Feel Better, Live More with Dr Rangan Chatterjee - #63 Gut Health and Probiotics with Dr Michael Ruscio

Episode Date: May 22, 2019

Gut health is a hot topic these days, with more and more research showing that our gut health impacts so much more than our digestive system. The gut is now being implicated in a host of different conditions, from joint pain to depression. But why is gut health so problematic for so many of us in the 21stCentury? I discuss this with clinical researcher, author and gut expert, Dr Michael Ruscio, on this week’s episode. We talk about the increase in hygiene practices and antibiotic use and ask whether we have traded life expectancy and infant mortality for allergy and autoimmune conditions. We delve into what happens in the gut in the first three years of life and discuss what you can do to improve your gut health. We also discuss the use of probiotics and Dr Ruscio explains how you can figure out which probiotics are right for you. Finally, Dr Ruscio shares some fantastic top tips to help you live your best life. This is a really interesting conversation – I hope you find it useful! Show notes available at drchatterjee.com/63 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Hosted on Acast. See acast.com/privacy for more information.

Because for many people, and my clinical experience has definitely reinforced this as true, the issue that's causing their symptoms, even if they're not digestive symptoms, even if it's only joint pain or fatigue or insomnia, could be a problem in their gut. Hi, my name is Rangan Chastji, GP, television presenter and author of the best-selling books The Stress Solution and The Four Pillar Plan. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it.

I'm going to be having conversations with some of the most interesting and exciting people, both within as well as outside the health space, to hopefully inspire you, as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier because when we feel better, we live more. Hello and welcome to episode 63 of my Feel Better Live More podcast. welcome to episode 63 of my Feel Better Live More podcast. My name is Rangan Chatterjee and I am your host. Before we start today, just a quick reminder to let you know that my most recent book, The Stress Solution, Four Steps to a Calmer, Happier, Healthier You, which has been a number one best seller in the UK, is now available to purchase in the United States. You can get it from amazon.com

in paperback or from Audible as an audiobook, which I am narrating. Gut health is a hot topic these days, with the gut being implicated in a host of different conditions, from joint pain to depression. But why is gut health so problematic for so many of us in the 21st century? Well, this is one of the topics that I discuss with today's guest on the show, Dr. Michael Ruscio, who's a clinical researcher, gut expert, and author of the book, Healthy Guts, Healthy You. We talk about the increase in hygiene practices, the overuse of antibiotics and whether as an advanced society we have traded low life expectancy and high rates of infant mortality for increased rates of allergy and autoimmune conditions. We also delve into what happens in the gut in the first three years of life and discuss what we can all do to improve our gut health. We also talk about

probiotics and how to find out which ones are right for you. Finally, Dr. Ruscio gives some fantastic tips to help you live your best life. I really enjoyed my conversation with Michael and I hope that you do too. Before we get started, I do need to give a very quick shout out to our sponsors who are essential in order for me to be able to put out weekly podcast episodes like this one. Athletic Greens continue their long-term support of my podcast. Now, I absolutely prefer that people get all of their nutrition from foods, but for some of us, this is not always possible. Athletic Greens is one of the most nutrient-dense whole food supplements that I've come across

and contains vitamins, minerals, prebiotics, and digestive enzymes. So if you are looking to take something each morning as an insurance policy to make sure that you are meeting your nutritional needs, I can highly recommend it. For listeners of this podcast, if you go to athleticgreens.com forward slash live

more, you will be able to access a special offer where you get a free travel pack box containing 20 servings of Athletic Greens, which is worth around £70 with your first order. You can check it out at athleticgreens.com forward slash live more. Now, on to today's conversation. forward slash live more. Now, on to today's conversation. So Michael, welcome to the Feel Better Live More podcast. Hi, thanks for having me. Hey, not at all. So we're doing this over Skype. You are, I believe you got a day off from clinic today. Is that right? I do. I take a few days off per week. I spend about half my time in the clinic and the other half of my time sifting through the research literature, writing, investigating various things.

It's been a really nice balance to make sure that I'm on the cutting edge of what the science is saying, but then also taking time to apply it in the clinic and make sure that everything that we're seeing in the literature pans out. Because there are some times when things look good according to the initial literature, but then when we try to vet them in clinical practice, these things don't really play out the way that we thought that they would. So yeah, I have half my time in academics, half my time in the clinic, and it's been a nice balance. Yeah, that sounds fantastic. And when I read your book, Healthy Guts, Healthy You,

which is a really deep dive into gut health, but in a very practical way. So people who are struggling or feel as though they want to improve their gut health can get a lot of benefit from reading it. I was really impressed that actually you were very careful to present the research, but you presented both sides of the argument. You weren't trying to just go down one viewpoint and try and make a case of that. You were sort of saying, look, on balance, these studies show this, these studies show the opposite, but on balance, this is what I think is going on. And I really liked that approach. And I think that's an approach that is very much needed these days

in particular, where we have really become, as know, as professionals, you go on Twitter, you see this all the time, people have to almost choose which camp they belong to. And I think that's sort of counterproductive. So, you know, thank you for writing such a great book and actually taking the time to go through all the research. Well, thank you. And I think that's really an important point, because one of the things that I noticed early in clinical practice, just like you're alluding to, you know, you'd study a various expert's work or you'd go to a seminar and it would be one opinion. Everyone has to avoid gluten. Everyone is toxic with mercury.

It's really confusing in clinical practice because that's not what ends up happening. Some people have a problem with gluten. Some people may have a toxicity problem, but not everyone. And I found it to be very important to be practical and just help people figure out, okay, what do you as an individual need so that we're not just inundating you with thousands of dollars of testing and tons of treatment, but rather let's be precise and figure out what you need so that we can get you healthy as quickly and as inexpensively as possible yeah absolutely i think i think clinical practice is very very much necessary and i think actually the best researchers and i've had a lot of them

including someone called professor sachin panda on my podcast who um you know he's great he's at the cutting edge of research and time restricted feeding at the salk institute in california but he recognizes that he's a researcher and and recognizes that clinicians need to be able to put his recommendations into practice and see what happens. And I think that's so, so important. But Michael, before we get into gut health, you, like many of the doctors in this area, have had a bit of a personal story. So I've know, I've read about when you were 23 years old. Can you tell me what happened? Sure. So I was in college doing my undergraduate studies, of course, and my focus was exercise, kinesiology and pre-medical. And so I was pretty ensconced in

kind of health and medicine and nutrition. And because of that, I had all the dietary and lifestyle factors like you teach in your book, pretty dialed in. I was doing a pretty good job with all those things. And I had always felt well throughout my entire life. I was also a college athlete, so I was in pretty good shape from a physical perspective. Yet, all of a sudden, I started having insomnia, brain fog, fatigue, depression, and I couldn't figure out for the life of me why. Nothing changed. It wasn't like I was eating really poorly and only surviving on caffeine because I was cramming for exams all the time. Everything was pretty dialed in, but I was having all these symptoms for a reason I could not determine. And it was very disheartening to not feel well because it was the first time in my life I hadn't felt well.

