Gut Health And Probiotics With Dr. Jason Hawrelak

Gut Health And Probiotics With Dr. Jason Hawrelak

We discuss how:

– Dr. Jason Hawrelak is the head of research at probioticadvisor.com
– He has focused his research on microbiome, probiotics, and everything to do with gut health
– He became passionate about it because research was just at the tip of an iceberg when he started
– In the last 20 years there’s been an exceptional rise in the field
– Now the link between gut health and autoimmune diseases has become accepted even in mainstream publications
– Gut integrity and a healhty microbiome are pivotal to good health
– The technology currently available can provide much more information than before
– In this episode you’ll learn all about probiotics and their use in autoimmune conditions!

Clint Well sometimes you have guests on the show that you look forward to for many weeks in advance. And today is a great example of that. Inside Paddison program support, we’ve had more than a few people recommend that I get today’s guest on the podcast. He’s an expert when it comes to the microbiome, probiotics, and everything to do with gut health and his clinic has been set up to treat people with these kinds of intestinal disorders. His name is Dr. Jason Hawrelak and he’s the head of research at probioticadvisor.com. His passion for gastrointestinal health and the GIT microbiota and probiotics was ignited during the final year of his undergraduate training and subsequently, Dr. Hawrelak did his first class honours degree and PhD degrees in the area of the gastrointestinal microbiota, irritable bowel syndrome and the clinical applications of pre and probiotics. He has written extensively in the medical literature on these topics including 16 textbook chapters and his research has been cited over nine hundred times. So thank you Dr. Hawrelak for joining us today.

Dr. Hawrelak You’re very welcome. It’s a pleasure to be here.

Clint This topic is so massive. You know it’s one of these things where I would love to be next to you on an aeroplane between here in Perth and have five hours to talk about this stuff.

Dr. Hawrelak And I could speak about it for five hours straight without much gap. Definitely.

Clint And in fact this is how your suggestions as a guest have come about quite frequently because my clients have attended your seminars and have gained so much out of your seminars where you present on this topic.

Dr. Hawrelak Great. That’s lovely to hear.

Clint Yes. And the feedback has been wonderful and they’ve wanted to have you share to a greater audience. So, first of all, how did you become so passionate about gut health?

Dr. Hawrelak Good question. And unlike many people wasn’t because my own personal health issues Recalculated (inaudible) one of my strong systems my lung. My lungs are arguably the weakest system but essentially at a lecture in my final year I’m (inaudible) training and in fourth year gave a lecture around an increase intestine permeability and dysbiosis which were constants widely discussed and by a naturopath. Probably for 15-20 years even prior to that but weren’t widely discussed in the biomedical community and the lecture was just inspiring to me going you know this is something I want to delve into more because he was just really talking about the fact that we’re just at the tip of the iceberg and we need people to delving deeper and I was like Yes please, yes please I put my hand up I want to be one of those people. So I approach him right afterwards and said hey I’m very counting my honours research in this area. And then that flowed straight onto my PhD as well so and it just was like a perfect match from my perspective in terms of once I started delving into the research. This was like this is what I want to do, is what I wanna be doing. And just 19 years on 19 years plus I still find great enjoyment from reading papers on intestinal permeability and gut microbiota and probiotics and prebiotics and ways we can alter that. That got ecosystem and it’s just been phenomenal to watch the rise of this field from being much more fringe you know going back nearly 20 years ago to now where it’s widely talked about by mainstream media for example. And mainstream television networks having shows talking about it. So it’s been amazing to see that sort of New York rise in that time period.

Clint Yes I just in the time period that I’ve been paying attention to such things. I got diagnosed with RA in 2006 and in that year I think I saw a bunch of different naturopaths and one of them talked about leaky gut and so forth. And it was the first sort of exposure I had to that concept. And then as I read you know some scientific papers certainly not the extent that you do but just as it as a layman just reading some of these things. I’ve noticed that it’s become more and more acceptable and mentioned in some of the first tea like the very highest level medical journals that are behind autoimmunity. So we’ve gone beyond the fringe as you said and into the mainstream.

Dr. Hawrelak Yes hugely so but it’s still in passing coz you still get patients who are still sort of some medical committee is brought out on TV occasionally like wooh there’s no such thing as leaky gut. Have you not read papers in the last 20 years. It’s just you could say that 20 years ago and I could say yes. You’d have to search for the literature to find it whereas now with the link between obesity, type 2 diabetes, autoimmune diseases to name just a few and got increased permeability the data is so there and so widely published that it’s hard to see people. Now you see it as putting their heads in the sand and then trying not to look for information. Yeah. Because you’re right. It’s there and it’s in every mainstream journals and high impact mainstream journals.

Clint How do you say, how do you implement what you’ve learned over all this all these years into your clinical practice and how do you help people?

Dr. Hawrelak Yeah I mean it’s been… I think back to how I practice you know 15, 18, 19 years ago. It’s like things evolve as they should. And so for me though looking after the microbiota has always been a core concern of my practice and looking after it after got integrity and I think research  has evolved in my clinical experience has has broadened and I’ve gotten a lot more experience obviously as time progresses and technology that we have access to its conditions have evolved as well as meant that the way we treat now is so much of them before. But I still see the maintenance of good gut integrity as being pivotal to good health and I see the maintenance of a healthy microbiome as being pivotal to good health. And I think what’s really change is we just have more data on how to achieve that now particularly in the realms of microbiota alteration and and importantly we have my self as a clinician have access to tools to assess the microbiota in much greater detail than I would have 10 or 15 years ago with the tools that we had were far more crude and you know we would do as to analysis of a tell you but like six different gut species six out of one hundred and sixty or so he might have I get that but that was the best we had access to back in the day. Whereas now we have tests that can tell us about the entire bacterial composition of that ecosystem and many of these species we actually don’t know what they do because it’s just recently been discovered and we can say hey these things exist, we know they existed before because our technology has improved it’s going to be another ten years before which is that what some of them do or 15 years. So I think it’s whilst we’ve come a long way there’s still a long way to go. Sure but because we do have a greater capacity to look at that ecosystem now it means that we can, researchers can see the impact of interventions from a dietary perspective, lifestyle perspective probiotics etc. on that ecosystem and even things like medicines and then also as a clinician I can see firsthand you know after treating hundreds of patients looking at microbiota pre and post you start seeing patterns and you start seeing what works well what’s been brought from the clinical trial realm into the clinical practice from successfully and what things don’t translate that well.

Clint And this other test those, sort of the samples still stools that are being used and it’s just the way those stools are being interpreted that provides the more detailed information?

Dr. Hawrelak Yeah the old technology that essentially went from the late 1800s to late 1900s was culturing, where you would you take the poo sample and you spread it into a petri dish with some growth media and you would look to see what would grow. Essentially and you try growing in different types of media and different environments some with oxygen some without and then  we’d expose it to different chemicals and we would see what it looked like what it smelt like what it did and then classified as a (inaudible) or an ecoli or something along you know some subspecies based on those characteristics. It was very time-consuming process for one but most importantly from early 2000 onwards we realized quite clearly that that technique was insufficient to see most of what was there. And because instead some research comments suggesting that maybe we can call to 30 percent of the species (inaudible) someone’s got at most 30 percent sediment. But we’re missing it and some people argue is even 90 percent of what people or where species are present people’s guts we couldn’t actually grow using that old technology.

