus years is the companies that use that don't list strains are the ones that are missing. They might make contain no bacteria, they might contain a few bacteria, might contain the wrong bacteria. Whereas those companies that use the well researched strains pretty much always meet their label claims. Yeah. In terms of the number of bacteria that are present and the right bugs being present. So that's another way of kind of assuring. So in some respects. Yes, rep. You're kind of guaranteed that if it's got the strain designation there, you can pretty much guarantee that they tried hard to make a therapeutic product and to make sure the bugs survive. It's the ones that do not list strains where, you know, they've taken cheap shortcuts along the way or, or ignorant around the whole field of probiotics. Either way, it's not a good sign.

Yeah, it's not clear. Okay. Yeah, yeah, let's, let's have a chat about microbiome tastes. So what's, so are they, you know, reliable nowadays? What are the best tests we can do? Yeah. What's your advice on the microbiome tests?

Yeah. And again, as someone who's been in the field for a long time. I've seen them change a lot. You know, when I first started off, we were doing comprehensive digestive stool analyses that would tell us about four species of the gut ecosystem. And we were making clinical decisions based on E. Coli, Lactobifobacteria and Pterococci. That was like it, those are the four. And then, you know, a few years later there's a test that brought up 12. We can look at 12 different species and they use PCR instead of culturing. So things technology has advanced and tools that we have access to as clinicians and as the general public have advanced dramatically too. So now we actually have access to high quality, accurate scientific tools to assess the microbiome that we really did not have 20 years ago. So yes, I think the DNA based tests that we have access to two of the broader sort of technologies and sorry, it's going to be complex terminology here, but the shotgun metagenomic sequencing, which is arguably the best, most accurate way of assessing the microbiome, we can see metabolic pathways and that allows us to get a feel for even what some microbes might be doing for us when they're not even named yet or haven't even been discovered as yet. And then you have 16s RRNA testing, which is a lower cost point but still gives us accurate information from the genus level. So you know, Bifabacterium lactobacillus, Thecalibacterium, akkermansia, escherichia, like that kind of level data is accurate and if we stay within that testing paradigm, then we can definitely see the consistency. You could take the same person, same diet, no change of anything, get them to a poo sample every day. It's going to look very similar all those days. Yeah, so it is. And then we can give them intervention and we can see the change. Yeah. And the one of the first companies that, that brought like cheap, accessible, you know, microbiome testing to the world was you biome, you since went broke. But listen, for $50 or $100 sometimes they would do these specials. For 50 bucks you could buy these kits that would tell you about the entirety all the bacterial speedies of the ecosystem. And for me that was, it was mind blowing. Crap is changing because before then my patients are paying if when I would rarely order the test because of the cost. But $800 to tell me, but 12 species of bacteria, that's where we're at before you buy them. Yeah. And all of a sudden like oh my God, I'm seeing 300 species of bacteria for 50 bucks. It's just like amazing. And they were using, you know, the right technology. It wasn't like they're skipping on technology. It's just that, you know, things as technology improves the cost could come down. And that's, and that's why we can even do things like shotgun sequencing now because the cost point still higher. But you're looking at you know, two, three hundred dollars a pop instead of, you know, a couple thousand dollars that it was not that long ago to that kind of testing.

But it's thank you for specifying, for clarifying this concept because especially here in, you know, France and Italy, I can see so many different types of, you know, what they call like, you know, stool test, microbiome test and even that sometimes they're still culturing. Right. Very confusing for you know, someone that has no, you know, I mean they trust us, they trust, you know, clinicians.

Yeah.

And sometimes it's really very cheap and not really they're not metagenomic. So.