But I figured, well, you know, I want to be a doctor. This is what doctors do. So I'll go see a doctor and they'll figure this out. And I kind of took a deep breath and said, OK, you know, relax. This is what medicine is for. This is what health care is for. a deep breath and said, okay, you know, relax. This is what medicine is for. This is what health care is for. And then I went and I saw three different doctors, an internist, a family doctor, and a GP. And they all said, you're really healthy. Your tests look normal. You've got a

good body composition, good blood sugar, good cholesterol. And I remarked, well, okay, that's great. But can you offer me any reason why I'm having this insomnia, why I'm waking up multiple times per night, unable to fall back to sleep, why I am tired during the day, why I have these bouts of brain fog and low mood that I've never had before? And none of them had an answer. And so that led me to look for other options. And I found a clinician who later kind of became my mentor. And he suggested the idea that I may have had an intestinal infection. And I remember thinking, this guy has to be crazy because I didn't have diarrhea. I didn't have abdominal pain. I didn't have any of those symptoms. The only symptoms I had were again, brain fog, fatigue, insomnia.

But at that point, I didn't have anything to lose. So I said, okay, I'll look into this. And I'll do the stool test that you're recommending. Even though as a college student, the $300 stool test felt like a million dollars. Because as a college student, $300 is a lot of money. But I did the test. I had an infection in my intestines, an amoeba actually. And it was treating that infection that led to a resolution of my symptoms. And there's one other piece I should mention,

which is before I got that diagnosis, I went on the internet. I read about adrenal fatigue, about hypothyroidism, about metal toxicity. And I kind of self-diagnosed myself with all these conditions. And I tried different protocols for adrenal support, for thyroid support, for metal detox. And I'd see a little flicker of improvement, but nothing really long-lasting, not until I addressed the true cause of the symptoms, which was this infectious inflammatory issue in my intestines. And it was only by treating that that I saw a long-lasting and permanent resolution of my symptoms. And that really taught me that when someone's not feeling well,

you want to make sure to look at their gut first. It's not a guarantee, but if we were to have an order of operations in terms of what should we do first after diet and lifestyle, I think it's a very tenable recommendation to say, do a check for your gut, make sure everything there is squared away. Because for many people, and my clinical experience has definitely reinforced this as true, the issue that's causing their symptoms, even if they're not digestive symptoms, even if it's only joint pain or fatigue or insomnia, could be a problem in their gut. So it was not fun to go through it, but it was a very valuable learning experience. Yeah, I mean, thanks for sharing that. but it was a very valuable learning experience. Yeah, I mean, thanks for sharing that. And I'm sure many people listening to this will be resonating with what you said right at the start,

which is you had, you know, a lot of symptoms that were clearly affecting your quality of life. And, you know, you did what many people do, you went to see a doctor, and they ran some tests, they checked you out, and they said, well, everything's normal, yet you're not feeling normal. And, you know, that for me as a doctor with, what, 18, 19 years clinical experience now, that really was what, you know, really changed the path that I went on as a doctor. Because I thought, you know, we're so good at so many things. We're very good at diagnosing acute problems, giving treatments for them. But often people were coming into my GP practice, not feeling great, their quality of life was poor, get all the tests that I had been taught about. So all the tests that I was taught, and that I ran, and the treatments that I had often were quite limited. And I thought,

sure, there's got to be something more to this than just what I've been taught. And as I've gone around the world trying to learn more science and more tools, you find there is a lot. And it's really just that it's just highlighting that acute medicine, I think, conventional medicine is very good at. But these sort of chronic conditions, fatigue, brain fog, insomnia can often be challenging for us. So, you know, you had to figure it out for yourself and that's clearly you know led you down a path in your own clinical practice but there's a couple of things you brought up which i think are interesting one of them is that the gut can cause a lot of non-gut symptoms and you know you had symptoms that were not typically associated with your guts

yet the solution to getting better late in your gut is this something you see a lot in practice yes and if there was one concept i'd like people to take away from this conversation today it is the symptoms that you're experiencing if they're non-gut symptoms, so brain fog, fatigue, depression, skin lesions, insomnia, they could be caused by a problem in the gut even though you're not exhibiting symptoms in the gut. And we do see this bore out by a growing body of literature where people can have only what's known as an extra intestinal or outside of the intestine manifestation of inflammation and damage in the intestines. And that was what threw me. I thought when this doctor proposed the idea of an intestinal issue, he was crazy because I had no intestinal issues, yet that was the ultimate source of all my symptoms. And again, modern research is now really establishing this connection we know

of the gut brain connection the gut skin connection the gut joint connection the gut thyroid connection so yes you you can have a digestive problem that is not manifesting digestively and is only manifesting in other symptoms outside of the gut. Yeah. And, you know, we say that modern research is really, you know, highlighting this and burying this out. But even within conventional medicine, you know, this idea of something called gluten ataxia, for example, has been around for a long period of time, you know, where, you know, you can eat gluten and, you know,

if you are susceptible, it can cause issues with your balance in terms of how you're walking and your gait simply from eating gluten and what it's doing in your digestive tract and then the messages that's sending around your body so i think you know it's just it has been there in conventional medicine but probably you know it hasn't been as recognized until recently that actually you know there's many other things that can be going on that could be coming from your gut so so Michael you know we hear the term gut health being banded around a lot now but when we're talking about the guts and when you talk about the gut what do you mean so the gut

technically starts in your mouth your mouth would be the first section of your gut it's less common to see problems in the oral cavity, and that's not really my area of specialty, but it is worth mention. And then we have your throat and your esophagus, of course, and then the compartments that are more commonly fraught with problems like inflammation would be your stomach, your small intestine, and your large intestine. And it's really the small intestine that might be the most important out of all these. The small intestine represents over 56% of your digestive tract. So if you took your entire gastrointestinal system, the largest section of that is your small intestine. And the small intestine is also most responsible for absorption of nutrients, about 90%. And it's also the most prone to inflammation.

And so when we say gut health, that may be the one section of the intestines that's most important. And how we define gut health, I would say loosely that you want to have a gut that is devoid of inflammation because that's a key aspect of how the gut causes problems and is adequately absorbing nutrients. So if you have a gut that's functioning, it's absorbing nutrients. You're getting the nutrients in that you want. It's absorbing nutrients. You're getting the nutrients in that you want. And it's also not overly inflamed, meaning, as an example, if you have a leaky gut or a damaged gut, now it's almost like having a border that's malfunctioning. And inflammation is used to try to stop anything from getting through your intestinal barrier that shouldn't get there. stop anything from getting through your intestinal barrier that shouldn't get there.