Dr. Hawrelak So when we started shifting to using a technique called 16 SRRNA essentially using a bit fragment of DNA that all bacteria share but it’s unique to that that genus. So I’ll go back to Woody’s will have a different barcode to give the bacteria which have a different barcode to (inaudible) for example. And we just look at the amount of that barcode in someone’s stool when we work out OK well back towards makes up 30 percent of that person’s ecosystem bifido bacteria 15 percent. And then we also see that there’s a whole bunch of barcodes that match no known species to be able to grow before. So some of them some of these have been named some haven’t been named but we’re still teasing out what characteristics they have and what roles they play in the gut. But it is that change of technology that allowed us to see what was going on in much greater depth because previous studies and I can think of a study in rheumatoid arthritis specifically that I think illustrate this well. And you probably saw with the research that was using you know fasting and raw food vegan diets for improvement of RA. And I think it was in the early 2000s that some of the research teams up in the Nordic nations where this was a common sort of helpful, somewhat common way of treating RA decided like hey maybe that’s changing the microbiota so let’s look, and they use culturing and they couldn’t see a difference from taking people to a Western die so that raw food vegan with lots of fermented foods. And they said wow we can’t actually see a difference here. Using that the traditional techniques culturing but they did a novel technique which was looking at I think was fatty acid profile and the (inaudible). And with that technique, they said there were massive differences between essentially said that this dietary approach completely changed his quality of life and symptom profiles et cetera. And it looks like it changes the ecosystem but not with the techniques that are commonly used. We need to develop new techniques to see what was there and that’s really what rolled out for the early 2000s and now we know that those sort of dietary approaches can make a dramatic shift in someone’s ecosystem. And the data from the 1960s and 70s looking at dietary interventions and impact in the microbiota was just too crude the tools we’re using to actually make and see what was going on.

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Clint Well that’s very enlightening that we have these tools now, and the challenge that we have as patients is once we go to a clinic such as you biome just to one that I’ve used personally is the interpretation of it. I mean you get the results and it’s just mind-blowing, it gives you all of these very difficult to pronounce bacterial strains and it shows you a comparison between what your stool composition looks like to all the other folks who have a healthy apparently healthy lifestyle. And it’s very hard to interpret what to do with those. In your clinic what do you see between a relationship between someone who say has Crohn’s disease and of course I want everyone to appreciate that when we have a bowel disorder an intestinal disorder with rheumatoid arthritis these are the same sort of internal problems that we suffer. So if we learn from Crohn’s we learn from other similar health challenges then it can be implemented into a case of rheumatoid arthritis or somatic arthritis or so on. So what do you see in terms of the severity of symptoms and the link between people’s microbiome? And is there any pattern that’s always showing up that you’ve learned that is a red flag in terms of their bacterial balance?

Dr. Hawrelak I would think for many conditions and in my practice is very much GIT basis or (inaudible) IBS small tests for bacterial overgrowth, peptic ulcers disease, celiac disease, fructose intolerance, lactose intolerance, so they would make up the bulk of who I would see in practice. And there are some commonalities that I think would run through a lot of those and maybe with the odd exception like celiac. Where low levels of betray producing bacteria that is a pattern that tends to run through those disease states, and often high levels of hydrogen sulfide gas producers would be another group of bacteria that pattern would run through Crohn’s, (inaudible) irritable bowel syndrome is well for example.

Clint Right, okay. Now if we just try and relate that information onto what most of us appreciate on a simple level which is that we kind of has good bacteria in so inverted commas and bad bacteria. And we read on probiotic bottles when we buy them that something is a lactobacillus acidophilus or lactobacillus X Y and Z. So how does that footprint of knowledge match with what you’ve just said?

Dr. Hawrelak Not too much, because the probiotics that we have access to are generally based on two different genera Lactobacillus and Bifidobacterium. And that’s perhaps a bit of a quirk of fate in terms of what was isolated you know 50 hundred years ago from people’s guts and in fermented foods that we sort of stuck with those two genera. Despite the fact that they are important to relatively small players in the overall gut ecosystem versus something like (inaudible) producing bacteria. In many people and in its healthy populations makeup 40, 50, 60 percent of what’s there. Whereas lactobacilli in a healthy person are 0.01 percent of what’s there.

Clint Which is fascinating if I may jump in because so many of my clients including myself on one of my U-biome tests showed that I had no lactobacillus, and it was quite concerning to those individuals and also raised my own eyebrows. So what you’re saying is that that’s not at all uncommon.

Dr. Hawrelak Well you’re right it’s not that uncommon. I mean I can’t say that clinically by putting lots of effort back we can we can generally bring a majority of patients who have apparently no lactobacillus we can bring it back with targeted feeding which is different than trying to supplement your way to get around it because there are problems with that which are probably a chance to touch with but touch on. But if we focus on feeding up your indigenous populations by using the right probiotics. For example the right some dietary approaches that we can often bring in a species that are apparently extinct like (inaudible) up to two healthy populations thankfully. But there would be about 20 percent of patients I can see clinically from my practice where they are truly extinct from that ecosystem.

Clint And if they’re truly extinct then before I ask you some of these dietary interventions which everyone’s desperate to hear now. Is it then possible to restore them without that seed of, like if the earth suddenly got flattened by nuclear warfare and there were no humans left? Like how do we then, do we need two humans to then recreate the population?

Dr. Hawrelak Well, yes so that person is extinct of lactobacilli for example that taking eating some sauerkraut (inaudible) yogurt or taking a probiotic supplement won’t promptly colonize it. And I think we’ve probably got 40 years of research showing this clearly that in the vast majority of cases these probiotics strains are very transient visitors. You know there’s the odd exception to that of you one 100 studies that show that one cheek a strain can colonise repute of time. Most stick around for a few days at best a couple of weeks at best and you can see the population diminishes every single day. So that is temporary to bear so that means we can’t do it that way. And there’s certainly that the capacity potentially receding with a faecal transplant for example and there are certainly these days the rationale for FMD or faecal microbial transplants, however, has increased pretty dramatically from where it was in 10 or 15 years ago. And there’s a lot more of patients that I see that have actually done FMD these days too as a way of trying to restore diversity back to a very damaged ecosystem as well as to treat specific disease states like clostridium (inaudible) difficile infection.

Clint So what if we were to do a combination of eating? Well, you mentioned that the probiotics are transient, so if we take one of these off the counter supplements that we can go and buy from our local health food store. And we take this supplement that’s what you’re saying is that we know from the studies that over the period of say a week or two, whatever we took is no longer inside our body it doesn’t yet pollinate it doesn’t stay with us. The argument I’ve heard against that just colloquially is that yes but it takes up some of the so-called real estate or area there for helping to minimize the impact of other so-called bad bacteria in that space. That’s one question and the other question. So if you could comment on that and also comment on. Whether or not if doing that and supplementing like we do and then adding foods that are rich in prebiotic which we’ll talk about in a second, can that maybe provide the spark and also the fuel for them to colonize maybe?

Dr. Hawrelak Yes so I’ll answer that second question first that’s fresh in my mind now. It’s a lovely idea, and they’ve researched the particles it’s called symbiotics where you combine the right probiotic with the right prebiotic. And there are still very good data showing that when we do this and we know that this (inaudible) for example is one particular strain of probiotic bacteria that’s commonly found in those you called milk drinks. All around.

Clint Yeah, the Japanese’ Yakult.

Dr. Hawrelak Yeah that’s right. So they know that this bag likes (inaudible) saccharides which do have prebiotic. So they combine the two and said maybe this will mean it will stay around the gut for longer? It didn’t, didn’t make any feel different. So and there’s a couple of studies showing that didn’t really enhance the duration of time at which they colonized. Now it doesn’t I mean you can still play with that and they may well give it a bit of a boost a population which is not a bad thing first little bit maybe you make it stick around for a little bit longer than before. But it’s not enough to make it permanently stick, sadly I wish it was as simple as that.

Clint Yes wouldn’t that be great.

