Dhru Purohit Show - How To Activate The Healing Benefits Of Fiber With Dr. Will Bulsiewicz

Episode Date: February 13, 2023

This episode is brought to you by InsideTracker and ButcherBox. Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Will Bulsiewicz to discuss the topic of fiber and its many benefits for gut and whole-body health. Dr. Will Bulsiewicz is an award-winning gastroenterologist and New York Times bestselling author of Fiber Fueled and The Fiber Fueled Cookbook. Dr. B completed a bachelor’s degree from Vanderbilt University, a medical degree from Georgetown University, and a master's in clinical investigation from Northwestern University. Dr. B was the chief medical resident at Northwestern and the chief gastroenterology fellow at the University of North Carolina. In this episode, Dhru and Dr. Bulsiewicz dive into: -The top drivers that are making us sick and overweight and causing gut issues (1:55) -Tips for better bowel movements (11:15) -How to add more fiber into your diet without the GI discomfort (21:15) -What fiber does to support gut health and the gut microbiome (30:40) -The American Gut Project and the benefits of eating a diversity of plant foods (36:36) -Recommendations for fiber intake and personalization (46:10) -Backlash on CGMs for plant-based diets (1:14:53) -Guidance for parents on how to handle picky eaters (1:25:13) -The process of incorporating more fiber into your diet (1:29:28) -Research on the gut microbiome and cancer (1:34:33) Also mentioned in this episode: -Dr. B’s book, Fiber Fueled -Dr. B’s cookbook, The Fiber Fueled Cookbook -Dr. B’s available courses -https://www.Joinzoe.com and use the code willb10 for 10% off  For more on Dr. Will Bulsiewicz, follow him on Instagram @theguthealthmd or through his website, https://www.theplantfedgut.com. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 20% off. Just go to https://www.insidetracker.com/DHRU to get your discount and try it out for yourself. ButcherBox has a variety of different boxes, and you can choose your box and frequency. For a limited time, you can sign up today and get two pounds of ground beef free for a whole year PLUS $20 off by going to https://www.butcherbox.com/dhru. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

The reason why fiber has overwhelming evidence to support its health benefits is because when we consume fiber, it comes into contact with our gut microbes. They release short-chain fatty acids, and those short-chain fatty acids are what activate the healing benefits that we get from fiber. Welcome to the Drew Proff podcast. Each week, we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Will Balsowitz, an award-winning gastroenterologist. internationally recognized gut health expert and a New York Times, Wall Street Journal, and USA Today best-selling author

of Fiber-Fueled and the Fiber-Fueled Cookbook. Dr. B, as many of his patients call him, has a passion for plants and helping people. He sits on Scientific Advisory Board and is the U.S. medical director of Zoe, has authored more than 20 articles published in peer-reviewed scientific journals, has given more than 40 presentations

at national meetings presented to Congress and the USDA and has taught over 10,000 students on how to heal and optimize their gut health. And on today's podcast with Dr. B, he's going deep into the topic of fiber and how fiber is one of the lowest hanging fruits that people can optimize in their diet for all sorts of better health outcomes, including less constipation, less bloating, and just overall better protection around long-term chronic disease. Now, a little bit more background on Dr. B. He completed a bachelor's degree from Vanderbilt University, a medical degree from Georgetown University, and a master's in clinical investigation from Northwestern University. Dr. B. was the chief medical resident at Northwestern

and the chief gastroenterology fellow at the University of North Carolina, and received the highest award given by both his residency and fellowship. Stay tuned for a fantastic episode on all things gut health with Dr. B. Well, Dr. B, thank you for being here. Now, 10 years ago, you, You were 50 pounds overweight. You were sick. You were miserable. And your gut was totally messed up. Now, I'm excited for you to be on the podcast.

And thank you again for being here. And we're going to talk about your story and what things you did for you. But I want to start off a little bit big picture. Help us understand why so many people today who are listening, maybe even, are in the same place that you were in 10 years ago where they feel not their best and especially their gut health is messed up. What do you think are some of the top drivers today that are causing this situation for a lot of people? Drew, first of all, thank you for having me on the show. I'm excited to be here and they connect with your audience. I think that there's, this is like

an entire story of its own. And it's a very important story because it informs the way in which we're living in the modern world and how this is impacting our gut in a negative way. And ultimately, understanding what has changed allows us to create a strategy or a plan to bring it back and get back to those roots that we need to in order to support our gut health and ultimately live our best, healthiest lives. So, like, if we take a step back and just think about, like, how much the world has changed in the last 100 years, you know, we're talking about, like, for me, this is going back to my great grandparents, who were the ones that immigrated to the United States. States from Poland. And like, they didn't have cars. They barely had electricity. Our food was all locally sourced. They knew their farmers. They like my grandfather, he hunted to put food on the table. And, you know, you fast forward to where we are today. And like food supply wise, the food system has like basically grown into bigger is better.

It's almost like Wally is becoming true. They are putting food in front of us that is highly addictive. It's designed to trigger our brain and make us come back for more. This has resulted in the American diet being 60% ultra-processed foods. Clearly, we are way overdoing it on food that literally did not exist 100 years ago. And in the process of adding in all these ultra-processed foods, you have to crowd something out. And what we've done, Drew, is we've crowded out the high fiber foods. And so we sit in a place now where 95% of Americans are like not just low on fiber,

but actually in a place that we would call them deficient. And from my perspective, as a gastroenterologist, I see this as a tremendous opportunity. Because if this is something that is meaningful, if this can make a difference in a person's life, And if they are currently deficient and we can fix that deficiency, then we can get them to a place where this could potentially radically transform their health when we project this out over 10, 20, 30, 40, 50 years. So this is just the tip of the iceberg. We could get into how we're sitting on the couch. We're watching television. We're being exposed to blue light from our phones, from our computers, from our TV late at night.

That's disrupting our sleep hormones. We're not getting good sleep. We're not spending time outdoors. we're not connecting with real people in a real way. And instead, we're connecting with them over social media. And that's just quite simply not the same. And so I think, you know, the bottom line is that so much has changed in the way that we live our lives in such a short period of time.

And I would personally say that most of the changes that we've made, they're not in the best interest of our gut health. So we'll unpack a few of those. But, you know, you're most notably known for writing about fiber. So just I want to start up with those basics. What are one, two or three signs that somebody doesn't have that adequate amount of fiber in their diet? Something that they're experiencing, risk factors, daily stuff that they're going through or not going through. What are some signs that they don't have enough of that fiber?

I think the most obvious sign that you're not getting enough fiber is if you're not eating enough, like, real plant food. So, I mean, if you're not really sure where the plants are in your diet, then you're clearly not getting enough fiber because fiber is. was found in plants. And the average American, only about 10% of our calories are actually coming from plants. And unfortunately, the number one plant is a potato because French fries are sort of the number one thing that we're consuming that's vegetable based. So that's, you know, there's a lot of opportunity for improvement there. But to get into like symptoms, to get into sort of what you're looking for, Drew, I would talk

about bowel movements. You know, if I were a cardiologist, I would be here to talk about heart rate and blood pressure. If I were a pulmonologist, we would talk about pulse oxymetry, respiratory rate. I'm a gastroenterologist. This is my vital sign, bowel movements. And I personally think that we're facing an epidemic of disturbed out of balance, out of rhythm bowel movements. There's something to be said for having a good, complete, and dare I say satisfying evacuation on a routine basis. Like probably once a day.

It doesn't have to necessarily be that, but probably once a day. a day. And when you're consuming more fiber, many people are going two or three times a day and having really good bowel movements. If it's a struggle, if you feel like you can't completely empty, if you have this sense of like, gosh, I did all that work and only that little thing came out. Like those to me are signs that we have an issue. And if you're not adequately evacuating your bowels, then the number one symptom that we're going to see, Drew, is bloating, gas and bloating. And this is widely prevalent. There are a bazillion people.

I'm quite sure listening to the podcast right now who this is something that they've experienced is like the routine presence of gas and bloating. And I'm here to tell you, I'm here to tell you that this is very closely tied to your bowel movements, that if you are backing up, that is the cause of your gas and bloating. And if we could get things moving through, then we can relieve that issue and you'll feel better. And fiber is one of the ways potentially that we could get that work. Yeah. What I appreciate about your work is that you address it from all sides. So there's people that are out there that might not be having enough fiber and constipation is something that they really struggle with. And then there's people that start adding in fiber. And if you're that person and you've had challenges with it or you notice a little bit of bloating, you notice a little bit of constipation, even when you start to add in, you have a bunch of tips and a bunch of nuances that are there. We're going to get more into that later on in the interview. But real quick, we're going to jump around a bit. And because you mentioned it, helping people poop better. You made a fantastic video. This is a few weeks ago.

You had four tips that you presented inside of that video to help people poop better and have better, more complete bowel movements. I have them here in front of me if you want me to tee up. And if you want to bring up another four or whatever you want to get into, feel free. But could you share some of those tips for improving constipation? All right. Drew, how about we do this? You lob them my way and I'll try to crush them. So because I don't remember the exact four tips that I did.