So if you think of immune cells like being little police officers in your gut, the guns that they would use to attack invaders would be these little inflammation guns. And inflammation is the instrument of the immune system that's used to clean things out. And then the problem, not to get too off topic here, but the problem with inflammation is that inflammation can go systemically throughout your body and settle into the brain and cause things like brain fog or settle into the joints and cause things like joint pain. So a healthy gut will be one that's devoid of inflammation and is absorbing nutrients effectively. And as the healthcare consumer, the more symptoms that you have, the more likely

there's a problem in the gut. And it's not just gut symptoms. It could be joint pain. Joint pain could be the only manifestation of your gut inflammation. So the less symptomatic you are, that's usually a good proxy to say that your gut is in good condition. Yeah, I think that explanation was great. And even that thought that your joint pain might be related to your gut health is quite revolutionary for some people. And it's something that I've seen over the last few years in clinical practice, when people may come in with a particular problem. I remember one patient who had type two diabetes, and, you know, it was a very pro inflammatory diets, it was diets full of lots of refined and processed carbohydrates,

you know, lots of heated vegetable oils, all kinds of things that were probably going to be pro inflammatory for her. And I remember, you know, trying to really clean up her diets, really trying to help her understand the sort of foods that she should really, if she can, try and concentrate on eating to help, you know, get on top of her type 2 diabetes. And it was, you know, designed around her blood sugar, really. But I remember seeing that after two or three days her joint pain that she had had for about 10 years that she was told was you know osteoarthritis it was wear and tear it was related to her weight actually once we took out the pro-inflammatory foods and

put in the foods that were not driving inflammation within two I think three days afterwards her joint pain vanished and it never came back and that really taught me I thought wow she has not lost enough weight in three days for her joint pain to suddenly get better but what she has you know I've seen this so many times now that I understand that it's actually that you know it's inflammation that was driving her pain and so if we can reduce that inflammation, and in her case, it works with her diet, her pain went down. Yet this is, this is, you know, for so many people, this is, you know, a brand new thought, really, isn't it? It absolutely is. And just to piggyback upon your case study, this was maybe about five years ago, this is one of the earlier cases that really showed me how profound

fixing a problem in the gut can be for joint pain specifically. A patient came in, his name was Johnny, and he was on Humira for rheumatoid arthritis. I'm not sure in the UK if Humira goes under another name, but a pretty powerful biologic immune suppressing drug. And he said, powerful biologic immune suppressing drug. And he said, you know, I've heard that the gut might be at the root cause of my rheumatoid arthritis. Do you think we could experiment with some treatments for bacterial overgrowth or other problems in the gut? And I said, well, I mean, we can do this with herbal medicines, so we don't have to make a strong case for it. And it's minimal risk and potential for some gain. And I said, I can't tell you that I've seen this before, but sure, why not?

Let's give it an experiment. Let's give it a trial and see what happens. And within three months, he was off Humira because his joint pain responded that profoundly. And for someone who, and I should mention, he already had a pretty healthy diet. So his diet was pretty well tucked away. And so to see someone on a healthy diet who had such bad joint pain that he needed one of the strongest immunosuppressive drugs to manage the joint pain, to think that just using some herbal medicines to treat a bacterial

overgrowth in the gut would be enough to get him off that massively powerful drug is astounding. But he was the first of many a case that I've seen where, gosh, there is a strong connection between the gut and the joints. Yeah, it really is incredible. And I just want to reiterate for people who are hearing that and getting quite inspired by the story, it doesn't clearly happen in every case. You know, it doesn't, that sort of dramatic improvement where you can come off, you know, a heavy immunosuppressant drug. But again, I have seen similar cases in my practice. You know, as I say, unfortunately, it doesn't happen to that degree in every case, but it certainly shows us what might be possible. And a lot of the sort of things we would recommend for gut health are pretty low risk.

So, you know, it's worth giving them a go. And if, you know, you're not feeling any better, okay, fine, at least we've tried that. At least we've tried to sort out the gut. I kind of, you know, I think if we just sort of take a bit of a 30,000 foot view, to take a bit of a 30,000 foot view. Why is gut health so problematic for so many of us in the 21st century? Great question. And I agree with your caveat. Gut health is important, but it's definitely not a cure-all. And yes, I agree. We should definitely approach this conversation not painting it as a cure-all. It's definitely worth taking some steps to optimize, but there are some people who will still clearly need medications after optimizing their gut health.

So yes, thank you for making that caveat. And then why are so many people inflicted with problems in the gut? Well, there's likely several environmental factors that are not working in our favor. And this is kind of the double-edged sword of hygiene. With antibiotics and with increased hygiene practices in westernized countries, we've seen increased life expectancy, decreased infantile mortality, decreased infectious disease. So we've made a lot of strides forward. But some of that may come at a cost where we are seeing increases in inflammatory and autoimmune diseases. And this is likely because without adequate exposure to dirt, animals, and bacteria early in life, and also the bacterial killing effect that early use of antibiotics can vector, we may really be crippling the development of the bacteria in our gut from a young age.

And that bacteria in the gut from about the first day of life through about three years, the bacteria in the gut programs the immune system pretty much for the rest of your life. It's malleable as an adult, but a large chunk of the programming of the immune system, which remember is what dictates your level of inflammation, is established really even as far back as while mom is pregnant up through the first three-ish years of life. So if mother doesn't have much exposure to a natural environment that has a litany of different bacteria and dirt and animals in it, that thwarts some of the early life programming

of the immune system. That thwarts some of the early life programming of the immune system. And then if the child is not exposed to those same environmental bacteria and other sources of dirt and germs, plus let's say they're not breastfed, plus they're cesarean birthed, both of those give you more exposure to bacteria. And if the child is given unnecessary antibiotics early in life. Some cases, the antibiotics are needed, and clearly we want to do that. We want to be very careful not to tell a parent not to use an antibiotic if the child has a life-threatening condition, of course. However, sometimes antibiotics are used too indiscriminately, and that can be a problem more so for children. So when we combine all these factors together, the exposure to environmental dirt and bacteria

that the immune system needs in order to train and develop isn't present. And when that's not present, the immune system doesn't develop the way that it should. And when the immune system doesn't develop the way that it should, now you run the risk of this increased inflammation. And it's that inflammation that tends to be one of the common factors of things like joint pain, autoimmune conditions, depression, anxiety, and you could even make a case for things like metabolic conditions, like high cholesterol and high blood sugar. So yeah, so it's a number of factors early in life that are not really working in our favor. Some of these we can modify and some of these we can't modify. But a lot of this probably comes back to things that happen the first few years of one's life. Yeah, I mean, super fascinating. There's so many threads I want to pick up on. Just say at the end,

you mentioned you could even make a case for metabolic syndrome, which is really this sort of, you know, the syndrome in the body, which encompasses things like insulin resistance, type two diabetes, obesity. It's the gut microbiome absolutely plays a role there as well. And there was a paper in 2007, it was an animal study, but it really showed causatively that LPS, so LPS, for people listening who are not familiar, something called lipopolysaccharide, it's a coating that sort of exists in your gut um as long as it stays in your gut it's absolutely fine it lives on things called gram-negative bacteria but if that LPS gets into your bloodstream so if you've got a you know impaired intestinal wall it can actually drive

inflammation it can drive insulin resistance so it was it was a really great study to look at that showed that simply transferring LPS from your gut to your bloodstream can set the tone for insulin resistance, which ultimately leads to type 2 diabetes. So I absolutely think you can make a strong case for that. The thing I find fascinating, and you wrote about this in your book, is this whole idea that have we traded life expectancy and infant mortality for allergy and autoimmune conditions? I think that's so fascinating, this idea that, you know, with our increased hygiene, with our increased antibiotics, you know, we've cut down infant mortality. We've improved our life expectancy. Yet at the same time, we're living longer with a lot of conditions like allergies, autoimmune conditions, even mental health problems you can put into this.