Dr. Hawrelak Yeah it would. Going back to your original question. I mean I prescribe probiotics a lot in my clinical practice but not because they’re permanently colonizing their gut. There’s a whole wide range of reasons to take probiotics, and when you start looking into the probiotic science more you realize that they’re not just a place holder is that that’s some specific strains can release compounds that help heal up a damaged gut. You know that’s a great trait to have and they don’t permanently stay there but whilst you take them they’ll secrete that compound which is helpful for speeding up healing. Others will have a direct anti-inflammatory effect. Others can bind to viral pathogens for example and prevent that viral passages from causing your gut damaging getting diarrhoea, a great reason to take it. And then we have those situations like antibiotics or chemotherapy or radiotherapy where you have a pretty (inaudible) taking agent that causes a pretty great ecological change to that ecosystem in your gut. And there’s lot of vacant space in which case when you take a probiotic at that time they will take up those, I always using analogy the car parking lot that when it’s full there’s no room for sort of pathogens to grow into or for pathogens you ingest to find a parking spot. They just have to go out the other end go in no place to park they go out. Whereas after antibiotics are chemo you get lots of car parking spot to become available and it’s easy for those that have survived the onslaught of the chemicals who have resistance to that agent to grow into that space. But it’s also possible that you ingest some microbes that normally wouldn’t be a problem but when you’re ecosystems that disturbed does lots of food and space available for it. And that is a great argument for taking probiotics that at those during those sort of interventions and then certainly afterwards to help take up space and taken to compete for food with potential pathogens and certainly these prebiotics that way too.

Clint Yeah. That’s fascinating I love that car park analogy, I’ll use that one in the future. I’m wondering which way we can go here, I want to talk about foods of course and we can spend some time with that. I also want to explore the actual physical mechanics of what these car parks look like, and where these gut bacteria actually live inside the body. So why don’t we save the foodstuff for a little later?  Let’s talk about the mechanics of taking probiotics and their journey from our mouth to where they’re going to end up. So what does that look like?

Dr. Hawrelak Yeah well (inaudible) I think we now know that even (inaudible) like our digestive enzymes may actually have the capacity to decrease in growth. Some probiotic bacteria that we may have ingested and then that is so that’s the first hurdle they have to overcome. And then we have gastric acid or stomach acid which is probably the biggest hurdle of all. And these days most of the better probiotic brands or supplements contain strains that can actually tolerate gastric acid. Well, they’ve been selected on that (inaudible) they’ve been trialed and tested. Yeah, they can jump that hurdle, they can survive stomach acid well. So they have that aspect and they reach the small intestine and then they have to deal with bile and has to deal with the intestinal digestive secretions. And again some don’t tolerate that as well, some like most yogurt producing bacteria, for example, explode when they hit the bile in your small intestine. So you don’t get out alive from that point (inaudible) help you in any way. But again well thought through and well-researched probiotics actually will tolerate those conditions and then potentially have interaction with other components of the microbiota in the small bowel and large bowel or with Amine cells in small and large bowel as well.

Clint My observation of the literature tells me that most of our bacteria should be in the colon, and we have a sort of an almost a small percentage of bacteria living in the small intestine. First of all, if you could clarify that and also talk about what happens in the case of small intestinal bacterial overgrowth and why that’s such a bad thing.

Dr. Hawrelak Yeah you know you’re pretty spot on that if you look at the bacterial counts in the stomach or you know 10 200 bacteria per mil of fluid stomach acid is very good at killing microbes in general. But in the small bowel, you’re looking at normal levels are a thousand by trade per mil or less for the first bit of the small bowel. And as we make our way down though I think it’s nine metres in length. That’s small bowel, it’s amazing to think it’s all wrapped up in your gut. Towards the end of that, it gets up to about 100 million bacteria per mil, and then you’ve got that (inaudible) valve which separates the small intestine from the large intestine. You hop over and (inaudible) eleven from 10 (inaudible). So it’s you know a thousand fold more bacteria per million of contents. (inaudible) far more densely populated and a far wider variety of microbe species present. But you do get people where through potentially you know it can be things like surgery where they removed the ileocecal valve for example or another common cause would be people taking proton pump inhibitor as the class of medications used to treat reflux disease where they’re essentially stopping the stomach acid from doing its thing where the small bowel can be overpopulated by bacteria.

Dr. Hawrelak And then some people having a smaller amount of bugs won’t actually make a difference to their quality of life, they won’t even notice it. But you’ll find other people were (inaudible) small bit of your small bowel it can serve severely disrupting nutritional status as well because the bacteria are eating your food before you do. So you can end up with things like iron deficiency and I’m sure they could grab zinc as well but certainly iron is was well noted. And they will eat things like the fructose and lactose and you know we’ll get the very obvious symptoms and or even glucose in that case too so if you (inaudible) I wouldn’t want you to eat it. But if you’d like a Danish pastry or something like that you would get symptoms like about half an hour afterward and bloating, distension, increased gas. For example, potentially pain and diarrhoea and that can happen in (inaudible) overgrowth from having cherries and mangos and healthy foods too because essentially the bacteria are in that bit of your small intestine where you would normally absorb that fructose. For example, it’s in those other foods but it’s not being absorbed as being eaten by the microbes who produce gas and then you get a range of symptoms as a consequence of that.

Clint That definitely got some clients who suggest that they get a lot of bloating and challenges that sounds like Sibo. And is there some just some really simple tests they can do? Is there a breath test that I think I’ve heard? And what should they do about it? Just a couple of sort of no brainer things that they should do about that.

Dr. Hawrelak I’m not sure with the no brainer, it’s a tricky thing. (inaudible) bacteria growing in your small bowel it’s like, not that straightforward. Yeah I think breath testing is very helpful to help determine. You can get some of this data from good questioning as well surely about looking at timing of things (inaudible) when you eat an apple do you get symptoms in 20 minutes 40 minutes versus two hours. Two hour, an hour and a half two hours afterwards you can say clearly say it’s colonic or large bowel fermentation whereas before that time you would argue small bowel. And I think that’s a good general rule but I do think doing breath testing is very worthwhile to do (inaudible) we see what’s going on. And for me  my typical approach would be a triple sugar tests, where they would do they would do glucose and these would be at separate times I should point out too. But they would do glucose, they would do fructose then they would do lactulose on different days. And essentially after they ingest those sugars if you aren’t familiar with the technique, they essentially breathe into these bags every 15 to 20 minutes to collect their gas levels. And what we’re looking for is bacterial produce gases, and that would be generally hydrogen or methane currently. And we don’t produce hydrogen or methane, human cells don’t, but your gut bacteria do. And we’re looking at whether you produce it in what time point you produce it. So lactulose for example is a good control sugar in that, nearly everybody will produce hydrogen or methane from taking lactulose, but for most of us it would be easy to give to 50 healthy general people it would be from the 90 minute mark onwards whereas in the colon. But if it happens at the 40 minute mark or 60 minute mark do you like OK that small bowel. And certainly with fructose you shouldn’t be producing any gas at all for ingestion of fructose or glucose they should be well absorbed into your system. And if you produce gases that generally tells you that there’s a problem there, although with fructose it can be either a small bowel issue where you get this big spike in gases at the early minutes. 20 or 40 60 Minutes for example or in the more classic case of fructose intolerance it would have actually happened in the colon which wouldn’t be Sibo but if it happened to that early time points would be Sibo. And same with glucose you should always absorb glucose fine, you should not have any increase in gas but if you get a big spike then you know it’s actually bacteria eating it in the small intestine to blame. From that we get to look at hydrogen, whether you’re a hydrogen producer or methane producer. And just those two simple things can actually change how we treat and this is where doing the breath testing is versus just basing on symptoms can give us more useful data. And for me whether you react to lactulose, fructose, or glucose tells me data that actually impact my prescribing of generally herbal antimicrobials as well. So I find useful data from that.