I got them for you, brother. I did my homework. Don't worry. So the first one was coffee. And I'd love for you to talk about coffee and what its benefits are in terms of helping with bowel movements. And also, is it ever a concern that some people need coffee to actually have a full evacuation or full bowel movement in the morning? So let's talk about coffee first. Yeah. So coffee clearly helps people poop. The vast majority of people, when they consume, coffee on a routine basis, they're going to notice that they often will have a bowel movement that come shortly after that. And it can be a part of that really healthy daily routine that you build in the morning that really gets your day started. I mean, I honestly believe that having a good complete evacuation in the morning is part of stepping into a great day. So what is it about coffee? There's a couple of things. Coffee is very rich in polyphenols. Polyphenols are antioxidant compounds. An example would be corrogenic acid that the research suggests may help us to move our

bowels. Coffee, believe it or not, even without adding fiber to it, actually contains some dietary fiber. And so this is soluble fiber. The soluble fiber is not grit. You would never know that it's there. But it is fiber and it is feeding your gut microbiome. And so that's one of the other the things that potentially helps. Now, I will say, there are some people that coffee just is not a great fit. And so there's about 10% of the population that will drink a cup of coffee and it will actually trigger urgent bowel movements. With those people, I would consider adding a fiber supplement to your daily coffee,

which by the way, I kind of recommend this for everyone. I do this myself. I did it this morning. Adding a soluble fiber supplement to your coffee on a daily basis is a great. great way to amp up the microbiome support. So examples of fiber, acacia powder, partially hydroized guargum, wheat dextrin, these are examples of ones that will dissolve. You won't even know that they're in there. So, and I would try that if you're having some urgency after you drink a cup of coffee. Some people that will trigger anxiety. Coffee may not be a good choice for them. It's,

I think, the caffeine in that particular setting. And then you have to be careful about this causing insomnia. So for some people, they're very caffeine sensitive. So you want to be careful about coffee in the afternoon. For me, I could drink it at 9 o'clock at 9 and go to Ben at 10 o'clock, and I'll be perfectly fine. That's just the way it is for me. But for others, it will be potentially different. So I think from my perspective, coffee is good for the microbiome. We actually have research that indicates that there are specific microbes that thrive when we regularly consume coffee. And it's a rich source of pre-biotics, both polyphenols and fiber. And I think it's a good part of the morning. I love it. To extrapolate further on my

second part of the first question, is it a challenge that some people feel that they can't go to the bathroom first thing in the morning without having coffee? Or as a gastroenterologist, you're like, look, coffee's generally good for you. Sure, would we like it a particular way? That might just be a, you know, their body's just used to it. But yeah, is that a challenge at all? No, I don't think so. I don't really, I don't really have concerns if you feel that you're having good, like better bowel movements because you drink a cup of coffee. Like I actually experienced that myself. So from my perspective, I don't see that as a red flag.

Awesome. All right. Number two that you went into, which is often underrated, is movement. Tell us how movement actually can help us with not being backed up and relieving constipation. There's this expression that exists called the runners trots. And basically these are distance runners, people who are training for marathons. and things of that variety, where when they run, they have to poop. And when they're on their like legit marathon run, they find interesting ways to do that.

So what we know is that movement actually stimulates motility within the intestines. When you move, your bottles will move. And our bodies really were designed to move. So this sort of lifestyle, coming back to the lifestyle thing, Drew, this lifestyle where we're, you know, sitting at a desk and working from 9 to 5 or something like that and then going home and popping down on the couch. Like this is not the way that we were designed as humans. So it doesn't have to be a run. It could be a walk.

A good, brisk walk, you will notice the difference. This can help you to have a good regular bowel movement. The second one that you went into and you kind of covered this a little bit and we'll be talking more about it was just high fiber foods, right? The importance of fiber in the first place to make sure that you are, well, actually I'll let you say it in your own words. High fiber foods. How does pre, like having them in our diet help us not get constipated in the first place? Well, you know, I think there's, there is some nuance to this particular topic. Like, I'm not here to say that the solution for every person who is constipated is to

crank up their fiber. I think that there's a little bit more to the story than that. But what I will say is this, that when your bowels are moving, like as their, as your bowels are moving through, fiber is your friend. So for people who are, constipated as a gastrologist. My goal, the way I always tackled to this issue is I want to get your bowels moving first. And there's a number of ways that I would do that. And then once I have them moving, then I want to bring the fiber on board because the fiber is going to help us to keep them moving. So I sort of see, I think the key learning here for the audience at home is that it's not so much that I lean into fiber to treat constipation. It's more so that I get your bowels moving and then I bring

the fiber on board to keep the bowels moving. I love it. The last one was a supplement recommendation, and this can be helpful for people who kind of feel a little bit stuck and need things to kind of get moving. And it's magnesium citrate. How do you use it? How do you recommend it to patients? And then you have some dosages that you suggest that people could start off with to help them with relieving constipation. Yeah. And this is actually something worthy of us unpacking beyond what I did in the actual post because when I did this post, I was talking about a bottle of magnesium citrate. And many people tried to correct me. And I think part of it is sort of trying to educate on complex topics through social media. So let's just kind of unpack this together. So magnesium citrate,

you can buy at your local drugstore. It's typically about the size of a can of soda and carbonated, lemon lime flavor. It really does not taste good. But when you do an entire body, of magnesium citrate like that. The intent of this is to jumpstart your bowels. So if you are a person who is constipated, you would not do this on a daily basis because that would basically leave you perpetually in diarrhea. But instead, if you were constipated, you would do this first. You would drink a bottle of magnesium citrate.

This gets things going. You have one or two really good solid bowel movements. And then after that, you want to get into something that's more of a routine that you're going to do on a consistent basis, which could include fiber, but also would potentially include magnesium supplements. So magnesium supplements are more like the routine, daily intervention that you will do to support good healthy bowel movements. And when it comes to magnesium supplements, there's a number of different ones that are good for constipation, magnesium citrate, magnesium sulfate, magnesium oxide. These three particular ones I've had great success, the way that I

typically approach it will be depending on which type starting at four or 500 milligrams per day. I usually tell people take it before bedtime. It can help in terms of sleep. There's a number of other benefits to magnesium. Magnesium is kind of a cool thing to take. And by the way, I've found that the vast majority of people are actually deficient in magnesium. But if you're concerned about that, you can always get your blood drawn with your doctor before you start doing this. Just get your blood drawn. Make sure you know where it is. Then you start doing this and you take four or 500 milligrams before bedtime once a day, give it a week, see how you feel. If you're not where you need to be in terms of having those good regular bowel movements,

then you can start to increase the dose by about 250 milligrams at a time. And until you get yourself to a place where it's like, okay, cool, I'm in a rhythm. This is where I need to be. And you know you're in a rhythm, by the way, Drew, with this particular thing, if you were constipated, you like almost sure. are going to have gas and bloating. And from my perspective as a GI doctor, when I treat people with this issue, what I'm looking for is that their gas and bloating has improved substantially, if not completely gone.

Because I know that once the bloating is gone, I know that I have them in a rhythm where they're moving their bowels the way that they're supposed to. So magnesium is one of the ways that we can accomplish that. I want to continue on the topic of gas and bloating because so many people suffer from that, right? And we know through books like yours that the data around fiber is so, so strong, at least the data that's available to us right now as we continue to look at like what leads to these positive outcomes in society. Are there ways or foods that people can start off with when it comes to fiber?

I don't know what the correct term is, but sometimes people completely get excited about fiber. They start adding a ton of stuff and they notice that their gas is, they have a ton of gas. They have a ton more bloating than what is their normal baseline. For example, does it make a difference if we cook foods versus having them raw? Generally, anecdotally, and just talking to friends, sometimes the same foods or ingredients that somebody would have raw, when they have them cooked, they seem to tolerate that fiber a little bit more. Is there anything like that that you would recommend to the listeners? Well, first of all, that is 100% true. When you cook your food, when you modify your food, you know, these are forms of processing.

And there's nothing wrong with processing, meaning like cooking your food or chopping your food or something like that. That's a different thing from my perspective than say an ultra processed food where we're like throwing together chemicals that frankly we don't even know what they are or what they do. So when we process our food, when we chop it, when we cook it, heat it up, boil it, steam it, whatever it may be, the food structure actually changes. And it's kind of interesting, Drew. There was a study that was done out of the University of California, San Francisco by a gentleman. His name is Professor Peter Turner, Ball. He's one of the leaders in microbiome research out there. And essentially what he did is he took the exact same food, it was a plant food, the exact

same plant food. And he served it both raw and in cooked form. And what he discovered is that you actually get different effects on the microbiome when you cook the food. So there is no doubt that processing our food, specifically cooking our food, or breaking it down, such as you would do with a smoothie, for example, that these are ways that we can make it easier for us to digest because in a way we're sort of predigesting that food through that process that we're doing. So I do think that there's benefits. For the person who has gas and bloating, we're focusing on food right now. We could open this conversation up into bigger things too when it comes to gas and bloating.

But for the person who has gas and bloating, I do think that it's really important that you ease into your fiber intake. I always say start low, go slow. And what that means is that we're going to try to get you in a place where the amount of fiber that's on your plate, you're actually capable of processing and digesting it. We want to be at a level that actually is matched to what you're gut. microbiome is capable of doing. And then go slow basically means that we're going to start to escalate over time. And as we start to escalate and challenge your gut, your gut will have the ability to keep up with

what you're doing as long as you're going slow enough. And this is how you build. It's the exact same concept of what we do in the gym. When we go to the gym, we start off low in terms of weights that we can handle and then we go slow in terms of ramping it up. So for the person who has gas and bloating, yes, processing your food. This could be done through cooking your food, making, like I'm a big fan of soups, stews, things like that.