And have we traded that off? It's so fascinating that I've never really seen it put like that before. Well, in biology, oftentimes we have these tradeoffs. So one example, this isn't a perfect example, but it's something that might be easy to visualize. You could make the argument that longevity and performance are inversely related. Meaning if you're an athlete who's trying to optimize their power and their muscle mass, you may eat in such a way that's good for performance but may not be the best for longevity. A lower calorie, somewhat calorie-restricted diet may be better for longevity.

And you could also make a potential case that high amounts of training may not be good for prolonged joint health or for prolonged just overall and even mitochondrial health. for prolonged just overall and even mitochondrial health. But it's not to say that if we lived like monks and we lived to 100, that would be better than if we lived to 88, but we had a little bit more ability to have this robust athletic output and maybe optimized body composition. So there's oftentimes these trade-offs in biology where we sacrifice one thing for another. And I think that's important to keep in mind just to kind of juxtapose what sometimes happens is medicine gets blamed for all these things,

as if medicine's doing these things with ill intent. And I think what's happened is we've made some great strides forward in medicine with these advents, but we're also learning the biological tradeoff of some of those interventions. And now the pendulum, I think, is starting to swing back a bit where we're saying, okay, perhaps we became a bit too staunch in the antibacterial direction. And now we're recognizing some of the benefits of these bacteria and these, these dirts and what have you. And so we can bring some of these back in and, and I am hopeful for the future. For example, some hospitals now for children who are cesarean birth and for the audience, cesarean birth, this means instead of going through the vaginal cavity, the baby is cut out of the stomach. What they're doing now in some hospitals, they're taking a vaginal swab from the mother and coating that around the child to help confer some of those bacteria onto the child.

And that seems to have a protective effect. And also, of course, most people have probably heard that antibiotics are not being given out quite so readily now. They're being used a bit more judiciously. So I think we're moving in a good direction. But yeah, it's always an issue of trying to navigate the pros and the cons of any decision that we make. Yeah. Yeah, I think it's really well put that. And I think as medicine is evolving, it's continuing to evolve. And we have that era where we thought bugs were bad and we gave a lot of antibiotics out. And we probably, you know, rather naively thought that we could do no wrong with them,

that this is just a magic pill that we can treat all sorts of things with. And really over the last 10 years, particularly in the last five years, has really been an acceleration of, wait a minute, are we overdoing it? And it's just about that pendulum swinging back, isn't it? It's about not saying antibiotics are better necessarily, but maybe we need to be very careful with when we use them. We only use them when absolutely necessary. And that's particularly important for children,

particularly in the first few years of life, as you talk about in your book, for children, particularly in the first few years of life, as you talk about in your book, about, you know, taking two or three years before the microbiota is, you know, is properly formed in most people. But you also brought this interesting case study in from Papua New Guinea, which, you know, I've never come across before. It was really, really fascinating. And I think that's quite empowering for people, because I think a lot of the time when we talk about gut health and we say, you know what, let's not give our children too many antibiotics. Well, if you're a parent and you already have,

it's pretty depressing, that thought. And you think, oh man, have I already done that? You know, what damage have I done? Or if, you know, if someone had a good reason to have a cesarean instead of a vaginal delivery. Again, we know that actually that can have an impact on the gut microbiome of the child. But again, we don't want to make people feel guilty. And I think that Papua New Guinea story where, you know, well, why don't you tell me what happens in Papua New Guinea?

Sure. And you're making a fantastic point. And I couldn't agree with it more. And the study from Papua New Guinea is very interesting in the sense that they took a group of hunter-gatherers and this group of hunter-gatherers also had access to modern medicine. So if someone from the village got sick, they could see a doctor and get antibiotics if needed. When they looked at the microbiome, the world of bacteria in their guts, even though they were having antibiotic use when needed, they still had vastly more diverse and ostensibly healthier bacteria than those in the West. And what that should illustrate to people is that antibiotics are not the one factor

that has led to us in Western societies having less favorable intestinal bacteria present. It's one of many. And so if we can try to have more exposure to natural environments and a healthier diet, like those in the Papua New Guinea hunter gatherer tribes would it's it's arguable it's it's uh it's tenable to say that you could improve the health of your bacteria irrespective of the effect of antibiotics so good news antibiotics aren't the only factor and if you've used those as a kid or as an adult you're not doomed to some kind of negative outcome just because of that one variable. Yeah, it's a great point. And many of the podcast listeners have

read my two books. And I talk in both of them about this idea of thresholds, that there are multiple things contributing. And it's about like my last book on stress, I said, we've all got a personal stress threshold. And actually, you can accumulate all these little doses of stress, which in isolation don't do very much. It's when they all add up on top of one another and they get you past your threshold. That's when things become problematic. And it's kind of the same with gut health, really, isn't it? It's this idea that there are so many different things that play a role.

And yeah, let's say you've not been lucky with your antibiotic use. Fine. But you can optimize so many other things. So the overall impact hopefully will be very, very low. So you mentioned diets and maybe we could dive in a little bit. You know, for people who, you know, obviously some people need to go and see a clinician, they need to see a doctor, they need to try and find out what's going on. But you also, you outline an approach, don't you, where many of us can actually start off by getting the basics right and for many of us that is all we need to do and we will see an improvement so when it comes to gut health what are those basics whether it's diet or non-dietary factors that we can all do as a starting point for for diet there's so many diets out there and i i

really feel for today's healthcare consumer going on the internet and looking up healthy diet, because it's like, whoa, the amount of options at your disposal must just be maddening. So I tried to provide people the starting point with diet regarding the two diets that are the most likely to lead to resolution of your symptoms. And those two diets, in my opinion, and I think this is fairly well supported by the research literature, is an elimination-like diet. And I think you talk about this in your book to a greater or lesser extent, an elimination diet where you cut out processed foods and you focus on whole, fresh foods.

And I take that one step further into a paleo diet-like template where you focus mostly on fruits, vegetables, healthy sources of protein, healthy fat, fish, nuts, and seeds. And that's kind of your healthy elimination diet as one dietary option. And that will be all that many people need to do. Michael, can I say that I've seen in a previous interview that you were keen to emphasize that this sort of paleo type diet that you often recommend as a starting point can also be quite vegetable heavy and doesn't have to be meat heavy if people you know want to choose to be vegetarian for example yes

absolutely and we're even working on a uh putting together a vegetarian paleo diet handout for uh you know as part of our resources page for the book because i think there is this misconception that a paleo diet maybe the word paleo can be interpreted in so many different ways um you know a lot of people assume a paleo diet to be a very meat heavy diet but but it really doesn't have to be at all you know i've got many patients who follow you know what would literally be considered a paleo diet but it's it could be vegetarian or could have very very you know small amounts of fatty fish in in it because they're basically eschewing the highly processed foods. They're having the whole foods, which is ultimately – these terms, I know they can be misinterpreted.