Clint Okay. Beautiful. First of all I love the in some ways the practical nature of it is that we have a finite period of time that it takes for our food to move from A to B. And using that as a guideline we’re able to find out where on the path the problem is that based on how long it takes for the gas to come. Breathing into this bag, does that bag then get sealed and given to your laboratory and then the tests run on the gas?

Dr. Hawrelak Exactly so that they will then look for the amount of parts per million of hydrogen or methane in the best labs at those points. And you also want to make sure it’s they do it After 15 a 20 minute time marks, not thirty or forty-five minutes. You see some labs that do 60-minute time points it’s just too big of a gap. you can’t see what’s going on, you can have a totally normal zero that arise in the normal 60 minutes but then at 120 it’s to spike up and you’re like well yeah what’s happening between. So the best labs will do 15 or 20 minute time points, and they will allow you to do those three sugars on patients in essentially more but at least those three.

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Clint Yeah. Okay. And then you said you treat those with antimicrobials. And then what sort of expectation of success do you have once you start the patient on those?

Dr. Hawrelak Yeah. Well, it would usually be for me a combination of things. So I would use you know choose the right probiotic to suit the patient in the presentation. I would use the right prebiotic in that situation and then I would use herbal antimicrobials too and that would be tailor done whether it’s methane or hydrogen dominant and whether the bugs had cookie flatulence or not. So I’d fine tune it based on those and same with some other by prebiotic recommendations might be fine-tuned based on the breath test results as well. Now typically there’s a few ways of approaching Sibo that there is perhaps more hardcore ways which could include no antibiotics or antibiotics combinations through to more hardcore herbal agents which you know high potency (inaudible) essential oils through to what I would see as an extra level down of using herbal tinctures that have anti-microbial effects. But are less likely to cause collateral damage to the colon ecosystem, wanting to be selective and that goes back to what I said before about really caring about that colonic ecosystem and doing my utmost with every intervention. I’m prescribing to take into account the health of that ecosystem when I’m prescribing. So I try to choose my herbs to work more selectively least for my first few iterations before I pull the bigger guns in terms of treatment. And generally they work which is good but it may take a bit longer to work and then taking hardcore essential oils that are entirely that might work within a couple of weeks. In my experience, we usually start seeing some shifts sometimes it is within a week or two which is always great for me and my patient. But I can see the median time with my approach is around the four weeks where something the (inaudible) gets turned on. I’m not sure why it takes that long but it’s pretty consistent that’s the median time. You know sometimes sooner but that’s the most common.

Clint Do you think that. And now I’m pulling out my big guns of knowledge that there’s some quorum sensing going on with regards to the shift of the microbiome or the shift of what goes on even in the sibo situation. And for my audience what I’m talking about is there was a study by a lady I can’t remember but she talked about how it took a certain amount of bacteria. I think in a sea creature before it shifted from a certain colour to another or something. Anyway, I’m not putting the other much of a factual statement here but this concept of where the bacteria somewhat aware of their numbers around them and at some point they can then make a collective decision about a takeover or so forth.

Dr. Hawrelak Interesting idea, interesting concepts. Yeah. I mean I’m not fully for and we’re often using as a multipronged approach where you have a prebiotic compound that’s nourishing certain species. You’ve got a…who then start changing the environment to one that’s less conducive to the growth of potential pathogens is often the way I’m looking at it. (inaudible) using a probiotic strain that can also have selective anti-microbial activities to reduce levels of bugs we don’t want present. And then the herbs are helping that too and whether it just takes time to get through that resistance and certainly we know that some of the medicines clearly can degrade biofilm for example which is sort of that protective layer that sort of path of pathogens may actually have or the sibo bugs may actually have in that sort of gut layer that will initially protect them from the antimicrobial compounds. But then as that may slowly yet get stripped away over time and then they allow the herbs to penetrate through and actually kill the bugs off the mark more core aspects of it so that certainly a potential (inaudible) of what’s occurring in them that explains the time distance difference.

Clint Okay. Thank you. Now I have a couple of clients who have been in a state of wellness and this is not so much a question but just to add to what you’re saying as a warning. Who have taken for things like see sibo or just for some other milder health conditions than rheumatoid arthritis symptoms? They have taken some anti-microbial anti parasitic herbals, and have had consequently symptoms of their rheumatoid arthritis come back. And so I think that your warning about how cautious you are about the treatment of the sibo is very apt because I’ve had as I’ve said some clients who were fairly freely taking these herbal treatments and had a negative impact on their symptoms. So just a word of caution that you want to be getting these kinds of prescriptions from someone like yourself rather than just buying them over the counter or taking them.

Dr. Hawrelak Yeah definitely. And I concur I have certainly seen patients whose gut integrity has deteriorated from taking indiscriminate herbal (inaudible).

Clint They’re powerful aren’t they?

Dr. Hawrelak These days with some of the (inaudible) techniques we have, they are. You know like the amount of oregano for example that goes into making a little drop of essential oil is actually quite substantial. And if you had to grow your own oregano to steal it yourself you would use it like gold because it makes you realize how much you’d have to grow to get that small amount. And all of a sudden now we’ve got these intricate capsules with a tremendous amount of herbal components. And it’s also it’s a selective extract that only pulls that certain constituents, and I think I even talked about this just a few weeks back at a medicine conference was looking at a cake as we can a lots of it ways of giving a herb from a powder, to a tea, to (inaudible), to a tincture, to a tablet, extract to you know Terry Koch essential oil type combo. And when we only pull out the high notes we’re sort of leaving behind lots of other compounds that may have balanced out that impact. And we can see that clove is a good example, clove a herb that does have an anti-microbial activity that’s in the volatile component so the essential oil components. But it’s also extremely potent in polyphenols, and polyphenols tend to have selectively nourishing effect that they nourish sort of the more beneficial bugs in the gut the anti-inflammatory ones. But can also be anti-microbial in their own right. So when you give it as a tincture or just ground up clove you’re actually getting the complete combination of compounds, whereas just the essential oil you’re just getting these sort of the anti-microbial bits with the other notes alongside. And I think this greater potential causing harm in that situation than if you’re giving it as a tincture or as a powder for example. And I do enough pre and post testing with my patients to know that they’re giving some these same anti-microbial herbs as a tincture doesn’t result in the same microbial ecosystem disruption as it does from taking a more concentrated tablet and extract.

Clint Yeah, gotcha. Let’s talk about where these bacteria live within the colon if you don’t mind. my teachings around this in my presentations involve what I have read in the literature which is that our mucus on the epithelium increases as we move throughout the small intestine and into the bowl or should I say it’s a single layer or it’s there’s a small amount of mucus in the small intestine but there is a double layer and much thicker mucus inside the colon. And that’s where our bacteria live, and I’d like you to comment on that and if that is indeed what goes on. And also I’ve got a theory that the drugs like prednisone the steroids that are taken in some instances for some people with inflammatory arthritis, tend to deplete the mucus that exists on the wall. In the same way that when asthma patients take steroid treatments as inhalers for their asthma it gets rid of the mucus and helps them breathe better. I believe that those drugs also deplete the mucus on our intestinal wall thereby reducing the available space and home for bacteria to live in. And furthermore thereby making it hard for nutrient uptake because as I understand the mucosal linings where a lot of our nutrient uptake occurs. So I just like your feedback on my understanding of these concepts.