Also making smoothies and predigesting it. Additional things to think about. You could sprout your food. You could ferment your food in some cases that actually improves it and makes it more easily tolerable. And the other thing is to look at low FODMAP foods. So FODMAPs are the parts of our food that are fermentable that cause gas and bloating. and for the person who has a damaged gut, for example, if you have chronic gas and bloating,

you have your old bowel syndrome, then it could be a good place to start with the low FodMap foods and then ramp up over the course of time. So an example are raspberries. Raspberrys are low in Fodmaps, but they're actually very high in fiber, like extremely high in fiber. And so it can be a great food to start with because it's less likely to cause gas and bloating and make your symptoms worse. but at the same time, like you're giving your body exactly what it wants in terms of building up your microbiome and making it stronger. Let's go back to your story a little bit.

What were some of the key behaviors for you that you think were leading to the underlining factors that were causing you to feel sick and your gut being messed up? So I think one of them that you've mentioned is that you were eating a lot of fast food. So fast food would fall in the category of ultra-processed food. give us an idea of your your life of like what kind of diet were you eating at that time and then we'll go to other other factors in your life i mean that was a textbook example of the things you should not do and this is despite the fact that i had graduated medical school from georgetown and was a chief medical resident northwestern and you know all these things like i was an accomplished medical doctor and yet my lifestyle was not aligned with what i would recommend at this point in

my life being in my 40s. And I think that, you know, kind of what happens is that the demands of what I was going through professionally from medical school, residency, fellowship, like those three things for me, they were four years each. So this is 12 years of my life from 22 years old to 34 years old where I'm spending six days a week in the hospital. I'm working like a minimum of 12 hours a day, but most days, 15 or 18 hours, sometimes 30 hours straight. I'm giving everything that I got to getting through this process. And when you're in that sort of place where it's like, look, your sleep is disrupted. You don't have time for exercise.

You don't have time for yourself. You're constantly stressed. When you're in that place, you just, you desperately want some sort of control. over your environment. You want something that you actually have control over. And it needs to be something that makes you feel good. And for me, that thing was food. And so it's not like I sat there and thought that I was eating a healthy diet when I was getting $15 worth of Taco Bell.

But at the same time, I also really wasn't that worried about it because I thought I'm young. My body can handle this. I'm going to be like, you know, I'm strong enough. I'm tough enough. And frankly, I need this. Like I deserve this. I've earned this because I've worked so hard. This is all I got is this.

And you know, you make those sacrifices. And over the long run, it's just like, I mean, I know this didn't happen overnight. But I felt like I woke up one day. And I felt like you look in the mirror and you think of like my self image of myself was an athlete. I played three sports every year when I was in high school. And you look in the mirror and you're just like, dude, who are you? And my gut was sagging over my belt. I had high blood pressure.

I had high cholesterol. Tons of anxiety. And I was just in a bad place. And I knew I needed a way out. And the, uh, the irony is despite, like nothing against these institutions. I'm very proud of my education. But despite being educated at Georgetown and Northwestern. in the University of North Carolina.

Like, I really didn't have a great solution to my own problems. I didn't want what I was actually offering to my own patients, which was pills. Like, I didn't want that. But I wasn't really sure how to fix this, despite all that education. So there was a period of time where I was trying stuff. And the first thing that I tried was exercise. I thought I can exercise my way out of this. And I was doing about 45 minutes of strength training plus 30 minutes of

cardio of some variety, six days a week. And I could grow stronger and faster in those kind of things. But the gut didn't go away. The anxiety didn't go away. The low self-esteem didn't get better. And so it was ultimately, frankly, stumbling into a dietary change that allowed me to get myself to a better place. And when it, when it changed my life, I, as a medical doctor, felt like I have no choice now. Like this has to be a part of what I do for my patients. Because if you find something that powerful, that it doesn't matter whether you learned it in medical school or you learned it on your own.

When you find something that's that powerful and that healing, then you have to deliver that to your patients because they deserve that to it. And so that's really sort of the takeoff point for everything that has happened since. It's just like, I felt like I needed to do this and do it for my patients. And now here we are. Here we are. Bestsellers later, hundreds of thousands of copies of your book, great mission, message, social media. And you're really trying to help people understand that a lot of these super amazing hacks that people are looking for we can get with daily basic solutions.

And one of those being obviously fiber, which we've talked about, we'll talk more about in a second. I want to zoom out a little bit big picture and go from what does it seem to. to be as basic as it sounds, just making sure we connect all the dots for everyone. What is it that fiber is doing to the gut that allows us to see that people who are having a certain level of fiber, we'll go into that next, are generally going to be better, more healthier and better off? Yeah, it's an interesting story because I think we've all known and I think we were all raised hearing from our grandmother that fiber is good for us and we're supposed to be eating more of it. My grandmother used to nag me about that when I was a kid. And I was just like,

whatever. So it turns out that she was right. And I think that the science that really has changed, that is exciting because there's a new story. There's a new understanding of fiber. And this new story is like enough with us pretending that fiber is boring. It is not. It is so exciting. It is so interesting what we have learned in the last 15 years, which is that when you consume fiber, which by the way, just kind of taking it from the top, fiber is a carbohydrate. It's a complex carbohydrate. So essentially, if you take a bunch of sugar molecules and you fuse them all together and make a super long chain, that's fiber. And fiber is intensely complicated. So I was a chemistry major in college.

and when I look at fiber molecules and I see their chemical structure, I have zero clue how to properly describe them. And it gives me like a brain cramp to even consider it. So because it's so complicated, we have done some things to try to simplify our understanding of fiber. And we've broken it into two main categories, soluble and insoluble fiber. So soluble fiber is the part that you and I were discussing earlier, Drew, when we were talking about coffee, because basically, if you take soluble fiber and you put it into a beverage and you stir it, it will disappear. You won't even know that it's there. And there are certain properties to soluble fiber, but the main one that people need to know about

is that it's food for our gut microbiome. I'm going to come back to that in a moment, but just to take on insoluble fiber real quick insoluble fiber insoluble meaning this does not dissolve no matter what you do you could heat it up you could stir it all you want it doesn't matter it's still going to be there and this is the grit this is the roughage this is the more traditional understanding of fiber that we've always kind of learned which is that you chew it up you swallow it it sweeps through your intestines and then it launches out the other end like a bowel movement so as a bow movement So insoluble fiber is not the part, generally speaking, that really is important to the microbiome.

It's the soluble fiber. And this insoluble fiber, what's unique and interesting about it is that as interesting and complicated as we are as humans, our digestive system is actually rather simple. We only have 17 digestive enzymes. that are designed to process complex carbohydrates. And this number 17 is inadequate to allow us to break down fiber. We don't have the ability as humans to actually digest it. So if we didn't have microbes, we didn't have a microbiome, we would never be able to get the benefits from fiber.

But because we have a microbiome, and they're mostly concentrated in our colon, this is the main place, the colon is the large intestine where you will find these microbes. There's about 38 trillion of them there. Because they're there, the fiber will work its way through our small intestine, which is about 15 or 20 feet long, and it will arrive in the colon in your right lower quadrant of your abdomen. And that's where it comes into contact with your gut microbiome. And this is their food. This is their food because it is one of the only things that we can guarantee that it will not be changed. It will not be altered by digestion. It will be exactly the same that you found it in your stomach. And so those microbes, they have tons of these enzymes.

So again, like we are big and complicated, but our digestive system is simple. We only have 17 enzymes. A single cellular bacteria that we can only see with a microscope could have hundreds of enzymes alone. And collectively, the entire microbiome we've estimated could have 60,000 unique enzymes. And they use these enzymes. They go to work. They break down the fiber. The fiber stops being fiber. It's now been digested by your microbiome. And they release, Drew, the sort of key part here, they release the most healing, the most anti-inflammatory molecules that I've ever come across, which are the short chain fatty acids, butyrate, acetate, propionate. These three molecules, many people have heard of butyrate. They have healing effects in your colon. They have healing effects for the lining of your gut.

They have healing effects on your gut microbiome. But they also have healing effects throughout your entire body. They will enter into your bloodstream and they will travel down to the tip of your toes and all the way up to your brain and make a difference everywhere they go. So the reason why fiber is so special, the reason why fiber has overwhelming evidence to support its health benefits is because when we consume fiber, it comes into contact with our gut microbes. They release short chain fatty acids. And those short chain fatty acids are what activate the healing benefits that we get from fiber. That's great. And do all fibers impact? Of course, you talked about the differences that are there between insoluble, soluble fibers, but do some of them

produce more of these short chain fatty acids than others? Or is that generally related to, you know, diversity and general sense of quantity? So there are, to be honest with you, Drew, we don't even know how many varieties of fiber exist. And the reason why is because the biochemical complexity of fiber makes it very hard for scientists to even get their, like, wrap their minds around this. But what we do know is that different plants, different plant types have different types of fiber. And those different types of fiber will feed different families of microbes. This is where diversity within the microbiome. This is where diversity with our diet become very important. Because ultimately what we want is we want to eat a wide variety of plant

foods that allow us to feed a wide variety of different microbes. So all of these different types of fiber, they're all unique. Now, Drew, to answer your question a little bit more directly, some types of fiber are better at producing buterate, some are better at producing the other short chain fatty acids. There's another thing that I should toss in here while we're talking about fiber and we're talking about buterate. And those are the resistant starches. Resistance starches are technically not fiber.

