Dr. Will Bulsiewicz: Heal Your Gut Microbiome in 24 Hours

so what is the case if you radically transform your diet and you go 100% whole food plant-based all at once you will be miserable and the reason why is Dr William bwitch is a board certified in Internal Medicine and gastroenterology and also a New York Times bestselling author of fiber field I think it's quite an unexplained area can you first explain what is sibo sibo small intestin Vector overgrowth this is something that first of all it's real but also lots of people get worried about IBS what do you say to that those people that are listening that might struggle to have fiber to be clear impossible to cure but if you put it into remission where you are no longer having symptoms get the treatment that they need breaking in that chain and that is a rocket ship you watch that person fly and it is the most beautiful and exciting thing and you're like this is incredible so much of this conversation has actually been don't fear that food which I think is a really important take home message completely agree and I'm not advocating that people inflict harm on their body and be crippling pain see I have tremendous sympathy for this and 10 years ago I was in that place myself no matter where you are today there is the opportunity that exists to have a better tomorrow what I believe [Music] is I'm your host Sarah and mlin and I'm on a mission to uncover the Maze of Health myths around nutrition and well-being and guide you through my Seven Pillars of Health join me on a journey of Discovery and connection and put up a pew you for a front row seat to the most exclusive health conversations of our time welcome to live well be well if you've watched one episode and enjoyed it I'd love to ask in agreement for you to subscribe to the show subscribing is such a small thing but gives so much exposure bringing bigger guests bigger production and more that we can deliver each week to more people every time you subscribe it shows me that you enjoy the content so if you do me a favor and if you've enjoyed the show please press subscribe Dr W switch welcome back to L B well how are you I'm great saranne thank you it's great to be here I am I'm so happy we're doing this um and next time I want to be able to do it in person but our last conversation was probably about eight months ago and it was I think one of our most highly listened episodes and we had so many questions from that so I'm going to just dive straight on in on this yes um so last time you spoke on the show and you said something quite significant that a few people picked up on that I wanted to start with so you spoke a lot about the gut barrier and I think when we think about gut health we think a lot about the gut microbiome and we maybe less think about the gut barrier and you mentioned that every four to six days you can have a brand new layer of cells around your gut barrier and that's really important to one reduce inflammation and we know how important inflammation is to keep down because it drives disease so I wanted to start in this place actually around the gut barrier and I wanted if you could outline what are the most important factors to keep a gut barrier healthy okay so let's pretend for a moment that we have a microscope and so we're going to use that microscope to zoom in on this part of our body that exists it's completely alive right now things are happening in this place and we just can't see them like it's almost conceptually similar to like if you up in an airplane you would look down on the earth and you would just see a big dome a big planet and you wouldn't know that there's people down there living their lives right now there's microbes down there living their lives we're going to zoom in with the microscope and what we see is this community of microorganisms our microbiome and um and they're hard at work and much like you know I mean they're quite similar to our world in many ways um they have like each microbe has different skills different things that they do well um they have different temperaments some are very nice very supportive some are a bit nasty um they have different friends so they run in Clicks in a way like there's certain people that they hang out with that are similar and they do things together um and they have different dietary preferences so like they don't all like the same thing and this is is where the concept of dietary diversity comes in all right so now these microbes one of the things that they're hard at work doing is helping to support and nurture the gut microb the the gut barrier and the gut barrier is a single layer of cells that separates what's happening inside your intestine from your immune system 70% of your immune system is immediately on the other side of that gut barrier and your bloodstream and if you can get access to the bloodstream then you can pump whatever it is that you just put into the blood you can pump that to the brain and other parts of the body in seconds so these are highly vital highly important parts of our body we just don't think about them because like they're largely you know microscopic and quite small MH so now this gut barrier it's constantly uh being revised constantly being rebuilt and part of it is the workers who are gut microbes hard at work building it but on the flip side there are the disruptors the bad guys who they don't like the gut barrier if anything they want to smash through that gut barrier mess up your immune system basically meaning create inflammation get access to your bloodstream and put things into those bloodstream that are going to make you sick like bacterial endotoxin and so so those disruptors they exist like ecoli they're there but provided we have enough Good Guys the the bad guys just aren't really able able to do much mhm the problem that exists in 2024 sarahanne is that we're not properly supporting the good guys and in some ways we're actually like not even realizing what we're doing we're actually supporting the bad guys and so it creates an imbalance between the microbes and this is the first step towards disrupting the gut barrier which is that the gut barrier is actually High dependent on these microbes and the balance of microbes determines the uh ability of the of the gut barrier to remain intact and serve its purpose um so what are some like actually like very direct examples of how this works MH um the number one the number one I like I don't care what people say on the Internet by far in the science the number one factor is fiber fiber and resistant starches because that fiber and resistant starch passes through the intestines unchanged we as humans don't have the enzymes to break it down which means it's intact it arrives intact to the colon the microbes come into contact with it and they have they have the enzymes and they will apply those enzymes working in teams their little click of friends unpack that fiber or that resistant starch releasing butyrate or acetate or proprionate these these short chain fat and specifically berate is the one that creates the cement that holds the building blocks of the gut barrier together and this becomes the key and so here we are and in the United States 95% I always say this 95% of Americans are deficient in fiber 90% in the UK wow so what foods are high in Beauty rates if people are thinking okay if I'm having fibrous Foods what are the ones that are going to have these certain type of properties that release these short chain fatty acids that can help basically restore my gut barrier because what's quite also hopeful about this conversation is what I mentioned at the beginning every four to six days there's a new turnover so we can do something about this