Dr. Hawrelak I think in terms of the broader concept of it because of sickness et cetera I think that’s pretty spot on and I think you’re right. That for the most part bacteria are where they should be living is in that mucus or on the outside of that mucus ideally and there are some species that tend to live a little bit deeper in there. But what we don’t really want is a bacteria directly interacting with gut cells and that is something we see in inflammatory bowel disease like Crohn’s or ulcerative colitis. As you often do have bacteria interacting directly with gut epithelial cells, and people arguing that’s part of the issue here is that you have some species and in those cases that might be some kind of ecoli or (inaudible) that are interacting in a way that causes that sort of information and causes that disrupted integrity and that localized area. There are certain medications and I’m not sure about prednisone specifically because I haven’t specifically looked whether they’ve researched it’s another question. But there are meds that do damage the mucosa layer and I do have some caution around. I mean obviously there’s times and places for a whole wide range of medications were they save lives, and they alter completely what’s going or in a beneficial way in terms of quality of life and pain et cetera. We have to keep that in mind too. But there are some cautions about meds that do strip away that protective lining pickling with long term use to and in terms of potentially increasing risk of a relapse of certain conditions. In that case or certainly, change in the system composition as well because if you’re altering that sort of thickness or you’re altering the food that’s available for microbes and that will result in it a changed ecosystem.

Clint Yes okay. You touched upon the Crohn’s situation where the bacteria getting in contact with the epithelium and interacting with the cells where the gut wall. Let’s now talk about leaky gut just get with the mechanisms behind it where it occurs small intestine large intestine or both.

Dr. Hawrelak Well arguably both but I would say that generally when we use the term leaky gut or increase in permeability,we are talking about the small intestine. But there is certainly the case of large bowel leakiness. So we need to keep that in mind. But generally, when we’re talking about that’s what we’re referring to.

Clint And what are the mechanics behind it. If you could just give us a refresher we’ve got some bacteria and food particles maybe passing through into our bloodstream.

Dr. Hawrelak Yeah. Because normally your gut cells have this lovely intact barrier there and it just floats in certain things in certain amounts. So it’s much more it’s quite tightly regulated. But what can happen is if we take a medication like non-steroidal anti-inflammatories like ibuprofen or something like that even continuously for a week or two is enough to cause disruptions to to the gut integrity, alcohol and you know more than four standard drinks is enough to cause you gut leakiness as more acute examples and certainly an imbalance of microbes in the gut can also result in increased gut permeability and that can be through the production of I mentioned before hydrogen sulphide, hydrogen sulphide gas can cause increased gut leakiness and another bacterial component called Endotoxin or Lipo-polysaccharide that is found in an all gram negative bacteria but a very pro-inflammatory sort of endotoxins found in a group of bacteria called proto-bacteria which can be very much overgrown in many Westerners for example and that itself can cause damage to that gut and that leads to a couple of things. And you’re right that means we can start absorbing food proteins that we wouldn’t otherwise do. And food chemicals and that can be things like (inaudible)that weren’t a problem before and all of a sudden your gut is leaky. These things get in and obviously you start reacting to these different foods but also healthy foods that you didn’t react to before but you’re also getting bacterial compounds too like even more lipid polysaccharide and lipid polysacharride is very much a driver of a body wide inflammation that’s now been implicated with obesity type 2 diabetes, metabolic syndrome, Alzheimer’s disease depression anxiety and so essentially when the gut’s leaky we get more of that compound into the bloodstream your liver can deal with a bit of it and then it can just constantly be coming through a county with all of it it reaches the extra broader circulation than it causes inflammation and they can manifest in different ways and different people. And that’s where I think genes come into the picture as well. But certainly it’s very very pro and floundering compound. So it’s pretty common for my patients to present with a whole bunch of people with anxiety depression through to you know also quite as in Crohn’s and those more and Celiac Disease when leaky gut’s definitely part of what’s going on but also that despotic environment where there’s too much endotoxin in the gut. Lumen is a common scenario in practice for what range of conditions.

Clint Lipid polysaccharide is that…sorry I think you mentioned it but just to clarify is that a by-product or a toxin or is it part of the bacteria itself?

Dr. Hawrelak It’s part of the bacteria. It is so just like we grow in the fingernails and hair they grow hair this stuff called Lipid polysaccharide. So it’s not like it’s secreting this compound to make us ill but it’s just that it’s composed of it. And when they die that just releases that into your gut and your gut cells are really intact only a tiny amount that gets through and your liver will deal with it generally but when you get you’ve got cells aren’t so intact that increased permeability and or you have a much higher level of endotoxin containing bacteria in your gut a lot more gets through.

Clint Right. Okay.  You mentioned before in talking about the hydrogen sulfide gas-producing bacteria but also the butyrate producing bacteria. Butyrate is a product that is produced by bacteria also. And we want a lot of that, don’t we? Can you speak about that for us?

Dr. Hawrelak We sure do. We sure do and it’s one of the most marvelous substances that bacteria produce for us. We’re so dependent upon it that our colon cells our large intestinal cells are reliant on it as a food source like we’ve evolved this complete reliance on bacterial creation of butyrate because that makes up about 70 percent of their energy needs are met from this. And if we don’t freeze enough our colon cells don’t get fed essentially. That’s a big issue. And there are people arguing that this is a haze or something a driver for a lot of Western diseases where people tend not to feed their butyrate-producing bacteria very well on a standard Western diet. But certainly cases like this ulcerative colitis as well which we see being associated with the Western diet and lifestyle. So Butyrate as alluded to the main food source or fuel source for your your colon aside large bowel cells. And then when we produce more than they can use then it goes into your circulation. And this is the most amazing thing because when it is in your circulation has a body wide anti-inflammatory effect it heals up like a damaged blood-brain barrier it actually changes how neurotransmitters are created in your brain because it decreases information there, improves blood sugar control and insulin sensitivity, it’s an amazing substance and more research we do, the more amazing we actually find it is. And here we’ve got these new factories in our gut happy to make it for us if we feed them. And this state, the issue is a lot of people aren’t feeding these species and that means that our gut cells don’t even have enough let alone our body has enough of this substance that we’ve evolved with and we are reliant on for physiological activity.

Clint OK. So the million dollar question then is how do we feed them. And if that’s really beneficial for our large intestine these butyrate producing bacteria also helping the leaky gut scenario in our small intestine.

Dr. Hawrelak Yes. And this is a cool thing to and is when we actually increase butyrate reproduction in the colon we actually speed up healing regeneration the small intestine too. So for me this is a big part in leaky gut treatment is looking at. Yeah, I’d look at I might supplement some glutamine and other things that are the main food source for small intestinal cells. But I have to nourish the butyrate-producing bacteria because if they can increase their production of butyrate is going to heal up the entire small and large bowel.

Clint Amazing isn’t it. I mean I can see why you’re passionate about it. I think I get goosebumps because we haven’t really touched upon like something that’s you know a life-changing example where it’s very emotional but it’s intellectually exciting stuff.

Dr. Hawrelak And when I read more papers about butyrate as I said I get even more passionate about it. And it’s doing lots of stool assessments with their microbiome assessments with patients that you know some patients have got 10 percent butyrate-producing bacteria other people 60 percent.

Clint 16 or 60?

Dr. Hawrelak 60. Six times as much butyrate producing bacteria in their gut. And that obviously flows on in terms of what consequences there is. Because if you only have 10 percent of what’s there means you’re not feeding it well they’re not producing much Butyrate and there’s gonna be flow on consequences from that which we’re seeing all around us in terms of the conditions associated with metabolic dysfunction are very much related to this area. So how do we feed up our butyrate-producing bacteria in our microbiota? It’s really soluble fibres and resistant starches are probably the core aspects of things. So fiber more broadly. Having a wide variety of fibre is possible I think is certainly one of the recommendations I do give to my patients across the board. But it’s soluble fibres and resistant starches that are perhaps the biggest drivers of butyrate production.

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Clint So can you give us examples. Obviously, we’re all pretty across this being on a plant-based diet with most people who were following my program. Yeah. So soluble fibre. Yes, but I would like you just to talk about fibre a little bit more in some basic terms and give us the differences and then some examples of some resistant starches as well.