Yeah, yeah, yeah. And the culturing tests, like we should not be using them for microbiome assessment. Like there'll still be always culturing will be useful from, from a broader microbiology field perspective and maybe to see whether you know how to kill different pathogens. Where you grow that pathogen, you dump some herbs antibiotics on and see if it dies. Like that aspect will always be clinically useful but it's just is lacking the capacity to see, you know, up to 90% of the microbes in your gut. We cannot culture even using the best possible conditions, which we don't have when we do home stool kits. Yeah. So all the testing labs are so used in culturing can tell us so little about the ecosystem. They're really not worth, not worth using. And there's other tests that use PCR which is definitely a much better technology but also often limited in terms of what they tell us about. They might tell us about 30 species or 50 species, but not tell us about the other 250 that might be present and the balance of them in the ecosystem too. So I think what I love about the shotgun testing or the 16s testing is we get to see the balance. You look at the entirety of it and go okay, what's the like between the pro inflammatory anti inflammatory ones, we get to see a whole range of species that, that Right. Like polyphenol transformers and the whole suite of bead rate producers that aren't, aren't really talked about by most, most PCR tests. So I think again I don't use, I rarely use PCR test in my practice. It's always 16s or shotgun testing because they tell me about diversity, they tell me about the richness of the ecosystem and they look at the entirety of the ecosystem. And I think all those things are vital if you really want to properly ascertain the health of someone's microbiome.

Wonderful, thank you. Thank you. That's awesome. And we're lucky because we can find both Tests, especially 16s in Europe pretty easily. So that's awesome. And shotgun is slowly, I think is coming as well. So that's awesome. So who should do a microbiome test? Jason, would you recommend? Of course. You know, people have like digestive issues, but not just the distributions, right?

Yeah, for sure. And I think that's what's changed too, because our linking in of what? The diseases that are caused by microbiome, the microbiome has increased dramatically again in that last 20 year period from just gut conditions to actually Alzheimer's disease, type 2 diabetes, obesity, fatty liver autism, chronic fatigue syndrome, eczema, asthma, type 1 diabetes, type 2 diabetes, rheumatoid arthritis, Hashimoto's. And this is not an Parkinson's, multiple sclerosis. This is not an exhaustive list. It's like, yeah, almost every condition you can see, think of that we see as clinicians working in Western countries has, has essentially a microbiome link whether, and sometimes the microbiome is the main cause of, of that disease, sometimes it's just a major contributing factor, but not the main cause. So you could make an argument that everybody with a chronic disease should get their microbiomes assessed. And I can definitely make that argument because it does allow for individualized, nuanced treatments. Even though in some respects we know what's required to achieve a healthy microbiome, broadly speaking. Yeah, so it's like eating more plants, eating more fiber, eating more polyphenols, having time in nature, any more organic food. There's a bunch of stuff that we go across the board will make people's microbiomes healthier, but it's just allowing us to fine tune and use specific tools to achieve changes in certain areas more quickly. When we do the microbiome assessment, because you might go, okay, you've got early stage Alzheimer's, you've got really high levels of E. Coli or Klebsiella in your gut and we know that they're endotoxin. It's what's likely driving the Alzheimer's, based on the recent research. So let's hit that hard. Rather than going, oh, let's just change your diet for a bit of time, which will over six months make a difference. Yes, but I'd rather just use some herbs and some prebiotics and bring it down within, within a couple weeks and then use the diet as a long term ways of keeping those bacteria in check. So I think it, you, you would do. There are advantages for everyone to do the testing in terms of just the, the chance of individualized treatment to a greater degree and to potentially move things along more quickly. Even though as I said that in some respects some of the recommendations are generally across the board useful for everybody. With every disease state. You would argue that we can see with improving diversity of the ecosystem, improving levels of butyrate producing species, reducing levels of proximity proteobacteria. It's going to be stuff we do pretty much across the board because research has shown that maybe triad of dysbiotic states is like a driver of western chronic diseases that we see on a day to day basis.

And inflammation, as you were saying, all these inflammation and all these LPS producing bacteria, they're a major driver of inflammation. It can be not just gut inflammation, but systemic inflammation.

