DR. WILL BULSIEWICZ ON THE MICROBIOME: Heal Your Gut, Sidestep Disease & Thrive | Rich Roll Podcast

You are not cursed with the microbiome that you were born with. You have the ability to shape and change that microbiome and make it your own through the choices that you make. And the choices that you make today could literally alter your gut microbiome by tomorrow. (upbeat music) Permanent results come from consistency. What you want is you want small changes that you repeat every single day and if you're willing to do that, small changes that become healthy habits start to really add up in terms of what they can do with your gut microbiome over the course of time. Hey everybody, welcome to the podcast. Today I come bearing gifts and good news, because the good Dr. B is back and this conversation on all things, gut health, and microbiome, and the powerful health benefits of being "Fiber Fueled" is just absolute fire. One of the most popular guests in the history of this podcast, Dr. Will Bulsiewicz is a board certified award-winning gastroenterologist and the New York Times bestselling author of "Fiber Fueled". Dr. B has authored more than 20 articles in the top American gastroenterology journals. He's been featured in many prominent media outlets, and he's got a new Book out called the "Fiber Fueled Cookbook", which beyond the amazing recipes is filled with tons of practical, actionable gut health promoting takeaways. Our first episode checkout episode 538, if you missed, it spent a lot of time focused on the why behind gut health. Well, this episode picks up where that one left off, focusing more on the how, how to eat optimally, how the microbiome affects cognition, brain health, mental health, and many other fascinating topics. Final note, much like Simon Hill, Dr. B was kind enough to create a PDF with links and citations to the many studies and articles in support of the claims that he makes over the course of our conversation. A link to which you can find in the description below. We've got a feeling that this episode is gonna rock your world. So please hit that subscribe button and let us now take a fantastic voyage into the mysteries of the microbiome with Dr. Will Bulsiewicz. Dr. B is in the house. How you doing, man? I'm great. Happy to be here. I'm happy to be live in front of you right now. I know. Last time we did this and I was not only on a Zoom call with you. I couldn't get my microphone to work properly, and I was on call and I had a patient in the hospital who was sick and it was just crazy. Well, the audience didn't seem to care. You didn't feel distracted to me in any way, And that was a very popular episode. People loved it. And I made you promise that if you found yourself in LA, that you had to come by and here we are. Here we are. It's the first time I've been in LA in about 15 years. Really? So, yeah, seriously. It's crazy. The last time that I was here I was actually interviewing for GI Fellowship at UCLA. And this was, you know, I was like in my late twenties and clearly not married and no kids. And now it's like, this is, you know, my life is completely changed. Yeah. There is a lot of changes. There is a lot of stuff to catch up on. You've been on quite the trajectory in lockstep with everybody's growing fascination around all things, microbiome and gut health and your particular skill set and level of interest intersects, you know, perfectly with all this emerging science that's occurring right now that we're gonna get into. So I'm really excited to sit down with you and my desire and intention for this particular episode is to have it be a little bit distinct from the first one where we kind of went into your backstory and cover a lot of ground, of course, but for people who haven't listened to that, or haven't stumbled across that episode. I mean, definitely go check it out. I think it's episode 538 from like a year That's about right. And a half ago or something like that. Yeah. I would very much like this to be a standalone comprehensive review of all things microbiome, gut health, why it's important and the many ways that we can take action in our own lives to not only sidestep disease, but to live to our healthiest potential. Yeah. I mean, I think we could do an incredible episode where we take it all the way from the top, that way you have the introductory material that you need, but we're gonna bring you all the way to the cutting edge, there are studies that I'm ready to talk about today that have been published in the last few weeks. Well, let's come out of the gate hot with the cutting edge. Like what has got you excited in terms of the latest literature and what we're discovering about the microbiome. I was at a microbiome meeting recently and blown away, and this is coming from, you know, the guy who's nerding out on microbiome studies all day, blown away by what's happening in cancer research with the microbiome. Complete game changer. So what we're seeing here is that first of all, going back a few years, we discovered that cancer has a microbiome. Like-- How does that work? Like a distinct microbiome that it has differentiated from how we commonly think about it, explain that. I'm not even talking about the gut microbiome. So let me start with this. Microbes are everywhere. They cover us from the top of our head to the tip of our toes. They're most concentrated inside of our gut, but they're on plants, they're part of the plant microbiome, they're in the soil obviously. Everything that's alive in this planet either is a microbiome or has a microbiome. Those are the two choices. So everything has a microbiome. And I thought like a tumor would be, you know, I mean a sterile mass of cells. And a few years ago, they discovered that tumors, cancer tumors, actually have their own microbiome. Wow. Separate from the gut microbiome, they have their own microbiome and they took this further. They were taking a look at pancreatic cancer, which is one of our most deadly cancers. And they analyzed the microbiome of the tumor, not the person's gut microbiome, of the tumor, and discovered that a person who has a low diversity within the tumor microbiome has a worse prognosis or a lower likelihood of survival relative to the person whose tumor has a high diversity. So explain what that means, low diversity. So diversity is looking at sort of the spectrum of different types of microbes, so like different varieties of microbes and how strongly they're represented. So like inside of us, as humans, inside of our gut microbiome, we could have anywhere from hundreds up to potentially a thousand different varieties of microbes living inside of our gut. And one of the things that we would look at in terms of the health of the gut microbiome in a human being is the diversity within that system. Sure. So what we find, Rich, is that if you look at ecosystems, whatever that ecosystem may be, you know, it could be the Amazon Rainforest. It could be the Great Barrier Reef and it can be actually our personal gut microbiome, which is an ecosystem. And what we discover, biologists will tell you this, is that diversity within the ecosystem is a measure of health. Right, It makes it more robust and resilient. Right. Because there are different players that are there And they all have different unique skills that they can basically contribute to the greater good. And if you, you know, for example, if you take the rainforest diversity and like remove the snakes from the forest, I'm not a huge fan of snakes, you remove the snakes, the problem is that the other animals they're not snakes. They're not really designed to fill that role within the ecosystem and so when you remove the snakes, it actually has a ripple effect because all these other animals are being affected by the fact that you have disrupted the balance that exists within that ecosystem. So anyway, getting back to the cancer, they discovered that these cancer cells have their own microbiome and that the diversity within that microbiome could indicate prognosis. Now this is quite fascinating. And so they continued down this path to look into this in more detail. And there have been a number of major discoveries. First, in acute myeloid leukemia, one of the treatments that they will give people are stem cell transplants. And it's basically trying to throw hail Mary and save a person's life. And there are some people who do great and there are some people who do not. What they discovered recently is that the microbiome, the gut microbiome of the individual people who receive the stem cell transplant actually is difference making. If you have high diversity within your personal gut microbiome and you receive the stem cell transplant, your survival is actually much better. By conversely if the diversity of the microbiome with respect to the tumor is high that would correlate negatively with treatment receptivity. Is that what you're saying? So if the microbiome on the tumor is very diverse and robust, then it's gonna be much more treatment resistant. No, actually more treatment. Or actually actually it does better. Oh, I see. 'Cause I was thinking the diversity of that microbiome is there to support the tumor growth. So the less resistant it is than the weaker it is. No, actually, so in both cases, a more diverse microbiome whether it's inside the tumor or whether it's the patient's actual gut microbiome, in both cases, a more diverse gut microbiome is associated with the better prognosis. So now MD Anderson is like taking the ball and running with this. And they're doing quite fascinating research with melanoma specifically, which is a skin cancer. It's the most deadly form of skin cancer that exists. And one of the ways that they will commonly treat melanoma is with immunotherapy. Now they've been doing this for about 10 years and it can be highly effective, but of course there are people that it does not work for. So how do we determine who are the people that it's good for versus the people that it's not good for? Well kind of building up to the most recent stuff that's just from a couple weeks ago. A few years ago, MD Anderson did a study where they gave antibiotics or they looked at the effect of antibiotics immediately prior to receiving this treatment for melanoma. Antibiotics reduced diversity Sure. Right. Within the gut microbiome. And what they found is that in doing this, they actually were reducing the effectiveness. That's fascinating. Of their treatment. Taking in a step further, they then took a group of people and they showed that once again, if you have a higher diversity of your microbiome, you are more likely to survive and have a good result from immunotherapy. They gave them a fecal transplant. So they started giving fecal transplants to people, and when you received a fecal transplant to boost your diversity temporarily, people had a better survival and better outcome from immunotherapy. That's amazing. So now bringing it all the way forward to where we are today more recent research has shown that the diversity within a person's gut microbiome, their gut microbiome is very relevant to this melanoma and they've identified specific species, and what's interesting is that the species that you want to have that basically pretend a better prognosis are the exact same ones that help us to process and digest our fiber. And produce short chain fatty acids, and these short chain fatty acids. They are the... We can talk about it more later if you want to, but they are the product of fiber degradation by our gut microbes. Wow. Fiber is the prebiotic, our gut microbes are the probiotics, and when they come together, the fiber, the prebiotic, with the probiotic bacteria, they basically create this new compound, which we would call a post biotic, and these are the short chain fatty acids like butyrate. So they showed in this research that melanoma patients have a better survival if they have higher levels of these butyrate producing microbes in their gut. Wow. So they did a new study looking at dietary fiber. What happens when people are eating more dietary fiber. And again this is in the context of treating the melanoma with this intervention immunotherapy and the cutoff that they used was 20 grams of fiber per day. Now let me just first comment and say, this is actually less than the recommended-- Yes, I was gonna say, it is not very much. It's not very much. But probably more than most people are eating. Yes. So in this cohort of people, where this cutoff is 20 grams of fiber, so they considered it to be like, if you're more than 20 grams of fiber, you're a high fiber consumer. I'm just gonna tell you the minimal recommended amount for a woman is 25 grams of fiber. And you're probably eating, I don't know, 200 grams of fiber a day. Yeah. I'm super charged on as much fiber as possible. The average for a man, the minimal recommended amount for a man is 38 grams of fiber, right? So even at 20 grams, we are low. 71% of the people in this study did not hit 20 grams of fiber. And what they discovered is that the people who were the high fiber consumers, this 29%, they had a significantly improved survival after the immunotherapy for melanoma on the high fiber diet. Wow. And when they broke this down, so check this out. This is where like my mind is blown. When I saw this. For every five grams that you increased your fiber consumption you increase your survival by 30%. That's an insane number. That's crazy. So the most general takeaway from that is if you are suffering from cancer and you're about to undergo treatment or you're currently undergoing treatment, you should be boosting your fiber intake as much as possible. So I would expect that that would be true. We can't necessarily apply that to every single cancer, but here's what I can say. What we just saw this-- It's not gonna hurt you. No, it's not gonna hurt you. Yeah. This five grams of fiber translating into a 30% greater survival is giving me dejavu from a colon cancer study that came out in 2018, where if you increased your fiber intake after you were diagnosed with colon cancer, now these are by the way, people who did not have metastatic colon cancer. Okay? So 'cause metastatic is a totally different animal, but among people who do not have metastatic colon cancer, if you increased your fiber intake after you were diagnosed, for every five grams that you increased your fiber intake, you saw an 18% increased likelihood of survival. Wow. So we're seeing the patterns showing up among different types of cancers, and further study is going to push this even further along. Melanoma is where we have the most robust research because MD Anderson has really taken an interest in this particular topic. But I think this is the future. This is where people are going to be looking, and what's exciting, Rich, is that this is not just us describing the microbiome. We're talking about manipulating the microbiome by quite simply eating plants to save people's lives Right. That's wild . On that idea of a tumorous growth having its own unique microbiome. What has been learned about the quality of that microbiome or the particular microbial ecology of that in terms of like how it can be manipulated to produce a favorable outcome with respect to treatment. So I haven't seen any research specifically looking at the use of the tumor microbiome to create interventions that can improve cancer care, this has become a very hot topic within the cancer space and there's more research that's ongoing because first they did this study with the pancreatic cancer showing that you lived longer if you had a high diversity of your tumor microbiome. And so now what they're doing is they're looking at different types of tumors. Step one is you first sort of describe what you're seeing and then step two is gonna be, so how do we manipulate this? And they do believe that these microbes, Rich, are playing a role. This is part of the thought process here. They do believe that these microbes that are like literally a part of this tumor are playing a role in the ability of your cancer treatment, whatever it may be, whether it be chemotherapy or immunotherapy to actually get access to the tumor cells and basically disrupt them. Right. It would follow logically from the idea that fecal transplants can be at least temporarily effective. That with respect to say a skin cancer that there could be some kind of microbial topical ointment or treatment that could be rubbed on this or in turn for an internal tumor for there to be some kind of injection to the tumor with some kind of microbial solution that would increase that diversity or somehow make that tumor a better candidate for treatment. I completely agree. And some of what they're saying, for example, the researcher out of MD Anderson, that's doing this melanoma research. What she said in this meeting recently is that she believes that as we continue to unpack this particular topic and understand this new finding, that the tumor has in microbiome, that this is going to like radically transform cancer care and allow us to become so much more effective than we currently are in terms of our therapeutics. Yeah. So super exciting. I mean, in terms of just human biology in general, the science that's coming out on the microbiome is the most interesting to me, with maybe the exception of some neuroscience stuff. But, I mean, it's mind blowing stuff. Yeah. And it's like this thing that was there all the time that we didn't understand at all and essentially ignored. And now we're just tip toeing into the most basic understanding of it. And each new study or discovery is just more mind blowing than the one that preceded it. That's so true. And I think that part of it for me is it reminds me to have a sense of humility with the science, because there is so much about what we understand today, that 15 years or 20 years from now we're gonna look back at the conversation that you and I are having and saying, "Wow, like we have completely changed "how we feel about stuff on these particular topics." 