quite actively and quite quickly so what food should we be looking at to to help support that yeah 100% and these microbes are turning over 20 minutes so the gut barrier may be several days but the gut bar the microbes a new generation is being spawned potentially every 20 minutes wow so quick yeah and if you were to look at that over the course of a day and try to translate that into like human years because like for example a human you know it takes us like on average 20 to 30 years to create a new generation so they're doing it in 20 minutes so if you were to do that over the course of a day we could go back to the time of the the pyramids like we would be before Christ um in 24 hours that's how many generations are being spawned on a daily basis so this is where we have clear evidence that the choices that we make today by tomorrow will be reflected in your gut microbiome not some massive overhaul like you have one good meal that doesn't mean you've completely changed your gut microbiome but what what is happening is that the change is underway you are starting to spawn the microbes that thrive so the question was what foods can we eat and you know the the beautiful and exciting thing about this is that like we could try to get super technical like I've seen lists where people say here are the foods that contain inulin which is a fermentable form of fiber that produces butyrate and they they'll say Jerusalem artichokes and you know things of this variety we don't have to do that we actually don't have to do that we can keep this super simple all plants contain fiber all plants contain fiber now not every single form of fiber is fermentable not every single form of fiber preferentially translates into more butyrate but if you are consuming more plants no matter what plant it is I can assure you there is fiber content there and that fiber content is some of it is going to be fermentable fiber that's able to feed and nourish these gut microbes so and and of course the resistant starch I don't want to leave out the resistant starch because actually like there's some studies that suggest the resistant starch is preferentially like if you're asking me what is the one I might actually say resistant starch is the answer not even fiber wow there are some studies that say that preferentially resistant starch is is is transformed into uh butyrate and and so that's a cool thing and you can get resistant starch from potatoes and green bananas and legumes so green bananas legumes and white potatoes sweet potatoes would they be in there as resistant starch or white potatoes believe it or not more so white potatoes than sweet potatoes this is where I always come to defensive potatoes look I'm not here I do like potato chips I think we all do I think we all do they're crispy I do enjoy that um but um I'm not here to defend like french fries and chips you know in the states we call them chips it's crisps right in the UK okay yeah it's crisps fair enough fair enough so I'm just trying to translate here but like I'm not here to defend those things um but sometimes I think that we are like going too far in our attack on the on the potato we shouldn't just eat a potato diet but there are beneficial properties in potatoes and one of the things that you can do is when you heat up your potatoes such as making mashed potatoes and you let it cool down that process of cooling down after you heat it reconstitutes the starch and when it reconstitutes when it comes back together it forms resistant starch MH and so it's this cool process where you can heat up cool heat up cool and um and in doing so um create resistance starge for yourself recent studies in the UK have shown a concerning Trend nearly a third of Britain suffer with insomnia or severe sleep disturbances with dress screens and sleep hygiene largely to blame this isn't just about feeling groggy in the morning the NHS has linked poor sleep with a high risk in chronic conditions such as heart disease diabetes obesity and not to mention the impact on poor mental health that's why I'm excited to share with you my experience with natural mat a company that truly understands the science of sleep crafted in Devon with it organic renewable materials natural mat 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about improving their sleep quality for my UK listeners looking to transform their sleep and by extension their health I encourage you to visit natural mat. co.uk and don't forget being a Livewell bu listener you can get 10% off your first order using the code Live Well invest in your sleep your health and your planet with natural mats and is that the same as pasta cuz I've heard that with Pastor as well with resistant starch if people have pasta any starchy food any starchy food you can do this um so it's most uh notable though with potatoes but yes like think about the mashed potato does the mashed potato taste different after you've cooked it and then cooled it compared to the warm potato mhm I would argue that it does does the bean taste a little different after you've cooked it and let it cool compared to when it's warm I would argue that it does and so you see these things this is it's um quite interesting how there's this gift that exists in nature where you the starch can reconstitute in a way that's actually beneficial to our gut microbes I mean it's quite amazing isn't it and I'm just thinking about this in terms of a lot of people mentioned before when we were talking about fiber and and we didn't talk about resistant starch we're thinking about these foods that are high in resistant starch and these foods that are high in fiber or plant compounds lots of people get worried about IBS IBD symptoms and having a huge load of fiber but obviously what we're saying is this is really important for our gut barrier to reduce inflammation to help you know support and reduce disease what do you say to that those people that are listening that might struggle to have fiber what's the answer for them so first of all I'm grateful for the opportunity to address this issue because sometimes in nature things are nuanced m this is an example sometimes it's not so completely straightforward and winnier at all times um and there was a book that came out a few years ago that I'm personally not a fan of called the plant Paradox and I would argue this is the true plant Paradox this is the true plant Paradox because the Paradox is that the people who need fiber the most MH these people with IBS and inflammatory bowel disease are the people who will also struggle the most to introduce fiber into their diet so I would like to unpack this for a moment and then explain the path forward um so first of all I am not here to say that everyone should take their diet and add 30 grams of fiber today that's a bad choice for for pretty much all of us um the the thing about fiber and we can include resistance starch if we want resistance starch tends to be a little more gentle but the thing about fiber is that the human digestive system does not have the ability to digest fiber it's the microbes right so the microbes produce the enzymes so what is the case if you have a microbiome that hasn't been processing fiber that lacks the enzymes to digest and process the fiber mhm what happens when you you know it's January 1 and you radically transform your diet and you go 100% whole food plant-based all at once you will be miserable and the reason why is because of the mismatch between the digestive capacity of your microbiome and what you're putting into your mouth and swallowing your gut microbiome has been trained already like all of us we have a trained microbiome it's been trained to whatever you've been eating in the last