Muscle for Life with Mike Matthews - Elisa Marroquin on Gut Health and Body Composition

Starting point is 00:00:00 Hello and welcome to Muscle for Life. I am Mike Matthews. Thank you for joining me today for another episode on gut health, but on an angle of gut health that I haven't written or spoken much about and that I have not covered in previous interviews, at least not in the amount of detail that this interview is going to cover it. And that angle is body composition, how our gut health influences our body composition and how poor gut health can lead us to gain body fat, retain more body fat, maybe even gain less muscle and how better gut health can bring about the opposite conditions, faster fat loss,

Starting point is 00:00:44 easier fat loss maintenance, easier fat loss maintenance, easier body composition maintenance, generally staying leaner, and possibly more muscle and more muscle gain. And in today's episode, you're going to be learning from my guest, Dr. Lisa Marroquin, who is an assistant professor and the director of graduate studies in the Department of Nutritional Sciences at TCU, and who has conducted a number of studies on today's topic, specifically how the gut microbiome can affect obesity and body composition. Hello, Elisa. It's nice to meet you. Nice meeting you, Mike. Thanks for taking your time to come and talk to us about microbiome

Starting point is 00:01:24 and body composition, which is something that I have not written or spoken about. I'm always looking for, after doing this for many years, what's some interesting angle that I haven't already beaten to death? And this is one of them. So I'm excited to talk to you about this. Thank you for the invitation. I appreciate it. So maybe we should just start. I have written and spoken about the microbiome a bit in the past. I have had one or two other guests on the show to talk about it more in the context of general health and general gut health.

Starting point is 00:01:52 But in case people listening have not heard any of that previous content, let's just start with maybe a brief explanation of what the word means. What is our gut microbiome? The gut microbiota involves different microorganisms, not only bacteria. So we have, in addition to bacteria, we have viruses, we have archaea, we have parasites and fungi. So we have a lot of different microorganisms, although we have focused more on bacteria. And so we have around the same number of bacteria cells per each of our human cells. So we have three trillions of human cells and we have around 3.8 trillion bacterial cells. We are as bacteria as we are humans. But if we consider the number of genes we have versus the number of genes bacteria have,

Starting point is 00:02:48 they have around 100 times our genetic information. And how does that influence different aspects of our physiology and our health? Yeah, so the goat macrame has many functions. Among them we have, for example, Yeah, so the goat macrame has many functions. Among them we have, for example, it helps with the education and activation of the immune system. So when we are burned, it's really important for our immune system to get in-chain fatty acids such as propionate, butyrate, acetate, and these ones have a metabolic impact in the host, in our metabolism, and helps with digestion of complex polysaccharides that our human enzymes cannot digest. And by doing so, it provides around 10% of the calories that we consume each day. So it has a lot many other functions. For example, it converts the primary biliary acids into secondary biliary acids, which have a function.

Starting point is 00:03:59 We have specific receptors for these biliary acids called FXR, amongst others, and they take care of insulin and sensitivity, etc. So they have so many functions. Very symbiotic relationship, I guess. They need us to keep them healthy and we need them to keep us healthy. Yes, we do. In fact, there's a new term called holobiont, and that term is now being used to refer to the human plus the microbiome. And so why? Because we cannot really be healthy without them. We need them to exist. We have co-evolved together for so many years that we need each other to live. And if people listening have looked into the microbiome at all,

Starting point is 00:04:46 they've probably come across some of what you just explained. But something that they might not have come across is this element of body composition and how the microbiome can influence body composition. Can you help explain a bit of how that relationship works? Can you help explain a bit of how that relationship works? So this is actually the area that got me interested in to study the gall microbiome. So when I was doing my PhD, there was a professor that gave a talk about the gall microbiome and how it could change body weight in this animal research. So basically what the study she presented to us was talking about is basically they perform a fecal transplant from an animal model of obesity. It was genetic obesity. It's

Starting point is 00:05:32 called the OBOB mice. So they have a mutation in the production of leptin. So they don't produce leptin. They have hyperphagia, reduced energy expenditure. So they develop obesity. And basically what they started did is they took fecal samples from this animal and they transplanted those fecal samples into a germ-free mice. A germ-free mice or mice that they are put into spatial cages since the moment they are born and they are free from bacteria inside and outside. And so these germ-free mice started gaining weight without changing their caloric intake. So they continue to consume the same calories, yet they were gaining weight. And to me, that was very shocking and very... It sounds blasphemous.