20 years ago, I mean, was there anything on this planet less valuable than poop. Right. Right. It's like, Right. Who would even possibly care about poop or the microbes that produce those smells? Why would we care about that? And now what we we've discovered is this is a radical source of information about human health that complete like is transforming cancer care, right? And at the same time, like scientists are fighting over, you know, there's like these fossilized poops, they call 'em fecaliths. And like scientists are fighting over who gets to have ownership of fecaliths because they wanna study, you know, old poop and say Right. Like, "What does that mean? "And what does that tell us?" Right. It's like the mosquito and the amber in "Jurassic Park". Yeah, exactly. And also the analogy that popped into my mind was, you know, the microbiome is to human biology as is dark matter to astronomy. It's sort of like this thing that we don't really understand that we're just only beginning to understand, that has just, you know, massive implications in terms of how we think about, you know, life in general. I think that's very true. And I also think that there are these planes of existence that it all depends on are you zooming out or are you zooming in. If you zoom in on our gut, you discover this community, this like thriving, vibrant community of microorganisms that are as alive as you and I are, Rich. And it's very hard for us like to conceptualize this and understand this because they're invisible to us, but they are there and they have personalities just like you and I do, they have clicks or like groups of friends, they have different skill sets and they have different dietary needs. So they're very, very similar in many ways to humans and think about like mother earth. Right? And if we zoom out, if we were standing on the moon right now, you don't see you and I here having this conversation. Right? But yet the earth has this microbiome. Right. We are the microbiome as humans. Yeah. And sometimes I feel like with this biotic. Yeah. It's the perfect organization of the universe from the smallest thing to the largest thing. And it always kind of, you know, it's always in lockstep, it's this idea of looking at everything holistically. Like if you telescope out and you see our freeways, they're like arteries and each car is like a cell, you know, delivering something to some part of this larger organism. And these mechanisms, you know, scale up from the thing that we can't see all the way to, you know, the laws of the universe. And I think the kind of implications for that in terms of medicine and health is to, and we're seeing this, is to think about human health in a more holistic way. And I think the danger or kind of, not really the danger, but the predilection of the scientist or the researcher and the scientific method in and of itself is to look at things in isolation, right? We have to. And it becomes tricky and that's how we've made tremendous progress, but we cannot be myopic to how those, you know, variables are functioning within the construct of a much more like an infinitely more complicated system. That's completely true. We look at things in isolation because we have simple human brains. And so we're only able to really understand things in a sort of a linear way when in fact our body is this confluence of multiple things that are bumping into each other by a fraction of a millisecond, you know, and it's all like coming together to form. Yeah. You and I having this conversation. Yeah. Yeah. Yeah. I wanna turn attention for a few minutes and talk a little bit about our immune system and how our microbiome plays into that. When we did our first episode, it was early days of COVID and we talked a little bit about how to keep our immune systems healthy and to make sure that our microbiome is diverse as you know, something necessary to combat disease. Here we are, you know, two years later, we're sort of beginning to come out of this period. So I'm interested in what you've learned over the last two years in terms of, you know, how COVID has impacted us. I mean, we've been in this era in which we've been forced to socially isolate, we've restricted our exposure to other human beings and a multiplicity of environments, we've over sterilized everything. This has to have an impact on not only our microbiome, but the robustness of our immune system to combat disease in general. And of course, you know, Yeah, totally. These protocols were necessary Right. And Public health demanded them, but at the same time, I think it's important to really take a look at, you know, how we were living and now how to make appropriate adjustments moving forward. Were there any studies that have, I'm certain people are gonna study this period of time in the context of the things I just mentioned but what are your thoughts? Yeah, totally. So I think that the conversation about cancer is a nice segue into this type of conversation about the immune system and how it interacts with our gut microbiome. Because basically looking at those cancer studies, you know, effectively what we're saying is that the gut microbiome has a direct impact on your immune system's capability of doing its job. And that's because 70% of the immune system is literally right there, separated from your gut microbiome by the most thin single layer of cells. So 70% of the immune system on one side, 38 trillion microbes on the other side, constant communication across this little barrier that's there and they're talking to one another. And so when it comes to COVID-19, this becomes very relevant because of some of the things that we've learned. When you and I got together back in June of 2020, I made a prediction that I believed that fiber would be one of the keys in protecting ourselves from COVID-19. And I was basing that on, not on actually a COVID-19 study, but instead on data that actually was looking at infections with a respiratory virus in an animal model, and they did this study in an animal model where basically they gave these animals a high-fiber diet versus a low-fiber diet. And the prediction of the scientists was that the high fiber diet, because it's anti-inflammatory, that it would actually reduce the effectiveness of the immune system, and when they infect them with a respiratory virus, that these animals would be more prone to death because of the high fiber diet. They found the opposite. And when they went to unpack this, they were like, "What is going on here?" They dove deeper, and they discovered that the key was that the fiber was coming into contact with these gut microbes. So the listeners at home can already hear a pattern of what's happening here, and the gut microbes release the short-chain fatty acids, the short-chain fatty acids, enter the bloodstream, leave the gut, enter the bloodstream, travel to the lungs and in the lungs are actually able to manipulate the immune system to protect against this respiratory virus. So in these studies the mice that were on the high fiber diet, they were less likely to die, they had better lung function and they had less severe illness. Well, if you fast forward through the pandemic, you know, what's fascinating, Rich, is that for me as someone who really values high quality research information, I'm looking for trends. I'm not looking at single studies. Yeah. And we have to be cautious about what we can extrapolate from a mice study. A hundred percent. We always have to be cautious Yeah. Because many times it doesn't translate. This is why we want to see, okay, so we have the preclinical study or the animal model study, and now what happens in humans, we need to see that. And so there was a study that was published in the journal gut, which is one of the top two gastroenterology journals on the planet, where they were looking at the gut microbiome of people with COVID-19. And what they discovered is that, number one, were clear disturbances of the gut microbiome if you had COVID-19. But there was actually a signature pattern that as the COVID-19 became more severe, this signature pattern became even more entrenched in the microbiome. And that pattern was, to be very specific, it was the loss of the specific bacteria that produced the short-chain fatty acids, severe COVID-19 was associated with the loss of short-chain fatty acid producing microbes. It would lead you to believe that the fiber is a relevant part of determining whether or not a person has severe or mild COVID-19. And it wasn't until very recently that we had a study that came out among healthcare workers from six countries, frontline people being exposed to the virus and looking at dietary patterns and health outcomes. And they found in this study that people who were eating a plant-based diet had a 73% reduced likelihood of having moderate to severe COVID-19. That's amazing. Did that factor, was this pre-vaccination, or did it factor in vax versus non- vax people or were these people vaccinated? The data that was collected for the study was pre-vaccination. It was published post-vaccination, but the data was collected pre-vaccination. Got it. So these were people that were unvaccinated and the pescatarian diet did pretty well as well. It was a 59% reduction of moderate to severe COVID-19 among that group. Well, pescatarian diet, I mean, there's no meat, there is no dairy, there is no eggs, but there is fish, and there is a lot of plants. Right. Right. Is it possible to interpret from that data, the extent to which the diversity of plant foods in the diet were the thing, moving the needle versus the absence of animal foods or other unhealthy foods or how do you parse that? It's one thing to just say the plant-based people did better, but what is actually the, like the active component in this? Well, we don't have the granularity to go into great detail about like, what was the diversity of plants within their diet? Sure. What we do know is that these are people that are eating a plant-based diet. And so the clear assumption there is that this is a high-fiber diet relative to low-fiber diet. But then on the flip side what was interesting in this study is that there was an additional finding. The people who did the worst had a specific dietary pattern as well. It was low-carb. The people who were eating a low-carb diet, again, they did the worst, plant-based did the best. And if you were to line this up and compare it low-carb to plant-based, what you would discover is that the people who were consuming a low-carb diet had a 3.8 times higher likelihood of developing moderate to severe COVID-19. That's interesting. I would've thought the people who were doing the worst would be people who would be like on the McDonald's diet, which isn't necessarily low-carb but just tons of processed foods and refined grains, et cetera. You know, I think Not so sure. It bring forth questions about the low-carb diet. And we don't, with this particular study have the answers of what are the specifics of what was their low-carb diet. But I think it's within reason to assume that people who described their diet as a low-carb diet were doing a general ketogenic type diet, which in many cases is-- Is low-fiber. Where you're basically reducing your plant intake, and you're going low on fiber and you're cranking up the animal products. Now, if we bring in a nutritionist who's highly facile in this space, could they craft, like could they craft a diet that's higher in fiber and yet still low-carb? Yes, they could, but that's not the way that real people eat in the real world, right? Right. If you're just eating broccoli or something like that, right? Yeah. If we start getting a little more technical with the low-carb diet, 'cause some people will do this and trying to protect the space-- Yeah, plant-based, low-carb diet is a thing. That's right. And there's also like a Clean Kiddo, where, you know, you're specifically looking to get your dietary fiber and yet you're still predominantly getting your calories from fat. And, but there are still some issues with these types of diets. I mean, you can't do that without eliminating fruit. You just can't. Right. Right. So that's interesting. So essentially the takeaway is the people who, if you can interpret that data, the takeaway would be that people who are amping up their fiber in their diet just fared better in general. Yeah. So now here we are and we're just a few minutes into this episode and we're already seeing a pattern in the real world of where fiber and the gut microbiome are impacting the ability of our immune system to properly do its job. Whether it's cancer care, whether it's the real world protection from the pandemic, we're already seeing this pattern exist. (upbeat music) Profits walk among us as a writer and podcaster for nearly 10 years, I've become more convinced than ever that our world is populated by scores of beautiful and brilliant people who have amazing stories to share, those that we don't know who can teach us something new and leave us all the better for the experience of their sharing. And so I've dedicated my career to tracking down the most compelling profits on the planet, going deep with each of them on my podcast to elucidate the best of what they have to offer and to sharing the insights gleaned for the benefit of all. But the podcast is not the only medium by which to share their stories, which is why I'm proud to announce the release of my new book, "Voicing Change Volume II" more than mere words on paper. "Voicing Change" is a physical manifestation of the magic, inspiration and timeless wisdom that transpires each week on the Rich Roll Podcast. The first edition of "Voicing Change" was a beautifully rendered book worthy of display on any coffee table and Volume II follows in that tradition by showcasing even more of my favorite conversations in an elegant publication replete with interview excerpts, essays, and stunning photography making for an exquisite companion to the first volume or a satisfying standalone work. Picking up this book allows you to revisit the wisdom of your favorite everyday profits and physically interact with the life changing ideas contained with them. "Voicing Change Volume II" available now while supplies last for a limited time order your copy today only at richroll.com. Now, Rich, going back to your original question, like, you know, do we have data about the pandemic itself and the effect of the pandemic on people's gut microbiomes? I haven't seen any good high quality data to really unpack that conversation. But what we do know is this, we know that people do better when they're close to other people. We know that in terms of their gut microbiome and the diversity within that, we know that people have a healthier gut microbiome when they're under less stress, but we've all been under tons of stress, right? And we know that people have a healthier gut microbiome when they're spending more time outdoors. And like literally there is a study where they took a group of adults and they had them stick their hands into soil for two weeks. Like literally that's all they did. Right. They put their hands in the dirt, they weren't even gardening. They were just hands in the dirt for two weeks. And they had healthier gut microbiomes at the end of the two weeks. Right. I would think that there was probably a lot less hands in the dirt over the last two years, and, you know, all told like if you were to canvas the entire global population, I would suspect that there is a reduction in microbiome diversity, just as a result of the lifestyles we were compelled to lead over the last two years. There is data about the increase in, for example, mood disorders, there's data about the increase in substance abuse during the pandemic, and obviously these are things that have a direct impact on the gut microbiome in a negative way. Yeah. And is there not a loss of microbiome diversity? It's sort of a crisis, right? Like the more the world becomes developed and industrialized the less sort of, you know, species diversity we're seeing in the microbiome at large, right? Yeah. In the same way that we're, you know, experiencing mass species extinction of animal and plant life as a result of the way Yeah. That we live. Yeah. It's a bit unnerving to talk about, but there is a mass extinction that's taken place within the gut microbiome. If you compare our gut microbiome to, for example, the Hadza, which is a tribe of hunters and gatherers that live in Tanzania, and they do have these studies Rich where they will take a look at people who immigrate to the United States coming from third world countries. And what they discover is like, I mean, look, I would expect that if you come to the United States you don't just show up and change your diet on day one, like to some degree you're still eating most of the same foods. And yeah, you're probably starting to integrate some of our stuff that we have, or perhaps going out to restaurants. But within like literally within three months of arriving in the United States, there already is a disturbance and a reduction of the gut microbiome in people who are immigrating to the United States. And even within the Hadza community, I mean, they're suffering encroachment on their native lands and there's a loss of, you know, biodiversity within their, you know, ecosystem. So their dietary habits have begun to shift as well. Yeah. Because we can't help, but like being alone. The Hadza being, we should say, like being the population of people who have demonstrated the greatest diversity within their microbiome. Correct? Correct. Yeah. But we can't weave them alone, we were very curious, and we want to study them and interact with them, and then when we study them and interact with them, oh, what's that you have in your hands, oh, that's a cell phone. Yeah. And then like the young Hadza of tribe members don't wanna be a part of it. Yeah. Yeah. Yeah. They decide to leave the tribe. Yeah. I had David Choe, in here, the artist, and he's gone and lived with them for months at a time. Yeah. To, you know, basically refresh his soul. And he has amazing stories about that culture. That's really cool. What are we learning about long COVID. It's still early days in terms of understanding what that is, how long it'll last, what the, you know, long term repercussions are from that. But how are you thinking about this and understanding it and what kind of studies do we need to do to better understand it in general and also the role that the microbiome plays in it? Yeah. So long COVID is the manifestation of symptoms that will carry on for months potentially after you've had COVID-19, it's a very personal response. You can't really describe it as one particular symptom, it could be any of a number of different symptoms that people experience. And there is actually a study that just came out in December, Rich, that showed that people who have long COVID have once again a disturbance of their gut microbiome. And when you drill down and you take a closer look at what's going on there, it starts to bring parallels to what we were seeing in the COVID-19 study, where the gut microbiome of people with long COVID is once again, disturbed, and there is a loss of the short-chain fatty asset producing microbes. So we don't yet have a dietary intervention study or any sort of dietary study in association with the long COVID. But it is my expectation, like if I were to make a prediction, my prediction is that either in 2022 or early 23, we're gonna see a dietary study that's gonna tell us that fiber is protective from long COVID. Yeah. It's really weird and disorienting, this whole thing, because some people get COVID, they recover very quickly, other people suffer very dire consequences. And it appears from a layperson's perspective that there is some level of randomness in terms of who's suffering from long COVID and who isn't. I'm sure it correlates with, you know, other kind of health complications that people have, but, you know, from what you're saying, it makes sense that we should be looking at the microbiome and the correlations between these two. 100%. And the microbiome is unlikely to explain everything. Yeah. But it's likely to explain a very large part of it. Right. It not like Bitcoin, it doesn't solve everything. I wish it did. I wish it did. But it is something that we've never really looked at in depth until current times and to the extent that it can shed light on matters like this. I mean, I think it's super interesting. Every time we look, we find something interesting. Yeah. And you know, you mentioned that there may be these other risk factors and really the risk factors you're referring to are metabolic things. So for example, obesity, high blood pressure, type II diabetes. And if you go and look under the hood, what you discover is that in every single thing that I just mentioned, there is disturbance of the gut microbiome. So, you know, once again, this is a player in all of these different conditions. Yeah. And just to put a finer point on that, you're often one to say that the idea of the microbiome gets conflated in this reductive definition of just being about gut health, but really what it is, is it's about metabolic health, right? And to the extent that we can tend to our microbiome, it will improve our metabolic health, which of course the downstream implications are that, you know, we become better and more resistant at fighting off all of these chronic ailments that are a result of problems with our metabolic health. Metabolic health is associated with inflammation. Inflammation comes from the immune system. We describe these things in their own separate way, but they're not separate, you know, this is all part of the confluence of factors that make us human beings and they're completely integrated. Yeah. Well, we're well into this podcast and we have yet to define our terms here. Yeah. So if somebody has stumbled into this episode, and this is their introduction to the microbiome and their only kind of association is that the microbiome means like bacteria in our digestive system. Perhaps we should take a few minutes to kind of really define what we're talking about in terms of, like what is the microbiome and why is it important? Yeah. The microbiome is a community of these invisible microorganisms and there are several different varieties that are there, but they're there, they're covering every external surface that's a part of us as humans. So like they're covering our skin. If we were to literally look at our thumb, there as many microbes right there in our thumb as there are people in the UK. There're inside our mouth, inside our nose, inside a woman's vagina, but they are most concentrated inside our intestines, specifically our colon, which is the large intestine. In that spot you will find that there are about 38 trillion microbes. And 38 trillion is a pretty ridiculous number. It's hard to know exactly how to like frame that. So let me put this in the perspective, there is about a hundred billion stars in the sky. So if we were to take all the stars in the sky, all the stars in our galaxy and shrink them down to a ball, we would have to place a hundred galaxies full of stars into your large intestine. And even that actually is only a fraction of our gut microbiome. How'd you, that's a good one. How'd you come up with that? I'm a math nerd. It's impossible to wrap your head around that big of a number. Yeah. It is impossible, it's completely ridiculous, but that's a part of who we are. Every single one of us has a microbiome, right? In this conversation that you and I are having, when we talk about the microbiome, typically this is what we're gonna be referring to as the gut microbiome specifically. So, and these microbes, they're a part of human history going all the way back to the very beginning. There has never been a moment where a human being did not have a microbiome. Whoever