Dr. Will Bulseiwicz, gastroenterologist, is joined by our ambassador Emma Sutherland, to explore the holistic method of supporting a gut microbiome that pays us back by reducing risk of developing chronic disease. Dr. B. takes into consideration that we’re uniquely bio-individual to the level of our gut microbiome and a person’s health is intrinsically connected to its own unique gut terrain a.k.a. gut microbiome. Emma and Will discuss the benefits of maintaining a healthy gut lining by supporting mucus secretions such as secretory IgA and the usefulness of probiotics. In holistic fashion there’s discussion of various sources of probiotics beyond pill and powder forms and how to use them effectively in a clinical setting. Dr. B makes recommendations on how to choose the “right” probiotic for you patients and how to support this use with natural sources along with prebiotics. The discussion then moves to an interesting area of fermented foods and spore forming probiotics (typically from Bacillus spp.)
Covered in this episode
[00:32] Welcoming Dr. Will Bulsiewicz
[01:34] What inspired you to focus on this area of practice
[05:35] The evolution of germ theory
[09:35] Terrain theory and the microbiome
[12:33] Supporting the terrain via dietary fibre
[16:45] Functions of the mucous in our gut
[19:50] Probiotics and gut barrier integrity
[25:32] Choosing the right prebiotic
[32:27] Spore-based probiotics
[34:35] Emphasising small changes for long term success
[38:36] Thanking Will and final remarks
Key takeaways
- Historically, a paradigm shift occurred when penicillin was invented, which put a lot of trust into a pill that appeared to be able to cure disease. This shift applied today where our Western health system is reactive – someone falls ill and they’re prescribed a medication.
- Bio-individuality takes into consideration our unique environmental exposures, dietary and lifestyle factors that can lead to vastly different gut terrain health that directs various health outcomes. i.e. identical twins (research shows they only share 37% identical gut microbes) who are raised and fed in the same manner yet have different health histories
- Terrain theory explains the innate connection that the gut microbiota has with human health and physiology. The health of the gut terrain influences digestion, metabolism, immunity, hormones, mood, etc.
- When in balance the gut microbiota functions well to produce short chain fatty acids (SCFA’s) that support host defences and anti-inflammatory responses.
- An adequate gut mucus layer creates a barrier containing S. IgA, peptides and proteins that builds an integral line of defence preventing direct contact from exposures that can affect health. An healthy “thick” mucus layer related to optimal gut health where an eroded layer can lead to increased intestinal permeability and dysbiosis.
- Probiotics are microbes or yeasts that are clinically demonstrated to benefit human health and it is important for clinicians to know their health targets and to align those with clinically trialled probiotic strains for a higher likelihood of patient improvement.
- Both prebiotics and natural sources of probiotics should form the foundations to supporting a healthy microbiome. Natural sources can be found from fibre rich foods and fermented foods (sauerkraut, kefir, kombucha) and not only in the commercially available form of pills/powders.
- Diversity in the diet is key when consuming fibre rich foods (both soluble and insoluble) that gut microbes can interact with providing the prebiotics to help fuel short chain fatty acid production. If supplementing with mono-fibres and there are serious gut issues present start low and go slow – a sign of excess dosage or excess variety is a sudden change in bowel movements.
- A novel form of probiotics are bacillus spore-based organisms which don’t have the research history backing them such as traditional probiotics but may be an option for those who have tried other products without seeing benefit.
Resources and additional reading
Transcript
Emma: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. I'd like to begin by acknowledging the traditional owners of the land on which we record today. I would also like to pay my respects to elders, past and present.
I'm Emma Sutherland, and joining us on the line today is doctor, gastroenterologist, and New York Times bestselling author, Dr. Will Bulsiewicz, also known as Dr. B. He sits on the Scientific Advisory Board of Zoe, has authored more than 20 articles published in peer-reviewed scientific journals, and has taught over 10,000 students how to heal and optimise their gut health. Today we'll be discussing the topic of the gut terrain, host defence, and how to think outside the box when working with patients.
Welcome to FX Medicine, Dr. B.
Will: Thank you, Emma. It's a pleasure to be here. I'm excited to talk about it.