They're starch. You will find them in green bananas. You will find them in mashed potatoes when they cool off. You have to cool off the mashed potatoes to form the resistant starch. But this starch is not processed by our digestive system. And as a result, the resistance starch actually behaves exactly like fiber. And what's interesting, Drew, is that the resistant starch tends to support and produce a significant amount of butyrate, which is part of the reason why there's an emerging science

that is increasingly showing us that there are benefits to us, including these resistant starch type foods in our diet. So again, potatoes when they're cooled off, green bananas, you'll also find resistant starches in legumes and beans, things of that variety, whole grains. So I want to go back to, again, you know, your ancestry, my ancestry, everybody. kind of ancestry in the past. Now, we know now through things like the American Gut Project, you've talked about this a lot, that diversity was one of the biggest components that showed people had, you know, better guts, but also the healthiest people had the most diversity. Is that right? Did I accurately relay that from the American Gut Project? Well, so in the American Gut

project, what they did, and just to kind of set the stage for this where I think you may be going, And Drew is that the American Gut Project was led by a team out of the University of California, San Diego. And essentially, this was way beyond the United States of America. I mean, this included like 54 other countries and territories in addition to the U.S. But what they managed to do was to get over 11,000 people to provide a poop specimen so they could analyze their microbiome. And simultaneously, they filled out a massive survey. giving feedback about how they eat, what their lifestyle is like, things of that variety. So this is the largest study to date that allows us to make connections between our gut microbiome

and our diet and lifestyle. And one of the points of emphasis in this study is the diversity within the microbiome. And the reason why diversity within the microbiome was sort of a focus within the study is because leading up to this study, there were a series of important publications that really started probably 15 years ago, where they showed us that many different significant diseases, whether it be metabolic issues like diabetes, heart disease, obesity, whether it be immune related issues, such as autoimmune diseases, celiac disease, Crohn's, all sort of colitis, rheumatoid arthritis, lupus, hormonal issues, mood related issues, cognitive issues like Parkinson's disease

or Alzheimer's, the tie that binds these conditions together is that you will discover that there is a reduced diversity within the microbiome. And so this has led to us observing that we want to have a more diverse microbiome. And so their focus in this study was, how can we, like, what are the factors that are predictive of a more diverse microbiome? Great. Thank you for that. That's fantastic. Do you feel that, you know, again, when we say ancestors, we have to, you know, kind of define things. But let's say we're going back like 500 to a thousand years. So relatively near, you know, ancestry, at least to the place where we don't have a lot of data on maybe longevity, obviously, because we, you know, we didn't have

the science levels that we have. But we generally know that chronic disease was not at the levels that it was today. Is that a fair statement to say? Yeah, I think that's definitely a fair statement. people were dying, even if you just go back to 1900, Drew, people were dying of infections at a far higher rate. Right. You know, childbirth, things like that. Childbirth or other trauma or other injury. You know, we didn't have the ability to repair those things.

So those were a lot higher. Yeah. Yeah. So then even go back a little bit further, you know, 10,000 years. Do you see diversity in the diet as just something that society, that society is? sought out or it was a byproduct of just having to live in the natural world, which meant seasonality and migration and a lot of things. And so people just ate whatever they could find. And so therefore, they ended up having diversity. What have you seen in your research,

reading, and just your own hunch about the situation? Yeah, I think that the issue is that we lived in the setting of food scarcity for the majority of human history. And really, that's focusing on before 10,000 years ago. 10,000 years ago is when we started to form agricultural practices that allowed us to create a food supply as opposed to being hunters and gatherers. And in the setting of being hunters and gatherers, which is more than 99% of human history, people were starving. And there really wasn't any sort of possibility of an obesity issue because you were just trying to get. buy, get enough calories. And as a result of that, you know, there was no food system.

There was no supermarket. And you just ate whatever was available to you. And so that's, I also think that Drew, it's an interesting conversation because I think that's part of what informs dietary preferences that continue to exist today, even though a lot has changed in the way that we live. I think those dietary preferences still exist because 99% of human history was in the setting of food scarcity and so we needed certain things. Got it, got it.

So, so to kind of recap to make sure I understand correctly is that because we had food scarcity, that led to a lot of the way that we ate before. And it's essentially part of that was just we went to eat whatever we could find. And but also because we're living within the changing of the seasons and other things, diversity was a byproduct of us just being around, right? comparatively to necessarily like groups or societies and there's so much variation, I'm sure, in different, you know, groups of humans and tribes that live back then. We were so focused on making sure we got enough calories.

We didn't necessarily, you know, the focus wasn't necessarily diversity for diversity's sake. We were just trying to eat whatever we could get. Now today, part of what we have, if I understand you correctly, please correct me if I'm wrong, because we have this food abundance and primarily it's in the form of ultra-processing. foods, you know, we have to intentionally seek out diversity because our natural sort of lizard brain tendencies would be to want to get the highest concentration of calories that have that dopamine effect, which would mean that in turn, we're not seeking out diversity because it takes extra work. Yeah. And I also think that the food system is problematic. So if you think about

your supermarket, 75% of the plant-based calories that exist in your supermarket come from three plants. Wheat, corn, and soy. And that's problematic. You know, that we have consolidated through our agricultural practices down to just a couple specific ones that we're going to like push into the American food system and get people to buy this. And we're going to basically like hack their brain to figure out ways to hit the bliss point so that they're essentially craving this and coming back for more.

And, you know, even among the fresh produce, even among the fresh produce, we have consolidated down to just a couple of specific crops. And in the American Gut project, in this study, what they found are the people that had the most diverse microbiomes were the people who are eating at least 30 plants per week. And what's interesting about that is that, like, there are some people that that sounds very overwhelming to them to get to 30 plants per week. And now I would argue, like, first of all, you don't need to hit 30 plants this week to be healthy. I think that you can build up towards this and you can start to figure it out over the course of time. But the fact that it's hard to get 30 plants per week in our diet because of sort of the way that our food system is structured and what's delivered to our supermarket, that's very disappointing. because that like 30 plants a week would have been a slow week, I think, if we went back to the time you're describing. I'm quite sure that they were eating 50, 60 or more varieties of plants per week because they had to.

Do you know, and you may not have it offhand, so we can look it up later on. But of those people that were eating the 30 different, you know, fruits and vegetables, right? They were fruits and vegetables is kind of part of that. diverse species of, you know, plant foods that are out there. What percentage of that was it from the Human Gut Project? Like if they would extrapolate, and again, you know, I don't know, you mentioned different countries being a part of this, but what percentage of those people that participated in the Human Gut project were in that category of that sort of optimal level of diversity of foods? It's a small, it's a small percentage. It was not the majority of people

who were doing this. And also to break down the math and the way that they were actually attacking this, they were looking at, let's compare the people who are eating at least 30 plants per week to the people who are eating five or less plants per week. And so when you make that comparison, that's where you see the biggest gain. Now, is the average American consuming less than five plants, five or less plants per week right now. I don't think the average American is quite that low, but I also don't think that the average American, the average American is above 15 plants per week. So I think that there's plenty of opportunity for us to step into this. You chatted about at the beginning of the podcast, but I'd love to make it sort of a visual extrapolation. So can you give us again,

what is the recommended dose of fiber based on everything that you've come across? Like, especially that sort of minimum viable dose for like a healthy lifestyle, right? And then we can get into like sort of the optimal category. And then remind us again what you've seen and pull together of the research of what people are getting currently for men and women because I know there's a difference that's there. Yeah. So I will answer this question. And then I want to also add the way that I approach this issue.

So. Yeah, you don't track your fiber. You're not measuring your fiber on a daily basis. you have a different system which I'm excited to get into. Yeah. So, but like it's important because I also cite these statistics. So it's important for me to be clear on what we're exactly talking about. I keep saying 95% of people are not getting the minimal recommended amount of fiber.

So that's, I'm about to unpack that specific number of the 95%. And essentially, the Institute of Medicine recommends that the average person consume 14 grams of fiber for every 1,000 kilocalories that you consume. So obviously big guys like me, I'm six foot four and I'm over 200 pounds. A big guy like me, I need to be consuming more fiber to hit that mark because I'm definitely consuming more than a thousand kilocalories a day. Whereas like a more petite woman may not be consuming nearly as many calories. So the way this ends up shaking out, the typical recommended amount for a woman is 25 grams of fiber per day. And the average woman in the United States is getting about 15 and a half grams.

So that's like again, the minimum is 25 and the average woman is 15 and a half. Men are actually doing worse. The recommended amount for men is typically 38 grams per day. And the average man is about 18 grams. So we're consuming more calories, but we're getting not much more fiber. And so in both cases, what we see is that there's a lot of opportunity for improvement. And one of the challenges that we've had, Drew, in terms of just like, this is just being nerdy for a quick moment. But when we do research studies, it's very hard for us to really understand the effects of an adequate amount of fiber because it's hard to find people in the United States who actually are consuming an adequate amount of fiber.