that first human was, they had a microbiome, and from that point moving forward to today, three plus million years of human evolution, it was never exclusively human evolution. It was always co-evolution. We were rising and falling with these microbes, and that process galvanized the relationship that we have with these microbes, where we grew, like very clearly if you look at the science, we grew through evolution to really trust these microbes because we gave them tasks that we completely need them to do the job for us to be healthy humans. So starting with digestion, like digestion is access to nutrients. If we don't get access to nutrients, we don't live and we need them, we rely on them for the digestion of many of our foods. We've talked about our metabolism, our hormones, let me also inject, we talked about our immune system, our metabolism, let me also add our hormones and our mood, our brain health, our cognition, the expression of our genetic code. They are powerful and they're not even human. Explain the one about the expression of the genetic code. Is that in reference to our ability to express certain genetic dispositions, like if our microbiome is out of kilter, then we're not able to, you know, basically function because our genes are under expressed, that are intended to perform a certain function or what do you mean by that? If you go back to the year, it was roughly 2000, 2001, and they were wrapping up the human genome project. And this is Francis Collins who just recently retired. But at the time he was one of the most preeminent well-respected scientists at the NIH. Bill Clinton was the president. And he called a press conference along with Tony Blair and in the Rose Garden, they have all these people there to announce that they had just cracked the genetic code. And the reason that this was such a big deal from their perspective is that they sincerely believed that once we cracked the human genetic code, we're gonna basically have the path to curing cancer or stopping heart disease. Right. And they really believe that that would be the truth. And the problem is here we are and it's more than 20 years later, and clearly that is not the truth. Clearly it has not worked out the way that they thought that it was going to work out. And that's because we are not a... I think this is actually empowering. We are not a set of predetermined health outcomes in a genetic code. Instead, our genetic code is more like a series of switches and you can turn them on or you can turn them off and whether or not you do that is going to determine what actually happens with our body. But the question is who's sitting at the switchboard and flipping the switches and the appearance is that these are the gut microbes. Right. They're in control of basically flipping the switch and determining whether or not we have health conditions or we don't. Yeah. And what's fascinating about that is cracking that genetic code through the human genome projects seem like an impossible task. Now we're capable of doing it, but we're dealing with a very limited set of variables in that context, right? And now analogously, we have like the Human Microbiome Project and the American Gut Project, which, you know, correct me if I'm wrong, seem like the microbiome version of that same way of trying to understand it, except with like an, you know, an infinite number of complex variables, because you're dealing with, you know, these, you know, hundreds of thousands of million, you know, millions, whatever it is of microorganisms and different species, et cetera. Well, so there is the complexity of the microbiome. There are the challenges of measuring the microbiome. Like if you take a stool specimen you are representing what's happening in the rectum, far more than you are representing what's happening in the right colon. You know, there is a geographic element. Like there may be specific spots within your colon where specific things are happening and not necessarily in other locations, right. So how do we measure that? That's really hard. And it's dynamically evolving literally by the second, because the half life of these microbes is so quick, you know, they could be turning over every 20 or 30 minutes, a new generation. And so like in an hour, in the time that you and I sit and we have this conversation, we may have cranked out, you know, five, six generations of microbes. And so yeah, so there are these challenges that exist. And the other part of it is the amount of information that exists. So our human genome is actually quite small, right? Like it's very easy for us to get egotistical Right. About this because we're such big strong humans. And that's the way we see ourselves. Yet if you look at the genetic code that we carry as a part of us, 99.5% of our genetic code is not human. It comes from these microbes and only 0.5% of our code is actually human. So when they cracked the human genetic code, they were using, they were basically working with one two hundredths of the available genetic information. And the amount of information that exists in stool is completely absurd to the point that the computers of the nineties were incapable of handling this. Right. And this is part of the reason why we really weren't able to take a look until like 2005, 2006, there was a laboratory breakthrough, and there was also, our computers were able to finally catch up and handle it. And, you know, Rich, some of the studies that you've mentioned, like the Human Microbiome Project and the American Gut Project, these are powerful studies. We will talk about stuff that we have found from them. But on the flip side, the science is evolving so quickly that you start up these big, massive studies, and then you discover that your laboratory technique is completely outdated within five years, that's what's happening. It's crazy. But I would think at some point with the super computing ability that we have and the kind of technology that we have in terms of analyzing massive data sets will come into play, and, you know, elucidate certain things that, you know, we're not gonna be able to see in a microscope. Yeah, that's very true. And I think that this is where the future exists. And so this is actually something that I'm actively a part of right now, which is to take a look at personalized nutrition and the way in which we have different personal responses to the same intervention. You give two people the exact same diet, get two radically different results. And the way that we're approaching this is to use the microbiome as sort of the starting point to ask these questions. What do the gut microbes say about what's happening with the human body? And the more people that we collect as a part of these scientific experiments the more robust the data becomes. If you had 10 people it would be completely worthless. But what happens when you have 10,000 or a hundred thousand or a million people, and suddenly these super computers are basically able to run complex algorithms and identify patterns that exist that actually can be applied to the individual person in a very powerful way. Right. So talk a little bit about that. I mean, you're in the middle of a big life change, you've left your medical practice. You're now medical director at this company called ZOE that is doing this very thing. Yeah. Yeah. So a lot has changed for me. And, you know, "Fiber Fuels" came out in may of 2020, was a New York Iimes bestseller. And here we are, and it's sold basically 200,000 copies. That's amazing. Congrats. Thank you. And with that discovered that there was an opportunity for me to try to do something even bigger. So, you know, my mission throughout all of this was just quite simply to provide ways to help people who need it. And, you know, it started in a clinic, one on one, and then it became an Instagram account and then a book. And now I'm seeing opportunities to get out there and do something on an even bigger scale. Where I feel like I can impact millions of people. And part of it is more books, part of it is courses and things like that. But part of it is also being a part of the future. And I think that the future is in the microbiome and personalization. That's where I think it is. So walk me through the personalized nutrition thing. We talked a little bit about it before the podcast, and I think it would be instructive for people to hear about that because it's really interesting, it's emerging, and I think, you know, might be a sell to people who have struggled to adopt a certain dietary protocol, and aren't seeing the results that everybody told them they would have, you know, et cetera. Yeah. So we know this, there is no one size fits all. And that's because we are completely unique individuals. We each have a gut microbiome that is completely distinct. There are no two people that have in the entire planet, 8 billion people. There are no two people that have the exact same gut microbiome. You take identical twins and you look at how much their microbiome overlaps. And it's only about 35%. Wow. Even when they grow up in the same house? Exact same house. So it's not twin studies where they go and lead completely different lives. No they've done these studies, Tim Spector. Who's one of my colleagues at ZOE. He actually is responsible for the TwinsUK Registry which they've been running, I believe since the '90s, and have done some of the best genetic research. And what they've done is they've actually taken some twins that cohabitate, and even they have completely different gut microbiomes and completely different responses to the exact same foods. That's wild. So, and we see this in clinical trials. Because the problem, Rich, is that we may do, let's pretend that we do a randomized control trial and the goal is weight loss. And this is just a hypothetical here, I'm not describing actual data, but let's pretend that it's plant-based versus keto. And in this study, the plant-based diet wins. All right. The average person consuming the plant-based diet loses four pounds. The average person consuming a ketogenic diet loses three pounds. And this is statistically significant. So we call, "Oh, plant-based is better." What do you say to the person who gained five pounds on a plant-based diet? What do you say to the person who lost 20 pounds on a ketogenic diet, different people have different responses to the exact same dietary intervention. Right. We are not the norm. All you have to do is go on Twitter to realize that's the case. Yeah. And none of us are average. Yeah. To expect the average results is ridiculous because none of us are the average, in every single measure we are going to be our own unique personal selves. So if you go back to 2016, I was actually at a microbiome meeting and there was a study that blew my mind where basically what they did is they took microbiome specimens, this was done out of the Whitesman Institute in Israel. They took microbiome specimens, and they had people wear a continuous glucose monitor and record in an app what they were eating during the week. And integrating this information, blood sugar, food, and microbiome, they were able to distill it down to the microbiome, could predict your response to individual foods. Wow. And they applied this to a validation group. So they first started with a study group, they built their model, and then they applied this to a second group and it proved to actually be true. That they could actually predict robustly what your response to an individual food was going to be based upon your microbiome alone. So enter this company, ZOE. ZOE starts in about 2017, completely off my radar at this point, I'm not aware that they exist. But they start in 2017 and they basically do three years of clinical trials. And it builds up to June of 2020, which is right around the time that you and I got together for our first podcast, where at the American Society of Nutrition, they present for the first time their data, that basically shows that they have the ability using microbiome testing and app, continuous glucose monitor and blood lipids. They can use the microbiome to predict what is your blood glucose going to do with a specific food? What is your blood lipid going to do with a specific food? So they're taking it a step further looking at our metabolism, our blood sugar and our blood lipids, which by the way are cardiac risk factors that we can then integrate into a model of looking at what is our risk of, for example, having obesity Yeah. Or a heart attack. It's super interesting. We work with Levels, they're sponsor of the show. So I've spent plenty of time with the CGM. And it's been really interesting to kind of try to understand, you know, when I see these spikes and valleys, and I, you know, I try to extrapolate from that. Like, here are the foods I should avoid, here are the foods I should eat. But I found also that it's easy to jump to conclusions that might not be correct in that stress, sleep, physical exercise, all of these things play into it. It's much more complicated than a very binary, like don't eat this food or do eat this food, but to introduce the microbiome into this obviously makes it a much more, you know, robust data set from which to, you know, make predictions and kind of advise behaviors and dietary protocols. And how do they do, sorry, I didn't mean interrupt, but like you say, Yeah. Well, they take into consideration the microbiome, but like, walk me through this. Like I'm a consumer, I wanna do this, how do they, they take a sample of my microbiome, and then how does that get factored into how these, you know, sort of decisions are made about what to avoid and what to lean into? Yeah. So if you are a consumer partaking in this like scientific project. I mean, basically this is citizen science, so anyone can decide that they want to contribute to the science that's taking place in this space. You receive a kit, and what you're gonna do is you're gonna first submit a stool specimen that ultimately is going to be your microbiome test. In that kit you're also gonna receive some muffins. These muffins are standardized meals. That way we can compare, Rich Roll's results to Will Bulsiewicz's results. We're having the exact same meal and we can see what our CGM, what our continuous glucose monitor does. But the other thing that we do is we do the blood lipid testing. So we can see after a meal what happens to our blood lipids when we're eating this particular meal that's controlled. During the week you wear your CGM and you enter into the app what foods you're eating and that information that you're entering into the app is then integrated into these super computers. We have more than 10,000 people who have signed up so far, 10,000 is a hell of a lot better than a thousand people or a hundred people. And we're gonna keep going higher and higher, and with every single person who signs up we become more robust in our ability Sure. To powerly we predict Sure. What specific foods are gonna do well. So what's exciting about it is that, you know, in June, after they presented their results, they published a paper in "Nature Medicine", literally the top journal on the planet. We've published multiple papers now in 'Nature Medicine", nature endocrinology, gut, I mean basically the highest level scientific journals. And this is all predating in many ways, the release of a consumer product. So what we have is we have something where the science is being done first, and then it's offered to the consumers after the validation is already there. And to me that's what attracted me. Because I don't wanna be a part of something that isn't actually proven to work, but I actually respected the integrity to have the gall, to spend that much money on science before you've even sold a single kit, three years. Sorry to interrupt the flow. We'll be right back with more awesome. But I wanna snag a moment to talk to you about the importance of nutrition. The thing is most people I know actually already know how to eat better and aspire to incorporate more whole plants, more fruits, vegetables, seeds, beans, and legumes into their daily routine. Sadly, however, without the kitchen tools and support very few end up sticking with it. So because adopting a plant-based diet transformed my life so profoundly, and because I want everybody to experience some version of what I've experienced, we decided to tackle and solve this very common problem. The solution we've devised, I'm proud to say is The Plantpower Meal Planner, our affordable all in one digital platform that sets you up for nutrition excellence by providing access to thousands of highly customizable, super delicious and easy to prepare plant-based recipes. Everything integrates with automatic grocery delivery and you get access to our amazing team of nutrition coaches, seven days a week, and many other features. To learn more and to sign up, visit meals.richroll.com, and right now, for a limited time, we're offering $10 off an annual membership when you use the promo code RRHealth at checkout. this is life changing stuff, people, for just a dollar 70 a week, literally the price of a cup of coffee. Again, that's meals.richroll.com, promo code RRHealth for $10 off in annual membership. All right, let's get back to the show. Talk a little bit because we're on the subject of weight management, the relationship between metabolic health and weight management and how the microbiome plays into that. The microbiome ha has a powerful role in our weight balance. Now this is obviously not the only thing, and it's in some ways, a little bit difficult to separate from our dietary pattern because our dietary pattern will affect our gut microbes. But what we do know is this. So there's a number of studies that we've seen through the years. First of all, if you take a group of people who are overweight or obese, you will discover that there are changes in their gut microbiome and that that's categorically there, and there is a loss of diversity within the gut microbiome, which is a theme that we've been talking about. So it's quite fascinating because they have these studies where they will look at a mouse model and they will go back and basically do fecal transplants into mice. Right. This is the study. A lot of people know about this study, right? Like the fecal transplants from... Like take a fecal sample from an obese mouse and put it into a thin mouse. And then suddenly the thin mouse becomes obese and vice versa. Yeah. They have ones where they'll take identical human twins, but among the identical human twins, one is obese and the other is skinny, and they'll take a stool specimen from the obese human transfer it to a germ-free mouse, and they'll take a stool specimen from the skinny human transfer it to a germ-free mouse and then they feed these two mice the exact same diet, the exact same number of calories, they eat all their food, and then you get different results in terms of their body habitus, one becomes obese, the other becomes skinny and it coincides with the microbiome that they received. So the writing has been on the wall that the gut microbiome is a critical part of determining our weight balance. And there is a number of different parts to this. You know, I think one of the big things, Rich, that is not discussed enough in the obesity space is satiety. Like actually feeling full when you eat a meal, because we eat a diet, that's like a fast food junk food diet, devoid of fiber. And as a result of that, we actually have studies from Kevin Hall at the NIH where on this type of like ultra process diet people overeat, because they're hyper palatable foods, like you want more and you're not triggering your natural satiety hormones to stop you when you're supposed to feel full. Is that because they're nutrient deficient? Like what is the relationship between that satiated impulse? It's really like a nervous system, like trigger to the brain, right? To stop eating. What is the relationship between that signal and the nutritional value of the food you eat? Like what is impacting like whether you feel full or not, 'cause it's not just the distension of your stomach, right? Yeah, there is a number of different hormones that are produced actually by gut microbes that ultimately will go to the brain and tell us that we feel full. And what we've discovered is that fiber actually plays a critical role in this pathway in terms of the release of these hormones, so that we do feel full. And there is an interesting study that they did where they compared two burgers that they fed to a group of people and the burgers were completely matched and identical, not only in terms of calories but in terms of macronutrients. So same carbs, fat and protein. The difference between the two burgers is that one was a pork and cheeseburger and the other was a tofu-based burger. And in this study, what they discovered is that people actually felt more full on the tofu-based burger than they did on the pork