two months mhm so to make a dietary change we have to allow the opportunity for adaptation because as you add high-fiber foods to your diet it's not that you lack the microbes and they can never be grown is that those microbes are not properly represented because that's not what you've been eating when you add fiber to your diet you will start to get those microbes represented now you could go hard and like ramp up your fiber aggressively and you will be miserable but at some point it will get better because the microbes will catch up flip side that's not what I by the way that's not what I'm advocating for um I don't sometimes I think people think that they hear me say that no um I have a saying that I've been pounding this drum for many years now I have a saying low and slow is the tempo love that now conveniently I I grew up in the 80s and this is a beasty Boy song All right so when I was a kid low and slow is the tempo was like I was like yeah like I'm like waiting for the school bus low and slow is the tempo all right so this is a beasty Boy song but it's also the way that we should approach introducing fiber and plant-based foods to our diet because the gut conceptually is like a muscle it can be trained it can be made stronger a person who has IBS or particularly inflammatory bowel disease that muscle is not strong I promise you it is not in fact that muscle needs to be rehabed not just made stronger it needs to be rehabbed and the way that we rehab a muscle is by starting with what you're actually capable of doing and over time slowly increasing that and doing more and so low and slows the tempo basically means that you start with where you are today and you gently add a little bit more over time and by doing it slowly and gently and backing down if you need to because you're starting to get bloated or other digestive symptoms by doing it that way your gut you're giving it the time to catch up you're giv it the time to adapt you're bringing forward the microbes that will help you to process and digest these food you are capable this is the this is the message of Hope and optimism you are capable of having a healthy gut we are capable of having a healthy gut you're not stuck but the issue is that you need to rehab your gut and you need to start with where it is today which may be more of a challenge and then gently ease it up and what you will discover is that you will start to become capable of processing this food without any symptoms without any bloating next thing you know this is a powerful part of your diet and you're thriving and feeling the best that you've ever felt and that IBS or that inflammatory bowel disease it's to be clear in possible to cure M you can't cure it but if you put it into remission where you are no longer having symptoms and if you have inflammatory bowel no longer having flares if that's where you get to and it never turns back because you have made some change to your diet that allows you to accomplish this MH that's effectively a cure a permanent remission is the same so you because you're grro enterologist and I'm just thinking if somebody came in with IBS or IBD to see you some gastroenterologists and I don't know if you would do this um would say go on an exclusion diet or start stripping back loads of foods and what I hear you say is don't be scared of these Foods introduce them slowly and I think there's this like very foggy landscape where people are so confused about what is hurting their gut that they either become quite scared of food and they totally strip it out of their diet until they've stopped having symptoms which can massively reduce their intake of nutrients um but they're not in pain or they feel so overwhelmed that they don't know where to start and they carry on with these symptoms so what would be your take on how you would then advise somebody what would you do if somebody came in with those symptoms to you well so I've I mean I've dealt with this scenario a bazillion times you know um because ER B syndrome is the most common diagnosis that exists in a gastrologist practice and so um there are a few things here first of all I can't speak for the entirety of all gastrologists across the globe there's Millions there's millions of gastrologists and with the with the internet and social media you will find someone who advocate for everything yeah right so if you have some sort of bias and want to fulfill that bias you will find someone in another country somewhere in the world that says that and 99.999% of their peers may say that person is insane and we completely disagree mhm and yet if that's what you want to hear you'll call that person a genius and that's the world that we live in um the the evidence first of all with regard to fiber and these conditions is clear it's clear people who people who introduce fiber into their diet increase the fiber in their diet we this leads to Better Health outcomes there's no dietary guidelines there are advising people to eliminate fiber from their diet temporary is a totally different thing temporary is part of a process permanent elimination permanent restriction that does not exist aside from people who have specific medical conditions like celiac disease it's a totally different thing like you can't take celiac disease and then generalize that out to other people who don't have celiac disease so now when we look at like what happens in the gut microbiome when people reduce diversity within their diet we have a number of different studies where this is the case people may be following a gluten-free diet and and again like if you have ciac disease you should but people may be following a gluten-free diet people may be eliminating fod maps from their diet um and when people make these choices consistently the gut microbiome appears less healthy in our studies so regardless of the dietary pattern dietary patterns of restriction and exclusion are not the optimal long-term approach it's clear that diversity and abundance is actually the way forward Ward now sometimes we will take one step backward so that we can take two steps forward and that's part of the process that I describe in my second book which was the fiber Fields cookbook in the fiber Fields cookbook one of the things that I'm proud of is that the book was made for people who have this exact issue San people that have iral wow syndrome or are struggling to add more plant-based foods to their diet because I want to help you accomplish that cuz clearly I wholeheartedly believe in this and so what I did is I put two dietary protocols in there basically I just eat the recipes that are in the book read the chapter eat the recipes and it will help you sort this out so the two that are in there are fod maps a low FODMAP diet and histamines a low histamine diet and these are things where you might actually temporarily eliminate these things like fod maps and histamines go low low FODMAP low histamine and that's a diagnostic process that's temporary you're going to bring it back on board the other thing I would say real quick is the days of a One-Stop shop for healthcare are are gone and so if you go to your doctor expecting your doctor to be all things all at wants that's a mistake you need to build a team and when it comes to nutrition that team should include a person who's adequately qualified to talk to you about nutrition which to me is a registered dietitian I think that's really important right having having having the support but also having the time to do this and making sure that you're actually setting out time where you are doing this properly is probably one of the biggest key factors to helping understand your gut health and something that it was it was a personal