You see multiple studies where like the high fiber consumers are 20 or 21 grams of fiber per day and they're all deficient. Like whether you're a guy or a girl that is a deficient amount. on a fiber. And those are often the high fiber consumers. So, but I personally don't count grams of fiber. I've never counted grams of fiber. I don't fixate on this. And I also don't worry about it. Because what I'm a believer in and what my message is when I'm here to really try to convince the listeners of is to stop counting grams of fiber and start counting the plants in their diet. because when you focus on this, counting the plants, eating more varieties of plants, and you naturally start adding more plants to your plate,

then you are going to be starting to crank up your fiber intake, but you're also cranking up your fiber intake from many different varieties of sources. And those varieties of sources, they will have many forms of fiber. But they also have other benefits like other polyphenols, vital chemicals, which are plant-based chemicals that have healing. effects, vitamins, minerals, starches such as resistant starches. So I'm a big believer that we, we need to make the choice. The food system is not going to do this for us. We need to make the choice to consume more variety in our diet. And when I say variety, it's not just the fresh produce,

by the way. I just want to be clear on that. Yes, it is fruits and vegetables. They could be frozen. It's still super healthy. Fruits, vegetables, whole grain. seeds, nuts, legumes, they all count. And then there's one, also, there's one additional category that has fiber and it's not a plant. And those are mushrooms. Mushrooms have fiber as well, which is kind of cool. They're fungi. I love it.

Thanks for that breakdown. So just so that people can extrapolate out further, you know, you say that I've heard you share before that, you know, it's a plant rich, a plant-based diet. And that if I'm understanding correctly, that you're total. consumption for you is at 90% of your total food. And I wasn't sure if that was by volume, if that was by calories, is plant food. Is that accurate? So I think that what this is starting to get into is what do I see as a healthful diet? And I think it's an important topic because I want to make sure that I'm totally clear and people understand where I would like to take you.

Number one, like, I want to meet you wherever you are. So the way that I wrote in my book and the way that I attack this issue is the way that it would have worked for me 10 years ago when I had a really unhealthy diet. I was definitely less than 10% plant based. If you were less than 10% plant based, like, it's all good. I just want to try to get you moving in the right direction. And I don't want to put some sort of expectation on you that's overwhelming and excessive. I just want to get you moving in the right direction because I'm convinced that by moving you in the right direction and adding more of this into your dietary pattern, you're going to feel the difference. And when you feel the difference, you will want more.

And that will naturally propel you towards a more healthful diet. I believe that there's many different forms of a healthy diet, Drew. I don't think it's just one thing. I don't think that everyone in the world has to be vegan in order to be healthy. Do I think that you can be healthy and be vegan? 100%. And for many people, that is the perfect choice for the person. them. But my approach is to try to guide people towards something that is plant predominant.

To me, plant predominant means that we're getting into the range of in terms of calories, 70, 80, 90, or up to 100% of your calories are coming from these plant foods, fruits, vegetables, whole grain, seeds, nuts, and legumes. There's wiggle room in here. But when you get up towards, like, because I would argue that a healthy paleo diet, that's exactly what it is. somewhere in this range. When you get up towards 90% plant-based, the reason why from my perspective this is a magical number or the place that I want to get people to is that our research on the longest lived populations, the work that Dan Butener has done with the National Geographic has shown us that the blue zones,

these five locations where people are living, you know, with longevity in the modern world, they have similar dietary patterns, even though they come from different places and they have different cultures and they may substitute different choices. But there is this sort of theme that exists among these five places where they're all predominantly plant-based. They're all about 90% or more plant-based in terms of their core intake. Thank you for that. Thank you for that breakdown. I think where even for somebody like myself, you know, I was reading your book and going through a lot of your content. And, you know, one of the things you had mentioned was like counting your plants and what

you're eating. And I have some of my meals that I work with a chef to prepare. And then some of them I just do myself. And I counted up the number of plants that I had to just make sure that I hit to 30. And I pretty easily got to 30 on the foods that I have. Where I'm also trying to balance out like a lot of the audiences. And again, you're a doctor and a doctor at the end of the day is going to meet their patients where they're at. And for most people, just increasing your fiber in the version and format that works for you,

because everybody has different foods that work or don't work for them. And ramping up in a way that makes sense, like, that's just going to drastically support a lot of folks that are out there, especially if it gets them to move away from a lot of the ultra-processed foods that are there. So when I added all my plant foods together and I just had a few minutes before our podcast, I had a ton of them. And I was like basically at like 40 or so, like that I got you pretty easily. That would work. Now, along with it, you know, because I listen to people like you. I also have had on individuals like Simon Hill on the podcast and other individuals who talk about the benefits of also making sure that we get adequate protein intake.

Right? That's there. And proteins roll in longevity, which I know is a fiercely debated area and a lot of people have different thoughts on it. But generally looking at people from both sides of the aisle, even people who are plant rich who talk about what adequate protein looks like. And I feel I have a deep understanding of like the science around it, like somebody like Simon Hill. Then I'm looking at, okay, I need to hit 150 grams of protein a day as well. So when I start to, to look at getting that much amount of protein and in particular making sure I hit all the plant foods that I have, I find that from a caloric level, I'm probably a little bit more like 50-50, especially because I do eat things like fish. I have some targeted amounts of, you know,

dairy and I do eat some other animal foods in my diet. But you look back and you say, listen, as long as you're hitting that richness and the diversity on a regular basis consistently in your diet of all that plant food, you're still getting a lot of the benefits that come along with it. There may be ethical and moral reasons and environmental and other components, but I'm just making sure that I understand the way that I eat in the context of kind of how you view the world from just counting the total number of plants that you have. Yeah. And I think those are all good points, Drew. And I think that that there's like definitely valor to all of them. You know, I think that the first thing that I would say

is that the average American is 10% plant based and 60% ultra processed based. And that is such an opportunity to make a change. That's a low hanging fruit. That's a super huge low hanging fruit that so many people could benefit from improving. And who disagrees with that? Like Paul Saladino and I would agree on that. So that we should that we should get rid of the ultra processed food. And so I think that that's the first thing is I see an opportunity where if you would just make that plant-based, then we're talking about 70-30. And so that doesn't require you to even diminish the amount of animal products that you consume. And you've already gotten yourself up to 70% plant-based in terms of your calories. When it comes to the protein, I hear the debates.

I think that from my perspective, like protein is important. there is no doubt. I don't really like it when within the plant-based community, we dismiss protein as if it does not matter. Because I do think it matters. I also think that it matters if we overshoot and we do more than we need. There's evidence whether it's plant protein or animal protein, that when we overshoot and we consume more protein than we actually need, it puts a strain on our kidneys. Protein equals work for your kidneys. So I'm trying to find the right balance. And I think that that is an individualized thing. The amount that Simon Hill, Simon Hill, for those who are listening at home, if you haven't

heard of this guy or if you haven't met him, I'm just going to tell you, he's like six foot two and he's like an upside down triangle. He's built like a moose. His amount of protein that he needs to sustain that amount of muscle mass is going to be more than someone who's not a serious athlete. To me, the amounts that I believe in may be a little bit. but different than the amounts that you will hear in different spaces, I don't think we need to be going above 1.5 grams per kilogram of body weight in terms of protein unless you are like legitimately

a professional athlete or a competitive bodybuilder. So to me, I think that for the vast majority of us, Drew, myself and you included that somewhere in the range of 1.2 to 1.5 grams per kilogram of body weight of protein on a daily basis is what we need. Now for me, I'll just, speak for myself. I'm eating a plant-based diet and I'm in my 40s and I'm actually the strongest I've ever been. And I would argue I'm probably in the best shape that I've ever been. And I don't think that eating a plant-based diet necessarily enhances the muscle mass. I do think that it helps my recovery. I've noticed when my diet is clean, it helps me there. And what I've done is I've built up to a certain point without using any sort of protein supplement. And then I wanted to see what would happen

when I added the protein supplement. And so I did. And I built a little more muscle mass. And I don't think that there's anything wrong with that. There's tons of people out there using protein supplements, whether they're omnivores or vegan or whatever they may be. They're doing that as well. So I guess the point from my perspective is that I do want people to, to your question, Drew, I do want people to focus on diversity within their diet. I do want them to be. I do want them to max out the amount of calories from fresh or at least minimally processed, fruits, vegetables, whole grain, seeds, nuts, and legumes. I want people to max that out. And there is plenty of protein in there. I haven't struggled to get protein. But I also see that like there is this place

where people are like not everyone's going to be eating a completely plant-based diet. And there are some people who try to go completely plant-based and it's not working out for them. And so I understand that there's going to be different variations. And basically what I'm here to say is, look, like I'm a believer in personalized medicine. I'm a believer in personalized nutrition. There are many forms of a healthful diet. But the science and the evidence that I'm seeing is suggesting to me that not just eating diversity of plants, but eating a diversity of plants that are minimally processed and allowing that to be the dominant source of our calories to me is in our best health interest for all of us. You know, you mentioned something earlier, which was when you're looking at what is the

optimal level of fiber, it's so hard to do that study because there's just so few people that are out there that are eating actually like that level of high quality fiber on a regular basis. Like you need enough people that are out there and you can't find them. I've often heard people say that similarly, you know, do we have enough people that we could study that are eating a ton of healthy fiber, but that also have some variation on many of the things that you mentioned? They might be getting their protein sources from different areas. but they also have good metabolic health.