and cheese-based burger. As a result of the fiber content. The fiber content was the major differentiator there. That's really interesting. Yeah. Really interesting. But when you look at, you had mentioned this study earlier with, you know, we were talking more generally about studying people who eat low-carb or plant-based and average weight loss numbers, but there is the outlier, the person who goes on the plant-based diet, and instead of losing the average five pounds, ends up gaining 10 pounds or whatever it is, that brings us back to this topic of what their microbiome looks like, what their satiety, you know, situation is and how to address that through-- Right, this is when we conduct our research through ZOE, we're discovering that you can predict a person's visceral fat deposits, which is basically a measure of obesity. You can predict that more reliably with the microbiome than you can with a person's body mass index. Yeah. That's wild. I mean, that's crazy, because we always look at the body mass index as sort of being the measure of obesity, I mean, it literally is the measure of obesity. A person is considered obese when they have a certain body mass index, but in this case we can actually predict their visceral fat, which is the bad fat, much more reliably with the microbiome. And when they broke this down even further, looking deeper, like taking a deeper dive into the metabolism using these tools, you know, visceral fat percentage, but also the microbiome, the continuous glucose monitor, the blood lipid tests. They were able to ultimately identify specific microbes that were associated with a healthy metabolism. So we now have 15 specific microbes that are associated with a healthy metabolism and 15 specific microbes that are associated with an unhealthy metabolism. And so we can look at these particular 30 microbes and it does provide us with some inferences about the health of this ecosystem, the gut microbiome, and what that ultimately means for a person's metabolic health. Right. So the science minded person inside of me thinks, well, if we know what these 15 are, that promote better metabolic health, why not just inject them into people's guts and that would solve the problem. So that would be-- I'm sure it's more complicated than that though. Yeah. Well that's an idea that, you know, we kinda we're hoping to be true from the very beginning and this is the genesis of probiotics, right? So we've been trying the probiotic thing for a very long time and with frankly, pretty mediocre results. Now this is not to say that there aren't people who benefit from probiotics. There certainly are. The challenge that we have is how do you identify the specific people that will benefit from that specific probiotic? And it may be the personalization that we're missing. So perhaps with personalization we are in fact capable of producing probiotics for that individual microbiome that will completely, for example, transform their metabolism that may be possible. But the other challenge that exists is that this is a complex ecosystem that's closed off to the outside. So it's kind of like Right. Having a high school and like, you're the new kid who just showed up, right? And how is this new kid going to integrate into this culture that already exists and the clicks that already exist and whatnot at the high school? You just don't know until you actually see it play out. Right, right, right. What you were talking about earlier reminded me of something that I read that that was along the lines of when you analyze somebody's gut microbes, you can predict with something like 90% accuracy, like what their BMI is. Does that ring true to you? I can't remember exactly what the quote was or where I read it, but the idea being that, you know, really understanding the quality of one's microbiome is such an accurate predictor of other, you know, you can extrapolate from that and understand, you know, things about this person's health without looking at anything else. Yeah. so what we know based upon our nature medicine paper from June of 2020 is that if you were to look at each one of these individual factors, right? We could look at your blood glucose after a meal, we could look at your blood lipids after a meal, we could look at your weight, and what we're gonna do is we're gonna identify what are the factors and how prominent are they in terms of their ability to predict. And there's a number of different factors. So like clearly the foods that you choose are a factor in terms of your blood glucose response. And your microbiome is a part of that too. How much is the microbiome represented relative to your diet? Well, what we found in our study is that the diet is more powerfully represented to the microbiome but the microbiome is still a part of that for blood glucose. Sure. But what's fascinating is that blood lipids was the opposite. So your triglyceride level after a meal is actually predicted more by your microbiome than it is by the foods that you're choosing to eat. Wow. So in other words, by tending to your microbiome in the most robust way possible to promote metabolic health and everything that that considers is a means by which you can better control your blood glucose. Yeah, and it's-- And blood pressure and nutrient absorption and you know, everything else. And potentially our immune system and potentially your mood, and so you could go down the line and all, you know, and your digestion Wow. And access to nutrients. So this is a powerful thing, and I think what's exciting about it, and what creates hope for people is that you are not cursed with the microbiome that you were born with. You have the ability to shape and change that microbiome and make it your own through the choices that you make and the choices that you make today could literally alter your gut microbiome by tomorrow. And how robust are those adaptations? Like, let's talk about malleability, right? If it's possible, and it appears from the science that it is to change your microbiome, if you do a fecal transplant it's only a temporary thing, right? Yes. So how do you, you know, promote lasting sustainable long term healthy changes in your microbiome? Obviously we can just adopt a high fiber diet, but what are the other things that we should be doing to, you know, make this as permanent as possible? Well, permanent results come from consistency. Yeah. Persistent habits, right. And being sustained, yes, exactly. So that like one week cleanse or that 30 day fat diet, they're not really helping you. So at the end of the day what you want is you want small changes that you repeat every single day, moving in the right direction, and if you're willing to do that small changes that become healthy habits start to really add up in terms of what they can do with your gut microbiome over the course of time. We do see people who have certain types of autoimmune diseases or ulcerative colitis, things like that. I personally have friends that suffer from this terribly and have tried all manner of microbiome related protocols to repair their gut lining, et cetera, with pretty mixed results. Yeah. So, you know, because I'm sure there's a lot of people listening or watching to this, who have some version of that, that they're dealing with right now, Yeah. And are perhaps frustrated by doing this, you know, battery of probiotics or adopting a really high fat diet and then adopting a really high fiber diet and really never being able to find a solution that has lasting benefits. Like how do you think about that? Yeah. So I've taken care of many of these patients throughout my career, you know, as a gastroenterologist, taking care of patients with ulcerative colitis and Crohn's disease, these are the people who have the deepest dysbiosis. Crohn's disease and ulcerative colitis are inflammatory bowel diseases. They are literally a condition where your immune system is attacking your microbiome, right? So it's not even an autoimmune issue. It's an attack on your microbiome. So how do I counsel my own patients and what is the conversation, and I say, "There is no shortcuts, right? "There's no shortcuts. "There's no quick fixes. "This is a chronic inflammatory disorder." And we have to set, frustration comes from unmet expectations. So setting proper expectations from the very beginning ends up becoming one of the keys to getting good results. And the other thing that becomes key is actually knowing what direction to go, right? We have to basically plot the proper path and then we just walk down that path, not trying to be perfect, but just moving in the right direction, and if we do that consistently over the course of time we are maximizing our results. People who have these conditions, there is a genetic predisposition. It would be unfair to pretend that this is just exclusively a dietary thing. And I don't think they should carry that burden of guilt in any way, because like, you didn't do anything wrong. We're all eating junk food. Right. Right? Right. So it's just that that junk food-- It can be a result of, you know, a significant antibiotic use as a young person and things like that as well. Right. Yeah. There is so many different factors that can disturb and disrupt the gut microbiome. And ultimately put you in a position where a disrupted gut microbiome with a genetic predisposition leads to the activation of these conditions. And once you have it, there is no cure. To say that there's a cure is not accurate. There is remission. Remission basically means that your disease is not active. And if you have a permanent remission that is as close to a cure as we can ever get. So how do we accomplish that? Well, to me, this is not exclusively diet in lifestyle, and this is not exclusively medications, and any approach that ignores the other side is not taking advantage of the opportunities that we have to make a person better. So what we need is we need to bring the best of diet and lifestyle into these patients in a sustained way that develops healthy habits. And at the same time, like if a person has Crohn's disease and ulcerative colitis and they're in my clinic and they're actively flaring, let me be perfectly honest with you, Rich, I'm not worried about their diet in that moment. Because when the forest is burning, you don't plant new trees. Yeah. You put the fire out, right? So you have to put the fire out first. Now that the fire is out, you have this scorched earth, and we can rebuild the forest, but rebuild in the forest doesn't happen overnight. We have to plant the trees and we have to allow them to mature with the right fertile conditions in order for the forest to grow back. So to be more specific with these particular conditions like ulcerative colitis and Crohn's disease, I will change their diet, I will change their lifestyle, and my expectation is that we're looking at at least months, and I don't mean two months. I mean like six months or 12 months, or more than that, for us to really fully see the effect of what we're trying to do. I would suspect that the personalized nutrition piece could be very beneficial in this context also. I think that there's going to be a future in this particular arena when it comes to personalized nutrition. Now that would be a bit different than what we're currently doing with ZOE, because you have to understand that the outcome that we're looking at with ZOE is a metabolic outcome and not a, for example, digestive health outcome. Right. Got it. So we would need to basically pivot towards a different health outcome, but we could still apply the idea using the exact same tools in many ways, to figuring out how to help these people. Let's shift focus. I wanna talk a little bit about the brain gut connection and in particular the relationship between mental health and the microbiome. Yeah. These things are not separate. They're integrated. Our gut, it's best friend is the brain, our brain's best friend is the gut. And they are in constant communication with one another talking literally right now. There is a number of different ways that the gut will communicate to the brain upstairs. It can send signals through the vagus nerve, which is an information super highway. It can create neurotransmitters. So we have a number of different neurotransmitters that are produced in the gut. 90% of serotonin is produced in the gut. Serotonin is the happy hormone. It makes us feel vibrant with energy, it makes us feel uplifted in terms of mood. That's not mostly produced in the brain, that's mostly produced in the gut. Because in the gut, it's actually involved in our motility and our rhythm, but there are also serotonin precursors. One is called 5-HT that actually produced in the gut, crosses the blood brain barrier. The point is that there are a number of different, short-chain fatty acids are another example. There is a number of different ways that our gut is able to basically create signaling molecules that will then travel through the bloodstream approach, the blood brain barrier, and potentially affect the blood brain barrier, or even cross the blood brain barrier into the brain and affect mood, cognition or memory. It's so insane. It's crazy. I mean, hence the phrase, you know, the gut being the second brain, right? And for me it calls into question like our sentience, right? Like if our gut has so much power and influence over all of these things and the impulses that are being sent to our brain, you know, what is you, right? Like, how do we think about our independence of thought and decision making? I mean, we all know like, oh my God is telling me this, but it truly is. Yeah. In so many ways. Yeah. Rich, you are a super organism. You are a super organism. You are not Rich Roll functioning in isolation. You have this entire community of living creatures, and yes they're invisible, but they are there. And they are a part of what makes you who you are. And that includes potentially the cravings that you have for food, that includes your mood or how you think or your memory, and so it's just quite fascinating to imagine that they can be that powerful. But I don't think that they're powerful to the point that like I'm just a zombie walking around being controlled by my gut microbes. Like, I don't think it's like that. Sure. But the cravings thing is really fascinating. I think we talked a little bit about that last time. Yeah. But there are all these studies, I think there are studies with chocolate and mice when you do a fecal transplant of a mouse that really likes chocolate and put into another one that is indifferent, or maybe they've done this in humans, I think. Those cravings shift, which is bananas. Yep. And it's interesting in thinking about that because I'm sure you've heard people come to you and say, "You know, well, I was plant-based, "but like, I was really like, you know, "my body was telling me I needed X, I needed meat. "I needed this or whatever." And it's like, well, is that, is that really like your body telling you that it has a need that's not being fulfilled or do you have a certain microbial ecology in your gut that thrives off that kind of food and needs the microbes in those foods in order to survive. So it's signaling your brain to please feed it. Right. And we do that, you know, perhaps with sugar, for example, right. And you get these cravings for sugar that exist in the evening, is the sugar actually good for you? No, but there are microbes that thrive when you consume that sugar and they may be sending signaling molecules that are basically motivating you to go and do this. And does it not follow then if you shift your diet and start eating healthy foods, let's say suddenly you've never eaten kale and broccoli and spinach and stuff like that, and suddenly you start eating that over time, you're seeding your gut with a new ecology of micro flora that will in turn, once it takes root crave a different type of microbe and will thus signal your brain to crave those healthy foods because that's what it needs, and suddenly the cravings for French fries and ice cream dissipate, and are commandeered by cravings for these healthier foods. What happened with you when you changed your diet. Yeah, it did, and I talk about it all the time. People don't believe me or think you're like a lunatic or something like that. You are a bit of a lunatic, but. But I'm telling you that it is true, right? Yeah. And unless you've experienced it, you think it's an exaggeration. Yeah. But-- So my favorite foods, my favorite food, a celebratory meal for me, if you were to go back 10 years ago was a ribeye steak. That's what I would get. I would go get a ribeye steak and a glass of red wine. And when I was working in Savannah, this was probably 2013 or 2014, I had the week from hell when I was on call. So my daughter was a newborn and I literally did not see her awake all week because I was leaving to go to the hospital at 4:30 in the morning. And I was coming home at night at 10:30 or 11 o'clock. So this is the week that I have, goes on all week, and then I get to the end and it's Friday, turn over the pager to someone else, okay, cool, I'm off the clock now. Man, you deserve a treat. I'm gonna treat you right now. And I went out to Logan's Roadhouse, which when I was in college, used to be in Nashville at Vanderbilt. That used to be one of my favorite places to get a steak. And so I went to Logan's Roadhouse in Savannah, Georgia, and I got a ribeye and a glass of wine, and I took like, first of all, it smelled different. And then I took two bites and I was just like, and this was like not an ethical thing. This was quite simply that it did not taste good. And I was a little like embarrassed because here is this huge stake, and you know, that the server is going to freak out when they realize that you're not eating it. So I covered it all up with my napkin and I got my bill and I got out of there as quickly as I could and had realized, 'cause it had been probably 18 months since I had a steak, that my taste buds had completely changed. Yeah. And you know, it's kind of interesting that, just another anecdotal piece of evidence, 'cause I sincerely believe that this is the truth. And I've seen this a bazillion times where people shift their diet and there is a shift in the taste buds that takes place. It just lags. It takes a little time to catch up. But that lag is not months. Right. But you gotta stay in it to win it. You gotta stay in it. And so I'm convinced that what mom eats during pregnancy ultimately determines the taste buds of the child during, like when they're an infant. And the way that I know this is if anyone has had broccoli sprouts, I mean, look, I'm a huge fan for their health benefits, they're bitter as hell. It's an acquired taste. Don't tell Doug Evans that, well, he's gonna start calling you. I have him every day. He calls me. Yeah. He calls me all the time anyway. Yeah. All right. I'm a big Doug Evans fan. Yeah. I love that guy. But you know, broccoli sprouts, I have 'em every single day in my smoothie, they're in acquired taste, but they're intensely bitter. And I embrace the bitter because that is the phytochemical, the sulforaphane that's fighting cancer inside my body. But like how do you take a seven month old child and put broccoli sprouts on a tray and they smash them. How do you explain that? And this was not a one time event. This was every single day. That's your experience? That was my son. Wow. That was my son, Liam, who's five. And, but like when he was six, seven months old, and he started to eat solid food, we were putting broccoli sprouts on his tray and he was smashing them. And all I can say is I'm pretty sure that mom's diet ultimately parlays into the child's microbiome and their dietary preferences. Yeah. Super interesting. Back to this idea of the gut brain connection. What is the science saying about like people who suffer from some level of mood disorder or depression? Like is there any interesting research coming out about how treating the microbiome can produce positive results? Not in the way that we have with the cancer research and I think part of that is the investment of money into cancer research that's out there, but I think it's gonna come. Here is what we do have, we first have dietary data and we have interventional data, like not epidemiology studies, but instead an interventional trial where we will ramp up a person's fiber intake and we will see an improvement of mood disorders. So I'm talking about things like depression. And so we have these dietary interventions, but at the same time more recently we have microbiome data. So we can see actually in the microbes a specific pattern that exists among people that have mood disorders. This is true of both anxiety and also major depression. And the-- What about people who are suffering from some form of trauma or PTSD, does that overlap? Oh man, I wanna talk about that. So let me hold that for a moment All right. We'll put a pin on that. And we'll come