Emma: Yeah, me too. Now, you specialise in gut health. Can you share with us what inspired you to focus on this area of clinical practice?
Will: That's an interesting story. And I will try to condense down what could be...I could talk about this all day.
Emma: Yeah.
Will: So I'm just going to cut to the chase. So I started this journey into medicine when I was a teenager, and I'm 42 years old right now. And if we went back to 2004 or 2005, I discovered gastroenterology, which is my specialty now. And I fell in love. I fell in love with the different organs. To me, it's so exciting to become the expert on the oesophagus, stomach, the small intestine, the colon, the liver, the pancreas.
So I didn't really think of it as going into any gut health specialty, to be honest with you, Emma. I made the decision this is what I wanted to do, and I worked towards this goal. And I really, truly sacrificed my own health in the interest of trying to complete this goal of medical training in the United States. I was 20 kilos overweight.
Emma: Wow.
Will: And having health issues. And so that was in my early 30s, and I needed a fix. And part of this was a life intervention, I feel like God presented my wife to me. I met the person who's now my wife, and I didn't know that this was going to be so transformative…
Emma: Yeah. Beautiful.
Will: Yeah. And she was eating plant-based, and it just piqued my curiosity. And I just...I was like, “You know what, let me try.” And it started with a smoothie and it escalated, where slowly over time, like years, my diet transformed into a plant-based diet. And as this was happening, I was paying attention to the science of the microbiome. And the science was explaining what happened in my life, because I lost 20 kilos. I got rid of my blood pressure problem and my cholesterol problem. I got rid of my depression issues by changing my diet.
And I started to understand, I was the doctor, but I was also in a way became the patient. I needed the help. And what I discovered was, wow, what happened for me was probably because of my gut. So that is what inspired me to start this journey that this was not a plan. I didn't know this was going to happen. I just started a social media account, and then I started to do podcasts much like yours. And actually, a big moment for me was 2018 when I went on Simon Hills' podcast in Australia.
Emma: Ah, yes. Yes.
Will: And it went viral.
Emma: Yeah, I've listened to that.
Will: And that podcast from 2018 is what allowed me to get a book deal. And then the book deal turned into my first book, Fiber Fueled, which is now 300,000 books sold.
Emma: Yeah. Well, we're all very grateful that you ended up on this journey. And your story is also about the power of food as medicine, which is one of my passions, the incredible impact that food has on our bodies.
Will: Yeah, I completely agree. And I think that what it comes down to is I want people to understand that you are the product of your environment, and there's so many elements to this environment. But part of the environment is actually your food choices and that food, all of it is going to come into contact with your gut microbes. And it's going to shape what your microbiome looks like.
And the issue is whether we're talking about supplements or medications, either way, the reality is that a couple of milligrams is not going to overpower the kilogram of food that you ate during the day. So the point is that we should really look to get to the root of what is affecting our health.
Emma: Yeah. I love this holistic framework because this is exactly how as clinicians, integrated clinicians that we view things, which is great.
Look, I'd really love to set the scene a little bit today. So, we have the germ theory from Louis Pasteur, which says pathogens take up residence in the body and cause harm. And then we have the terrain theory by Antoine Béchamp, which says, the health of the individual will dictate how severe an infection will be. Now, I feel, personally, that as clinicians, we tend to have a focus on eradicating microorganisms from the gut instead of actually harnessing the power of the gut terrain itself. But I'd love to know what your thoughts are with this.
Will: I completely agree with you, and I think that to build upon the historical elements that you nicely laid out there, the reality is that Louis Pasteur's work was completely transformative because people did not — and we're not even talking about that long ago. We're talking about the 1860s. Okay? So, this is less than 200 years ago, where prior to this, people thought that when we got sick, like for example, the plague in Europe, when we got sick, they thought it was this supernatural phenomenon. They didn't understand that there was actually a scientific explanation for what was happening.
Emma: Right.