And they have, you know, they don't have insulin resistance. You know, for me, I grew up in a community that was primarily vegetarian, plant-based. And I saw a lot of sedentary lifestyle, which obviously is very common in the South Asian community with a lot of working professionals and desk jobs and computer scientists and many doctors like yourself. And I also saw a lot of diversity in the diet as well. But I also saw a lot of focus on refined carbohydrates, a lot of processed flowers. I saw a lot of sugar in the diet. And unfortunately, there were so many beautiful habits that were there.

But there was also a lot of habits that were not supportive that I'm sure that, you know, are a byproduct of also moving. to America and being part of the sort of industrialized system that are there. So I think that this is just one, which is why I'm also interested in the company that you're working with now is that so much of the future of nutrition science feels, on top of the base things that we know, the low-hanging fruits that you've already talked about with things like fiber, for example, and getting away from ultra-processed foods, if there was a way that we could better study the variations, would we just basically tell people,

like, look, there's going to be variations, but these core things, as long as we hit them, we generally know that people are going to be healthy within these contexts there. Right. So if you hit this level of plant food, if you hit this level of working out, if you hit this level of, you know, whatever it might be, all the main categories that are there, then that can show us that all these different people can generally be healthy. I know it was kind of like a little bit of a monologue and I was jumping around. But, you know, it's something that I'm interested in the future. and I guess that's some of the limitations of nutrition science.

Well, there's no question that there are limitations to nutrition science. Now, that doesn't mean that we dismiss it. It just requires a little bit a little bit more of a nuanced understanding of what the studies are telling us. We should never take one study and overreact to one study. We have to look within the big picture of everything that we're seeing. So I want to comment real quick before we jump in the personalized nutrition dro that actually They've studied the South, the South Asian community. There have been research studies that have shown that literally within one generation of moving to the United States,

that the rates of multiple different forms of cancer actually go up substantially. And not yet to the level of other Americans, but that literally the first generation coming to the United States, you will see an increase, for example, in men in prostate cancer or in colorectal cancer in the United States. So it's a complicated issue, but I think what we've seen, in multiple studies of different groups that emigrate to the United States is that clearly what happens when they arrive is that they abandon not all of their traditions, but a substantial portion of their traditions and start to adopt an Americanized lifestyle, which is quite problematic. All right. So with regard to this, the way that I see it is this. There are the things that are

the laws of nature, right? Gravity affects all of us. and it affects all of us in the exact same way. And I'm of the belief that there are certain things that like are so reproducibly shown in science that we just have to accept that on some level there is truth there, right? This like it is clear that exercise is beneficial to humans. Can you do too much? Yeah, you definitely can. Right. There are people that we've seen who like they run so much that you kind of like kind of feel like, gosh, You've gone too far with that. So, but we know that exercise is beneficial to humans.

We know that dietary changes, such as adding more fiber to our diet, generally speaking, this is going to be beneficial to us. But there is this element that exists that is not one-size-fits-all because we have a unique biology. The way in which we process and digest our food is going to be very different. And I'm the medical director for a company called Zoe. We are a personalized nutrition company. We're actually actively running the largest personalized nutrition study in the world.

We have 80,000 people who have participated in our study and climbing. And what we have shown, some of our early research, has shown that you can feed two people. It could be me and you, Drew, eating literally the exact same food and have wildly different responses. And even among identical twins, you can feed identical twins the exact same food. And you can still get very different responses. And so I think that the way that I sort of have approached this in terms of my mindset is that we need to identify what are these laws of nature and we need to collectively agree, look, let's do this.

But I don't actually feel like those things are almost obvious at this point. It's the stuff that we're all talking about and coming at from different. angles, but we're saying the same thing. I feel like that's already there. But then there's the stuff that's like, okay, so what's the deal with this? You know, for example, the way in which a person responds to sourdough bread, right? I'm curious to see the ways in which different people respond to this particular food. And I think that this is the future is being able to discriminate on an individual basis so that we can make recommendations, not for the entire population.

and say the same thing to everyone, but instead to say, look, here's the way that I would tweak your diet based upon your unique biology, your unique identity. What have been some things that you've seen? Like, are there foods or categories of foods so far with your work with this company that you guys have seen that, you know, it's just really up to people's preference or there might need to be some on ramping that allows somebody to start having that food? Like what do you guys, what are some of the takeaway so far? Is that study still being conducted right now? Well, the study is still being conducted and it's continuing to grow. And the way that it works. So just for the people who are at home and curious what this is, what we're talking about here,

our company, Zoe, if you sign up and you want to participate and be a part of this, we send you a kit through the mail. Through that kit, you will provide a microbiome specimen. You will wear a continuous glucose monitor for two weeks. You'll do a blood test. You just do a quick little finger prick and you drop some blood onto a card. And you'll eat a standardized meal so that we can compare my results to your results. During the two weeks that you're wearing the continuous glucose monitor, you're going to enter data into an app. So we know what you're eating in relation to your microbiome, your blood sugar response, your blood lipids.

We have that information. And we can take this. And that's like just the microbiome, alone is a lot of information. Combine that with the CGM, that's a lot of information. And you take all of these people and you put them into a giant computer and you let these supercomputers run machine learning algorithms where it will stop being like when we run a population study, it's like, okay, so what is the average person doing here? That's the question that scientists are asking. But instead, what we're asking is what are the patterns that we can apply to an individual person. With all the information that we have, we can look at your biology drew through your microbiome, through your response to different foods. And we can predict

what foods are going to have what response with your body. And that's ultimately, ultimately what we feed back to you when you participate is that you are like you are a scientific contributor. You are making it possible for us to do this. It can help other people, but also can help you too. We will feedback to you what we're seeing in terms of the science and we will actually give you a list of foods with an understanding in terms of a specific score for all of these foods. Like are our are is kale unhealthy for anyone? No. Like there's there's no evidence that kale is unhealthy for anyone.

But is there varying levels to foods that are somewhere in the middle, right? Like are there people who they can have that scoop of ice cream and not necessarily worry that it's going to have a negative effect. Are there people that a banana is not necessarily a great choice for them? Right. That's what we start to look at is the more intermediate range foods and we're moving them up and down and you're receiving a score that allows you to understand how it fits within your personal biology.

That's great. So you do it. You contribute to research, but you're also getting recommendations for you that then you can try. 100%. I love it. That's the beauty of technology meeting all this research that. many of your, you know, your colleagues and you are, are involved in. I want to, real quick.

Please, please. The thing that I want to say on that is that this is, to me, this is an exciting time for this type of work because our government is never going to fund this. A pharmaceutical company is never going to fund this. In order to do a project like this, like you would need, like not a couple million dollars, right? Like you would need millions and millions of dollars to do this. But this is like a, um, uh, this is a scientific project motivated by just people, average people. average people participate. You get something in return for your participation. My belief is that you're getting

something that is valuable because it can transform your life. It can transform the way that you eat. It can elevate your health for years to come. But at the same time, like through that individual contribution. This is how we make this feasible. That we could actually have 80,000 people doing microbiome specimens and wearing CGMs and entering data into their app. I mean, I just think it's really cool. No, it's super cool. I have a few follow-up questions on what she said, but just what's the website so people know where they could sign up if they want to be a part of this and join? So you can go to the website join zoe.com. And I don't really love plugging stuff. I feel weird, but I will say that like you can save money if you use my code.

And I'm pretty sure the code is Will B-10, but if you have an issue with that, just message me. No, nobody should have an issue with that. That's great. That's great to support you and great to support people signing up and they can save money. That's great. We'll put the link in the show notes for anybody that's listening on audio. That includes Will's link.

So I want to ask you, you mentioned CGMs. You know, we, I'm an advisor to levels and, you know, love what their team and Dr. Casey means is up to when I saw CGMs becoming more popular. of companies integrating them. And obviously you guys are not just using CGMs, you're using a whole bunch of different things to do this largest nutritional research study that's out there. I noticed that there was initially a little bit of a backlash in sort of what I would say is more of the plant-based community. I'm sure you've seen this. For our listeners who are not familiar, what was the concerns that came up about maybe the way that data was being extrapolated or taken

out of context. And then also, how do you look at metabolic health from a plant, rich, plant-forward, plant-based diet? Specifically, like, how do you think about fasting insulin CGM data in the context of, you know, your dietary choices and the recommendations that you make for people? These are important questions. And I don't want to diminish the technology because I actually think it's an exciting time when a person gets access to technology that can potentially transform their health. And if it guides people to a better, place where they're more healthy as a result of it, I'm 100% on board and I'll support it. And I think just like CGMs, we have things like Apple Watches or Fitbits or garments or whatever

it may be that are providing, you know, a wearable technology with real time health-related feedback. And like this is part of the future, is using this information to create personalized choices. Now, to dig into some of the feelings around CGMs, and let me just say that, like, those feelings, at least from my perspective, I'm going to share how I feel about them. They're still there that hasn't really changed. I just think that it's a matter of having a conversation, people understanding what they're doing. So the thing about CGMs, it measures your glucose, your blood sugar continuously, where you eat a meal. And prior to that, meal, you were fasting, so you have a certain blood sugar. And what you will see over the following

series of hours is that your blood sugar will rise and then it will start to come down. By the way, I want to add something real quick while we're on the topic because I think it's super interesting and I think your listeners will dig this. So actually research that we've done at Zoe, we discovered something new that people hadn't seen before, which is that with the blood sugar, again, the blood sugar will rise typically for about 90 minutes to two hours after you eat a meal, and then it will start to come down. What we discovered is somewhere in the range of three to four hours after a meal. There are people who will actually have their blood sugar drop below baseline. So we call this a dip. Their blood sugar has dropped. So if they started at 90, they're below 90.