Dr. Hawrelak OK so we can start with resistant starch. You find that resistant starches are widely found in whole grains and legumes and root vegetables as well to give you an idea as well as some things like unripe bananas might be one of these sort of you know fruit selections that you seem it’s made it all that pleasant but you can’t take you know powdered green banana flour these days as a way of trying to get resistant starch and without that unpleasant as eating the unripe banana itself.

Dr. Hawrelak Yes but I think it’s those two groups that are that are sometimes avoided by people that are actually trying to look after their gut and trying to do the right thing but inadvertently end up starting off their butyrate-producing bacteria because they’re not feeding them. And so we find that pickly bigger chunks of grain rather than finely milled and obviously whole grains rather than then refined white will have more resistant starch. We also find that if it’s heated and cooled. So if we have cooks them I might cook some black and brown rice black brown red rice that I cook for dinner and then I’ll eat it cold the next day as part of a salad and it’s gonna have more resistant starch when it’s cold. Okay so this starch changes shape when it’s cooked and it changes shape again. This is called retrograde starch and then it’s resistant to our digestive enzymes reaches the colon where it feeds the microbes that produce butyrate.

Clint Sometimes I have listeners who take things very literally. For example we had a guest who wrote a book called “The Symbiote Factor”, Dr. Richard Matthews who’s in the United States who’s got a great deal of knowledge around similar topic that we’re talking about today and he talked about fermenting his oats and I still get questions all the time about how do I ferment my oat because he talked about fermenting my oats. And so just to kind of get ahead of the game here we should we be waiting on our food. Or should we occasionally be allowing some of our home cooked foods to cool down and eat the next day or is the level of improvement only small in terms of its butyrate potential?

Dr. Hawrelak I would say it’s pretty market actually so. So I certainly recommend that patients do this with pasta is the same as using like a whole grain gluten-free sort of pasta the next day it’s going to have more resistant starch and legumes it’s the same scenario as well as-as you know chunky grains like rice which are probably a similar with quinoa but I don’t think it’s quite as much in quinoa but rice is certainly a good example.

Clint So you say whack it on a salad the next day and you’re in business for your lunch.

Dr. Hawrelak Yes. So I might have like a vegetable stir fry one night and then the next day I would have I just had 12 leafy greens and some sliced up tomato and cucumber et cetera to make that rice in the salad dressing to make it a rice salad and have it the next day in that way I’m getting that resistant starch.

Clint Fantastic. And in terms of quantity of resistance starch are the green bananas or the powdered green banana. Yeah. The green banana powder. Are we going to have as much impact if we try and go down that path if we put the green bananas in smoothies or something or is the biggest impact going to come from just eating out whole grains and so forth and having legumes?

Dr. Hawrelak Yeah I mean I think that’s the best way of doing it. Yeah. And I think it’s quite fine with blending up some green bananas to a smoothie. I prefer that the using food as a basis for when I can and that’s not to say I don’t use probiotic supplements because I do and frequently when I’m trying to shift that he gets it and very quickly to a healthier state and tried to revise species at the edge of extinction. I totally use probiotics in that case as supplemental powders as well as they’re doing the diets from work but we’re trying to maintain it that healthy ecosystem with the dietary work long term.

Clint Okay. Love it. And then soluble fibre versus insoluble fibre a little less

Dr. Hawrelak Yeah and some people are wanting to toss out this concept because I’m not sure how you know. But essentially soluble fibre means it mixes with water and so insoluble fiber it doesn’t that’s really where the term comes from but we know that those fibres that do so mixed in with water that are more viscous tend to be fermented better whereas cellulose would be in insoluble fibre at least in westerns these days isn’t widely fermented. It’s a little bit but not that much. Now we gave a bolus silos to some rural African tribe that that hasn’t had antibiotics in the c sections and eaten the hybrid fibre diet for their all their entire existence. They still haven’t, therefore, I have to say those degrading bacteria so they’ll still get some nutrients out of that or some you know clonic energy out of that whereas we don’t so much yet but soluble fibre generally is fermented well and that’s why it’s feeding some of the butyrate-producing bacteria. Soluble fibre that we find in legumes, tofu, for example, would be clear examples of the types it’s been shown to increase butyrate production in the colon.

Clint It’s interesting you mentioned legumes both in the soluble fibre category and also in the resistant starch category. Is there therefore very little surprise that legumes that they sort of the blue zones hero of longevity.

Dr. Hawrelak It’s not that surprising when you’re looking at that from a gut perspective. I know people and this always blows my mind that their  feed it’s against legumes and certain parts of the blogosphere. Currently, when you’re looking back again these things have got polyphenols so often like a black black beans and they’ve got a beautiful red (inaudible) you could be into for example and polyphenols feed our good gut bacteria, they contain resistant starches. they contain soluble fibres and they contain all polysaccharides which feed our beneficial bacteria so they may contain four or five different compounds that are nourishing the sort of beneficial anti-inflammatory bacteria in our gut. So no I’m not surprised that you’re saying.

Clint Is there any common mistakes with for example legumes that people make when they eat them. Is there a problem for example because they’re high in protein to combine them with another food source that doesn’t get digested well as a combination like I guess my question is if people have beans and rice or if they have say lentils and rice in a yellow doll or something. Are we talking about a really healthy meal there or are we making some kind of mistake.

Dr. Hawrelak Really healthy. I would say I don’t think that we have to strict about separating out proteins and starches etc. It’s very very small proportion of people that it makes any difference to the quality of life. Yes. So now I think those are lovely. You know so far my Mexican beans with lots of black beans onions and garlic in there and then I have that on my my black and brown rice combo. You know it’s like you know nourishing my microbiota in numerous ways with a meal like that.

Clint You mentioned garlic and onion. All good?

Clint Yeah. Because they contain oligosaccharides and that they can be called inland or food oligosaccharides or in some terminology, they call fruit hands and galachands for the other sort of all those oligosaccharides We find like it for example or galacto oligosaccharides Yes. So I think the biggest issue people have is when you’re not used to eating them you start eating them. You produce more gas. Yeah. And if your gut is working the way it should you just fart more. That’s it. No problem. But and then that usually peaks out by day seven or 10. Now the problem comes is if you have CIBO for example then you get more gas you get more pain discomfort, bloating tension is not very pleasant. And if you have very slow transit time in that year what I would see. In some patients I have if they eat something and it comes out 16 hours later, other patients it’s 10 days later before it comes out. I might think of how much gas gets build up and how little of it gets expelled if it takes 10 days for stuff to move across. So you increase legumes in that situation. So that may again blow into stand rather than just getting more farting. So sometimes you have to do some preliminary work to make the gut capable of dealing with the increased gas production in people whose guts are very damaged because you know they’re going to be very much part of the process to keep them in good shape and to heal a gut but they’re going to cause symptoms in the short here and now. So we would often if it’s on CIBO, we deal with the CIBO first and then they often have clonic inflammation that we have to decrease first that makes their gut hypersensitive to the intestinal gas due to the level of inflammation that’s president in the gut. And so those are sometimes pre-work we have to do before they can introduce legumes and when we do it’s like take a tablespoon every second day, every week we have to try to open up. The mistake that you can also make is just eating a huge bowl once a week, you know you’ve got to not going to adapt so well as if you eat it. A relatively small amount every couple days and then slowly work your way up. But if you’re one of those people that just get more gassy, more farts more with legumes then you can you pretty quickly and just know that ecosystem will adapt quite readily over a period of a week to two weeks.

Clint Yeah I love that really really slow reintroduction concept and something that I recommend as well. I’m just very pleased to hear that that’s also something that you find works for your patients.