I'm just trying to emphasize that point. No, no, thank you. It's always important to clarify a term that may be confusing or misinterpreted. And you're absolutely correct. I could not agree with you more in that the point in my mind of the paleo diet is not to say eat lots of meat and eat lots of fat, but it's more so here are the foods to not eat grains and dairy, at least for a short experiment, are the foods that we want to cut out in addition to processed foods. And we want to focus on healthy sources of fat, protein, including meat and fish and nuts and seeds and eggs, and also vegetables and fruits. And it doesn't have to be

this, as you said, meat heavy diet. It can be quite light in protein and fat and much more weighted with things like fruits and vegetables. Absolutely, that's a great point. And that's why I try to use the term both elimination diet and paleo diet. Some people, they may not know what elimination diet is, and they may have an idea of what the paleo diet is. But then again, to your point, they may have a misrepresentative view of the paleo diet as a big, strong weightlifter guy who eats a ton of protein. And that's not the way the diet has to be applied. There's definitely some nuance.

So I recommend that. What strikes me is that a lot of the foods that would be cut out would possibly be high FODMAP foods as well, wouldn't they? So, you know, not exclusively, but it could be. I know you're also a fan, I think in the short term at least, of a low FODMAP diet sometimes. Yes. And so that's the next diet I was just about to mention is the low FODMAP diet. And it depends on what type of foods you put into your paleo-like diet or your elimination diet. But what I've noticed is when people go on a diet that's high in fruit and vegetables, which – OK, we're going to get you off of all the processed foods, off of all the convenience grains, and you're going to go more towards vegetables and fruits. What I've noticed is people are more prone to eat a higher FODMAP intake

because they're eating more fruits and vegetables and some fruits and vegetables are high in FODMAP. And this is the ultimate challenge for people. They say, okay, I'm going to try this whole paleo-like diet experiment. And they go through the labors of downloading a diet list and looking up everything and going to the supermarket and buying all these foods and cooking all these foods. And after a couple of weeks, they say, oh, I think I feel worse. And it's like, I'm putting in all this effort, but I feel worse. And it may be because you're eating a high amount of these FODMAP rich fruits and vegetables, which isn't necessarily a bad thing. But if you have a gut that has a heavy degree of bacterial colonization, if you have lots of bacteria in your gut, then eating a high FODMAP diet may actually make you feel worse.

Even though the foods that are high FODMAP, we would stereotype as being healthy. Asparagus, broccoli, avocado, apples, who would have thought that these foods when eaten in too high of a level could actually make you feel worse? But they can. The nice thing is that the solution isn't a hard one. If you download a low FODMAP diet list, you can clearly see, okay, here's the vegetables and fruits I want to focus on. Here's the ones I want to be a little bit more careful with. And that slight tweak in making a low FODMAP diet your next dietary trial can be very helpful for people who have not responded to that more foundational elimination diet that we just outlined. abbreviation for some fermentable sugars that exist in certain foods, which, you know, basically a lot of healthy foods are high in these fermentable sugars. But if you've got an issue

with your gut, let's say you have a small bowel syndrome or, you know, an imbalanced gut, often those foods can be problematic. And I've had previous chats with people like Jeanette Hyde and Megan Rossi and Professor Tim Spector, who we have touched on the low FODMAP diet. And a lot of them also, and I'm interested in your thoughts on this, Michael. A lot of those guys recommend it in the short term as a way of reducing people's symptoms. But the goal is always to get to the root cause so actually you can start to reintroduce those foods back in without causing any symptoms. start to reintroduce those foods back in without causing any symptoms. And I would agree with that.

And I think most diets that restrict a given food or group of foods, the goal is to use the diet to help the person gain awareness towards what their food triggers are and also allow some healing in the gut to occur. And then you can broaden your diet and move to the most diverse diet possible as long as those are healthy food, right? We don't want to broaden your diet back out to soda and candy bars. That's never something we want to bring back in. But as long as we're trying to bring in unprocessed, whole, fresh foods, then yes. But there are some people who they never seem to do great on some FODMAPs. And this, to your earlier point, has to do with severity of the condition. For some people with highly compromised guts, they may always be sensitive to some FODMAPs, and that's okay,

as long as they have the objective of running that reintroduction where they try to broaden their diet, and then they identify this food I can have, this food I can have, but this one kind of irritates me. So I'm just going to make a mental note of that one or couple foods. And I can have them sometimes, but I can't overdo it. I can't have too much, or I can't have them too frequently. And that's how you personalize your diet in the longer term. And I just make that recommendation because when some people read that the low FODMAP diet may starve intestinal bacteria, they equate that to thinking, well, if I don't try to bring back in all these FODMAP foods, I am going to hurt my gut. And then they force themselves

to eat foods that make them feel sick because they thought that they should do that. And that's also a misread. So there's kind of this nuance, this balance where, yes, we don't want to blindly follow the low FODMAP diet forever. We want to use it for a short term, heal, and then reintroduce and try to have the broadest diet possible, but also be okay with the fact that there may be a few high FODMAP foods that you don't tolerate. And don't stress out if you can't introduce some high FODMAP foods without any symptoms. Yeah, I think that's a great point. And you know, look, if you look at it a different way, let's say you don't have a problem with your, well, you don't have a problem where you have to go on a low FODMAP diet. There might be in your regular daily diets, there might be a few

foods you don't feel particularly good on and you learn what they are so you don't eat them much. You know, and very few of us go through life eating absolutely every single food that is out there and available. There's always a few foods that maybe people don't like or they don't particularly eat a lot of. So you can almost look at a low FODMAP diet in the same way. You're cutting them out. You'll then slowly start to reintroduce them as many as you can without getting symptoms. And so many people will find it helpful to do this with a nutrition professional, professional whether it's a dietician a nutritional therapist a doctor someone who can actually guide them through that process because it can be pretty intimidating for some people can't it to try and do this by themselves

yeah it can be and and there's also different philosophies and approaches in terms of how to do the reintroduction my two cents would be this. If you're someone who tends to get nervous about things and kind of worked up about them and you need some guidance, then I would enlist the help of a professional. Absolutely. If you're someone who feels like you can do these things on your own and you feel fairly able to tackle these things on your own, then the way I would do the reintroduction, not to say it is the right way, there's no established right way. But what I found to be the most practical is I have people start with reintroducing the foods that they miss the most.