Totally systemic inflation. Yeah. And we look at the research around Alzheimer's, like people with Alzheimer's, when they've done autopsies of their brains, they have between 2 and 26 times the amount of endotoxins in their brains compared to healthy controls. They do the look at the bloodstream of people with Alzheimer's and mild cognitive decline. They have three times the amount of endotoxin in their bloodstream compared to healthy age match controls. And we know when it gets, we know exactly the impact of LPS causes nerve tangles and causes amyloid beta plaque to develop. It's very clear that this is a key thing. And that's just Alzheimer's. But that is linked in with cardiovascular disease risk. It's linked into metabolic dysfunction. All these things are driven by endotoxin. And I think it's really important that concept itself gets out there more because I think there's microbiome dysbiosis. But one of the core drivers of essentially harm coming from the microbiome is endotoxin or lipopolysaccharide. And we really have to do our best to reduce numbers of the bacteria in the gut and prevent its absorption. That's. That is key. That is key. Yeah, yeah.

So everybody actually should do a microbiome test in the, you know, in the life or you know, I would say yeah.

And I think for most people, obviously in Western nations can afford that. Most people can because the price points are so, so low, you know. Yeah, yeah. You know, when I said I had to charge my agents at $800 a pot for the test, I was a little bit more picky about when I would definitely do one or whether I make assumptions. Like I'm going to assume you've got dysposis based on your symptoms or your disease state will make assumptions what's going on and treat you. But when that goes down to the, you know, 100, 200, $300 mark, it becomes like, now we can actually look and we can make sure what the system looks like and we can treat you.

Absolutely. It could be life changing. It's a great way for, you know, disease prevention. Yeah, it's great. Yeah. So what, what are the good things and what are the less good things that may affect our microbiome in terms of, of, you know, habits like food habits, maybe carnivore or even, you know, the famous or unfamous low fodmap diet or what? What do you reckon, Jason?

Yeah, I think broadly speaking, whenever we restrict plant foods from the diet, there's microbiome harm. The degree of restriction in terms of how broad that is will dictate how much harm there is. So the carnivore is the extreme example of that where we cut out everything that comes from plants. And this is where you get, get massive microbiome harm. You get substantial reduces reductions in all beneficial bacteria because they're all fiber consumers and you have these blooms of protein putrefiers and bile acid eaters which are pro inflammatory species. That's very clear. The impact of the extreme end of things. We cut at all plants and then you have intervening times of keto type diets. Well, that depends a bit on what your keto is. Is it like a plant type keto where you're still having it's olive oil and it's nuts and seeds and olives and lots of green leafy things that will have quite a different impact than the bacon, egg, lard and dairy cream keto, which will cause again massive negative shifts in microbiome, massive reductions in beneficial beef species. Because we know that even ketone bodies themselves are toxic to bifidobacteria, for example. So, you know, there are an obvious drawback there, irrespective of the, the restriction of food sources. Because I think, keeping in mind that these things, what grows in your gut, what bacterial species grow, depends on what we feed them. And what we feed them depends on what we feed us. So if we're just eating meat and fat, we're just feeding microbes that eat meat and bile for the most part. And if we're eating fibers and oligosaccharides and polyphenols, we're feeding those that eat fiber, polyphenols and oligosaccharides, et cetera, just in starches. And we know those ones are the ones that produce, the produce butyrate, that produce healing anti inflammatory compounds, whereas those that putrefy protein or eat bile produce ammonia. They produce a range of toxic metabolites, P. Cresol, for example, and hydrogen sulfide gas. And hydrogen sulfide gas, small amounts is fine, but larger amounts, which is what we have, when you kind of feed those species that eat sulfur amino acids and eat bile, causes a range of issues both both locally in the gut and, and body wide. Because hydrogen sulfuric acid is a mitochondrial toxin. It causes, you know, a leaky gut, it causes your nerves and your gut to become hypersensitive, called visceral hypersensitivity. Where that which is very common in irritable bowel syndrome, for example, where the nerves, you can feel little, you know, in severe, severe cases you can feel little gas bubbles making their way through your gut. And that is driven. There's a few causes of that but, but hydrogen sulfide gas is one of the causes of that. And I see that commonly in practice in those patients who have elevated levels of hydrogen sulfide gas producers will have visceral hypersensitivity. This, sometimes it takes a while to develop. And this is where I think the, the challenge can come in. Those people that have gone like animal type keto or carnivore is they're not going to feel that at first. That's going to take, take a few months before that actually builds up. Yeah, and a few months to really, really lose. You starve off enough of your good bacteria too. And it's those patients I can say from, you know, working with clinicians, with patients for, you know, 20 some years and seeing over 15,000 patients, the ones who've been long term carnivore are the hardest to get better because their microbiomes are by far the worst, they're the most damaged, the most deficient in gut bact, good gut bacteria, the richest, and some more problematic ones. But the degree of visceral hypersensitivity is often so severe that any plant food, when you first bring it back in any prebiotic Fiber you bring in, it will cause them pain and discomfort because the nerves just get triggered with a tiny little gas bubble. Now it's so severe and it's hard because you have to do so much preparatory work to try to heal that before you can bring food back in for the microbes. So it's a really slow process. And that's one of the diets that I've got the biggest issue with as a clinician because you just see the long term harm from it. Again, a week on it. No, it's not really a big issue, but you do it long term. The damage to the gut is hard to repair and the damage to the microbiome I would argue at a certain point becomes almost impossible to repair without doing, you know, fecal transplants, for example.