story for me which actually when I was 16 and you've mentioned and I'm saying this because you mentioned earlier about our immune system being kind of located within our gut and obviously with the gut barrier if it's permeated and it can kind of seat through into our bloodstreams that's a causal concern and disbiosis so I had glandula fever when I was 16 and that somehow caused a huge load of gut problems for me what's the link with autoimmune conditions and gut health because I think that's a really unspoken area or something that I haven't heard people speak about much on podcasts but I think there's such a big Interlink between these two and people that suffer with autoimmune conditions should they be focusing on their gut health that's something that I think is a is a really critical question when I was writing fiber fueled and I was doing most of the writing in the year 2019 the book came out in 2020 but I was doing most of the writing in the year 2019 I sat down and I asked the question do are autoimmune diseases associated with damage to the gut microbiome the word is disbiosis as you mentioned a moment ago um are autoimmune diseases associated with dispos and I created a list of autoimmune diseases and I started to go through by the way allergic diseases as well uh I started to go through and take a look at the research MH and what I discovered is that I could not find I could not find a study in which people had an autoimmune or allergic type health condition and when they tested the gut microbiome it appeared normal or healthy mhm every single study looking at the gut microbiome if you lift up the hood and take a look at what's happening on the inside in a person who has these health conditions every single study that I looked at showed me that there was disease or damage to the gut microbiome that's the starting point of the conversation but when you go further because I think back in 2019 we were thinking more about the gut microbes and had yet had not yet extended the conversation into the gut barrier but as you extend the conversation into the gut barrier it's no surprise that you will discover as well consistently that there's evidence of of increased intestinal permeability basically in intending or meaning that the gut barrier is not properly doing its job things are getting across mhm and this leads to activation of the immune system now I am not here to pretend that the only thing that matters for gut health is or I'm sorry that the only thing that matters for the for autoimmune diseases or chronic inflammatory diseases is your gut that's not the case but that being said you can take the microbiome of a person who has all sort of cius and form a feal transplant into an animal and transfer the health condition so there are clearly other elements to the story MH there's a genetic element that exists but clearly the rise like in many cases a 500% increase in or more in many of these autoimmune conditions the rise of these autoimmune diseases in recent years that is not a shift in our genetics our genetics don't change that quickly that is a change in the environment and I believe the effect that our environment is having on our gut microbiome that what we accept as normal in 2024 was not normal 100 years ago and are you talking that in the context of like our food environment such as Ultra processed foods are you talking that in the sense of stress and the chronic stress that we live in the reduced physical activity is all of these factors that you think are kind of harming our gut microbiome and the permability and the disbiosis Saran you're making this very easy for me because you're listing all these these things and all I have to do is say yes and you could I'm sure could keep going all right so I keep going the interesting thing about this is is that I want our our listeners to conceptualize this for a moment um living inside you is this ecosystem all right it's microscopic so it's not visible to the naked eye which makes it seem like it doesn't exist but it's there it exists it's an entire ecosystem that's alive and um not to give you a God complex people say that sometimes doctors have a God complex but not to give the listeners a God complex but actually you in a way get to play God um because you make choices with the way that you live your life that actually shape this environment the Top Choice being the food that you put into your mouth so we consume on average more than a kilo of food more than three like roughly three pounds of food um per day per person and that's coming into contact with these microbes and that shapes the environment the rise and fall of families are determined based upon those choices that you make but it's not just food it's not just food um that the way in which we sleep and exercise and and move and our mood and things that happen to us you know traumatic events in our lives um so as a quick example I've had many patients actually um I've said this before on other shows that for me the greatest most satisfying moments as a physician have not been the person that I've encouraged them to eat more fiber although it is amazing to watch them transform their lives and their health but actually the most satisfying moments have been when I have the person who's coming to me for a fifth or a sixth opinion they've been to every doctor in town and doctors outside of Town mhm and they are doing everything right eating the proper diet sleep exercise it's by the book MH and what you often discover is that there is some sort of unresolved Trauma from their past whether it be childhood or as an adult there's something that happened and they may not be consciously thinking of it mhm but it's unresolved and it continues to fester and exist in their subconscious so when we have stress stress leads to activation of our sympathetic nervous system the sympathetic nervous system is adrenaline MH um we call it fight or flight basically meaning that like if you were getting attacked by a saber-tooth tiger you're either going to try to fight that thing and you get charged up to do it right or you're going to like run so fast fast and climat Tre but like your athletic ability in that moment is actually Superior to what it normally is because your sympathetic nervous system has been charged up and activated you're superhuman the problem is like that's intended for that acute situation and that's not the way that we live in 2024 in many cases and for people who have unresolved trauma there's continuous continuous activation of that sympathetic nervous system and when this happens there's a consequence many of us during times of stress we manifest it in our gut quite sure that almost all the listeners can relate to this you have to go give a like you're nervous about public speaking and you're about to go up on stage what's going on in your tummy in that moment probably something on the spectrum of at a minimum butterflies flutters possibly something more intense possibly nausea possibly discomfort possibly intense cramping pain possibly diarrhea that is the manifestation of stress in our gut acutely and it's illustrating what I'm about to tell you is happening phys physiologically inside your body which is that in these times stress with activation of the sympathetic nervous system our brain releases a hormone called cortico corticotropin releasing hormone which sets off the stress response and its entire Cascade of things that come from this it spreads out and becomes a series of things within the body but the consequence of this spreading out of this stress response like there are benefits when we need it right but the consequence is negative harm done to the gut microbes so in a way this person who has