back in just a second. So in the microbiome, here is what we're seeing. We, first of all, see a loss of diversity, again, a trend that we've been talking about this whole time, but also the specific microbes have been altered. There are more inflammatory microbes. These are the microbes that have been associated with poor health outcomes, and simultaneously we see in these people that suffer for example, with major depression, with less of the anti-inflammatory short-chain fatty acid producing microbes. So part of the theory or idea behind this and like why is the fiber intervention valuable to a person with a mood disorder? The fiber intervention is valuable because it can change the microbiome and it can also lead to the production of more short-chain fatty acids. And we believe that the anti-inflammatory nature is helping to combat the inflammation of depression. Depression is an inflammatory disorder. That's super interesting. Now-- I've never heard anybody say depression is an inflammatory disorder. It's a hundred percent is. And-- Explain that a little bit more. Well, basically our body has an inflammatory mechanism and we evolve to have this with good reason. So if we go back to the time of like cave men, paleolithic times, the top causes of death, were infection and injury. And so inflammation is the way that we fight infection. Inflammation is the way that we heal from an injury. Inflammation is supposed to be our friend, but you fast forward to 2022, and our modern lifestyle is basically activating these inflammatory mechanisms in a chronic smoldering way. So it's not the big burst of inflammation that you would get from say an infection or a big injury, but what it is it's just kind of perpetual activation of the immune system to create inflammation. And that inflammation is tied to most of the major health related issues that we see as problems in 2022. So that includes coronary artery disease. That includes cancer, and I'm here telling you, and I don't think this is a big shock, but that includes mood disorder, Wow. Like anxiety and depression. Wow. So now Rich, what we don't have is... So we have food and mood, we have microbes and mood, but what we're missing is the full cascade, food translating into microbes, translating into mood. And that's a study I'm working on. Right. Meaning we don't have it because it hasn't been adequately looked at. It's tough because you need the right data in order to do this. You need-- Yeah. That's tough study to conduct properly. So what we're doing, one of the things that's interesting is with ZOE when people participate, they have the app and they can enter into the app how they're feeling on a daily basis, so they can enter in their energy levels. And it's done on what we call a visual analog scale, where you basically slide a bar from zero to 100. Now this visual analog scale is actually a validated measure, meaning that it's been proven through research to be valid and consistently useful for clinical research when it comes to anxiety. So people enter into the app, whether or not they're feeling anxious, and we can measure this for 14 days and now using the ZOE data, even though the entire thing was built for metabolism, we have the ability to go back and look at, you know, what are they eating? What is their microbiome say? And what is their mood. Yeah. Right. It seems like there should be an API where that data set would be supplemented with the data that you would get from, say, WHOOP, that's tracking heart rate variability, sleep states, respiratory rate, et cetera, skin temperature,, to be a more accurate predictor rather than just consumer reporting, which obviously is, you know, can be problematic. So we have the large scale consumer reporting where we're going to, you know, hopefully have millions of people who participate and that's going to be intensely powerful because the number of people, but where we started going back to like what predates 2020 in the release of the commercial product was a clinical trial called PREDICT 1. And in the PREDICT 1: trial, we actually, Matthew Walker actually has been working with us. Oh cool. And so he's the sleep expert Right. For those who don't know. And we actually published a sleep study very recently looking at our data because we actually did collect that. We had people wearing the accelerometer and collecting the sleep data so that we could actually do those types of analyses. So the PREDICT 1 study was not done, it was over a thousand people and it was not done using the at home kit. It was instead done more like a clinical trial. Yeah. Yeah. I think that's really important. I just noticed in wearing a CGM that the quality and duration of my sleep had a major impact on my body's ability to stabilize blood sugar, and I don't know like what's causing what, but there is definitely a relationship and an interplay there. There is an explanation for that. So and this comes back to the interconnection between our gut microbes and our circadian rhythm, all life on this planet, Rich, has a circadian rhythm, all life. That includes us as humans. And by the way, what I mean by circadian rhythm Do microbes do? Do microbes go to sleep? The microbes have a circadian rhythm too, because what happened is that once life came to earth, you know, 4.5 billion years ago, the first life we believe were the akia. which are some of the microbes. And these akia actually may be inside our colon right now. Like dinosaurs from 4.5 billion years ago are a part of the human gut microbiome. There is one evolutionary fact that was true of every single form of life on this planet, regardless of where you lived or what your diet was or anything else, the sun rose in the morning and it fell at night. So we all evolved to embrace that. And as a result we all have a circadian rhythm. Plants have a circadian rhythm, humans have a circadian rhythm, and our microbes have a circadian rhythm. And if you look at your insulin sensitivity, which basically means your ability to tolerate sugar and keep your blood sugar under control during the day. Your insulin sensitivity peaks early in the morning as a result of these gut microbes. And as the day goes on you become more insulin resistant. So in other words if I feed you the exact same meal for breakfast and for dinner, and you're doing the continuous glucose monitor, you will actually see a higher blood sugar in the evening compared to the morning, and that is the result of your gut microbiome. Right. And probably a slower to baseline as well. Yeah. Right. Yep. That's super interesting. The science here is mind blowing. Yeah. It's cool. Let's shift gears to getting really practical, with respect to caring for our microbiome there is many things that we can do, but obviously the low hanging fruit here and the most impactful is what we're putting in our mouth, right? So let's get really specific on food. We've talked enough about fiber, but when we're thinking about high fiber foods, what should we be thinking about? And what types of foods are you suggesting that we build into our diet? Because one of the things just to underscore this, that is a mantra for you is that, you know, moving towards this sort of microbiome promoting lifestyle and diet is not about, you know, reducing things or removing things from your diet, it's about building more abundance into it. A hundred percent. And we can thrive, we should thrive on abundance and variety as opposed to restriction. So the key point is this. All plants contain fiber, only plants and mushrooms contain fiber. That's the only place that you'll find it. Not all plants contain the same fiber. There are specific types of fiber. And if you go and you look at the word prebiotics, so prebiotic is a term that I want to introduce to the audience, which basically means food or fuel for these gut microbes, being that they are as alive as you and I are, they need food just like you and I. We have to feed them. Their preferred food is fiber. We've been talking about that throughout this entire episode, they consume the fiber and they don't just get rid of it. It doesn't disappear. But instead the fiber actually gets transformed in a very magical way. These microbes, it's like a Harry Potter thing, and next thing you know, it's not fiber, it's short-chain fatty acids. So fiber is a prebiotic, but there is two other forms of prebiotics that people need to know about. One is resistant starches. You actually find resistant starches in potatoes, sweet potatoes, starchy type foods. Well, resistant starches they're not fiber, but they actually behave exactly the same as fiber. So that's the second type of prebiotic. The third type are the polyphenols. Polyphenols are antioxidant compounds that are found in plants. Plants have the market cornered on polyphenols. And when you look at plants and you see colors, those colors are coming from these polyphenols and these chemicals, these phytochemicals, they actually don't do anything for us unless they come into contact with our gut microbiome. So David Sinclair talks about the benefits of resveratrol. Resveratrol is a polyphenol. Yes, you will find it in red wine. You don't need to drink red wine. You'll find it in red grapes. You'll find it in peanuts. You'll find it in a number of different plant foods. And resveratrol comes into contact with the gut microbiome and basically becomes activated by these gut microbes and then it has these healing longevity benefits that he likes to talk about. That's true of all these different polyphenols and every single plant has polyphenols of different varieties, different abundances, there is literally, we believe thousands of them. All right. So the key is this, our microbes, they want to eat, they need prebiotics. There are three types of prebiotics, fiber, resistance starches, polyphenols, and what I've just told you is that you will find all three of these in one place, plants. The power is in the plants. If you want a microbiome that is as healthy as possible, this is where you need to turn, and it's problematic because in the US, the average person is 10% plant-based. You know, even in these studies where we set the mark, the melanoma cancer research study, like they set the mark, high-fiber was 20 grams. Again, 20 grams is less than the minimal recommended amount. And 71% of the people were not hitting that mark, right? So Rich, you and I walk out on the street and assuming we are getting an average sample of the United States, like ignoring that we're in Los Angeles. If we have an average sample of the United States, 19 out of 20 people that we come into contact with are deficient in fiber right now. So what we need is fiber, but we don't just need one type of fiber, we need all the different types of fiber, all the resistance starches, all the polyphenols that you will find in all these different types of plants. This is why eating a wide variety becomes the key. Because when you do that, you have this wide variety of types of fiber and polyphenols that feed a wide variety of microbes. Diversity in the plate translates into diversity in your personal gut microbiome. And this goes beyond, you mentioned earlier, the American Gut Project, this goes beyond any sort of theory or idea on gut health. There Is a reason why the major gut health scientists of our time are stepping forward and talking about the importance of diversity in the diet. And that's because in the American Gut Project where they had 11,000 people and literally people from across the globe and they were analyzing their diet and lifestyle and comparing it to the health of their gut microbiome, they found that there was a single most powerful predictor of a healthy gut, which was the diversity of plants in their diet. Specifically in that study, the people who were consuming 30 or more different plants per week are the people who had the healthiest guts. Now why stop at 30? Why not go 35? Why not go 40? And so the point at the end of the day is make this a central dietary philosophy, And if you do this, like you don't need to count grams of fiber or macros or calories, You count plants. How many varieties of plants can you get into your diet? So to do this, I created a game, it's called Plant Points. Where like, basically we sit down at a meal and it could be like, me, you, my family, your family, and let's see who can get the most plant points. Right? And we're gonna see how many plants each one of us can get, every single plant counts. And you wanna get as many different varieties of plants into this individual meal. And so when we do this, it's a simple way, like, yes, we're gamifying it, we're having a little bit of fun with it. Guess what? Kids love this. If your kids are struggling to eat fruits and vegetables, introduce the game. And let's see how they play. It's really powerful. And one of the things I love about it is just how simple it is. It's not about eat this, don't eat this and over complicating everything and thinking about macros, et cetera, it's just eat the largest diversity of plants as possible. And if you take away one thing from this podcast and begin to implement that into your life, I think that can have the biggest impact and it's something that you can just grok super easily. Like, okay, how many plants have I eaten today? What is the extent of the diversity on my plate on a meal by meal basis throughout the day? Yeah, you're in the supermarket, and you hear my voice, Dr. B is in your ear, diversity of plants, right? Yeah. You worry about polyphenols, and just don't worry about any of that. Like, just focus on that one thing and it takes you pretty much to the goal line. This is how we distill all this complexity of the gut microbiome Yeah. Into one place and we make it so super simple. This is the golden rule. It's the only thing that you need to improve the health of your gut, is start with this. But it's funny 'cause the human brain is like, "Yeah, yeah, yeah. "But come on Dr. B, take me behind the velvet rope. "What's that one food? "What is that one secret "that no one else knows that's gonna solve my problem?" Well, if it was a secret that no one else knew I'd be making some crap up. Yeah. So. But, what-- I like. Here is where I'll go though. Yeah. Here is where I'll go with that. So let's go beyond just the power of plants and let's dig into some of the research being done by Justin Sonnenburg at Stanford University in conjunction with my friend, from the ZOE scientific advisory board, Christopher Gardner, and basically what they did, And it was published in the summer, I believe July of 2021> Is they were looking at different dietary patterns, different ways that they could intervene in a person's diet and ultimately what effect that has on the gut microbiome. And in their study they introduced people to fermented foods. Now fermented foods are traditional foods. Every culture in human history has included fermented foods as a centerpiece of their diet. Right. Funny how that works, right? This evolutionary adaptation that becomes central to a culture, but serves this higher purpose without us even being consciously aware of why. We love those foods, and yet when we look at other cultures that are not our culture, we often will point at their fermented foods and say, "Oh, that's an acquired taste. "I don't think I can eat that." But then they over there are saying, "This is my favorite food." Right? So well we gave them up. We gave them up. Because basically here in the States, we developed canning and, you know, ways for us to process our foods using preservatives and whatnot, where like something is sitting on the shelf for two years, And it literally has not changed. Now like think about that for a moment, that's kind of weird. Like food is meant to have a life cycle, right? A plant starts as a seed, it germinates, it grows, at some point it gets to a point where it's in the right position for you to consume it. It's edible. But if you don't consume it during that window, you miss that opportunity. And then it starts to rot and decompose and then it turns back in the soil and that's actually a beautiful thing. That's the circle of life. The microbes are involved in every single step. So if you want to disrupt that cycle, you disrupt those microbes. Right. So these foods that are on these shelves that sit there for two years and they never change from the day that you produce them, that's because the microbes have been retarded. Right. We've all seen those examples of people that put their McDonald's happy meal in the closet for 10 years or whatever, and take it out and looks exactly the same. So there is no microbial life. It's funny. On these quote unquote foods. Yeah. It's funny, but McDonald's is not going on a business, right? People are still eating that food. And so now the flip side of that, the completely like diametrically opposed food is a fermented food, where that fermented food is literally an ecosystem. It's alive. The microbes are transforming it. Take sauerkraut, for example. So sauerkraut is the simplest thing to make. And so delicious when it's made at home, instead of getting it out of a can. You chop up some cabbage, you put it underwater in a sea salt and water solution, and the microbes that already exist on the leaves of that cabbage will turn it into sauerkraut for you in seven to 10 days, you don't have to do anything. You don't have to add any probiotic. So well, we gave up our opportunity to consume these fermented foods because we were seduced by our canning and processing and preservatives, and we went towards that type of food. Now that's 60% of the American diet and it's time for us to swing the pendulum back towards a more traditional based diet. And in this study, Justin Sonnenburg and Christopher Gardner from Stanford, introduced people to progressively higher amounts of fermented foods over the course of weeks. People were not eating this prior to the start of the study. Like if they were, it was yogurt and that's about it. But basically over the course of weeks, what they discovered is that they actually were able to increase the diversity within their gut microbiome, and simultaneously there was a reduction in inflammation by simply consuming fermented foods. So my message to everyone out there, don't just eat a diversity of plants, but eat a diversity of plants and make sure that you're introducing the fermented foods into your diet. I think that's an important part of it. Yeah, yeah, yeah. But at the same time eating sauerkraut or kimchi once in a while, while also eating a predominantly Western industrialized diet, that sauerkraut is not gonna overcome that. No, not at all. I mean, at the end of the day I look at-- It's like if you, sorry. If you just, yeah. So if you're just eating... That's a great study by Sonnenburg and everybody should check out... Justin Sonnenburg did a recent podcast with Andrew Huberman, that's great. He's also along with his wife has been on our friend Simon Hill's Plant Proof Podcast. Yeah, and he supported my book, you can see the quote Right. In the front of the book that he gave me. So check those out. And I'm trying to get the Sonnenburgs on this show as well as Christopher Gardner. So anyway, I think what I'm trying to get at is people wanna find that quick solution. They're like, 'Well, I'll just eat sauerkraut once a week "or something like that." Right. And what I'm trying to say is like that's really not the way to think about this. I think of it like this, our dietary pattern is this scale of balance where you can be putting stuff on the side that heals and nourishes your gut microbiome in your entire body or you can be putting more stuff on the side that takes that health away, that disturbs the gut microbiome. And so now look at the average Americans diet right now, and what we see is that their diet is 10% plants, it's devoid of these fermented foods. It's 60% ultra processed foods, which I don't wanna sit here and pretend that they are categorically automatically bad in all cases. But I have serious concerns about them. I don't think that they're good for our gut microbiome. And the more studies that we do, for example, with dietary emulsifiers, we are finding that they disturb the gut microbiome. It's impossible for me to believe that preservatives designed to destroy microbes are good for the gut microbiome. That's impossible. Right. And then the last 30% of our diet is animal products, meat, dairy, and eggs. Now I can tell you what the fiber content of meat, dairy and eggs are, it's zero. Literally zero. The polyphenol content actually maybe more than zero. And it's kind of like, I get a little chuckle on the internet when I see people like talking about grass fed meat and how it's high in polyphenols. I'm like, that is such a small amount of polyphenols relative to you eating one leaf of kale, right? But the reason that there's polyphenols in that grass fed meat is because the cow was eating grass. And then you slaughter the