Because that tends to be what makes the user the most happy. If you love avocados, then let's make that one of the first foods that you reintroduce um and and that seems to really help people kind of stay engaged uh so i would recommend start with the foods that you like the most that you eat the most and then work your way outward yeah i think so i think i think that's brilliant and it just really highlights how much these things need to be personalized for the individual, for their desires, for their tastes, for what they want out of their health and out of their gut. You mentioned what to eat and also what to avoid eating potentially if you're having gut issues. But what about when you eat? You know, how much

of a role does that play in gut health? Great question. And I also, you know, we should come to probiotics in a moment because that can actually help people tolerate more foods because probiotics can have this healing effect on the gut. So I just want to kind of pin that on the board and we'll come back to that maybe in a second. But your other question also very important, which is meal frequency or meal timing. And there's kind of this camp of you either eat frequent meals, some people feel well there. And then there's this other camp of intermittent fasting or eating less infrequent meals. And neither one is right or wrong. But determining what works better for you can be quite a helpful intervention. Now, some people may notice I feel better when I don't eat breakfast.

And for those people, I would encourage you to continue to do that. If you've never skipped a meal in your life, I would try skipping a meal or two and see how you feel. Do you feel like you have better mental clarity, better energy, better digestion? Or are you someone who does not do well with skipping meals and you feel foggy, irritable, tired? And some people will feel that way. They will not feel well when they skip a meal, but other people will. And so, you know, sorry not to give a kind of one answer here, but a little bit of self-experimentation can go a long way. Now, there's one other note here that I do want to mention, which is fasting can be health-promoting. Fasting can be health-promoting, but it is a hormetic stressor in the sense that it's healthy to a point.

Then if you have a dose of that healthy stressor that is too high, then it can become counterproductive, just like sun exposure. Some sun exposure can be very beneficial for your health. I think the data there is incontestable at this point. But too much sun exposure can cause a sunburn, and that can be very damaging to your health. So it's finding the right amount of exposure to the stimuli for you. And you can experiment with this. Some people, on most days, they feel better if they skip breakfast. Other people, that will not go well at all. Some people try to do one day a week.

Personally, I, on Sundays, will skip breakfast and sometimes lunch, depending on how I'm feeling. And I'll have some green tea, maybe a little bit of coffee. And then I'll have either lunch and dinner or just dinner. And I do that once a week. And I do notice when I do that, the following few days, I have less cravings for food. And so for me, I feel it helps to kind of reset my satiation apparatus. But if I do it too much, I start to not sleep well and get tired during the day. So I've identified there's this threshold of fasting. Coming back to your earlier point of threshold, I've got to stay under the threshold so I don't overdo it. And finding that

sweet spot for me helps me feel sharp, clear, and keep me from falling into any type of cravings. But I have to also, again, be careful not to overdo it. Yeah. Thanks for sharing that. That's super interesting. And hopefully people can personalize and sort of do a bit of experimentation to try and figure out what works for them. And, you know, different people will respond to different things, as I said, on many occasions in the past. You know, what works for your partner may not be the right approach for you. You did mention probiotics. So why don't we just dive in there? And, you know, what is your view

on probiotics? How can they be used to help promote gut health? Because some of the literature can be quite, you know, you can be quite polarizing, can't it? You know, some studies are suggesting there's not much benefit there at all. Other studies are suggesting that they can be fantastic. What is your take on this? Right. And that's where, to your earlier point, looking at the totality of the data and then weighing the evidence is extremely helpful because we can find one study showing a positive effect, another study showing a negative effect, and we can fight back and forth with this one study, one reference back and forth game. But to really understand what the winning conclusion is, we should look at all the data

and then see, is there a trend in the data? And that's where I think it's fairly safe to say that probiotics have multiple potential health benefits. But we also have to be careful not to say that people who are otherwise healthy must be on a probiotic and make these overreaching claims that probiotics are going to heal every disease underneath the sun they they can be helpful there there's evidence showing that probiotics can improve mood actually two meta-analyses of clinical trials have concluded that probiotics can improve mood now again, two meta-analyses of clinical trials have concluded that probiotics can improve mood. Now, again, to play the other side of the coin

here, does that mean that someone with severe debilitating depression, all they need is a probiotic? No, that's an overstatement of what the literature shows. But clearly, some data is showing that probiotics can improve mood. A meta-analysis is a summary of clinical trials. mood. A meta-analysis is a summary of clinical trials. So if you're trying to get a weighting of what the evidence says in total, you can look to a meta-analysis, which by design will weigh the evidence and performs a mathematical analysis to determine what the trend line is. Does the trend favor the intervention, favor the probiotics, or does it favor nothing? And so in this case, intervention favor the probiotics or does it favor nothing? And so in this case, the meta-analyses show favorability for mood and probiotics. Now for IBS or irritable bowel syndrome, there's many studies, over a hundred at this point, showing benefit. These studies are of smaller

sample size, so we should have to factor that in. So the data here could be better. smaller sample size. So we should have to factor that in. So the data here could be better. Sometimes doctors who only prefer drug therapy for IBS will criticize the probiotic literature not having these super large randomized control trials. But only, at least at this point in time, the only companies that have enough money to fund those trials are drug companies. It's not to say that drugs for IBS are bad. That's not the claim that I'm making. But I think it's unfair to say because the probiotics don't have the studies as large as the drug studies, we can't endorse probiotics. There's definitely good evidence for probiotics.

There are over 100 trials, and there's a number of meta-analyses showing benefits for irritable bowel syndrome. So your gas, your bloating, your constipation, diarrhea, abdominal pain. Could this data there be better? Yeah. Will it get better? I'm sure it will with time. But there is one challenge with some of the natural compounds, again, funding. one challenge with some of the natural compounds, again, funding. The drug companies have the money to invest in these very large studies. Now, there's also some evidence showing that probiotics can improve neurological conditions like restless leg. There's other evidence showing that probiotics may improve skin or allergy-mediated conditions like urticaria or hives and what's known as allergic rhinitis or conjunctive rhinitis, essentially runny and

stuffy nose. There's some evidence showing that probiotics can improve cholesterol and blood pressure, although the effect there is small. So it's not a large effect, but it is a beneficial effect. And of course, we know that probiotics can decrease inflammation in the gut and that may be why we see probiotics having benefit in a number of different systems because if the root cause or one of the root causes of many ailments is inflammation in the gut and probiotics can improve inflammation in the gut then that would stand to reason that the we're treating kind of the cause and by treating the cause you can see anything from skin to neurological conditions improve so there's definitely some good evidence there but but

one other thing i'd like to mention just in a moment is how people can select the right probiotics for their gut but but before i i'll pause for a minute before i kind of jump to that no i think that's a great point and i think your point about drug trials versus probiotic trials it is a really important one to consider because but you're a practicing clinician like i am i have seen good quality probiotics help a lot of patients particularly particularly patients with Irritable Bowel Syndrome. Now, they don't always work. And often it's one of many things that I'm doing. So it's not all just on the probiotic. But I think it can be a useful tool in our toolbox to help patients for sure. But you do raise a good point. And that's the quality of the probiotic. So how can I appreciate you practice in America, I do have an international audience, but I guess,

you know, maybe 60-65% of the audience is based in the UK. But I think they'd be very interested in your thoughts as to how do you choose a high quality probiotic? One of the ways you can you can help to determine the quality of a probiotic is the cost. It's not a guarantee, but if you're looking at a certain ingredient label of probiotics, let's say you're looking at a Saccharomyces boulardii probiotic. So that's the main strain in there is Saccharomyces boulardii. And you look at four different probiotics and each one costs about $50. And then you find one that costs $30. There's a decent chance that if one probiotic is vastly cheaper than the others, then some type of corner has been cut.