this traumatic event that happens to them that they haven't properly addressed mhm they're doing everything right and they're like a rocket ship that has been chained to the ground and can't lift off because although they're doing everything right this thing is holding them back MH and when you bring their attention to this thing and I am not the person who actually does the therapy or does the treatment for this I am a gast neurologist but what I do is I help them connect the dots and see that this is the source of their problem and in that moment what happens is they get the treatment that they need for that specific issue you're breaking that chain and that is a rocket ship and then you watch that person fly and it is the most beautiful and exciting thing and you're just clapping and you're like this is incredible so and that's this is this is the way that it works with some people is that it's not just whether or not you eat fiber whe not you sleep and exercise that there's more complexity to it I mean your body your mind and body are connected and I'm such a True Believer in trauma that lives in the body and personally I've seen said this before on the podcast but I've suffered with my stomach since I was 16 and I know that it's been because of I've held trauma in my body since that moment and that's why I'm such a big believer of of the mind and body interconnection and the Vagas nerve and everything that it does with it kind of transformative power of telling the gut and the mind what's going on and Gara mat speaks about this so well about how your trauma is stored and how stress is manifested in the body and why are we why are autoimmune conditions on the rise potentially of trauma I totally I totally agree I think it's I think I mean part of it is dietary shifts but I don't think it's exclusively that I think that there's also these other things that exist completely and we even had um Dr Mar Al buuk on recently and she spoke about intergenerational trauma and that opened a whole new count of wor because there's so much unconscious trauma that we could be hiding within ourselves and it's interesting a lot of people do do things by the book and have this unresolved question why am I still in this state yeah and I also think that there's new there's new things that have changed that we have completely normalized very very very quickly that um depending on when you were born you may have grown up this way but like I was born in 1980 and I did not grow up this way um things were quite different when I was a kid in the ' 80s and an example of this would be social media so like look social media serves a purpose I have a large account I'm grateful for the opportunities that has brought to my life but I also hate it I also hate it and and I hate it particularly for the developing brain MH the young person that is on average in the United States right now spending 5 and a half hours per day on mine and the way that they think the way that those neurons fire is being formed by this and it's not a coincidence Sarah an that there's data that exists showing that depression rates have risen profoundly particularly among young people since 2011 2011 it was October of 2010 actually that Instagram started and I remember it was I didn't join I didn't sign up until 2016 but anyway um and the other thing that happened around then is the front facing phone uh the front- facing camera so that you could take a selfie and so now people are posting pictures of themselves and they're idealized life on the internet and for um vulnerable Minds that are forming you know going through a major restructuring of the brain during those teenage years um this is a uh it's a dangerous thing and I think it's created a lot of issues I can I could not agree more with that and I think we're there's a there's a line of obsession that comes with the phone as well and the dopamine hits and everything so there's that kind of need of addiction that that comes in line and again what that creates is stress and uncertainty and everything you just said about fight and flight and so the activation starts again and so you know the gut becomes activated from all of these hits and addictions and obsessions around you know needing to feel wanted or whatever that is that message that's coming through in the phone it's such a it's such such a bigger conversation that you know when we talk about anything I think it's just not isolated it's all interconnected um but something that I really wanted to touch upon when I started practicing on Harley Street about seven years ago now people started talking about leaky gut and I say anyone who's not watching um on YouTube with like quotation marks but now um sibo has become quite a big topic of conver ation and I remember it being quite a new thing back then that people were talking about but first of all I think it's quite an unexplained area for many people and we've never spoke about it on the show before even when we've done gut health issues so can you first explain what is sibo to everyone listening because I think it really links to kind of our first conversation so sibo small intestine Vector overgrowth this is a so much better oh no worries you know this is what happens when you're talking about these topics literally all day long but um this this this is something that first of all it's real but also it's not super satisfying because people want it to be something that's concretely and firmly established as this is what it is this is how you treat it this is how to improve it and I feel like that cake is Half Baked mhm you know when you take a half baked cake out of the oven it's a sloppy mess mhm and I feel like when we're rushing to make sibo into a thing we're not ready for it and it's a bit of a sloppy mess so let's talk through what this is so small intestine bacterial overgrowth okay there are microbes throughout your intestines um so there's no part that's completely sterile even your stomach has microbes it's just that the stomach has quite few because of stomach acid and there's this gradient that exists whereas you move further and further down into the intestines the number of microbes increases and then it pops and explodes in terms of a lot more microbes when you get to the large intestine which is the colon this is where the vast majority of these microbes exist in the colon all right and when they're in balance and Harmony this is the way that it works but when Things fall out of balance which again the word that we use is disbiosis then you can have things occurring in places that they're not supposed to be and that includes microbes infiltrating the small intestine so bacteria that are now existing within the small intestine growing multiplying coming into contact with your food um but not supposed to be there not supposed to be doing that the way that they're doing that and creating disruption and issues for people commonly causing bloating um with bloating and gas potentially discomfort and classic sibo is associated with diarrhea now there are some forms of so of sibo like there are multiple forms of sibo again like I feel like this is quite Half Baked but there are some forms of sio that are also associated with constipation and I would like to talk about them in a moment if I could yeah but to me starting with like to me as a gastrologist when I think of sibo I'm thinking about an overgrowth of bacteria within the small intestine that's associated with bloating discomfort in diarrhea and that is treatable potentially with antibiotics now here's the problem let's stop uh for a quick moment and I want to point out first that the testing that has been used in the vast vast vast majority of of studies and