Will: And so, Louis Pasteur opened our minds. Around 1900, the top causes of death were not heart disease and cancer. They were all infections. And we didn't have many tools at that point to really fight those infections. We're talking about things like influenza and gastroenteritis, meaning that you have diarrhoea from bad water or pneumonia. You could imagine, Emma, where all of a sudden, right around World War II, we discover penicillin. Imagine how much your mind would be blown if you realised that you could put a pill into a person's mouth and actually kill the number one source of death and disease affecting them. That was insane for that period of time. And the problem is that we became so seduced by the power of the pill.
Emma: Yeah.
Will: And so convinced that the way to win was to kill rather than to build up. That we spent the next 60-70 years bringing us really into the 21st century. We spent this entire time based upon this premise, “If it's bad, kill it.”
Emma: Yeah.
Will: Take the pill. The pill is stronger than anything else. And what we lost in the process, what we lost sight of, is that if you lean into your daily habits, your daily diet and your lifestyle, you have the power to prevent disease because you're getting to the root of the issue in the first place. You're preventing it before it ever happens. And that is always more powerful and that is always preferred instead of waiting until you actually have a crisis on your hands and trying to correct it with some medication or some surgery or some antibiotic or whatever it may be.
Emma: Yeah. The true definition of preventative medicine right there.
Will: Absolutely. And the problem is that we built our healthcare systems, and I believe that this is true in the entire industrial world, including the U.S., including Australia, including UK. We built reactive healthcare systems. We wait until you're sick, and then the doctor like myself shows up with a prescription pad, and gives you something that gets you out of the mess. And the problem is that we would be saving a lot of lives, a lot of money, and we would have happier and healthier populations if we started the intervention much earlier in the process. Don't wait until people are sick, do it now, do it today. And that's part of what my message is to the listeners who are hanging out with you and I right now is, today's the day. We can start. Let's do this and let's build a healthy life. And it's not about something radical. It's not about having to be perfect. It's quite simply make one choice today that you think is good for your body that you deserve. And if we do this day by day, we're going to start to build some amazing habits that are going to change our lives.
Emma: Yeah. Now, I would really love to deep dive into this concept of the host terrain and how we can influence this to optimise gut health. So as clinicians, what can we do?
But first of all, let's just back it up a little bit. Can you talk us through what's meant by the terrain, and what constitutes the terrain?
Will: Well, I think that the way that we think about this is to first acknowledge that there's such tremendous bio-individuality. We're so unique. And you can see this reflected in identical twins, where they have the exact same genetic code, they come from the same parents, and in most cases, they're raised in the same home, eating the same meals. And yet they can have very different health outcomes.
What is this? What explains this? And that's what leads us into a conversation about the terrain, or if we want to speak about the microbiome. Because what we have discovered is that covering your body everywhere, are microbes. And so these microbes, they coexist with us. We have what we would describe as a symbiotic relationship, meaning that we do things to help them and on the flip side, they do things to help us. And if we think about human evolution, there was never a moment in human history where we were missing the microbes. They were our partners through it all.
And when you think about these microbes, specifically and most importantly the gut microbes, these microorganisms live predominantly in our colon and they are deeply intertwined with human physiology. We need them in order to properly digest our food, in order to optimise our immune system, and maintain our metabolism and balance our hormones and maintain our mood, our cognition, our memory, and even the way in which we express our genetic code.
So going back to the twins, you could have two identical twins and they could have different medical issues. And the reason why, is not genetic. They have the same genetics. The reason why is because they have different microbes, and the research shows that even in identical twins, they always share about 37% of the same microbes. So they are more different than they are the same.
And so when we speak about the terrain and the terrain theory, the idea here is that there are these microorganisms that cohabitate with us and that they play a really central role in human physiology, again connected to digestion, metabolism, immune system, hormones, mood, brain health. And when they're in balance and they're in harmony, they're able to do their job the way that they're supposed to. And the issues that come up are many times because there's a loss of balance within the system.
Emma: Yeah. I think this concept of the symbiotic relationship between humans and microbes is fascinating. And particularly how critical those microbes are for digesting food, maintaining metabolism, balancing hormones, maintaining mood. We cannot survive without them.