Now, it's not a guarantee, but it's one thing to look at. Now, it's also not to say that the most expensive probiotic is going to be the best, right? You also want to be careful about that. Looking at companies that follow what's known as good manufacturing practices, I'm not sure if there's a different term in the UK, but essentially this is where regulators come in. But essentially, this is where regulators come in. They look at the facility. They make sure that all the equipment is clean and is operating underneath what would be considered the optimal standards. And in addition to GMP, that a company is periodically having a third-party test their probiotics to make sure that what is on the label matches what's in the probiotic.

Now, if you're a healthcare consumer and that seems kind of daunting, I would just find someone who you trust and follow their recommendations. So find a doctor or clinician or a guru who you trust. And if they're recommending a probiotic and they seem like they're pretty smart, they've likely done that fact-checking for you. There's another issue here that is equally important, probably even more important, in my opinion, which is there are so many probiotic products out there. How does one determine what product they should use? And this is one of the most telling things that I revealed when doing the research review for my book, which was, you can get caught up in this, this probiotic is best for this condition, that probiotic is best for that condition. But what I came to learn was, that's not really the way it works. It's more so when there's a new study about a probiotic, some supplement company will pick up that probiotic formula and then they will shout from the rooftops, this is the best probiotic for joint pain.

This is the best probiotic for brain fog. But if you look in the research literature, you see other types of probiotics that show improvement for that same symptom or condition oftentimes. And if you look even further and you get this kind of bird's eye view of all the studies, you see three categories of probiotic come into focus, meaning that we can organize most of the probiotics that have been used in the clinical literature into one of three categories. Most of the probiotics have been used in the clinical literature into one of three categories. And I talk about this in the book. Your category one is your lactobacillus and bifidobacterium strain blend.

So people have likely heard of lactobacillus acidophilus. That would be one strain. They've likely heard of bifidobacterium infantis. That would be another strain. And so you have a cocktail with various strains of lactobacillus and bifidobacterium. That's your category one. Category two, simple. This just contains Saccharomyces boulardii, like we talked about earlier. Many studies showing benefits for category two and for category one probiotics. And then we have category three, which are known as soil-based or spore-forming probiotics. And these typically contain various bacillus strains.

Now, that may sound like a lot, but all that breaks down to is you have three different types of probiotics. And you want to try each one of these and determine which ones work for your gut. Essentially, you want to try all three of these types of probiotics, and you want to use all three of them unless you have a negative reaction. A small number of people have negative reactions to probiotics, but if you do, now you can determine, okay, I tried the category one. I felt good. I tried the category two. I felt even better. Then I tried category three and I actually got a little bit bloated. Okay, perfect. We have now personalized the probiotic protocol to your gut. You will take category one and category two,

but you won't take category three. And this is impactful. We just released a case study actually on Monday of a patient in our clinic. Her name is Phyllis. And she had been on the paleo diet and then on the low FODMAP diet. She had been doing this for two years. And she had tried a number of probiotics and had negative reactions. And so she came in and she goes, ah, I'm so frustrated. I went on the paleo diet, didn't feel any better. Went on the low FODMAP diet, didn't feel any better. Went on a low FODMAP diet, didn't feel any better. I've tried numerous probiotics and I have reactions, negative reactions to all of them. But when I probed a little bit more deeply into her history, it seemed that she was having negative reactions.

I believe it was to category one probiotics. So she thought she was trying all different types of probiotics, but she kept trying category one. She tried one product. She didn't realize it, but it was a category one. Had a negative reaction. Tried another probiotic.

Didn't realize it. It was another category one probiotic. Had a negative reaction. So she kept trying different probiotic products, not understanding. She kept trying the same category, and that's why she kept having a negative reaction. All we had to do for her was put her on a Category 2 and a Category 3 probiotic, and she had better energy, better regularity, meaning she was no longer constipated, and she just felt like overall her gut was calmer and happier.

her gut was calmer and happier. So this greatly simplifies the probiotic landscape, understanding that there's no one strain for one condition. These are not drugs. These are not like a cholesterol-lowering medication that has a very specific mechanism of action, but rather these probiotics help to heal your gut, reduce inflammation, fight imbalances in bacteria and fungus. And so it's more so about finding what probiotic sits well with the bacteria in your gut and using that one and also identifying if any of these don't sit well with your gut bacteria and not using that one. So this protocol is simple, but it's vastly effective. And hopefully that's helpful for people because I understand the consumer is inundated with all these different products and all these claims for these products. And it doesn't have to be that complicated. Yeah, Michael, appreciate you sharing that. And I think that's such a good point. And it's something I always say to my patients when

I give them a particular probiotic, I say, look, there's no guarantee that this one's going to work for you. Everyone's got a different, unique sort of fingerprint as it were in their gut and you know depending on the state of your gut depending on what bacteria you've got is also going to influence what probiotic you respond well to if at all and so um you know it's always good to let people know that beforehand they might read a great study or their friend has had a great experience with one particular probiotic but when they have it they feel sick or they get bloated and it doesn't mean that probiotic is not good, it just could mean that it's not the right one for you. So I think it's a very, very helpful advice there. Michael, we're coming towards the end of the hour, unfortunately, because I really

wanted to talk to you about SIBO, which is a problem you see a lot and I see a lot of, but perhaps we can do that the next time, because I know you have to go. see a lot of but perhaps we'll we can do that the next time so i know you have to go um look a lot of interesting information there on gut health for sure including a really nice dive into probiotics there at the end and you know maybe just one quick note on SIBO to give give people something that could be constructive um because it does touch on on probiotics which is there there's this misnomer circulating on the internet that if you have SIBO or small intestinal bacterial overgrowth, which is this overgrowth of bacteria in your small intestine, as the name implies, that you shouldn't use probiotics. And that is incorrect.

The vast majority of the data have actually found that probiotics can clean SIBO out of the small intestine. That probiotics are actually like fighting fire with fire, meaning if you have an overgrowth in your intestine and then you take a probiotic, these probiotics fight that overgrowth and actually can kill off overgrowth of bacteria. and actually can kill off overgrowth of bacteria. In fact, there was even one landmark study that looked at two groups of patients with IBS. One group of the IBS patients had SIBO. The other group did not. The group with SIBO and IBS responded better to probiotics than the group without SIBO and IBS. So the simple probiotic protocol can completely resolve SIBO in some cases, and it's a good place to start. Start with the diets

that we talked about. Give that a little while. If that doesn't resolve the symptoms, then try the probiotic protocol. And there are certainly some cases that all you have to do is get the right probiotic protocol dialed in or personalize the probiotic protocol, and that will resolve their SIBO. Yeah, that's a great point. Michael, just to finish off, you know, that this podcast is called Feel Better Live More. It's fairly self-explanatory, but basically when we feel better in ourselves, we get more out of life. And, you know, we're talking about gut health. So I wonder if you could leave the listeners with maybe three or four top tips for them to think about applying right now into their life so they can start improving the way that they feel. So sorry to put you on the spot, but I don't know if you have a few top tips that you can leave the listeners with for their gut health.