that's also predominantly used in the clinic to diagnose sibo is wildly flawed wildly flawed like literally in some cases could be a 50% accuracy rate are you talking about the the breath thing the breath test yes I thought you might yeah yes so and this is what most people use because it's convenient it's not invasive it's easy MH but the problem is that there are a number of different things that can give you a false positive there's a number of different things that can give you a false negative it's hard to have great confidence m this test if you have sibo let's pretend you truly have sibo mhm but the test comes back negative you're not going to get the treatment that you need and if you don't have sibo but you get a false positive you are likely to be inappropriately treated with antibiotics which is actually going to set you back and make you worse so there's a testing problem the gold standard test there's always a gold standard test MH the gold standard test is what we call sterile junal aspirate so basically What's Happening Here is the person gets an oper endoscopy so you have to it's an invasive procedure you have to put someone to sleep you go a gastrologist like myself will go down into their small intestine through their mouth and then using special sterile technique because if you disrupt the sterile technique you throw off the entire thing using sterile technique you get a sample of fluid and you check to see how many bacteria grow in that sample all right so now this is the gold standard test the problem is first of all no one does this I've done I've done zero in my career and if you were to go and bring 25 new additional gastrologists on the show I'd be shocked if more than one says they've ever done even done one wow it's never done because I hadn't heard of it so when you said it I thought how do I not know this procedure because so this is the gold standard test but no one no one actually does it no one actually does it even demic centers they don't do this mhm why because it's just so CU people have endoscopies to see if they've got celiac disease or a coloscopy to see if they've got you know IBD inflammatory bowel disease why does no one do this to see if there sibbo because you require there's the fact that it has to be sterile there's special techniques that you have to use in order to get a a proper sample you have to go a little bit further down so the junim is the the second part of the small intestine it's not the first part of the small intestine it's the second part and that's not actually that easy to get access to it's quite hard mhm um so all of these things are barriers to the use of this test but then there's this other thing Saran which I there's a paper that came out I think in 2019 um in nature Communications where they looked at this gold standard test and basically showed that the gold standard test is flawed that like for example you could be a high fiber consumer like myself mhm and because you consume fiber you get a false positive on the gold standard test just because you consume fiber and on the flip side you could have um raging disbiosis of the small intestine and the gold standard test is normal so in other words even the gold standard test is not truly a gold standard so this is where like we have a problem with this we can't properly test for the condition mhm the second issue is that people often rush to do treatment for sibo with antibiotics and if the problem is disbiosis we know that the quickest way to actually introduce disbiosis to a human is with antibiotics like if you're trying to medically induce if I were if my goal was to give a person dispos I would give them an antibiotic so we're not fixing the problem by destroying the scorched Earth strategy is not going to work here mhm the way that we fix the problem is by building empowering the good guys because when we restore U biosis which is the healthy balanced microbiome it takes care of itself it's just that that requires time effort and may not be easy because these are the people that add fiber to their diet and they don't feel well but in that nature communication study that basically made it appear that the gold standard test is wildly flawed they found that the people to did the worst they they actually um added a a little pilot study of humans to this and they found that the people who did the worst were those who were consuming a high sugar diet refined sugar and the people who received antibiotics and the people who did the best were the people who were adding fiber so even though it's hard I think that this that's the solution to this particular issue again it's a bit complex um I actually did a so I'm a regular on the Zoe science and nutrition podcast and this is one of the topics that we have covered and we covered like I could literally teach for three hours on this topic so it's hard for me to get it down to like a couple moments but anyway for those who want to do a little bit deeper than what we just discussed there is a Zoe science and nutrition podcast on that topic they could check up mhm so I guess that anyone who maybe has just heard of sibo for the first time on this show um or maybe heard of it in the in the past but are also just overwhelmed where they don't want to go and get a test that isn't accurate and spend that money your advice would be to not potentially get antibiotics to actually start introducing more diversity into your diet is that the kind of best man man strategy for somebody who may relate to the symptoms that you just said all right so I would Branch it into two specific groups of people um because in order to believe that you have sibo you clearly have chronic digestive symptoms you have to mhm so and you likely have either diarrhea or constipation MH in associ be really confused with IBS yeah absolutely well this whole thing is quite confusing with IBS because there are some people who believe this is not universally accepted but there are some people who believe that most IBS is actually sibo I would argue that all all IBS all IBS is disbiosis meaning that the the colon microbiome is out of balance and that some people some people have also disbiosis within their small intestine as well that would be my argument but anyway all right so let's separate people you have diarrhea or you have constipation there are some there are many people who they're constipated they're bloated they get a sibo breath test it's positive and they think they have sibo and they go to take antibiotics and they don't feel any better MH that's because the issue is constipation and the way that you fix this is by addressing the bowel regularity if I could take that person and work with them and there's not one single solution constipation required uh working with a trained expert who can help you find the right thing but if I could get them into a rhythm where they're having good regular complete evacuations that's my way of saying a great dump if if if I could get them to that place yeah actually all these issues particularly the bloating it would all go away it would all go away if we could just get them into a better Rhythm so you don't need the antibiotics you just need to be on a plan that's going to help you address the constipation when you fix the constipation you will fix the issue mhm flip side diarrhea the person who has diarrhea from my perspective as a gastrologist that is not the diagnosis right it is not the diagnosis the diagnosis is we have to ask the question why why does this person have diarrhea the diagnosis might be IR bow syndrome m it could be sibo well let's not let go with the fact that there are many things that cause diarrhea that would include celiac disease MH or