Dr. Hawrelak Yeah well these days I’m seeing some very (inaudible)people very very inflamed guts compared to where I was at 14 years ago. So we have to go very slow if we sat in and strangely enough it’s not always like often find it in conditions like also quite as people can go straight on  the games and you know the sort of cooking called with whole grains for example and it’s totally fine but then I’ve got patients with your (inaudible)  and CIBO  where it’s actually really slow going. And even if the CIBO seems to be  treated we often will have to do six months of colonic work before they can introduce much in the way of legumes

Clint Right. Okay. I. I know we’re sort of out of time here. But if you didn’t just indulge me just for another few minutes if that would be okay. Vegetable oils. I have a particular passion against them for their pro-inflammatory effect. The literature seems to be a little bit into camps about this one is it’s the high omega 6 fatty acids which is the inflammation pathway that gets triggered. Another is that I have a lot of studies that I’ve pulled together that shows that fat in general high fat tends to increase intestinal permeability. Yeah. Could I get you to give me your your views on this. Which one is it or is it both.

Dr. Hawrelak Yeah I’ve come across those studies too, Clint. That link the high-fat diet with increased gut permeability and it’s as we point out of the current vogue is high fat. So those studies are being stuffed and we can actually see them we’re not talking about much. So it’s nice to have someone else actually can bring them up. So I think it’s a bit of both that they have certainly been making the omega 6 content. You know this is certainly the precursor of an aracon acid which is a pro-inflammatory compound that our body produces under you know some sort of stress or scenario. So having less of that in the system is obviously good. But I do think there is the potential of just the higher fat content particularly I think for me whereas isolated away from Whole Foods. So I’ve got less issues with people eating know all those nuts needing avocados. No big concerns there. But I do have concerns with people just dumping tablespoons of coconut oil on their foods for example or heat ghee or butter and lard on their foods. I’ve got far more concerns around that and there’s a whole bunch of data around the impact of saturated fat, in particular, facilitating the absorption of any entoxins that we talked about before and that saturated fats whether they be from dairy or even from coconut seemed to fit the bind to the polysaccharides or endotoxins and facilitate their absorption into the bloodstream. Now the way that that olive oil didn’t for fish oil didn’t.

Clint Wow. Okay. Yeah. I’d love to see that study as well. I’ve include that one in my stuff. That’s cool, that’s cool because I am always looking at ways to just justify the effects that we see in practice which is that if someone goes in and eats Ebola hot chips. I mean it’s game over tomorrow. It is over and it’s not the potatoes it’s the oil that they’re cooked in. So thank you for that. I just want to wrap up with some quick questions for you. Just so these commonly frequently asked questions that we get and instead of just some brief answers from yourself.

Dr. Hawrelak I’ll do my best.

Dr. Hawrelak The time restraints only to respect your time. So if you’re to give us longer answers that’s wonderful for us. I don’t think anyone watching or listening right now saying Come on wrap this up! Fermented foods you mentioned sauerkraut pickles and so on. You took questions around them are they helpful first aid. And do they provide us with potentially bacteria that can become part of our own ecosystem and is the salt an issue in them. Do you think the salt has an impact on how our health negatively.

Dr. Hawrelak Interesting that at last point I mean I think it would depend on how much salt was used. Because I’ve been a fermenter for nearly 20 years actually so I do think that I’ve often made very low salt varieties with just a pinch of salt like a big (inaudible) so I don’t always think salt is hugely essential. It depends on the takings you’re using and etc. It’s just happens to be that like the bacilli that are the main audience the left in notes these crucial ferments handle high salt and a lot of competing bugs don’t say you’re selectively creating an environment that you’re creating an environment that selectively benefits flat so they can tolerate competing bugs don’t you. So that’s part of the reason why as well as just the food processing aspect that salt pulls the moisture out. So when you’re just chopping cabbage by hand then the salt will do the additional job of pulling the moisture out. Worse for me I would use one of those twin gear juicers when I used to make my version ferments and I would pull the juice and fibre separate it out and then put it back together and you wouldn’t need much salt added to that they would cause nothing needed to pull out. You don’t need to pull up the water and there’s always enough native lactobacilli to dominate the ecosystem anyway because it always sauerkraut beautifully so I’ve made some yellow salt from it so I think it’s not always essential. So just keep that in mind I suppose with once you buy and how much help might be added to that. Lots that I have that are not usually salty. I’ve had others that are had way too much salt and you know I’ve eaten a teaspoon of this it seems like it’s way too much whereas others like you have a cup and doesn’t taste that salty hole so there’s that and I think we touch on this concept before about being able to colonize your gut with bacteria from fermented foods and it just doesn’t happen right and that doesn’t mean that you shouldn’t eat them enjoy them I had lovely bits of kimchi on my breakfast this morning for example but it wasn’t because the kimchi bugs wouldn’t live in my gut ever after. Wasn’t why because I like the taste mostly anything else but you also get that low glycemic index when you actually have the (inaudible) with the lactic acid in acetic acid began to find in these ferments actually lower the glycemic loading of that meal so your blood sugar will stay far more stable as you eat a fermented food like that or add that to your normal meal for example. It also has a range of got healing compounds called polymians in saeurkraut and in kimchi that speed up cell healing and regeneration of damage stomach cells in small intestinal cells. Another reason why and potentially antifungal compounds too because the main competition for that nutrient in that ferment vessel is often yeasts and moulds so that the lack of sunlight often produce some sort of antifungal compounds to keep them at bay essentially so we might be getting small amounts of this which you could argue would have a beneficial effect on your gut just keeping perhaps although I should point out that we know so little about the microbiome in terms of what’s healthy what’s not when looking at the fungal components of that ecosystem. But I think the trace amounts we find in there are probably not always considered beneficial anyway.

Clint Mm-hmm. Okay fascinating. Okay. Thank you. Shelf stable probiotics are now really popular versus the more sort of original style which was everything needed to be refrigerated. I’ve come to understand that it’s just the technology that’s used in the manufacture guarantees. The numbers on the bottle right to the expiration date. Do you have any, well I’m sure you do. What’s the official take on the shelf stable versus refrigerated.

Dr. Hawrelak Yeah it’s very much depends on the strain of bacteria that were used and I mentioned that obstacle course with probiotics that were that was used and one of the obstacles or hurdles they have to jump is shelf stability at room temperature. So newer ones often will take the boxes because they were chosen to be developed into a commercial product because it has shelf stability.

Clint Which isn’t a best motivator.

Dr. Hawrelak Well typically well it’s usually not the only one thankfully so these days they would look at gastric acid stability bile salt stability whether adhere is temporarily how it adheres whether it produces a compound that is selectively anti-microbial to kill off potential pathogens or pathobions but keep the good guys intact and shelf stability, those would be sort of like the basic criteria. And it’s safe when just as the basic writers tick those boxes and it’s like OK so what companies often do is take that strain and do some annual research with it then do human trials with it and they go from that isolation through to finished product and in which case we know it’s shelf stable and we know it may well have therapeutic effects beyond just taking up car spots in the gut but it actually may be useful for how well we can look at a strain of fracturing lactose 10-0-19 that speeds up colon transit time significantly. So this is one that’s very good for people with slow gut transit time or constipation. So that’s an additional attitude has besides just taking all those basic boxes. It actually has therapeutic effects and I think for me this is when the key things about probiotics is you choose the one that displays the actions or characteristics that you want to take or the physiology you want to change. So if I get from a slow gut transit time I can give the strain that speeds it up, if I’m someone with damaged small intestines or increased permeability, I can give the strain that can speed up healing of that. If I’m someone with pylori causing stomach ulcers. I can give a strain that helps reduce levels of pylori and not all strains do but some certainly do. So it’s really trying to match what you’re trying to do with the strain that has the action at hand. This is what is 40 years probiotic research has really told us. The best way of using probiotics is very in a targeted way rather than just throw let’s throw 150 billion see if you have ten different strains that something with another strain to do anything. But I think that’s a poor way of using probiotics and you’ll get poor results comparatively. Then if you use some selectively going OK well this strain has got the exact actions that I’m after. I’ll give you the dose that’s got human clinical trials showing it works and you know what it usually works rather than guessing and experimenting with unknown agents essentially.