They might be at 75 or 70. And what's interesting, this tends to occur when people eat a refined carbohydrate meal, right? So like a sugar or white flour type of meal. And they feel fatigue. It's because their blood sugar has dropped. So they feel fatigue. And the body actually has a reflex mechanism in place where because your blood sugar has dropped, the brain thinks that you now need to find food and they will overeat and they will actually chase carbs. They will chase refined carbohydrates. So the takeaway for the listeners, before I jump in the CGMs again, the takeaway for the listeners is pay attention to your meal and how you feel three or four hours after the meal.

Do you feel like you want to take a nap? Because this may be what's happening with your body is that you're having a blood sugar dip. And I'm telling you that if you could replace the refined carbohydrates, meaning like the sugar and the white flour, with whole complex carbohydrates from plant foods, fruits, vegetables, whole green seeds, nuts, legumes, that the way that you feel, you will improve the way that you feel. You won't have that sort of dip in energy. And again, like people who get this dip in energy in that fatigue, they overeat. So we know that from our research that once you have this happen, you're going to end up consuming

more calories over the course of the day because your brain, again, is interpreting this signal as, oh, crap, there's not enough sugar, I need more energy, let's find something. So just an interesting thing about the CGMs for people to look out. Not to mention, you also feel kind of like crap for a little while because your energy is low and you can't focus. And I definitely went through that. I was over. I definitely had a period of my time when I first got into kind of cleaning up my diet and where I definitely overate on a lot of those foods. Yeah.

So if we look at CGMs and we look at glucose monitoring after a meal, the technology. is going to guide you to want to lower your blood sugar. And when you make substitutions such as replacing refined carbohydrates like sugar and white flour with complex carbohydrates like whole plant foods, you will see an improvement in your CGM. And my hope is that you declare victory and you enjoy that because that's where the technology can be very helpful. But I also think that it's important for people.

to understand that the blood sugar is not the only measure of human health. And that context is very important and that there's other aspects to human health beyond just this one metric. So if we overly fixate, this is the messaging. I'm not anti-CGM, I'm pro-CGM, but I want to make sure the people understand this. If we overly fixate on our blood sugar and we think that the measure of human health is the lowest blood sugar possible, then it could potentially guide you to a eliminate really healthy food, like fruit. And you eliminate the fruit thinking, oh, well, this is good because it lowers my blood sugar. And you replace it with something else.

And I don't necessarily believe that that replacement is necessarily a step in the right direction. So I think that it's important for people to understand, like, that we, we want to guide towards better food choices, but there is such a thing as like using the technology and overly focusing on the technology and losing sight of, of whole human health. So, uh, Drew, when we eat, when we eat fruit, we reduce our risk of diabetes. We are, we are less likely to be diagnosed with diabetes when we're consuming these types of foods. So we should be consuming that food. We shouldn't be fearful of that food because of the CGM. What are the measures of metabolic health that I, that I look at that I see as being particularly relevant.

Well, one of them is insulin sensitivity. I think that insulin sensitivity is a really critical factor that we're often losing sight of. And you can't get insulin sensitivity from the CGM by itself unless you're doing a standardized meal or a standardized test. It would have to be standardized because you have to know exactly what the carbohydrate is and it has to be comparable to other people. and then you would see what your blood sugar does. So insulin sensitivity is one of the measures of health. Also, I'm very interested. This is some of the work that we're doing with Zoe,

is to look at your response after a meal. It's like I would compare it drew to a stress test. If we were trying to measure cardiovascular health, like how strong is a person's heart? I'm not just talking about having a heart attack. I'm talking about all of us. I could stand there and I could look at you and say, well, you know, you look like an athlete. You're probably got a strong heart.

And that's just me like lobbing a guess, right? Or I could have you run and see what you're actually capable of doing when I actually put some stress on your heart. When it comes to nutrition, when it comes to our metabolism, I'm very interested in what happens after a meal as opposed to doing. things when people are fasting. I want to see how things change by that meal. Part of that is blood sugar, so the CGM is very helpful for that. And part of that is also blood lipids like our triglycerides. And that's part of what we're also testing for with Zoe is to see what happens after a meal in terms of your blood triglycerides. It's fantastic. And generally would you say that, you know, again, while the goal is not to have a lowest blood sugar, but in general, we don't want to see

a lot of super highs and lows throughout the day. Is that well said? Yeah, we don't want to be, we don't want to be spiking it. We don't want to be having the glucose dips that I was talking about. And by the way, I guess let me just close out the question that you were asking me, Drew, which is why was the plant-based community fearful of this technology? And I think that you can understand that the plant-based community, carbohydrates cause your blood sugar to go up.

like that's just an indisputable fact and you can have healthy sources of carbohydrates like I'm talking about fiber or I'm talking about fruit that like fruit will cause your but sugar to go up and that's where the fear exists is that we're being misguided as opposed to non-carbohydrate foods or a low-carb diet it feels like the technology would naturally guide people towards that yeah no thanks for breaking it down I think it's good for people to just be aware because as you know, because you're in the trenches of it. I'm just sitting here as a non-expert and I get to ask people questions and I could say, hey,

I'm genuinely confused about this area and then people like you come on and you kind of share your opinions and I make my decisions based on everything that I'm going through. But naturally, a lot of my listeners are in that same boat where they'll hear different things from different sides. So it's nice to be able to have somebody on to be able to share their perspective about why would they have seen controversy or people arguing about this particular area? or another. Yeah, and I think it's cool technology. And I also think that the future is wearable technology. And so I think personalization, right? To create more personalization. Exactly.

I want to pivot here for a second. You have kids, right? Multiple. Yeah, three. Three. What have you seen for your recommendations and kids, especially in this context that it does seem to be that friends that I have that are in the health space, not in the health space, just dealing with kids. kids being picky eaters and gravitating towards things or not gravitate at things is just something that everybody seems to be dealing with. So what have you found works well for your kids? And what are some of the things that are more challenging just because it's challenging to raise kids in this day and age? So I have three kids. My oldest, I have my oldest daughter, Sarah Grace, is eight. My son, William, is six. And then we have a new baby at home. Her name is Susie. She's 10 months old. So,

So, you know, I think the first of all, let me just say that when you're a parent, you're just doing your best. So I'm not a big believer in trying to create some sort of image of perfection when it comes to parenting and how you raise your kids when there's challenges that exist. That's kind of what you're alluding to. I think that normalizing stuff in the home is an important part of the process. So if your kids are used to eating specific foods, they will just think of that as their normal food. This is what we eat. And so the choices that you make at the supermarket and choose to stock your pantry or establish as sort of the habit of this is what we eat for a snack.

This is what we eat for dinner. I think that goes a long way in terms of helping the kids along in terms of getting used to a healthful diet. There's going to be times like in this process across the years where your kids would be like, I'm not eating that. And it can be very frustrating when that happens. But I also think that like that is a blip on the radar. And what you learn as your kids get older, what I've learned through the years is that you, you work your way through that. You navigate it.

But it doesn't mean you abandon ship. It doesn't mean that you have to pivot away from your strategies. You stick to what you got in terms of wanting to support your family with healthful food. And, you know, again, you just figure out ways to make it work. Is there any guidance? You know, we have a lot of moms at listeners podcast. and people that have kids, any resources that are out there that have been helpful for you guys that you've integrated? Besides just the general sense of be a good role model, cook at home,

your kids grow up with it, include them in the kitchen, have them participate. Any additional resources that have been helpful for you guys? I would give a shout out to my recipe developer. Her name is Alex Caspero. And Alex is a registered dietitian. She did the recipes for both of my books, so combined about 200 recipes. But she also is a mom and she shares it very publicly on a Instagram feed called Plant Base Juniors. And she, uh, they have a book. So like I would encourage people to check out their book.

Um, because and their, and their feed because I think that's a good place to start. And you know, again, I think that like kids are going to emulate what their parents eat. Um, I think that. establishing habits with your kids that, you know, are, like, don't ask your kids to do something that you're not doing. That's not fair, right? And you want to do that in the workplace either. So basically, you have to establish the habits that they can then emulate. And I think that that is part of the process. So I mentioned this at the beginning of the podcast. And I'd love to give this a little bit of attention. What I love about your work and your book. And shout out to

your cookbook. We'll have the link to that in the show notes as well, is that you are very practical. You'll meet where people with where they're at. And it reminded me a lot of, you know, we had on our friend, Dr. my friend, Dr. Terry Walls, I don't know if you know her in her work in MS. And fiber is one of the important pillars that is there as part of her protocol. And she really talks a lot about like getting to the root of autoimmune condition by slowly getting a chance to ramp up your fiber in addition to all of the things that are there. So you have a method.

process for if somebody has is on the lower end of the spectrum of fiber you have a whole process of kind of how to start challenging your body so that you can start to be able to tolerate more of these foods and then get the benefits of having more fiber in the diet all the benefits that you talked about previously can you walk us through that process of how somebody would go about that yeah i mean i think about it conceptually similar to exercise so i i see the gut as first of all what's exciting and encouraging is that your gut is adaptable. Research has shown that the choices that you make today can start to impact your gut by tomorrow.