inflammatory bowel disease but also less scary things like microscopic colitis MH so there are many potential causes of diarrhea you have to start with making the diagnosis that's to me where we have to begin so there's not some Universal solution to this it's not simply add more fiber to your diet mhm fiber may be part of the plan fiber does help many of the conditions that I just mentioned it may be part of the plan but it's not the plan it needs to be that there that you first make the diagnosis understand what you're actually treating and then you take it from there so now are there people that I will treat with antibiotics yes but not many surprisingly not many if for every 100 people who says I think I have sibo and I want to take an antibiotic I probably chop that down to maybe two who end up on antibiotics on the back end it's about making the diagnosis make the proper diagnosis and then treat whatever it is that you've just diagnosed as opposed to um loading a person up with antibiotics on the first visit and discovering that it really didn't fix anything honestly it's one of the the biggest things I think for any Intervention when it comes Health whether it's mental health whether it's gastro Health they actually trying to fix the problem as opposed to use medication to kind of numb what's going on there's always I think as you know a placement for for medication and and treatment in that place always but so many times we kind of miss the solution and I think the thing that I've seen and I know you would have because I mean you've been doing this for years is that people then just get quite scared of food people feel like this is now going to harm me and they eliminate it and so much of this conversation has been actually that's ultimately The Cure actually kind of reintroducing this is actually the cure to it and I think that is why as I'm just like listening to this you're just reaffirming every time go back to the food go back to the food but I think we've got into this narrative especially in the UK of reduce that food if it hurts take it out take it out take it out and keep it out and so then when people start having less symptoms they don't want to kind of re introduced that back in again but so much of this conversation has actually been don't fear that food which I think is a really important take-home message so I'm not I completely agree and I'm not advocating that people inflict harm on their body and be in pain like crippling pain like obviously I have tremendous sympathy for this and 10 years ago I was in that place myself MH um what I believe is that the gut is highly adaptable and no matter where you are today there is the opportunity that exists to have a better tomorrow and it's just a process that we have to work through and I would make an analogy Sarah an with this to Let's imagine for a moment that you hurt your knee all right um so with this hurt knee one of the things that you could do is you could go plop on the couch and never get up mhm and if you do that you will not feel any pain if you never put weight on that knee you will not feel any pain but the problem is that there are other consequences that you will suffer as a result of the decision to just go and sit on the couch for the rest of your life um obviously you will fall out of metabolic balance and next thing you know high blood pressure high cholesterol diabetes waking dep your risk of right depression right like there's so many good on the line there's so many different things and this is not the choice that any rational or reasonable person would ever make because you know that the path forward is to rehabilitate that knee MH and the process of Rehabilitation is working with an expert to start low and go slow in terms of exercise MH so you don't immediately start running MH you start with what you're actually capable of doing and you do push your body a little bit and in the process of pushing your body a little bit there may be moments in time where you cross that threshold where you feel some discomfort but it's being managed right you're not going so hard that you're just throwing caution to the wind and you're in pain with a horrible knee that's swollen you're doing just enough to continue to restore function to that knee and that process that you invest into that every single person does cuz this is just completely accepted as the treatment for a bum knee MH that process that you go through is worth the discomfort and what you have to do the effort that's required to put you on the other PL other side where you have restored function to your knee and now you're back to skiing or for me playing basketball or playing pickle ball or whatever it is that you enjoy you can get back to that right if you lay on the couch you're never going to do that again so with me like I want us to think about our food in the same regard the gut may be broken right now it can be rehabilitated you can restore function that process of restoring function is starting low and going slow during the process of starting low and going slow you may at times feel a little bit discomfort and it does require effort but it's worth it because when you emerge on the other side you have restored function to your gut and now you are a healthier person who is thriving and more and you are able to consume food without fear without restriction as a result of what you just did I think that analogy of an is such a nice one actually because I've gone through so many times with a painful physio thinking this is not going to get better and it does but it takes it takes six months and it's similar to gut health but what's also really really hopeful is how we started this of saying you know even within 20 minutes you can start making changes and so you can see things things start changing maybe small but they they will change um and it might not take six months I think that's just a really nice hopeful thing CU I think a lot of people can feel very hopeless um in this situation and it takes me to like my next kind of question around which I don't think many people talk about but it's burping and belching and many people I know can suffer with this quite a lot and can feel really embarrassed but don't actually know how to control it so what's your advice around people that um are burping because there's obviously something happening um but I don't think people really know how to approach it yeah okay so many people um believe that when they are belching it is the result of you know something that's going on with the microbiome or the colon or things of this variety and you have to understand that's on the distal opposite end of your intestines like that is like you know uh 8 m Downstream relative to the top mhm and the air that you belch up typically has very little smell or smells like whatever is in your stomach mhm the air in order to belge has to enter into your body somehow there are specific uh ways in which it can sneak in without you even realizing it so it's important to bring attention to these specific things mhm some may seem quite obvious but in the moment when you're belching it's like sometimes we just need this obvious list so you can go okay check not that check not that one is carbonated drinks naturally anyone who's got a belching issue eliminate carbonated drinks mhm two sipping through straws next time you have a straw in a beverage what I want you to do is take a look at what's inside the length of that straw and I'm going to tell you what you're going to find there's a water level that exists wherever the straw enters into the water so everything below that will be liquid but everything above that will be air when you sip through a straw you wrap your lips around