Wow. Wow. And we see this quite a lot actually, as you just mentioned, because hydrogen sulfide gas. So we see in one type of SIBO as well. Right, Sibo or you know. Yeah, colonic also, of course, presence of hydrogen sulfide and. Yeah, definitely. So sensitivity, like hyper, like visceral sensitivity is very pretty common. Yeah, yeah. Which is.

Yeah, it is with my patient cohort because I've been working with, you know, IBS patients for 20, nearly 25 years because that was what my honors thesis was on and PhD was on. So my, my clinical practice has always had a, a huge gap. Got a gut focus because of that.

Yeah, yeah, yeah, yeah. You, you're, you're the world renowned, you know, specialist. So of course, yeah, you have a lot of experience and so you see a lot of sibo. So SIBO patients, of course, yeah, emo, imo, sibo and so probiotics, yes or no with sibo, what's your.

Definitely yes, definitely yes. And sometimes it's always worthwhile trying to, to, to follow back the evidence and see where some ideas come from too, you know, and some of the ideas of we shouldn't use probiotics in SIBO comes from people who work for pharmaceutical companies making antibiotics. So it wouldn't be surprising if they, if they're putting out ideas, you shouldn't take probiotics because no names here. No names. And listen, it doesn't mean that there's other components too. But I think for me, because I was looking at all the research around IBS and probiotics and I was using probiotics in my clinical trials and I'd read every single study about probiotics in IBS, you know, in the early, late 90s, early 2000s, when I was doing my Research and this idea came out that, okay, sibo is a cause of IBS. 80% of people, you know, had had IBS patients had SIBO. If that was true, then it makes sense that probiotics would work because there's always been clinical trials from the 1950s showing that probiotics work in IBS. But then for someone saying, no, probiotics don't work was always like, it just doesn't make sense. If this condition is an underlying driver of IBS and probiotics work in ibs, why would they? It's illogical to think they wouldn't work in sibo. And also because I think for me, the idea of probiotics is always different than they just go in your gut and grow. It was like they produce antimicrobial compounds that reduce levels of pathogens, they can improve motility, they can change gas dynamics. Those were where my brain was coming from when this whole SIBO stuff blew up in 2005, 2006. So it's like, for me it was like, of course probiotics are going to be helpful for this. And you look at some of the literature, even at that point, of kids who were hospitalized with severe life threatening sibo were treated with probiotics and they got better. And I thought, okay, so we've got that these case studies showing dramatic improvements. Yeah, it never made sense to me that why antibiotics, why probiotics shouldn't be used in sibo. And again, you fast forward to where we're at now. You look at all the clinical studies, it's very clear they're helpful. It doesn't mean that every single SIBO patient will respond well to every single probiotic. No, and I don't think that they're a panacea that you can just use a probiotic for every patient and that'll cure the SIBO either. No, but I think the idea that we can't use them is based on old ideas and I think some industry push about where we should be going, which is obviously an antibiotic. Focus was one of the core drivers originally came out with SIBO too, was like they had to use Revaxrin. That's the only way of treating sibo back. Back in the old day. Yeah. So I think there was a vested interest that had an impact on, on how our cautiousness was around tools to use to treat SIBO too. But yeah, you know, I've done do updates every year of research on probiotics and sibo and every year there's more and more studies showing they Work. And they. They've been core part of my practice since I first started treating Sibo. And when I've worked with IBS patients, even before we know SIBO existed, I was always using probiotics as part of that, too. Yeah.