Absolutely. that you can leave the listeners with that I got health? Absolutely. It's always been my contention that to live your best life, you have to be biologically healthy because then you'll have more energy and more mental clarity to effectuate whatever it is you're trying to do in your life. So if you're trying to learn an instrument

or learn a language or be a good mother or father or whatever it is. If you have energy and good mental clarity, it's much easier to do both of those things. So my, again, my posit has always been the healthier we can get you biologically, the more of you we can bring into the life that you're trying to live and trying to create. So your gut health, in my experience, has been a massive contributor to that endpoint. And so then it begs the question, what can you do to improve your gut health? Well, firstly and foundationally, take a large grain of salt with everything that you read on the internet. As great as the wealth of information on the internet is, it has been alarming to see how invariably a patient will think that

something is worse than it actually is after they read up on it on the internet. The number of patients in my clinic who, when we tell them they have SIBO, they look at me like I diagnosed them with cancer is alarming. People should not be that afraid of SIBO. It is not that big of a deal. It is merely a lab finding and it is very able to be treated. So understand that what you read on the internet will likely make you think things are worse than they are. And so realize that things are not as

bad as you think. The human body is incredibly able to heal, especially when it's given the correct push. Then I would consider a couple experiments like we outlined today. If you haven't tried an elimination diet or a paleo-like diet, great place to start. Give that a couple weeks. If that doesn't really seem to move the needle in terms of how you're feeling, then consider a low FODMAP diet and give that a couple weeks. And if that doesn't lead to an improvement, then stay on whatever diet seemed to be the most agreeable and then try the probiotic protocol. That can get you really far and that can be very helpful in improving your gut health, therefore improving your energy, improving your mental clarity.

And then the other thing I would offer people, don't forget to slow down. And I think it's, you know, especially in westernized societies, it's so easy to get swept into always working, thinking, and doing. This is something I myself fight with where I'm always listening to a lecture, a podcast, an audio book, and sometimes I overdo it where I start to not feel well mentally because I am never shut off. I never can just sit there and eat and look out the window. And so taking that time for stillness, for reflection is so important to help you key in on, maybe you're not happy with a certain thing in your life, and maybe you're just kind of running from that and distracting yourself in this never ending litany of

stimulation. And even though that simulation can sometimes be healthy, if it's something like an audio book, it's important to have that time to not be distracted to not have anything on your mind in part so that you can reflect and introspect but also so that you can just slow down and enjoy the simple things like looking out a window and and how amazing it is that we are here in an environment that is safe where we have food water and shelter we take that for granted but some people don't have that and i know that's kind of that kind of sounds platitudinous but a little bit of stillness time and a little bit of thankfulness can go a long way in helping to make sure that you don't just get caught up in this runaway syndrome of trying to have more be

more and do more and being a little bit appreciative for what you have. So that may be more than three things, but that's a few things that come to mind. No, it was great, Michael. Thank you. Really, really great points. I like them all, particularly the first one on take what you read on the internet with a pinch of salt. And, and, you know, it reminds me of something I often tell my patients who've waited a long time to come and see me. And then I talk to them and say look I understand that you've read loads and loads of different blogs you've really tried to empower yourself I get that but I think at the moment you know you've you put your your faith in me let me come up with a plan for you you put your energies into following

that plan try not to read any more blogs about anything at the moment and I think they find it really freeing, actually, to be told that and go, oh, okay, fine. I'm just going to follow what you've asked me to follow and not try and figure it out for myself. So I very much resonate with that. And thank you for sharing those things. Again, slowing down at the end. So, so important for all of us. Well, Michael, look, really appreciate you sparing some time to talk to me on Skype today. Have a great day and hopefully we can get you back on the podcast at some point in the future. Yeah, it would be a pleasure. Thank you.

That concludes this week's episode of the Feel Better Live More podcast. I hope you enjoyed the conversation and have managed to find one or two ideas during it that you think you might be able to apply in your own life. Michael talks a lot about some different diets that you might want to consider trying out to see if you can improve your own gut symptoms. There are only books out there that can advise you on how exactly to do this but if you are thinking of following something like a low FODMAP diet it may be worth having a chat with a healthcare professional first or getting in touch with a nutritional professional so that they can help you.

I really loved one of Michael's tips at the end there about taking everything you read on the internet with a pinch of salt. Do let Michael and I know what you thought of today's show. Michael is on Facebook, Instagram, and Twitter with the handle at DrRuscio. That's D-R-R-U-S-C-I-O. I, of course, am on Facebook and Instagram with the handle at DrChastji and on Twitter at DrChastjiUK. If you're interested in gut health and would like to read more about something called the gut-brain axis, you can do so in my latest book, The Stress Solution. Basically, the gut-brain axis is talking about the multiple communication channels that exist between our brain and our gut. Now, we've known for years that messages from your brain can get to your gut. A classic example would be a student getting stressed before

an exam. They feel a real strong urge to go to the toilets. That is stress signals coming from the brain going down to the gut. But over the past few years, we've also realized that messages from the gut can go back up to the brain. This really changes how we now can look at food. You see, food is no longer just about energy or calories. Food is information. Feed your cat bugs with food that they don't like to eat and you'll start sending stress signals up to your brain. Feed them what they do want to eat and you will send calm signals instead. There is a whole chapter dedicated to this in the stress solution as well as many practical tips to help you lower your stress

levels and live a happier and calmer life. It is available to order all over the world now, the UK, Australia, America and many more countries as a paperback, ebook and as an audiobook which I am narrating. If gut health is something that you wish to learn more about, you can also check out previous podcast episodes that I have recorded. about, you can also check out previous podcast episodes that I have recorded. Episode number one was all about gut health with Professor Tim Spector. And episode 40 of this podcast was with Jeanette Hyde, where we spoke about how gut health plays a role in Irritable Bowel Syndrome. If you enjoy my weekly shows, one of the best ways that you can support them is by leaving a review on whichever platform you listen to podcasts on.

You can also help me spread the word by taking a screenshot right now and sharing with your friends and family on your social media channels. Or you could do it the good old fashioned way and simply tell your friends and family about the show. I really do appreciate your support. A big thank you to Richard Hughes for editing the podcast and to Ali Ferguson and Liam Saunders for the theme tune. That's it for today. I hope you have a fabulous week. Make sure you have pressed subscribe and I'll be back in one week's time with my latest episode. Remember, you are the architect of your own health. Making lifestyle changes always worth it because when you feel better,

you live more. I'll see you next time. Thank you.