this you create a seal and that vacuum effect allows you to draw in through there whatever was above the water level you have now just swallowed mhm that's air okay um chewing gum sucking on candies when we do this we salivate and when we salivate we uh we swallow more and when we swallow more we swallow more air and this can lead to belching MH all right so these are some of the things that um people need to be aware of that like if you have an issue with belching get rid of the gum or like sucking on Candy get rid of the carbonated drinks stop sipping through straws like this is step one mhm there is this um condition that and it's like it's a complex conversation to have with a person mhm um like I have to like gently introduce this idea because people tend to get defensive because they feel almost as if you're accusing them of doing this to themselves which they clearly are not doing they're asking for help mhm but this condition is called aeroasia and aeroasia basically means that you are swallowing air repeatedly so think about the kid who I was never that great at this but I had friends who could do the entire alphabet with beling right so they could go a b c d but they're like doing it with burps how does a person do that well the way in which they do that is every single burp they are swallowing air right before they bring it right back up on the Belch and this is what's happening on aeroasia is that a person is not conscious or aware that they're swallowing air repeatedly but if you actually uh pay attention to what this person may be doing like for example they'll be in the clinic and they'll be belching and I'll watch I'll I'll like discreetly watch and I'll see that right before they belch you can see their atoms example if it's a guy move because they just swallowed so they bring the air down in many cases that air never even gets into the stomach it just gets into the esophagus and then they bring it back up so the solution to this issue if you're the person who's belching multiple times per hour the solution to this issue is first to diagnose the aeroasia and um treatment can include working with a speech therapist it may also believe it or not include working with um what are called um what we describe as centrally acting agents so like basically these are like anti-depressants mhm but you're just using them for a different purpose and at a different dose so like one that I've had great success in my patients who have this issue is called boost brone and like if you give a person boost brone at 45 or 60 milligrams per day um it can be used to treat depression but like for me I would give it to them at 10 or 15 Mig a day so like a very very small dose and that would be enough to help to actually break this cycle of swallowing air and then bringing it back up wow fascinating I love how there's so many different types of treatment options for one medication but just use in different Doses and I think that's something that's it's just quite fascinating I think a lot of people can struggle with this problem but would never have thought that that could have been an option for them um and sadly it can be a very embarrassing you know condition that people can suffer from and never seek help so I'm really glad that we approach that actually because so many times we can focus on IBS and IBD and stomach and what does our poo look like and what's a healthy poo but so rarely do we speak about that and so the last question that I want to leave with which I ask all of my guests and I've asked you last time and I should have gone back and I should have looked at what your answer was because I cannot remember but I'm going to find out and see if it was the same But the irony of when people come back on the show 95% of the time they say the different answer which I think is the beauty of this question I don't know if you remember it but it's Dr will volt switch what does live well be well mean to you oh man I think I remember what I said so I'm going to try I'm going to try to be at least slightly different in my answer um and I'll just share with you San what I think about which is that um we've added to our family since the last time was on the show so I now have four children and I think I'm just now in this phase where I'm all in on being a dad and to me live well be well is so I think about like our family and what we we're imperfect but we are trying to create a culture within our family of support and love and knowing that you are connected to this group of people that will always be there for you no matter what and and they will lift you up and they will defend defend you and they will work to protect you and all these things this is what we are as a family we stick together and to me live well be well is an extension of that we as humans are social creatures we were meant to be connected to other humans we actually get miserably depressed when we get isolated social media is actually quite isolating call it social it's actually antisocial and to me but will be well is stepping away from technology for a moment and getting back to these basic things of human connection looking people in the eyes and getting to know one another and caring about one another like to me this is the world that I want to live in this is the world I want my children to live in and I think this is the world that we all deserve to live in yeah oh I think that's such a beautiful answer the fact that it's true right knowing that you're a team I think that's a really beautiful know you know knowing answer that you can lift each other up and I think that is the actual the importance of human connection that it's not meant to be solo so that's beautiful thank you so much for sharing that and um please tell everyone where your two bestseller books people can buy from and what they are um so you can go in ahead and buy your cookbook and also your other book fiber fueled yeah my first book was fiber fueled I managed to write a book where both the words in the title are spelled differently in the UK than they are in the US so um so with appropriate British spelling you can find this this book and the fiber Fields cookbook in wherever books are sold um in the UK or if you're in the United States and listening you can find it anywhere the books are sold in the US as well I personally I personally a fan I mean I realized that like 95% of books at least in the states are sold on Amazon yeah um and that's fine I get it but but I also am a fan of trying to support your local bookstore and I say this all the time because the family that owns that local bookstore like you actually buying a book helps them to continue that business and I I don't want the days of me being able to Mosey into a bookstore and browse and have a cup of coffee like I don't want those days to ever go away so let's continue to support our local bookstore owners who live in our Community whenever possible I agree I agree thank you so much will for uh coming on the show and I'm hoping next time we do this we can do it in person amazing yeah we'll have to do that San thank you so much for having me it's always fun thank you [Applause] [Music] [Applause] [Music]

Channel: Live Well Be Well with Sarah Ann Macklin

Views: 47,057

Keywords: The Fiber Miracle, the fibre miracle, fiber fueled, gut health, live well be well, live well collective, Sarah macklin, Sarah ann macklin, will bulsiewicz fiber fueled, Gut microbiome, heal your gut, heel your gut, Dr.B, Dr Will B, Fibre Fuelled, SIBO, IBS, Burping, Belching, Top 5 foods, Top 10 foods, Rich Roll, Steven Bartlett, DOAC, Diary of a CEO, Balanced Diet, Fiber, Fibre

Id: n8-zRku5fh0

Length: 68min 24sec (4104 seconds)

Published: Wed May 22 2024