cow and whatever's in its blood you're gonna get some of that. So that may include polyphenols, but if the cow was pumped up with antibiotics, it's gonna be that too, right? What's amazing about all of this is the science is abundantly clear that eating a diversity of plant foods on your diet is key. We can talk about fermented foods, et cetera, but in order to function optimally, we need to be focused on fiber. Yep. And so many people are walking around worried about being protein deficient. We talked about this last time, we should be thinking about, you know, our fiber intake and that ends up taking care of a lot of the problems that we're worried about. Right. Because we're not protein deficient, we're eating too much protein. Way too much. Most people are fiber deficient, and yet amidst this scientific certainty or relative certainty, we have the rise of the carnivore diet. Yep. And this is sort of caught fire on social media. Yep. Yep. Lots of people are cottoning onto this, there are certain influencers who are promoting this and are holding sway over many, many people claiming that this is the solution for the chronic ailments that are unnecessarily debilitating people. This is a means to reduce your symptoms of your autoimmune disease, it reduces inflammation, blah, blah, blah, on and on and on. In light of everything that you've just shared, it's impossible for me to wrap my head around why adopting a carnivore diet would be a good idea. And yet here we are, and this is what we're seeing. I'm certain that you've thought about this. So please, you know, share with me your perspective. Well, so first of all, if we're talking about the scale of balance, you know, I'm proposing that where I want people ultimately to be is a predominantly plant-based diet in terms of their calories. And that is 70, 80, 90 or a hundred percent plant-based. Rich, there are many forms of a healthy diet. It's not just only a plant exclusive diet. A plant exclusive diet is when you align your desire for your best health with also ethical concerns about the environment and the animals. But that's not the only healthy diet, there is no denying the Mediterranean diet. So the point from my perspective is that there are many forms of a healthy diet, but they are all plant predominant diets, and we have powerful research studies to back that up. But the problem is that the starting point is 10% plant-based. That's where people are right now. And that's not me casting stones. I was 5% plant-based 10 years ago, right? But 10% plant-based is a heck of a lot closer to 0% plant-based than it is to 90% plant-based. And so it's way easier for people to move in this direction and many people want to hear that eating their bacon is actually gonna be good for their health, because they enjoy bacon. And I get that. When I ate bacon, I used to enjoy bacon too. So I totally understand that. But it's an illusion and you're being sucked into something that first of all, there are no long term studies and there is very close to no short term studies either. We have no data. The best that we can do is basically apply what we do know about science and say, "Well, what do we think is going to happen?" Now I have told you that single greatest predictor of a healthy gut microbiome is the diversity of plants in our diet. I've talked about how a low-carb diet was disadvantageous when it comes to COVID-19, I've talked about how fiber actually saved people's lives in melanoma when they were receiving immunotherapy. And we are talking about a carnivore diet that is zero grams of fiber, zero grams of fiber. It's impossible. The diversity of plants, like I don't even need to test you. 'Cause I already know, it's zero. It's impossible for me to believe that in the long run this is good for the gut microbiome, but there is a bit of a challenge that exists, which is that many of these people will claim that they healed their gut by going on a carnivore diet. Because, hey, like I had problems, I did not feel well when I ate the way that you described Dr. B. But when I do this, I feel really good. So how do we rectify this? Well, it starts with actually understanding the way that our body works. You have to start there, right? Not everything that feels good is actually good for you. That's completely absurd. If that we're true we'd all be doing cocaine. Well, yeah, we have to contextualize it in terms of short term and long term so. Right. If you're having a short term positive experience, it's likely due to the removal of all of these other things that we're contributing to deleterious health outcomes and shearly by reducing or removing them you're experiencing, you know, an uptick in how you feel and how your body is responding. I think that there is value to removing ultra processed foods. Sure. And the carnivore diet, one of the things that it does really well is that it gives people a framework in order to actually accomplish that. And when people do see improvements of their autoimmune disease, and I am not saying that there, like there are people who do this diet and they say that it improves their autoimmune disease. I attribute that to the fact that you have removed ultra processed foods from your diet. That's what I think you've done. I don't think it's that the meat heals, I think it's that you've withdrawn these ultra processed foods that were negatively effective. It's interesting. 'Cause that's the same argument that's used, you know, with respect to plant-based. Like, that's why you feel better eating plant-based 'cause you've removed all the process stuff. Well, and I think that that's a theme that brings together all these dietary tribes where we may be casting stones at one another. But that is one thing that we will all agree on, which I think, you know, at least we have that. Right. So, but the problem is, Rich, that you withdraw these foods, right? And you say, "Well, my gut is healed." Your gut is not healed because you have the absence of discomfort. Your gut is healed when you're able to actually tolerate those foods and a person who withdraws these foods on a carnivore diet, if they reintroduce these foods, their food intolerances are even worse than when they started. And so you're not actually healing the gut. If anything I believe that you're making your gut health worse in the process of doing this. You're completely devoid of fiber, which is the key from my perspective for optimal gut health, and at the same time you're cranking up the saturated fat to a level that's very deeply disturbing. And that this ultimately, like saturated fat has negative effects on the gut microbiome. Now going beyond gut health, talking about other health outcomes, for example. People will say, well, I cured by diabetes. You did not cure your diabetes because if you have a piece of fruit your blood sugar is gonna be off the charts. Saturated fat actually contributes to insulin resistance through a process called lipotoxicity. Anyone can look up research studies on lipotoxicity. And what you're gonna find is that it's not that the fruit is the problem, it's that the saturated fat is the problem, and then it's affecting your insulin resistance, and then you spike your blood sugar after you eat the piece of fruit, right? So this is what happens in this particular case. They say, "Oh, well I cured my diabetes." No, 'cause you're not capable of eating normal food without your blood sugar going off the charts because your diet has made you insulin resistant. Right. Your insulin resistant resistance is still there, it's just not being tested. So you think that it's resolved. Exactly. So this is the functional equivalent of like, if you are out running one day and you're running on a trail and you step funny on a route of a tree and you twist your knee, right? And it's like, okay, so Rich, you could stop walking permanently and you will never feel pain in your knee, but your legs atrophy, and now you're sedentary and your metabolism gets outta whack and you gain weight and your blood pressure goes up and so does your cholesterol, and now you have cardiac risk factors and you give enough time and this is how you get to coronary artery disease, right? So the avoidance is not the solution. You twist your knee when you're out running on the trail, and the solution is to heal the knee, to restore function. And that's working through a process like perhaps with a physical therapist, where you work through this process with this physical therapist restoring function to the knee. And yes, there may be some discomfort in that process. But when you emerge on the other side, you're running again and you're as strong as ever. Right. And this is the issue. Is that the avoidance that we see, whether it's in terms of the gut or in terms of your blood glucose, is not actually making you stronger, it's making you weaker, but because you're avoiding it, you can pretend that you have fixed your blood glucose level because it comes down. I think the last thing I wanna say real quick about this is that because, about the carnivore diet, is that because the consumption of saturated is so high, saturated fat drives up LDL cholesterol. LDL Cholesterol is a widely accepted risk factor for coronary artery disease. This goes beyond epidemiology studies where we say, "Oh, a person with higher cholesterol, LDL cholesterol has higher risk of coronary artery disease. Yes, that is true. But then we have multiple different drug interventions of different classes that work in different ways to lower LDL cholesterol and in these clinical trials people are less likely to have a heart attack and die of heart disease. Any person who promotes a carnivore diet and tells you that the LDL cholesterol is not relevant is causing harm. Well, that's the party line. They're very dismissive of this and say, "Don't worry about your elevated LDL. "It's not what you think it is." Do you wanna be the Guinea pig who has the crushing myocardial infarction at the age of 48, and you never get to see your grandkids? Do you wanna be that Guinea pig? We don't have that data, but what we do know is this, and an LDL cholesterol that's off the charts, all I can say is, show me a cardiologist that's willing to come in here and tell you that that's okay. You don't have to convince me, you know. It would be interesting to do a long term study on the microbiome of people who have persisted on a current carnivore diet. Yeah, or a keto diet. We'd see with that. Yeah, exactly. I would be very interested to see it. Yeah. Like I'm very open to these things. I'm not here to attack people or be a zealot about this. Like again, I'm here to tell people that there are many different forms of a healthy diet, but based upon everything that I've seen, these are plant predominant diets. And so I think that all of us, if you are 10% plant-based, that is more than I was and you just take it one day, one meal at a time, moving in this direction and don't put much pressure on yourself. Yeah. You mentioned food intolerances and allergies. I want to get into that. But before I do, I think just to put a cap on this portion of the discussion, I wanted to remark on how interesting and cool it's been to see the popularity of a plant-based or plant predominant plant-centric approach to diet is becoming in certain circles that have been traditionally resistant to this idea. And by that I mean the kind of biohacking or longevity interested or obsessed space, which has typically been populated with people who are more interested in a low carb approach or a keto approach, 'cause that's more of a biohacking lens on health. But you know, for example, I mentioned Justin Sonnenburg recently being on Andrew Huberman and he was very clear. Like if you wanna, you know, basically take an insurance policy out on longevity and you want your metabolism to operate optimally being as plant predominant as possible is key. And Andrew is a guy whose audience I would suspect is populated with a lot of kind of biohacking low-carb keto type of people. Sure. So I found that to be super interesting. Yeah. And then in the longevity space you have David Sinclair, who's going plant-based, he's influenced Peter Diamandis, who was recently here. Who is plant-based. These are people who are obsessed with living as long as possible. Yep. And that is very much a biohacking thing that has Silicon Valley, you know, very focused on this, and to the extent that a plant predominant diet is contributing to this, you know, idea of human health span extension, I find to be super interesting. We both know to Tom Bilyeu, you, I recently was over at his house, I did his show again, and one of the reasons he invited me back on is he wanted to learn more about being plant-based because he too had Peter on, and he had David on and he's hearing about how, you know, moving in a plant-based direction is so important in terms of longevity, which is something that Tom is really interested in. Yep. And the fact that, you know, people like this who traditionally, I don't know if I would characterize them as resistant, but just not part of the plant-based kind of subculture. Yeah. Are now thinking about it and practicing it in a way that even I don't think I would've predicted. Yeah. Well I think that... So first of all, I think that makes me respect them so much because that means that they haven't just planted their flag and standing by their flag, which is far too common in our society these days. You have to use the brain that exists between your ears. You have to continue to evolve and strive to do better. And that's a part of having the humility to say that what I believe today may change tomorrow. Right? As opposed to being rigid about your views and being unwilling to adapt to new information that becomes available to you. So it makes me have great respect for these people. But now the flip side of this though, Rich, is look, I think that's great, and I want the most inclusive plant-based tent humanly possible. I want everyone to feel like they're welcome coming into this. This is not an elite type of thing. And there should not be any holier-than-thou that exists in my tent. That's for sure. But at the end of the day if we look at meat consumption in the United States, it is not going down. Right. It's going up. So as good as I may feel about my book going out and touching 200,000 people, I have not accomplished my goal and we had a lot of work to do. Yeah. Amen that. I can't let you go without talking about food intolerances and allergies. This is something that a lot of people suffer from. So me through how you think about this and what kind of guidance you can give people who are dealing with this type of problem that continues to trip them up. Okay. So let's separate these two things because I think that it's important for people to understand the difference between these two. Food allergies versus food intolerances. In both cases, it starts with the consumption of food. You put something into your mouth and then there's some sort of reaction that takes place that follows that. But it's different things between these two. A food allergy involves the activation of the immune system. Your immune system has decided that this food is the enemy. Any allergy, I mean, literally the definition of the word allergy is the activation of the immune system in response to some sort of outside stimulus. So like asthma is an allergy in our lungs. We have seasonal allergies and allergic rhinitis in our sinuses, and this may be like dander that's causing that. And in this case, we're talking about food, and there are specific foods that have been most clearly associated with the development of food allergies. About 90% of food allergies can be attributed to a limited group. That includes dairy, eggs, fish, shellfish, soy, wheat, peanuts, nuts, and corn. I'm very proud of myself for getting through all that. Yeah. Why do you distinguish with between peanuts and nuts? Peanuts are legumes. Peanuts are actually legumes. Most people don't realize that. It's that right. So yeah. Peanuts are actually closer to a bean than they are to a nut, so. Wow. Why so much peanut allergy out there? They're very common. And actually there's interesting research looking at development of the infant microbiome and the belief that food allergies in children come from disturbances of the gut microbiome Wow. In these children. So anyway, and a food allergy is the activation of the immune system and it may manifest in a number of different ways, that could include GI symptoms. Like it could include bloating, gas, pain, diarrhea, or constipation, but classically we're gonna see other stuff. So we're gonna see like hives or a rash or the thing that we really worry about as doctors is like difficulty breathing, labored breathing, throat swelling, that's the stuff that we freak out as doctors. Now with an allergy, one of the important points is that the amount that it takes to activate the immune system is very small. So if I had a dairy allergy, you could potentially put one drop of milk on my tongue and that would be enough for me to have an allergic reaction. Flip side, let's talk about food intolerances. They're different and people need to understand the difference, but food intolerances are always manifested with symptoms. You don't have a food intolerance and be symptom free. Usually they're digestive symptoms. So gas, bloating, abdominal discomfort, cramping, diarrhea, constipation, and by definition, a food intolerance does not involve activation of the immune system. So what-- So if you have hives or some kind of other skin manifestation or other condition, that's more like an allergy than an intolerance. Generally speaking. So that is an allergy. Generally speaking, but we will talk about histamine intolerance in a brief, moment here. Right. And that's an exception to that rule that needs to be clarified so that people understand that. But a food intolerance is not the immune system. So it is not inflammation. It is generally sloppy digestion. Your gut microbiome, which we talked about in the very beginning of the show is critical to our digestive process, is struggling to keep up with the demands of the diet that you're consuming, and so when this takes place, this is why we get these types of symptoms. So we have to separate these two. Now, when we test for these things, if you were to do food allergy testing you would typically go to an allergist and there is a couple of different tests that they would do, and they would talk you through it. You allow a health professional to guide you through that process. It may involve a skin prick test where they basically will inject very small amounts of the proteins from specific foods underneath your skin and they look to see if you get an allergic reaction to it. It may involve a blood test, where they look at antibody levels, specifically IgE antibody levels to see what's going on. These tests are not perfect, but in the hands of a trained health professional they can guide you towards figuring out what the problem is. But on the flip side, food intolerances, there is poop tests, there is blood tests, there is antibody tests, there is saliva tests, there is hair tests. And none of them have ever been proven. And because of that they can create confusion and you can receive information that makes you not really know what you're supposed to do. Right. So I've seen a bazillion patients, Rich, who their food intolerance tests that they ordered off the internet and they did at home, it says, "You have a food intolerance to these foods." And I say, "Well, do you get any symptoms?" They go, "No, I never get any symptoms with those foods." You don't have a food intolerance and we didn't need the test. So what is contributing to that test result? Well, many, so it depends on which test you're doing, but in many cases it's the IgG antibody that they're looking at. And IgG is basically the immune system being shaped by something that it gets exposed to. So quite simply exposure of the immune system to regular consumption of certain foods could show up on one of these tests. And that doesn't mean that it's a food intolerance. Again, going back to the definition of a food intolerance. A food intolerance does not involve the immune system. So if it does not involve the immune system, why are we checking IgG antibodies? And if it had been proven, I would say it, but it has not been proven. We don't have any clinical study that I would describe as powerful enough to validate the use of these tools and actually guide people towards good results. So what do you do if you're the patient, like that's confusing, what am I supposed to do? The answer is this, you need a methodology, you need a stepwise approach that allows you to have information that you can wean on with confidence and know that you're making the right choice with your dietary pattern. And that ultimately is what led me to create what I call the growth strategy, and you'll