Clint Which really explains why your clinic is doing so well because this is hard to do as a patient. If you really know first of all working out what your actually situation is and second of all knowing how on earth you can then know what what bacterial strain is suitable to helping that and then know how on earth you’re going to find that. I mean you go to your local you know whole foods in the US or a health food store here and say hey I want this strain and someone’s going to look at you blankly.

Dr. Hawrelak So sadly yes. And that’s why I developed some online tools to make this easier because for that exact scenario. So if you look at something like rheumatoid arthritis like I think the strain with a positive study with bacillus coagulants GBI 30 60 86 which is a really catchy name with easy to memorize not and that’s been shown to help reduce pain levels in patients with rheumatoid arthritis for example. Yet there are other strains that there’s a combination of lactose prognosis G R1 and lactose fermented RC 14 give RA patients didn’t improve things at all. So I think RA like any other condition is that there are strains that to date have shown efficacy in the strains that are shown not to be useful. And as I watched the strains that have never been researched we have no idea what they do. So for me I would generally go with the ones that have clinical trials during that they’re helpful. And the challenge is as a patient is going through the literature and working out what strain it is and where to find it. And then this is also a challenge for practitioners to look. Yes, very multitude of products in the market that it can be hard to take the time to adequately assess before prescribing.

Clint Mm-hmm. Okay. When should we take our probiotics. I’ve read on an empty stomach and I’ve read it right before meals. And interestingly, right before meals that happened to have somewhat of a fat content in them.

Dr. Hawrelak So yeah I think the data is pretty clear that we get better survival with meals. Yeah. Your stomach acidity is far stronger, there’s more acid on an empty stomach. Well people get this said the PH might be to two and half on when it is designed is to kill any microbes that go in there and that’s what you’re doing. If you just take your probiotic on empty stomach it’s very strong acidity and suicide missions straight ahead. Exactly. Whereas when your PH when you’re having a big meal you’re looking at three and a half for four and a half and if you have much better survival at that PH range which is closer towards it’s not neutral but it’s more in that area then a much more acidic PH. So data is very clear and that has shown that that bigger meal in terms of like I’d say carbohydrate content is probably a whole grains sort of thing or legumes would actually enhance survival and there’s certainly research on dairy enhancing survival too and something about its capacity to balance PH in the stomach. That means you can give a lot less bacteria in a dairy form than you could in a capsule to get the same number of bacteria as a colon.

Clint I keep thinking of more questions. Sorry but I guess what will the comment on that is is. It always seems to come back to common sense. I mean if the body’s not eating anything then the body would think well at the moment I’m walking around and I’m just you know I’m outside I’m doing whatever I’ve been doing. You know from a evolutionary point of view for thousands of years, millions of years it’s not likely that I right now want to take in a whole bunch of bacteria right. It just doesn’t make sense. But then when I’m eating my food again if we look at more primitive kind of ways of eating we probably got some bacteria from the soil we probably picked up you know bacteria from the plants that we’re eating that aren’t washed and so forth.

Dr. Hawrelak And most likely faecal exposure right.

Dr. Hawrelak Because you didn’t wash your hands we’re drinking the water downstream from people that are upstream maybe right. Right. Or have their bottoms in that stream. You know.

Clint So yeah. So it does make sense. And do you think that as the food moves through the digestive track with that bacteria that bacteria begins to immediately start to consume some of those resistant starches and some of that fibre on its way.

Dr. Hawrelak And I would suggest that would be the case that you’re actually providing some food to for to someone that’s obviously going to be digested in this small bowel for example and absorbed but this could so even with a dose of like glucose which is as well as over sugar as a trace amount will always be mal absorbed in everybody. For example, sucrose so in that case, if there are any bacteria with that they would have a little bit of fruit source to go along. So yes I think that’s another way of looking at that you’re providing a bit of a food package with a drop off of bugs.

Clint I do get this image of like these bugs as they’re going moving down like a slippery slide through the intestines just feeding as they go you know eating away. Can we overdose on probiotics?

Dr. Hawrelak I think based on current data we’d say that they’re an immensely safe class of agent. Really. Like reviewing some the data for a textbook chapter I did recently just like you know. Looking at that all the studies today looking at kids the placebo had more side effects than the probiotic. So I’d say for the vast vast majority of people, probiotics are safe and in the range that we would typically use. Clinical trial perspective is between 100 million bacteria up to probably 40 to 50 billion. So giving way about that amount. Well you know we don’t know I suppose arguably because we haven’t done the research on it and certainly beyond what we would find interesting fermented foods. So there might be a point at which there is a problem because we just don’t have data. But certainly up to that point there medicine’s safe in the vast majority of people and doesn’t mean that there aren’t the occasional person that you have to be more careful with. Definitely and be more selective with what probiotic you use. Definitely. But I think in general they’re very safe class of agents.

Clint I now want to close by finding out how people can contact you and so forth. Before we do that, do you think that this is something we’ve overlooked is there something that you find is really important to convey in these interviews you’ve done with other people or in your life those occasions?

Dr. Hawrelak When I think we’ve covered most of the important aspects I believe in. Then you’d always limited by time. I think just love your microbes, nourish those microbes because you know I think that greater understanding this coming out is that they were not just a human body with microbes there that we actually are a superorganism that is composed of human cells and microbe cells and that makes you and I think so far we’ve put a lot of effort into killing things it virtually causing damage to our microbe components of yourself over the last 50 60 years from interventionists perspective through to through the medical interventions we are using and also the diet we choose to eat and I think we just need to be more aware that we are part microbes and we need to nurture and look after those components of ourself if we want to be optimally healthy.

Clint Yeah. Okay. Your clinic what you do. I know you’re very much in demand and it’s a it’s taken us a little while to find this time slot for yourself. How can people contact your clinic or even yourself. Do you work with clinic with people who are international I know you’re based in Australia and we’ve got a very wide worldwide audience. People are gonna be interested to talk to you and to learn more. What should they do.

Dr. Hawrelak A couple of things. I do offer some online courses which were around microbiota meet your microbiome for the sort of health conscious general public which is designed to introduce you to your microbes and get you to love them and get you to learn the skills of looking after it. So I’ve got some online courses and you might find that valuable adjunct to anything else you’re doing. I think that’s one thing and I do and that’s a probioticadvisor.com. That’s my website. And we do have a whole database around evidence-based prescribing of probiotics. That is a subscription service mostly designed for clinicians but we have 24 hour free access if you just want to play around a bit for that time point and if you take a lot of probiotics you will find that you know 49.95 of annual fee to quite find that your decision making in the area. Yeah. But we do have a range of courses too that could be useful. And then my clinical practice is IGould’s natural medicine which is an old natural medicine apothecary in Hobart that dates back to 1881. Yes. So I practice it as there are a couple days a week as well.

Clint Okay. All right well thank you so much. This has just been fascinating and as you said we’re limited by time and I wish this were a five-hour plane ride. But we’re going to have to let you get back to doing the great work that you do. So thank you so much for sharing everything you’ve done with us today everything you’ve talked about. I’ve learned a lot and I’m really stoked that we’ve been able to have you on the show and be able to share this knowledge with everyone.

Dr. Hawrelak I’m glad to be here. Thanks for the invite, Clint.

Clint Paddison

Clint Paddison has recovered from crippling Rheumatoid Arthitis and now assists others with this disease via the Paddison Program for Rheumatoid Arthritis, the Paddison Podcast and the blogs on www.paddisonprogram.com