Yeah, we are. Right. We were all using probiotics and all the good things for ibs, so. Yeah, yeah, yeah, totally. Yeah. So again, using them, but knowing what you're using and you know, for what type of maybe sibo you're using them.

So.

Yeah, always with a. With a. Thinking about the action. Yeah, yeah, that's right.

Because I'm sure that if you gave the, you know, like a probiotic that reduces, like there's some probiotics that produce high blood pressure and if you give that one placebo, it's probably not going to be that helpful. You want to use the ones that actually will target the overgrowth in some way or enhance motility in some way. It's like, yeah, we can definitely use probiotics for those tasks, but just choose the right one and then don't use some random one because it's got some high numbers because it may do absolutely nothing and might even contain what it's supposed to contain too. And that's.

That's maybe like just to share one maybe that you like using for maybe methanogens overgrowth.

Yeah, yeah. I mean, I like the. The Biogaia lactose redride, DSM17938 for methane issues. I think because we have again, clinical trials showing it works for constipation. It speeds up transit time, it softens stool, and we have studies shown reduces methane output when people take it. Yeah. So I think we've got all that data and it's usually well tolerated. Not every patient will tolerate it beautifully, but it's often well tolerated. And I see that a component, a useful component of treatment protocols sometimes with kids who are. Maybe the herbs that I might typically use aren't going to be an option. I will just use pre and probiotics and have some good results in that population. Just with them. I think with adults generally will often need more than that. And the herbs often work well. But I have experimented with more tough to treat SIBO cases who haven't responded with herbs or emo cases with just mega doses of different probiotics and have had some good results too, where you see these mass productions of breath gases just from using probiotics, again, the right ones in relatively high amounts. Because when it's bacteria in the small bowel can can more easily be outnumbered by a probiotic supplement. Yeah. In the colon it's a different story where you know, one gram of poo is like, you know, 10 to the 12 bacteria in there. It's hard to shift that much with a probiotic supplement. But in a small bowel the numbers are often far less and it's actually much easier to, to modify that population with, with probiotic supplements, essentially.

That's awesome. That's really great news. And do you have a favorite probiotic? Do you have any?

All my probably practice life, the one I've used most for the most applications would be lateral from gnosis GG to lgg. And, and I think for probably a couple reasons, one, it was the, the first of the sort of modern generation probiotics and two, it's still like, you know, I've got my, my probiotic advisor dad based the probiotic with the most research studies on it on earth. The most positive research study is for the most different disease states is ldg. It actually fills a whole page of different conditions. It's been clinically trialled and shown useful for. It doesn't mean it's great for everything. It doesn't help with urinary tract infections for example, or bacterial vaginosis. Yeah, no, not so much. But there's a bunch of things it's amazingly useful for antibiotics for example, or viral gastroenteritis, which is something that we commonly have to deal with as the, if you have kids or if you have pediatrics come out of your practice and, and many other things too.