find this in my new book the "Fiber Fields Cookbook". So now growth is a very big word in my community because I talked about in "Fiber Fields" the growth mindset, which came from Carol Dweck, she wrote a book about it. Right. And so the growth mindset is about ignoring, like winning versus losing, and instead is about valuing the challenge and valuing the process and enjoying and celebrating progress and letting go of perfection. In this case, I'm not talking about the word growth. I'm instead using this as an acronym to describe the stepwise approach that I take to food intolerances with my patients to identify and ultimately heal them. So the first step is G, G stands for Genesis. What is the root of our problem? So as a medical doctor the first question is, what am I treating? Because if I start delivering treatments and I don't even know what I'm treating, then what am I doing? Am I just throwing mud up against the wall and hoping something sticks? Like at the end of the day we are empowered when we know and have the right information to know exactly what we're going after. You have to start there. In my book, I introduce something called the big three of food sensitivity. And these are not the three things that are the most common causes of food intolerances, but what they are are the three things that I as a gastroenterologist as I ponder what is the root cause of my patient's problems, I wanna make sure that these three things are not present. So they are constipation, celiac disease, and gallbladder dysfunction. There is a process that I go through, every single patient that comes in and says, I'm having problem with food, Dr. B, this is what I'm thinking about. These three things, because if they are there I can fix them, and when I fix them most of the time the food intolerances go away entirely, and you save yourself from having to go through any sort of process 'cause you're done. You're good. Right. The decision tree ends there. Exactly. So, but once we get past that, let's pretend that we identify that this is irritable bowel syndrome, and we're trying to fix these food intolerances. Well, we have to know what foods we're actually intolerant of. This is where I get back to. Like these tests that are commercially available, you know, at home, they don't get the job done. So we need something that's more reliable than that. And the way that we approach this is with R-O-W, these three letters in combination that are almost like doing a dance together, there not one, two, three, but instead it's the three of them in a waltz, restrict, observe, work it back in. When we are observing throughout the entire process, keeping notes on how we feel and we take the food that we're worried about and we withdraw and then reintroduce, off, on, off, on, you flip the switch, and in doing that, you are creating flows of the current, and those flows allow you to determine whether or not it's causing issues. And you can figure out how much. So not only like what foods, but also how much of that food is causing trouble. So in this process you have to first identify what foods you wanna fix. But then once you get past that, it's time to T, train your gut. Train your gut is the process that you go through rebuilding and restoring function to your gut. Your gut can grow stronger. You can restore function. You are capable of tolerating foods that you don't think that you can eat. And the way that we do this is the same way that we exercise. Our body is adaptable. Like you become a runner in your forties and you progressively ratchet up the distances that you run, your legs grow stronger, you become more efficient with oxygen, your heart chambers grow larger. It actually is able to more efficiently squeeze blood, so it can slow down and your lungs actually expand and you're able to mobilize more oxygen. Yeah. You're not exercise intolerant, you're just exercise maladapted. Right. If you're outta shape. Exactly. Yeah. And so when we go through that process of introducing exercise, there is a process that we all familiar with, that we go through to basically build up that strength or build up that endurance that we're looking for. You can apply the exact same approach to your gut. These microbes can be trained when you don't use them, you lose them. They grow weaker, they atrophy. That's what restrictive diets do. But on the flip side when we take the foods that we struggle with and we go low and we introduce them slowly, increasing time, then that is conceptually the same as the person who is training for the marathon and starting off with a short run or the person who's going to the gym and wants to be ripped, but they're starting off with the five pound dumbbells. Sure. So essentially the idea being that if you have a quote- unquote, "food intolerance", you're not really intolerant to it. You just have a microbiome that is out of sync with being able to live symbiotically with the introduction of that food. Yeah. And by seeding it very slowly, you are seeding a new ecology that can metabolize that and ultimately acclimate to it to your advantage. 100%. So, and you hear this all the time, like somebody who goes plant-based out of the blue and maybe had a terrible diet beforehand and just says like, I'm just bloated all the time, is terrible, I can't do this. You know, if you eat beans or whatever, and I always just say, "Well, just stick with it. "Eventually your gut will adapt. You know, I'm just like, "Suck it up and do it." I mean, this is a much more gentle approach of like start small, which is smarter obviously, but this trainability of your gut, which goes to the malleability we were talking about earlier, I think is really powerful. And just more broadly understanding that these intolerances are not concrete, they're just a window into kind of where you're at now, and that is something that can shift. If you take advantage of this kind of growth protocol that you're talking about. Your gut has strengths and weaknesses, and every single one of us has a certain threshold at which it is becoming excessive and that would be true for you and I as well. You mentioned histamines though, like how are histamines different? This is something that a lot of people are concerned about in talking about. Yeah. So histamine is an interesting topic. And one of the things that I'm super excited about with the new book is that I feel like I'm bringing forward something that's going to change people's lives and give them a solution. So, first of all, histamine is a signaling molecule that's a part of our body. And like when we are healthy, we have histamine. It's a part of us literally right now. And it can contact receptors throughout different parts of our body. In our brain, in our vascular system, in our heart, in our stomach, in our gut, all these different locations. But if you consume an excess of histamine, because food ends up containing histamine because of the life cycle of the food, the microbes produce histamine. And so when you consume food that contains histamine, it's possible to overwhelm your body's ability to handle the histamine load. And that starts to stimulate these histamine receptors and activate symptoms.. And the number one symptoms, so you can have any of a number of different symptoms with histamine intolerance. The number one that people need to know is gas and bloating. If you have gas and bloating, that is unexplained, and you're not really sure what's going on, you need to try a low histamine diet and see if it improves. And by simply doing this for two weeks it could potentially change your life. And what would be an example of foods that would find their way onto a low histamine diet? Well, let me describe the foods that are high in histamine, and then there is sort of counterpoint. Yeah. So the high histamine foods, like the most high histamine foods are fermented foods. Comes back to the microbes are producing the histamine. So now fermented foods goes a little more broad than many people perhaps even realize, because I'm not just talking about sauerkraut and kimchi here, I'm also referring to things like vinegar and chocolate and alcohol. So all of these things are high in histamine, many different animal products are high in histamine. The most classic is fish. Fish can be very high in histamine and activate these types of issues, and then on the plant side of things, there are sort of four classic plants that we think about, and those are spinach, tomatoes, eggplant, and then finally it breaks my heart, but it's avocados. It's a tough one. So Yeah Nonetheless, the point from my perspective is that if a person has histamine intolerance, so let me just kind of say real quick that, like going beyond gas and bloating with histamine intolerance, it could be hives, it could be flushing, runny nose, headache, rapid heart rate, lightheadedness. So many of these are non-specific symptoms that you wouldn't necessarily Right. Equate to a food intolerance. What about puffiness in your face or under your eyes? So some puffiness in your face or under the eyes as possible, but like throat swelling in the way that we see with a true food allergy you're not gonna have with histamine intolerance. Histamine intolerance as an intolerance is not a life threatening issue, not in the way that a food allergy would be. So nonetheless, the challenge that we've had, Rich, is that there is no blood test. There is no CAT scan. There is no way to really prove who has or doesn't have histamine intolerance, which limits our ability to diagnose it because a doctor is never going to turn to you and hand you a packet full of recipes. The way that we have to diagnose histamine intolerance is with food. You have to eat a low histamine diet for two weeks. Now that's an overwhelming and complicated thing if you don't have someone guiding you and holding your hand, that's where my new book comes in. I saw the opportunity to help these people. Number one, identify whether or not they have histamine intolerance. Number two, once you realize you have it, let me show you how to fix it. But in order to get there, you have to do a low histamine diet first and so we give you 25 recipes that you can follow as a protocol, and you just basically quite simply cook the food that I give you for two weeks and see how you feel. And if you feel better, then we have we're on to something. But then this growth protocol would be equally applicable in the histamine context, in that if you feel better in that two week period of getting off of all these foods, you can start to reintroduce them very slowly and develop like a, you know, a robust response so that they're not, you know, giving you all these symptoms. There's two things. Number one, people who have a histamine intolerance, it's not just food, it's that they have a damaged gut. And we see this, that because there is a breakdown in the barrier of the gut they have increase intestinal permeability, which makes them more vulnerable to histamine intolerance because of the histamine that's in their food. So we're going to heal that part. So resolve the dysbiosis with non-histamine plant foods. That's part one. But the second part is that there is a process to training your gut and reintroducing these foods, and we have to be systematic about it. So if you just literally started throwing sauerkraut into a bowl, you'd have a problem. Yeah. But if you work through the process, one step at a time, starting with the lower histamine foods and working your way back up towards the top, you ultimately can get there. Right. That's amazing. But how would one, like if somebody just, how aware are people if they have a histamine problem. They're not. And That's-- That's the thing, right? That's what I'm trying to bring attention to. Yeah. Like I'm trying to shine a light on this because I know that there are people who are listening to you and I right now, and they're saying, holy cow, I have gas and bloating. and when I eat food, like, when I eat fermented food I don't feel well and I can get like hives or a little bit of a rash or flushing or a runny nose or a headache. And that person should be doing this low histamine protocol to identify whether or not they have histamine intolerance. Right. Yeah. I would suspect this is gonna be news for a lot of people and they're gonna try it and be like, "Oh my God, like this was right underneath "me the whole time and I didn't realize." I pray that that's the case. Yeah. Yeah. Because that to me is, this is where I am basically like using my opportunity to write a book, to create tools that can improve people's health. And that's what I'm here for. What about bowel movements? We talked about this before, but I think we should touch on it a little bit. Like what can we infer from, you know, taking a look at what's happening down there. You can refer a lot. It's incredible. About like, how... Like, I have a thing with this, 'cause like mine don't really measure up based upon what you're telling me they should look like. Well, so I think at the end of the day, how do you feel? I feel fine, but it's pretty runny down there. Yeah. It may be very runny because you are so high in fiber that you're producing a ton of short-chain fatty acids that ultimately are making it a little bit more on the loose side. Although when I really ramp up the fiber and I'm kind of crushing like super dense high fiber smoothies and the like there tends to be a little bit more form. Hey. I found that it's runnier Amen. When I'm, you know, off my perfect game. Yeah. Well, so I think that looking into, I think that the key here is this. We have stigmatized bowel movements and that's kind of silly from my perspective. Yeah. I feel bad. I'm like, I'm supposed to know how to do this and I'm not getting that optimal, like form. Our body thrives on rhythm, right? So if I take you, you are a runner, and you rely on the rhythm of your heart in order to facilitate your ability to run. If I throw you into an abnormal heart rhythm, I could literally make it so you can't even walk up a flight of stairs, right? Despite the fact that you're training for a marathon and the same is true with our gut, our gut thrives on rhythm and rhythm means that we are having good, regular, complete, and dare I say it satisfying bowel movements. Like they're supposed to feel good. You're supposed to look forward to bathroom time. And the best way to start your day is a great bowel movement. And so the problem that we run into is that there are a lot of people out there, this is not what they experience. It's not in rhythm. They struggle with it. It doesn't come regularly. They fear bowel movements because they have to strain just to have like a little nugget, right? These are people who are out of rhythm and ultimately they manifest symptoms as a result of that. Our stool is not the excrement of our food. Our stool is predominantly made up of our gut microbes. Your bowel movement is a window into the health of your gut microbiome. And what we look at is not just how often you go, like that to me is in itself usually not super helpful. And I will say, if you tell me, "Hey, Dr. B, I haven't pooped in seven days." Okay, you're constipated. Like I can say that for sure. But the problem is that there are ton of people who poop every day, they are constipated, they poop a couple times a day, they are constipated. There are people who have diarrhea that are actually constipated and it's kind of mind blowing, but what's happening there is that we're missing the second part of the story, which is really critical, which is do you have a complete evacuation? So when you go, do you feel like you're really completely going? Because if the answer is no and you're simultaneously suffering with symptoms, the number one symptom of constipation is gas and bloating. The number one cause of gas and bloating in my clinic is not histamine intolerance even though I've been hyping this up, the number one cause of gas and bloating is constipation. So if you are someone who has incomplete bowel movements even if it's every day and you're suffering with gas and bloating, I am guessing you are probably constipated. And if you strain to have these little nugget turds and you do that four times a day, you go into my office and you say, "Dr. B, I'm having four bowel movements a day." Yeah, but what do they look like? Right. Are you completely evacuating? You go, "Ah, I'm not really evacuating Dr. B, "there are these little chicken nuggets." But is it a kind of, you know, when you feel it thing. Like that satisfaction that you get where you're like, "Yeah, man, that thing, I emptied it out." When you whip You just know it? That door open and you strut out in slow motion. Yeah. Right? Like that is proof Right. in and of itself. You know, and there is that weird pride. Yeah. You know, you're like, yeah, man, I crushed that one. Oh, a hundred percent, right? But the-- About, sorry, go ahead. Well, but the problem is there's a lot of people out there that aren't experiencing that. And you know, the last thing that I want people to hear about because I really hope that there are people who benefit from this. Is that there is a group of people that have what is called overflow diarrhea. And these are people who chronically suffer with constipation. And one day the poop gets impacted and you have a column of solid stool that is not moving and the only thing that can get through, sneaking through the cracks and the crevices, Is the liquid. Is the liquid. Yeah. And it comes down to the bottom and our bottom is not designed to stop liquid from coming out. And so you get urgency and you rush to the restroom and it explodes out as diarrhea. And you go into your doctor and you say, "I'm having diarrhea." And they say, "Take Imodium." And Imodium slows down your motility even more, and your problem gets worse. Makes it worse. Yeah. The paradoxical solution in this particular case, with a person who has this overflow diarrhea, the paradoxical solution is to flush it out. You gotta get it out and then start over. I wanna get to colon cleanses in a second. I want to touch on that. But first I'm gonna take advantage of the fact that you're here. Like, I think I'm on the opposite end of this spectrum because I do a number two, like six times a day and I'm thinking this can't be, like it's so much more often or frequent than most people that I know. And Julie, my wife is like, "Yeah, but you're like a furnace, "like everything, you know, "everything down there is churning "like so hot all the time." But what would a gastroenterologist say about this? How do you feel? Like am I unhealthy in the other direction? How do you feel? I feel fine. Yeah. You know. So from my perspective, a guy who Is consuming a super high fiber diet, we know that, right? We know you're consuming a high fiber diet and you're a runner and that actually stimulates motility, and it keeps things moving along. Like we know that there's this common pattern among runners called the runners trots. Yeah. I mean, I'll do a full blown bowel movement in the morning and think I'm totally empty, and then I'll go running and 30 minutes into the run I gotta pull over to the side of the trail. A hundred percent. So when you move, this is important for people to know at home, like independent of talking about what's happening with you, is that when you move your intestines move, your stimulating motility. Our sedentary lifestyle is part of what's contributing to the epidemic constipation that we see out there these days. Constipation is far more common of a problem than diarrhea is. But when you move your intestines move, people who run quite frequently will have more frequent bowel movements because they're a runner. So you take a gentleman, yourself, who is on a high fiber diet, a high fiber diet by itself. You are not a runner, Rich, if you were a sedentary man, you would still probably be having three or four bowel movements a day. But then you add in the fact that you are going on these runs and you were accelerating that motility a little bit and that's probably what's contributing to. Right. Not only the frequency, but the form. Right. But if you're somebody who is constipated and perhaps not even aware of it for the reasons you mentioned, but you've got this skyscraper stuck inside of you, would that be somebody who would be a candidate for a colon cleanse? Like I'm sure you're not in favor of these kind of, you know, cleaning out the colon from the rear side. Sure. For, because it's gonna, you know, take out a lot of that microbiome. Yes. That you want in there. Right. But would that be a scenario in which maybe that would be a good idea for that person or would you just amp up their fiber until the motility enhances and it all gets cleaned out? Well, I think you're bringing up a very important point that I'm glad that we get to bring to address and bring out to the listeners. Who else I am gonna talk about this with. Yeah. So I think the