So, as clinicians, how do we help support that terrain? Clinically, for example, I see many patients with low secretory IgA and it really makes me wonder about that interplay between secretory IgA and host defence. Can you give us your thoughts here on secretory IgA and host defence?
Will: Well, our body produces different types of these immunoglobulins. There's many different types. IgA is predominantly produced in mucus membranes, and that would include within your gut. And that's where this becomes very relevant to our immune defences within our gut is specifically this IgA. But there's other types that people have heard of, which include IgM and IgG, which are antibodies that are created in response to some sort of stimulus. It could be a virus, like it could be COVID, right?
Now, this IgA is connected to these microbes that live inside of our colon. And so there's varying levels of what people can have, but I tend to agree with you that I think that one of the issues that exists is that when we are out of balance with our microbiome, it can ultimately affect these other elements, one of them being secretory IgA. But I would also bring into the equation other elements to our immune system and the way in which our immune system interacts with these microbes.
I think that the real take-home story from my perspective is that it's nearly impossible to separate the microbiome from our immune system. And when the body is in balance, meaning that the microbiome is in balance, when that's the case, then these things are working the way that they're supposed to, which includes secretory IgA, but also other elements of our immune system in order to maintain that balance and protect us, not just from viruses, but also protecting us from ourselves and excessive amounts of inflammation that can be problematic over decades.
Emma: Yeah. Inflammation is absolutely one of the big root cause drivers of chronic diseases and it does begin in the gut in many cases that we see in clinic.
Will: Yeah. I think that's very true. And I think that part of it is that the gut is designed in a way when we are properly supporting these microbes, they are able to produce the anti-inflammatory molecules, specifically, I'm referring to the short-chain fatty acids. And these short-chain fatty acids are effectively the way in which the microbes are able to communicate to our body. And so we really want our microbes to be cranking out like a chemical factory, these short-chain fatty acids, which have anti-inflammatory properties and help to keep our immune system in check. And in order for that to happen, you need a healthy gut and you also need to support that gut with dietary fibre because dietary fibre is the precursor to the production of short-chain fatty acids. So this is where you asked like, for as a clinician, how do we approach this?
Emma: Yeah.
Will: And I think where it begins is diet. Because, you know, I'm heralding fibre as the precursor to these anti-inflammatory short-chain fatty acids. You need the fibre in order to make them. And in the United States, 95% of people are deficient in fibre.
Emma: Wow.
Will: And it's not quite as bad in Australia, but it's still bad. 85% or so of people in Australia are deficient in fibre. So, we have a problem where we're just not doing what we need to from a dietary perspective in order to support these microbes, which in turn support our body.
Emma: Yeah. Going back to that symbiotic relationship in the give and take between the host and the microbe, it's essential that we have this dietary fibre coming in at certain levels. But what about that protective mucus layer that lines the gut itself, the mucus secreted by the goblet cells? What are the functions of that mucus layer? It's a structural thing, but is it functional as well?
Will: It is functional. So, if we were to zoom in with a microscope and take a look at the lining of our gut, what we would see, first of all, is that there's a single layer of cells called the epithelial layer. And this separates the lumen, meaning the inner tube of the intestine from the body. And it's intended to be a barrier, on one side of this epithelial layer is your gut and your gut microbes. And around this area, there is the mucus layer that you're referring to. And this mucus layer, it includes specific microbes that actually we don't tend to pick up when we do stool testing.
Emma: Okay.
Will: Because they're built into the mucus layer. So they're not necessarily moving through, they're staying more present in the mucus. We may get some shedding of them, but for the most part, it's more challenging for us to detect them. And in addition, this is where you may find the secretory IgA and other sort of peptides, proteins and other biologic products that line the intestine and are located in this general area.
The mucus layer is intended to be part of our protective barrier. So when it's healthy and thick, which actually comes from having a healthy microbiome and a healthy diet, when it's healthy and thick, then this is another layer that helps to protect us from pathogens or things like bacterial endotoxin, which are produced by some of the microbes. Bacterial endotoxin is something that actually triggers inflammation in the body when it gets into the bloodstream.