Starting point is 00:06:19 Yes, yes. Because, you know, I am a dietician. I have a master's in PhD, but I am a dietician. So to me, it was like, wait a minute. And that changes everything because it means that you continue consuming the same calories, but just because you have a different gut microbiome, that is going to change how your body responds to it. And I assume it wasn't related to activity levels, something simple like that.

Starting point is 00:06:43 Couldn't explain the... I don't remember if they measure energy expenditure in that sense. Even if it was caused by energy expenditure, just the fact that the actual fecal transplant changed the energy expenditure is something concerning because it's a factor that we have been ignoring all this time. And so there has been a lot more research, particularly the research that has shown stronger effects is in animal labs. In humans, these effects have not been 100% fully replicated. And there are some reasons why I think that has happened. The gut microbiome is affected for so many different things.

Starting point is 00:07:25 So diet, consumption of medication, sleeping patterns, exercise, your ethnicity, your location, so many, many things. And we don't have all those confounding variables in laboratory animals. So even with a small sample, you can detect significant differences between groups. However, in human samples, you have all these different variables. And if you don't have sample size that is high enough, you're not going to have enough statistical power to detect significant differences between groups.

Starting point is 00:07:53 And so a lot of the studies that have been done in humans have small sample sizes. And it could be one of the reasons why we're not seeing the same in humans in some of these studies. I think a lot needs to be done before we get to any conclusions. And if there are these mechanisms in play, and my understanding is there is some evidence in humans that suggests that there is something more to be learned here, but I'll defer to

Starting point is 00:08:24 you. And how might that look? It's obviously a new line of research and there are probably way more questions than answers. But with the evidence, the current evidence, are some of those questions kind of looming larger than others where it looks like there are some potential mechanisms here. Here's what we have seen. Yeah, so definitely the gold microbiome, what we have seen in humans is that it affects our metabolism. And so for example, our response to a diet is going to depend on the gold microbiome more so than it would depend on our genetics. And this has been

Starting point is 00:09:00 proven using twin studies. Basically, when you provide the same dietetic intervention, humans don't respond differently. Just to give an example, there was a study in which the scientists were providing either white bread or sourdough. And so, you know, the glycemic index is extremely different, 70 versus 40. And the recommendation always has been to consume whole grains and sour the over white refined bread. However, what scientists discovered is that not everyone responded the same. There were a lot of people that responded actually better to the white bread.

Starting point is 00:09:39 And that depended on the gold microbiome composition. So after seeing that response in the glucose, that glycemic response, what the authors did is go back, analyze the gut microbiome at baseline, and try to predict if the gut microbiome could give us an idea of who was going to respond better to each of these breads. And they discovered, I think it was like 82, 83% of certainty just by using the gut microbiome composition, what person was going to respond better to each of these types of breads. And that gives us an idea of how individualized the gut microbiome is. And the same happens with exercise interventions. We know that in studies, for example, that prescribe the same exercise, there's a huge variability. There's people that are going to respond like crazy.

Starting point is 00:10:28 There's people that are not going to respond like if they hadn't worked out. And a lot of that variability depends on the gut microbiome. And so what we have seen, for example, is that there are responders and non-responders. And you can classify the person before starting the workout. You can classify just by taking a look at the composition of the gut microbiome, whether they're going to be responders or not responders of that exercise intervention. And when you say exercise response, sorry to interject, I just want to follow up on that point before we talk about something else,

Starting point is 00:10:58 because that's very interesting. Can you speak a little bit more about what type of exercise and what you mean by response? Because if people are thinking in weight loss terms, they're probably just thinking in caloric expenditure versus maybe if we're talking about some sort of resistance training, now there's a more complex response that we're trying to elicit than just maybe burning some calories and improving cardiovascular endurance to some degree. Yes. I'm talking about body composition and glucose response, like insulin resistance, fasting glucose. So we are talking about fat loss. Yes. So what I foresee happening in the future is that before receiving a nutrition intervention and before receiving an exercise intervention, we are going to have to analyze our gut microbiome

Starting point is 00:11:43 and then we're going to receive a personalized nutrition intervention that is going to have to analyze our gut microbiome, and then we're going to receive a personalized nutritional intervention that is going to work for us. Because the same that happens with bread will happen with different foods. And that is going to depend on whether we have the bacteria that have the enzymes necessary to digest and metabolize that specific food. And the same for exercise. The composition of the gut microbiome can change your performance in the exercise as well, which has been shown. And do you think that's what the difference is in the response?