important point that I wanna touch on real quick, and then we'll talk more about the cleanse part is that fiber isn't always the solution to constipation. So in people who have mild constipation, meaning not every day and not going on for days at a time, but instead like a touch and go, here and there, maybe twice a month, right? In that person, you turn up the fiber, you increase your water consumption, you get some exercise, maybe you literally take a walk after dinner or something like that. Those people will poop and they will be good. So lucky them. The people that I've seen in my clinic, that's not them. You know, people with moderate, severe constipation, that's not going to work. And there is a problem-- Even if they do like psyllium, you know, those psyllium husks that you can put in water that are supposed to enhance your ability to get it out. You can try. You can try, but here is my word of warning. I just want people to be empowered with understanding what potentially could happen, so that they can react and respond Right. To what they experience in terms of their symptoms. So when fiber is moving through, fiber is your friends, but when fiber gets locked up, it turns into cement and your gut microbes are given unlimited access to ferment that fiber and what we see is that people who are constipated they at baseline produce more gas. And there is this interesting vicious cycle that exists, Rich, where we have discovered that methane gas, which is the product of fermentation of fiber, methane gas actually slows bowel motility. So you get constipated, you produce more gas. That gas makes you more constipated. Now you pour fiber into this equation and it's effectively pouring gasoline on the fire. And now if you pour the fiber in there and all of a sudden, boom, here we go, we're moving again. We're back in business. You're good. Right now fiber is your friend again. But if you are staying locked up and you're not getting it moving through, that's a problem. And you're gonna have worsening of your gas and bloating. And I've had a number of people who come to see me and they're like, "Doc, I was inspired by your book. "I started doing your four-week plan. "and I felt like crap." "Really? What symptoms?" "Gas, bloating, little bit of nausea, tons of fatigue." I'm describing constipation right now. This is what people feel like. And I know instantly your issue is constipation and it goes back to the very beginning of the growth strategy. Fatigue goes hand in hand Oh, big time. With constipation. A hundred percent. A hundred percent. And so does food intolerance. And so does food intolerance and the food intolerances are very non-specific meaning that you feel like everything causes trouble. It's not just like one thing or two things. It's like everything's causing trouble. Right. Because you get gassy. So what do we do? It goes back to the very beginning of the growth strategy. G stands for genesis. What is the root of the issue? And when I identify that it's constipation, treat the constipation, fix that, the food intolerances go away, you introduce the fiber now, after you've already got things moving through. Now you introduce the fiber and the fiber is rolling through and the fiber stays your friend. But how do you fix the constipation? Well, there is a number of ways. So it depends a little bit. I mean, we could do an entire podcast I, constipation. I'm not kidding. Right. I taught a course and I did a 90 minute lecture on constipation. Well, let's just drill it down Yeah. To make it digestible for the person who is listening, who does have that problem and is looking for some things that they can do. Yeah, totally. So just to be clear with everyone, please talk to your medical doctor, I am not giving you medical advice right now. I'm just telling you the way that I approach my patients and I'm trying to empower you with information. So one of the classic ways that I will approach constipation in the very beginning, 'cause many of the people who come to me they're like, "Doc, I want a natural approach. I don't wanna take medication. Well, I don't want you to take medication either if I can avoid it. So what I will do is I will use magnesium and magnesium is a beautiful thing because it can be taken before bedtime, helps with sleep, helps with mood, reduces headaches, and by the way, it's great for bowel movements. But there are many forms of magnesium. It's not just any form of magnesium. You go out and you buy magnesium glycinate or something like that, it's not gonna help you in terms of having a bowel movement, we need a form of magnesium that's not easily absorbed and so there is a few specific ones. Magnesium oxide, magnesium citrate, magnesium sulfate, and you start off at around 500 milligrams, depends on what brand you get and stuff like that. Like it could be 400 milligrams, but you start around 500 milligrams. You take it before bedtime and you do this consistently and you give it four days and you see how you feel. And if you're pooping, cool, we just won. And if you're not turn it up another 250 milligrams. And if you keep doing this, you can eventually, again, do this with your medical doctor, but you can keep turning it up until you achieve the effect. And like you don't wanna go overboard on the magnesium, but here is the beauty of it. If you're doing this in collaboration with your healthcare provider, you can check your magnesium level before you start and you can check your magnesium level once you get on a steady dose. And when I do this, what I typically will find is that the magnesium level before we start is too low, my patient is missing magnesium. Our diet is deficient, and when I supplement them and they start pooping and they're getting these health benefits, I repeat their magnesium level and all of a sudden I discover it's like exactly where it needs to be. So it's a function of both a deficiency and making sure that you're replenishing your requirements, but also this idea of it not being overly absorbable so that it stays in the gut and there is something about the chemical composition of magnesium that helps push all this stuff through. Yes. So magnesium, what it will do is it gets into sort of like college level chemistry type stuff where water wants to basically flow towards where the electrolytes are. So when you have this magnesium, Sure. The water starts to flow towards the magnesium and you're basically introducing some additional water into the colon that helps to float the log down the river. I see. I see. Yeah. I think the citrate version is the one that finds its way into most of these products. Is that correct? Yeah, it can be, but there's-- Like CALM is one. I think that's magnesium citrate rate. Yeah. It can be. But also magnesium oxide has randomized controlled trials that show that this is, like this is like placebo controlled trials showing that this works, Wow. As well as many drugs for constipation. So I think it's a great approach that people can start with. And then, you know, there is other things downstream, like again permutations of possibilities that are running through my mind as a gastroenterologist. Right, right, right. All right. Well, it's almost a closing hour at this saloon, but I'm not gonna let you outta here without kind of taking us out with just some top line advice for people. We talked about plant diversity, we talked about, you know, 30, you know, trying to get, you know, 30 different varietals of plants in our diet every day. We talked about fermentation, bowel movements, et cetera. What are some other, you know, just kind of really practical actionable things that think that people should be thinking about and practicing to enhance the, you know, the health of their gut. We wanna move the scale of balance. We wanna move the scale of balance and start to put the weight on the side of healthy foods. And so yes, this does involve eating more plants in variety, in abundance, it does involve eating fermented foods, but it also means that the substitution that we're making is withdrawing these ultra processed foods, withdrawing the animal products that are devoid of fiber and very high in saturated fat. So we're making substitutions that are leveling up our gut microbiome, leveling up our health, but we would be remiss 'cause like, gosh, Rich, there is so much more that we could talk about. And we haven't even touched on the topic of how you can heal your gut without even lifting a fork. There are ways in which you can heal your gut without even lifting a fork. Rolling in the mud, letting your dog lick your cheek, hugging other human beings, being out in the world. So that's a great place to start. You know, let's think about movement. So actually was a part of a recent study that was published from people from the University of Nottingham, where we did a exercise intervention and it was literally 15 minutes of exercise, that's it? And we did not change people's diets. And in doing this, 15 minutes of exercise, like who can't do that, come on, you can do that. In doing the 15 minute exercise intervention, we saw a shift in their gut microbiome and the results was that we had more butyrate producing microbes. So going full circle all the way back to the beginning, we were talking about like in COVID-19, severe COVID-19, the absence of butyrate producing microbes in people that have severe disease. Like there are so many examples where this is good for us, and what I'm saying to you is, yes, dietary fiber will increase the representation of butyrate producing microbes, but so will exercise. What is the mechanism for that? It's very interesting. So we think that there is a couple of different ways that it could potentially be doing this. But one of the ways is that we have this system called the endocannabinoid system and the people probably recognize this cannabinoid like cannabis, they're conceptually similar. It's not the same, but conceptually similar to the active chemicals that you will find in marijuana. And this endocannabinoid system is involved in our gut microbiome. And it's also involved in, for example, our perception of pain. So in this study that we did, it was people who had arthritis and when people do exercise and they have arthritis, they have improvement of their pain because we're activating the endocannabinoid system. But it turns out that the endocannabinoid system also has the downstream effect of affecting the gut microbiome, which leads to the emphasis on the butyrate producing microbes. And so-- It also has a mood altering aspect to it as well, doesn't it? Well, there may be a mood altering aspect to it in the sense that like, people just to (indistinct) Like just in terms enhanced wellbeing, you know? Yeah. (indistinct) The runners high. Right. Right? So like where is the runners high? Where does it come from? And we believe that this actually comes from the endocannabinoid system. So yeah. So it's quite fascinating to consider this and it's like you're not even changing your diet, but yet when you do consume fiber, you will get more short chain fatty acid from that fiber because of the exercise. So basically what I'm saying is we're synergizing. With just a 15 minute minimum dose. That was a 15 minute minimum dose. Now of course, like we wanna strive to do even more than that if we can. I mean, as humans we were not designed to only do 15 minutes of movement per day, right? But in this study just 15 minutes made a difference for these people. Yeah. So sleep becomes very important. We know that people who get more sleep, more restful sleep, have more diversity within their gut microbiome. If you wake up in the middle of the night at four in the morning, and like you're having those racing thoughts, this phenomenon of waking up in the middle of the night has been associated with decreased microbial diversity. So sleep is something, the people that we surround ourselves with. Very interesting study, Rich, where they looked at spouses and they discovered that you share more microbes with your spouse than you do with your siblings who share your genetic code, right? And come from the same place. And what was really interesting about this is that they showed that it was not their diet. That was the explanation. There was something else going on. But here is my favorite part, in this study the amount of love and affinity that you had for your spouse was associated with the beneficial response that you received. So the person who felt most connected to their spouse actually shared the most microbes with their spouse. Wow. Now I don't know if that's kissing, touching, if that's like sex, but at the end of the day, the people who felt closest to their spouse were sharing the most microbes, the people who felt most distant from their spouse were not. That's super interesting. That's super interesting. And also I couldn't help but think about the way we started this podcast, which was talking about how the micro mimics the macro and vice versa and in, you know, sort of creating this list of things to enhance your microbiome. It goes back to the same things you hear about when we're talking about, you know, weight loss, longevity, it doesn't matter. Right? Get a good night sleep, increase the amount of plant foods that you're eating, get outside and exercise, connect with nature, connect with other human beings, all of these things. And there is one more thing I want to add if I could, when we talked about the growth strategy, I missed out on talking about the last letter, which is H. H stands for holistic healing. We are so much more complicated than like simple biochemistry where fats, proteins and carbohydrates meet enzymes. We are complete humans. And the way that we feel affects our gut microbiome and trauma becomes critically important. And I have seen a number of different patients, Rich, where these are the people who bounce from doctor to doctor, to doctor, and they never get anywhere. And they will come in and they will say, "Dr. B, I have done everything that you have asked me to do. "I eat a diversity a of plants, "I sleep, I exercise," blah, blah, blah, blah, blah. The issue is that these people oftentimes have something in their subconscious that is holding them back. Trauma can continue to echo throughout our gut microbiome and ultimately manifest with digestive health issues. And I wanna share a quick story if it's okay, just to close this out. Yeah. I had a patient who I'd been taken care of for years. She has ulcerative colitis and I was pulling out all my tricks. So I mean, I had her on what I thought was the right medicine, I was working on her diet, lifestyle, all these different things. It was not working. It was a humble moment. And then one day recently she comes in, she goes, "Dr. B, I'm so excited to tell you this, I'm back. "Like I'm all the way back to feeling like myself. "I'm a hundred percent." You know, this is a person whose quality of life was destroyed. Like she's young, couldn't go on a date because of how sick she was. Waking up the middle of the night to poop. So when she came in and she told me this, was so pumped, but I needed to know. So what happened? Like what changed? And she says to me, "Well, I finally had the audacity to change my job." She was working in an environment where she dreaded going to work on a daily basis, where her boss would publicly belittle her in front of her work colleagues. It was a hostile environment. And she ultimately decided that she needed a change. She left, she entered into a new work environment where people treat her with respect and just this simple shift completely fixed her health issues. Incredible and beautiful. It's powerful. Yeah. It's really powerful. The holistic way of looking at it, how interrelated all of these things are, and to treat things in isolation is to be blind to the greater play. This is why we always have to, again, remain humble to the possibility that there is so much more going on with the body than we could possibly understand. So we do the best with our clinical tools, with our research. But at the same time we have to look at the whole human and understand how do we help this whole human. And more will be revealed. Like we're just at the start of this amazing adventure into the microbiome. Revolution. I think, you know what? We're gonna be learning and discovering over the next five to 10 years, it's gonna blow people's minds. Absolutely. And you're right there, man, on the cutting edge of it, doing the thing. Thank you. That was amazing. I think people are gonna get a lot of value out of what we just talked about and I appreciate you sharing so openly over the course of these past couple of hours, and you are doing fantastic work. I'm at your service, my friend. So everybody who is listening and watching, if you have not yet checked out Dr. B's first book, "Fiber Fueled", it's a must read. That's sort of the why behind all of this, right? And your new book, the "Fiber Fueled Cookbook" is the how, it's all about the practical things that you can do, consistent with the many things that we talked about here today. My new book is a toolkit for people to figure out how to create gut health in their own individual way. No matter who you are, if you don't have digestive health issues, guess what? I have 125, absolutely delicious recipes, and the plant points are listed on every single recipe. Yeah. You can turn it up. But if you do have digestive health issues, if you have food intolerances, I'm gonna walk you through the growth strategy in great detail and I'm gonna give you two food protocols. One of them is the histamine protocol, 25 recipes there. The other is a FODMAP protocol, 30 recipes there, you wanna ferment food, I teach you how to make sourdough. I teach you how to make delicious fermented foods. You wanna sprout like me and Doug Evans, you can join the party. I teach you how to sprout. The point is that you can implement this and introduce this in your own life in whatever way you feel works best for you and it doesn't have to be a 100% plant-based thing if you don't want it to be. I want you to walk that path in a way that feels right for you, at the end of the day I just want you to be thriving, be enjoying your food and having great joy in your life. That's what this is really about. So, and Rich, one last thing I just wanna mention real quick, we've talked about a lot of research studies during our episode today, we talked about a lot of research studies during our first episode. So in order to engage with everyone who's been listening to these two episodes. I want to be completely transparent with my science and provide that to everyone. So I'm actually going to prepare a PDF that's going to be available for download. And if you quite simply go to, this is my website. So you can go to my website, www.theplantfedgut.com/richroll, if you go to my website, theplantfedgut.com/richroll I will give you the references, both for this episode and the last episode. If you haven't listened to the first episode, go back and check it out. You'll have the references and at the end of the day this is about trying to empower you with knowledge that you can apply to your own life in a way that transforms your health. That's what I'm about. I love it. That's fantastic. Our friend Simon Hill did that for the episodes that he did on the show and the audience loved it. So that's very generous of you to do. And of course, I'll link all that up in the show notes if you can't remember the website or any of that stuff. In the meantime, pick up Will's new book, the "Fiber Fueled Cookbook", available everywhere, and you can find out more information about it on his website, theplantfedgut.com. And there are so many more, I made this outline, I shared it with you, and there were all these other topics that I wanted to explore that we didn't even come close to getting to. So hoping, I'll invite Some cool topics. To come back and dive deeper into all of this. Absolutely man. I would love to, it's always a privilege to, I mean, going back to the first episode, you know that this was a dream come true for me to be a part of this and to be here with you today for the first time in person is really, it's just crazy for me. Well, the pleasure and the honor is all mine and we'll see you back here soon, my friend. Thank you, man. All right. Peace. Plants microbiome. (upbeat music)

Channel: Rich Roll

Views: 1,974,507

Keywords: rich roll, rich roll podcast, self-improvement podcasts, education podcasts, health podcasts, wellness podcasts, fitness podcasts, spirituality podcasts, mindset podcast, vegan podcasts, plant-based nutrition, science podcast, microbiome gut health, gut health and weight loss, gut health diet, will bulsiewicz, fiber fueled, fiber fueled diet, gut health supplements, gut health foods, fiber fueled will bulsiewicz, fiber fueled diet review, good self improvement podcasts

Id: 9jDsQU1UEAo

Length: 175min 2sec (10502 seconds)

Published: Mon May 16 2022