So, this is all part of the gut barrier complex that exists, part of it is the microbes themselves and the microbes being in balance. When they're in balance, you have more good guys than you have bad guys. When they're in balance, those microbes are being fed and producing short-chain fatty acids. And then part of this is the physical anatomy, which includes the mucus layer as well as this epithelial layer that is fused together with these tight junction proteins to prevent what many people would describe as leaky gut. so what we want, I'm describing this as balance and the technical term that a person would use is eubiosis. And eubiosis basically means that things are in harmony and that you don't have increased intestinal permeability. The flip side of eubiosis is dysbiosis, which many people sometimes will use the term ‘leaky gut.’ But I prefer to describe it as dysbiosis because sometimes there are some differences between leaky gut and dysbiosis.
Emma: And are there specific probiotic strains that help maintain the barrier of the gut lining?
Will: There are, and the term probiotic, I think that we need to expand our understanding of this term because, when we think of probiotic, I think almost all of us immediately have a mental image of a powder inside of a capsule that we're going to swallow.
Emma: Yeah.
Will: And that is a probiotic. But additionally, when we ferment food, fermentation is the process of transformation within food that occurs as the result of processing by living microbes, specifically and typically a combination of bacteria and yeast. But here's the point though, a probiotic is a living microorganism that has been demonstrated in clinical research to have benefits to humans. So there are many, and some of them are ones that are commercially available to take as a capsule.
But again, if you consume fermented food, there are probiotics in there. And within your body, there are probiotics that already exist, that are already present, and we can support them and build them up through proper dietary choices. And this is not to discourage or reduce the value of taking the probiotics in capsule, it's more to say that I actually think that we should be doing a combination of all these things. So, I think that we should be supporting the microbes that live inside of us with prebiotics.
Emma: Yeah.
Will: Prebiotics are the nutrition that support microbes. So we should support those probiotics that are already there, build them up. But number two, we should also be consuming fermented food. There's research that's come out in recent years suggesting that by simply adding more fermented foods to your diet, you can increase the diversity within your microbiome and reduce measures of inflammation. So I sincerely believe that we should all be consuming fermented food. This can be challenging, by the way, for people that have histamine intolerance, but that's not the majority of people. The majority of us should be adding fermented food. And then the third thing is the role of probiotics that come in the capsule form.
Emma: Yeah.
Will: And there are many different types, and it can be quite overwhelming trying to figure out which one to take. So, let me just share briefly the way that I tend to approach this as a gastroenterologist. When you are taking a probiotic supplement, from my perspective, in the vast majority of cases, there should be some sort of motivation that you have. There should be a reason why you're doing this, like, “I want to reduce bloating,” or “I want to improve my irritable bowel syndrome.” And so these are examples of a specific goal that you have in mind.
The first step is to say, “Okay, now that I know what I'm trying to accomplish, is there a probiotic that has been demonstrated in clinical research studies to improve this specific issue that I have?” And if the answer is yes, then that's the one that you want to start with because it's been shown through ideally, a clinical trial that people benefit from this probiotic for that particular reason.
So, regardless of whichever probiotic you end up trying, it's impossible to know whether this is going to work or not work until you try. So, there has to be an element of trial and error, I typically will recommend that you try it for a month or two. And you pay attention to your symptoms, and if they improve, it's working. And it's integrating with your unique microbiome in a way that's beneficial.
Emma: Yeah.
Will: But on the flip side, we have different microbiomes and it's impossible to know, even if something's proven in the clinical trial, it's impossible to know whether or not it's going to work for you.
Emma: Yeah. Essentially, Dr. B, you're saying, first and most importantly, define the goal. Work out exactly what it is that you are aiming to treat with your patient. Next, find a probiotic strain that has clinical evidence of benefit and is obviously more likely to give a positive outcome. Trial it for a month, grade your symptoms before and after, and see what, if any benefit it's been. If there has been a benefit, continue. If not, discontinue and work in a different way.
Because it can be a minefield. Often patients come in to see us and they bring in a bag full of supplements and probiotics and all kinds of things. And as clinicians, we really have to help educate our patients on strain specific probiotics and the research that is behind them, and therefore more likely to work. But I think it comes back to if you're not doing the basics such as eating fibre and fermented foods, then it's really the icing on the cake most of the time.