That's awesome. Yeah. And what else can we know? What else can we ask from you today, Jason? How can we become more knowledgeable into this amazing, you know, world of probiotics, prebiotics and microbiome manipulation? What, how can we study with you?

Yeah, and that's really why I've kind of moved from, you know, I've taught universities for a long time to setting up my own sort of specifically centered courses on microbiome analysts course, sort of naturopathic functional medicine approach to gastroenterology course. So I could actually really intensively train people and upskill them in these areas. Yeah. Because I think we reached that point where these, we can no longer ignore the role of the microbiome in disease states that we're seeing. So it's imperative that we become microbiome literate clinicians. And that requires us to really upskill in what tests we can do, how to interpret those tests and how to use a whole range of tools to Modify the microbiome. And that's one of my key passions, is educating clinicians in that area and also treating a range of gut conditions with, with the microbiome as a key component that you're always keeping in mind. Now like for us, you know, my institution is the microbiome Restoration center where the microbiome comes first. It's our tagline because I'm always thinking, okay, we could treat this infection or this condition by using these microbiome harming things or we could use microbiota friendly things. That might seem like a no brainer but you have to know that this thing stuff here might cause harm and you can choose other options. Yeah. So a lot of the focus is on training people and going how can we use prebiotics, probiotics, selectively acting herbs to actually cause all the changes we want to see in a range of gut conditions? And always having that the microbiome is important. We don't want to kill it as a core underlying driver because there's a lot of tools that even we have access to as people in natural medicine world that can cause microbiome harm. Dietary protocols that can cause microbiome harm is imperative that we're upskilled. So we know that. Yeah, because I think it's, it's often, it's not an intentional thing, it's an, it's a thing of ignorance where people are causing microbiome harm because they don't know that the, the berberine they're giving or the enteric coated oregano oil or the ketogenic diet they're prescribing that variant is going to cause microbiome. They just don't know. So they're inadvertently causing harm to their patients. So I'm really trying to change that.

So yeah, so we need to be more, you know, well trained clinicians. I think we need more of, you know, of course people, you know, they train with you and I can personally test you. Yeah. Testify of that that you know, your courses are amazing and you have, you have a few courses, you have at least one more basic introductory course and a more advanced level and other, of course, other courses available. So this is all available online so everybody can study from all over the world. So which is awesome. And, and what else would you like to share with us as a maybe a take home message for people listening to this interview?

I think my take home message would just be to think of yourself as a custodian of your microbiome for future generations. And I think when we sort of Embrace that custodianship role. We know when we look after a family property or our property or thinking that we're going to look after it so our grandkids and our great grandkids can enjoy this space. It's kind of like for us, we're looking after our microbiomes. We can pass it on to our kids and grandkids and they can have the microbes that they're really supposed to have. I suppose might be the way. Because we know that with Westerners we are moving towards a microbiome desert. Every generation we get less and less diverse ecosystems. And I think we're seeing the results of that everywhere we look in terms of chronic disease is due to that sort of microbial desert that we're creating in our guts. So I think it's imperative that we're aware of the things that are causing microbiome harm, aware of the things that nurture and heal and optimize the microbiome. And we're doing it not just for our health, but for the health of our kids and our grandkids and our great grandkids. Because the competency of the microbiota has changed so much in Westerners because of the Western sort of dietary protocols, the Western medications, lifestyle factors, high stress, not enough time in nature, so many things that we do wrong. All the chemicals in our food that are causing microbiome harm that we should, yeah, try to minimize that as much as we can, but just not for our benefit, which is good enough, you know, But I think it's also looking at everyone else around us as a good rationale for, for preserving our microbes in our guts too.

No, thank you. That was an awesome take home message, really Jason, and an awesome interview together. I think everybody is going to love this interview and maybe we'll. So we'll have the pleasure of sharing more information maybe in the, in the future with you again. Thank you again, Jason. It was really, really.

Ah, you're welcome. A pleasure chatting with you.

Thank you.