And every single nutritional study, what we find is there's at least some changes to the gut microbiome that take place when we change our diet. So your gut will adapt to the choices that you're making. And I think about it drew very similar to exercise, which is that if you, like, your gut is adapted to whatever it is that you've been eating for the last three months. So if you have, if you're the average American or if you're eating the way that I used to eat 10 years ago, it's not going to be ready for a large amount of fiber all at once. That much like exercise, much like entering into the gym for the first time when you haven't been there in a few years,

you have to start off with a very light amount of work. But as you work, your gut will start to get adapted to those choices. It will become stronger and more capable. and that will allow you to then escalate what you're doing. So much like lifting weights, you may be starting off at five pounds, but you can work towards 7.5 and 10 and you keep moving on up. And next thing you know, you're doing 25 or 30 pounds. And you see that overt clear progress. To me, with the gut, when you consume a food and you feel unwell afterwards,

right, like gas, bloating discomfort, that to me is conceptually similar to overdoing it at the gym. them. You went too far and you got to scale it back. So reduce the amount that you're doing, get it back to a place of what your body is actually capable of tolerating. But over time, when your gut is where it needs to be, you'll find that as you increase the amount of these foods, you will not have symptoms. You will not suffer gas and bloating or discomfort. And that's proof. Like that is objective evidence that your gut has evolved, that it has grown stronger and that is more capable of processing your food. And that to me is where you want to be because that's

evidence of gut health. Generally speaking from the people that have followed your book, everybody's different. How long should people give to this process, right? Just so they have realistic expectations. Obviously, a lot of that's going to be dependent on where they're coming in and their starting place. But, you know, let's take somebody who's on the lower end of the fiber spectrum. How long should they give to this process here? When I would counsel patients who had Crohn's disease or ulcerative chlytis. So, so I consider these people that have inflammatory bowel disease, Crohn's disease or ulcerative clitis to be sort of the people who, who they need this the most, and they struggle with this the most because they have such tremendous damage to their gut.

The inflammation is literally attacking their microbiome. So how do I approach those specific issues? Well, the first step is those people need to be in remission. I think of it like we have a forest that's on fire when they're having a flare up. And we need to put the fire out. So if you're someone who has one of those conditions, Crohn's disease, or you mentioned Terry Wals, other autoimmune diseases, to me, step one is get the disease into remission. And they may require medication in order to do that. Once it's in remission, we want to play the long.

game. We want to rebuild the microbiome. If we had a forest fire and we just put the fire out, it's going to take us time to rebuild this forest. You have to let things grow. It doesn't happen overnight. So to answer your question, Drew, for the person who has like those particular conditions where I consider this to be the greatest challenge in terms of rebuilding their microbiome, I see this as minimum of three months, more on the spectrum of six, 12, or 18 months. in order to really see the substantial changes that we're looking for. Now, that's not to say that the average person who has digestive health problems is going to take 6, 12, or 18 months to get better.

In the majority of cases, within four weeks, you should see a substantial improvement. And we've seen this in multiple studies now where after four weeks, you can definitely impact your microbiome. Great. If people want more details, they can definitely pick up a copy of the book where it's outlined a little bit more specifically. Before we wrap up here, just two quick things that I want to touch on because I felt like we got to acknowledge it because it's such interesting research and emerging science that's coming. I saw another interview that you did where you talked about some of the latest developments with cancer and the gut microbiome.

And that obviously has its own link to fiber as well. Can you chime in on that, like some of the things that you're seeing in that area? Yeah. So it goes back to research that's taking place at M.D. Anderson. And M.D. Anderson is why do we consider it to be one of the top, you know, probably three cancer centers in the United States. And specifically, they're looking at melanoma. Melanoma is the number one cause of death related to skin cancer. Melanoma, for those that don't know, like you would see a skin lesion on the surface that, typically is dark in color. It's pigmented. And it can invade downward. So it may not look that big on the surface and it will invade downward and it will be very aggressive. Melanoma is extremely dangerous, which is the reason why like we should be getting skin checks routinely, especially people that have fair skin like myself. So anyway, what they noticed with melanoma is that these people that were going through something called immunotherapy,

where they were giving treatment intended to get their immune system to clear the cancer, they noticed the people who were receiving antibiotics were doing worse. And the initial question was whether or not that's just because they're sicker. Because there's a reason why we're giving the antibiotics, right? So maybe they're just really sick. And that's why they're doing worse. But they went on to study this in more detail. And the suggestion based upon their research was that even if you take a group of people and you randomize them and you give antibiotics to one of the groups, they will do worse.

And so their suspicion was that the microbiome was a part of the story, that the antibiotics are killing the microbes. And because the microbes are deeply intertwined with your immune system. So 70% of your immune system exists in your gut. There's a single layer of cells that separates 70% of your immune system on one side from 38 trillion microbes on the other side. And they're in constant communication with one other, they're talking to one another. So it's really hard to separate the gut microbiome from the immune system. And what they're showing here is that you give antibiotics, you injure the microbiome.

You also are injuring the immune system in the process of doing this. So they followed this up with a study giving a fecal transplant. And the fecal transplant is intended to restore the microbiome. And what they discovered is that after giving a fecal transplant to these people who are receiving immunotherapy, people actually had higher likelihood of cancer survival when they received a fecal transplant. Again, suggesting the microbiome is a critical. part of your response to cancer therapy.

So their most recent research, that was quite fascinating, is they decided to look at the role of dietary fiber because dietary fiber is part of supporting and nurturing the microbiome. So they took a group of people and they broke them up. It was not an interventional trial. They're following it up with an interventional trial. But what they did is they looked at people's dietary pattern and specifically how much fiber they were consuming. And they discovered that people who were consuming more dietary fiber had a substantially

increased likelihood of survival from this cancer when they received immunotherapy. So for every five grams of fiber that they were consuming, I believe, I believe the number was 18% increase in survival. And that, to me, it's like crazy and shocking. But it in a way also makes sense because this really speaks to, you know, one of the takeaway messages for everyone is these microbes. They are so important. And no matter who you are, whether you're healthy, whether you're unhealthy, from my perspective, it doesn't matter because the message is the same. This is such an important part of human health.

It's connected to our immune system as we're showing here, our metabolism, as we've discussed, our digestion, our hormones. our mood, our brain health, you know, you think about those things and you have to say, this is like really critically important to the way that our life is going to unfold and how healthy we are as we age. And for that reason, I'm really sincerely of the belief that gut health matters to all of us, no matter who you are, sick or unsick. We want to be healthy. And that's why this is so important.

That's a great final point. to conclude on. Dr. B, super appreciate you being here. Let's tell the audience how they can keep in touch with you. You're pretty active on social media, so we'd love to start there and then hit the books. And then you also have a bunch of fantastic courses. If there was one course that you would recommend as a place for people to start, I'd love for you to share that with our audience as well. Thank you so much, first of all, Drew, for having me on the show, man. This has been really fun, and I'm grateful for the opportunity to come and introduce myself to your audience. So on social media, you will find me as the gut health MD.

That is Instagram and Facebook. And if you're one of these TikTok kids, I am the gut health MD underscore because I'm pretty sure there's like a 12 year old somewhere who took my account before me. My website is the plant fed gut.com. And I have an active email list. I like to pop off emails about every two weeks with like brand new studies that are changing the game in terms of. of our perspective on things. So for example, my most recent one was on sourdough bread and the health benefits that exist with regard to the sourdough microbiome.

And the one before that was about exercise and how exercise impacts our microbiome and vice versa our microbiome impacts our ability to exercise. So that's where I do sort of my long-form conversations about science. You will find sort of my, you know, sort of philosophy laid out most clearly in my books, fiber fueled and the fiber fueled cookbook. By the way, the cookbook is really designed for people that have food intolerances. So if that's something that you've struggled with, this is literally the book for you. And then courses, thank you so much for mentioning that Drew. I have several different courses. I have big ones. I have small ones. Some of them are more topically focused. So like I have a

constipation course. I have a heartburn course. I have a series of food intolerance courses. But then my my sort of masterclass, my main course is a seven-week program. And it's called the Plant Fed Gut masterclass. And you'll find all of that information at theplantfedgut.com. Fantastic. Again, for anybody just listening, we have them in the show notes. You can get back to that later on. You can find all the links there.

Dr. B, thank you so much for coming on, sharing your knowledge, sharing all your information, all the science that you've collected and gathered. And really to make things simple in a world that is quite complex. and there might be a lot of nuances for different topics and there might be different foods that work or work or don't work, we can't lose sight of the basics that we know of, especially when we look at your story and how you moved away from ultra-processed foods and fast foods

and then just by using the power of fiber, cleaning up your diets. And that's an inspirational message in story because who wouldn't want that for the rest of the world? So thank you for coming on and sharing that with us. Thank you so much for having me and allowing me to connect with your audience, and I do appreciate it. It's been a lot of fun.