Will: Yeah. I think, Emma, that if you have a C minus gut and you're not taking advantage of the opportunity to enhance your diet or enhance your lifestyle, sleep, exercise, time outdoors, stress reduction, if you're not taking those opportunities and you're just taking a probiotic, the reality is you're not going to go from a C minus to an A plus by taking any supplement.
Emma: Yeah.
Will: But supplements definitely have value. There is no doubt. I've had many patients that have benefited from probiotics, from prebiotics and from other supplements. The key here is, the foundation is the diet. And the other thing is, not all probiotics are the same. So, you go to your doctor and you say, “I tried a probiotic and it didn't work.” The question for me is, which probiotic? And that doesn't mean the other probiotics won't work either. That just means that that one probiotic didn't work.
Emma: Yeah, exactly. That's right. And I wanted to dive into prebiotics because I'm fascinated by this world because I feel we all need to know more about it. And I was reading a recent review from 2021 that looked at the bidirectional relationship between immune cells, gut epithelial cells, and intestinal disease development. And it suggested we should think of the epithelial cells as the moderator between the microbiota and the immune system, which we spoke about before. But I specifically wanted to discuss the use of prebiotics in this space. And in 2017, the International Scientific Association for Probiotics and Prebiotics amended the definition of a prebiotic to a substrate that is selectively utilised by host microorganisms conferring a health benefit.
How can we use different types of prebiotics to help support gut health? As clinicians, we are looking at partially hydrolysed guar gum, we've got FOS, we've got GOS. There's so many for us to choose from. How do we know which one is best for what?
Will: Well, that is a really good question. And there's a complexity to it because much like the probiotic, if we're going to get into individual mono fibres. So mono fibre, meaning that it is a fibre in isolation that in a way has been purified and then put into a supplement.
Emma: Yeah.
Will: And by the way, I think this stuff is great. I personally use them on a daily basis and I don't use them to try to fix problems, I use them because I want to prevent problems and I wholeheartedly believe in the science.
Emma: Yeah.
Will: But if you want to know, which one should I reach for? Once again, what we come back to is the conceptually similar to the probiotic. You have to ask the question, what am I trying to accomplish? Am I trying to accelerate bowel transit and improve constipation? Am I trying to improve diarrhoea and actually form up the stool? Am I trying to address bloating and other food intolerances? These are different questions. These are different goals. And so specific prebiotic fibres may have added benefit or specific benefit to specific issues. Now, that being said, let's just make a general statement about different types of fibre.
Emma: Okay.
Will: Because fibre is a carbohydrate. It is a series of sugar molecules that are linked together in a highly complicated way. And it doesn't get broken down into sugar. In fact, your body lacks the enzymes necessary to break down fibre, which is one of the key features. Because since you can't break it down, then you know that the fibre will come into contact with your microbes.
And fibre is so intensely complicated from a biochemical perspective, even scientists have thrown their hands up and said, “We don't know how many types of fibre exist in nature. We just don't know. But we do know that there are these two main types, soluble and insoluble.
So, the behaviour of these two types of fibre is a bit different. Soluble fibre tends to be the fermentable fibre. And what that means when we say fermentable is that your microbes have enzymes that they can use to break down this fibre.
Emma: Okay.
Will: This is why some people when they change their diet and they start eating more plants, they may experience some bloating in the very beginning, but then after a couple of weeks, that gets better and it goes away. This is because their body is adapting to the dietary change they've made because they're eating more fibre. And so this soluble fibre is the kind that ultimately gets transformed into the short-chain fatty acids that about 15 or 20 minutes ago, I was heralding as being these anti-inflammatory molecules. So, we want the soluble fibre.
Now, the insoluble fibre is the type of fibre that's less active in terms of microbiome, but it does play a role in terms of maintaining our bowels and our bowel movements and keeping things moving through.
Emma: Yeah. Okay.
Will: And that's very important. So, every plant has fibre, every plant has many different types of fibre, that include both of these things that I'm describing, soluble and insoluble. But what is interesting is that these different types of fibre will feed different families of microbes. And so this is why we see, you can't say that partially hydrolysed guar gum is the same as acacia powder.
Emma: Okay.
Will: Or inulin. They're different because they're different forms of fibre. So, the key concept is this: from a dietary perspective, don’t worry about getting one specific type of fibre when it comes to your diet. Instead think about getting as many types of fibre as possible because when you have many types of fibre, meaning that you are consuming many varieties of plants, you are actually providing a nutritionist source, an energy source to many different families of microbes. A diverse diet will feed a diverse gut microbiome, and a diverse gut microbiome is exactly what we want to have because that is a resilient, strong microbiome.
When it comes to supplements, start low. If you have serious digestive issues, that could be literally a quarter of a teaspoon.
Emma: Yeah. Yeah.
Will: And then slowly work your way up from there and allow your body to adapt and see how you feel. And when it's working, you're going to know. And the way that you know is, it could be symptoms, but the other thing that's great is if fibre is doing its job, you're going to experience a change in your bowel movement.
Emma: Yeah, I have to say...
Will: And you have like...
Emma: One thing, Dr. B, that...
Will: Go ahead, Emma.
Emma: Yeah, one thing that patients often will say to me when we are working in this space, they come back and they're amazed. They're like, well, I'm actually having a bowel motion twice a day. It's type form. I'm kind of voiding completely. And they look at me and they go, where was all that going before? They're just gobsmacked about how much their bowels are actually going now.
Will: That to me is a beautiful thing.
Emma: Yeah.
Will: Because the body was meant to be in rhythm. Your gut was designed to regularly pass bowel movements. Now, I don't want to stress people out where they are like, oh, well, I'm not pooping as much as Dr. B says I should.
Emma: Yeah.
Will: There are many different ways that if you feel good, that's okay.
Emma: Yeah.
Will: But I think the point though is we all think that pooping once a day is normal. And I would say, no, that's not normal. That may be normal in 2023, but during the course of human history, we were probably pooping two, three, four times a day because we're getting so much fibre.
Emma: Correct. Yeah. It may be normal in the current diet, the Western diet, to not be voiding your bowels more than once a day. But yeah, that makes complete sense.
And I wanted to ask what you thought of spore-based probiotics. What are they, and do you find them useful or not?
Will: Spore-based probiotics are specific types of microbes, bacteria. The kind that we're referring to tend to be from the family bacillus, and the idea here is that the microbe actually can exist in different forms. You can almost think of it like in the U.S., we would call them roly poly, or you could think about something like an armadillo. I'm trying to think in my mind of an Australian animal that fits like this. But the point I'm trying to get at is, think of an animal that rolls into a ball...
Emma: Yeah.
Will: ...to protect itself. And so that's what the spore-based probiotic is, is that it can roll into a ball to protect itself and it becomes more hardy and resilient when it's in that form.
Emma: Okay.
Will: And then it will open up and no longer be in this ball formation and then can do its effect as a probiotic.
Emma: Okay.
Will: The thing about spore-based probiotics is that they're a unique class of probiotics. For some people, they're going to find that these work better for them. The amount of research on spore... There're a newer entry into the market of probiotics, so we're not seeing as much research. There's not as much research on these specific types of probiotics yet. It's coming. We'll continue to see more. And I am very open-minded to the idea that if you try this and it works, and you feel better, that's what you need. And it doesn't matter whether there's a clinical trial to back that up.
Emma: Yeah.
Will: So that's the way that I feel about it. And I think these are fair to try as a part of that trial and error approach that you and I are discussing.
Emma: Yeah, exactly. And particularly if patients have not had positive benefits using other probiotic strains, this could be a more novel use for these bacillus spore-based probiotics for those people.
Will: Exactly. Because they're a little bit different. So I think that little difference that exists there, for some people, they may prove that that is very relevant to them and beneficial. That's a great thing. I celebrate that.
Emma: Yeah. Yeah. Exactly.
Will: And one of the things that I want to bring forward is our body is not just like, “Hey, more of this is always better.” Our body is instead like, “Hey, this is the sweet spot that we want to get to with all of these things.” And so with dietary fibre, with fibre in general, when you change your diet, you should be prepared that you may experience some symptoms. And that's not a long-term thing, that's a temporary thing.
Emma: Yeah.
Will: And the reason why that's happening is that it comes back to something you and I discussed that I want to emphasise as we're about to close out. We are 100% dependent on our microbes to digest fibre. So if your microbes are not in a good place, like you are the person who has irritable bowel syndrome, or Crohn's disease, or ulcerative colitis, and they're not in a good place, when you add more fibre to your diet, you are asking them to do more work and they're struggling to do this.
Emma: Yeah.
Will: When you add more fibre to your diet, I like the expression, start low, go slow. So, when you gently introduce a little more fibre, you are changing, you are changing your diet, but it's a small change. And your gut microbes are more likely to keep up with small changes. And so they will adapt. And they will catch up. And they will become completely comfortable with this small change. And then you add another small change. Your gut is so adaptable, it is so capable of transforming and becoming stronger. And this is the process.
And it's much like exercise. When you go to the gym, you wouldn't start out with the heaviest weights on your first day in the gym. You would start with the amount that you're actually capable of doing, and when you work, you get stronger, and then you come back in a couple of days and you can work a little bit harder. And the same is true with your gut. Your gut is a muscle. It can be trained. It can be made stronger. And the process is very similar to exercise, which is start low, go slow, gently increase your fibre over time, give your gut a chance to come along for the ride with you to adapt to what you're doing, and you will not experience those symptoms that I'm describing. And your gut will get stronger. And what you will discover is that over the course of time, your ability to process and digest your food will improve and you will notice the health benefits in terms of how you feel.
Emma: And I think that appeals to our patients' ability to integrate change and to get compliance from our patients, to do it step by step with them rather than asking them to go from zero to 100 in one go. That you're not going to get compliance continuously and long-term with that approach. So I love that strategy, Dr. B.
Will: Emma, I kind of feel like the direction towards health is not that mysterious.
Emma: Yeah.
Will: There are many forms of a healthy diet. There are many forms of a healthy lifestyle. But quite simply, when we construct these things, what it looks like when we say many forms, again, not one size fits all, but we're talking about a diet that includes a lot of plants, a lot of variety of plants, a lot of fibre but ideally, we're really minimising the ultra-processed foods.
Emma: Yeah.
Will: We're getting our sleep, we're moving our body, we're engaging with other humans and being social, we're working on our stress, we're spending time outdoors. These are the basic tenets of a healthy lifestyle. And I think we all know that. And so the problem is that it's not that easy to do and we need a process for how to get there.
So, let's focus on how do we get there? What does the journey look like? How can I be successful? How can I deal with it when I have a bad day? And ultimately, through perseverance and persistence and consistency, you will build yourself up to a point where you are capable of becoming something that's incredible, but in order to get there, you have to take this journey and take it one step, one day at a time.
Emma: Yeah. So true. Goodness me, thank you so much for joining us today, Dr. B. I have so many key points, but I think my top three, ooh, okay, so the critical role of the gut terrain and how we as clinicians, we can really use targeted therapies like dietary fibre, fermented vegetables, specific pre- and probiotics to harness that host defence and strengthen the gut.
Secondly, how prebiotics can be utilised to influence the gut towards a more anti-inflammatory profile. And thirdly, diet and hence fibre diversity is key for a diverse microbiome. I think they're my three key takeaways. Dr. B, thank you so much for your time today.
Will: Thank you so much. I completely agree with those three key takeaways.
Emma: Yay.
Will: And it's exciting. This is a great time because we are more empowered with information than we've ever been in the course of human history.
Emma: Yeah.
Will: So it could be so simple as, hey, sometime this week take a meal and let's add more varieties of plants to that one meal.
Emma: Yeah.
Will: And you know what, I'm dancing with joy. I'm so excited for you.
Emma: I love that, the cheer squad on the side-lines. Thank you, everyone, for listening today. Don't forget, you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website, fxmedicine.com.au. I'm Emma Sutherland and thank you for joining us. We'll see you next time.
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