Starting point is 00:12:12 Do you think it's, okay, so let's just say it's a simple exercise intervention of doing 30 minutes of zone 2 cardio every day. And you have certain people responding very well to that and you're seeing market changes in their body composition whereas other people not responding well minor changes in body composition why might that be is it is it a point of maybe performance the people who respond well are exerting themselves more vigorously and therefore burning more calories in those workouts or no no no it had nothing to do with that. And so basically when the baseline gold microbiome was analyzed, we couldn't detect today, human eye, basically significant differences between them. But then after the workout was done, they say,

Starting point is 00:12:57 I can't remember if the intervention was like 12 weeks or something like that. You can see that there was a significant difference in the gold microbiome composition between responders and non-responders. And non-responders, and these are people that also worked out in the 12 weeks, behaved basically and had a similar gold microbiome composition than the control group, like if they hadn't worked out at all. And so by using machine learning algorithms is that they were able to analyze again the gold microbiome composition at baseline and detect very subtle differences in the gut microbiome that were able to predict a high degree of certainty

Starting point is 00:13:31 whether a person was going to respond or not. So I think that we are going to head to that direction. And perhaps in the future, before we start an exercise intervention, we can either take a specific probiotic or do something to change the composition of the gut microbiome to make sure that we're going to respond to the exercise intervention before we even spend the time working out. And this might be just my ignorance of why I keep coming back to this, but how do you square that with something like energy balance, which would be considered at least some a fundamental mechanism

Starting point is 00:14:06 that would dictate right, like whether somebody is going to lose fat with a if we take into account what they're eating as well. It's just maybe I'm missing something. But some people listening might be like, does this wait a minute. So energy balance, it might just be that, you know, my gut is the reason why it's not that I drink three bottles of wine every weekend. No, no, no, I do believe that the energy balance equation is still happening. So basically what I'm trying to say here is there's some people have a gold microbiome that is able to extract more energy. You know, in the calories you are consuming, you think it's the same calories. Your GI tract, your gold microbiome has the capacity to absorb more calories.

Starting point is 00:14:43 your GI tract, your gut microbiome has the capacity to absorb more calories. So still, you know, there is an increased energy intake just by having a different gut microbiome. And also the gut microbiome has been shown to change energy expenditure. So I do believe that the question is still respected. And when you talk about extracting energy from food, can you explain a little bit what is extracting more energy from food? Is that a good thing? Is that a bad thing? Because if people hear, oh, extracting less energy, so I just like poop out the rest,

Starting point is 00:15:13 isn't that a good thing? Can I eat more food then? Well, the thing is, in evolutionary periods, that would have been awesome because it would have allowed us to survive in periods in which we probably didn't have enough food. So that was a good thing. Being able to extract a lot of energy from the food, right? Like getting the most we can out of it. Yeah. So bacteria are going to help us to extract around 10% of the calories that we ingest each day. So that much, you know, it doesn't sound a lot in a day, but in a month, in a year is a lot. And so bacteria basically are, they have specific enzymes that humans do not have

Starting point is 00:15:54 and they are able to ferment and to metabolize complex polysaccharides that we humans cannot even touch. And so by doing so, it provides molecules that can provide energy. So like short-chain fatty acids or other oligosaccharides that can now be digested by human enzymes. And so that is how it can affect with our body weight. Now, there are other mechanisms that have been proposed, for example, certain bacteria have shown to have the potential to alter the delivery of hunger satiety hormones, such as GLP-1, PYY, CCK. And so in doing so, it can also change our appetite. That makes sense. Just to follow up one more question on that energy extraction point. So could you just explain quickly how variability in that can influence energy balance, thereby influence body composition. If somebody's microbiome, it sounds like you'd say it's working efficiently,

Starting point is 00:16:53 it's extracting a large amount, maybe it's maximum 10%, but then you could have somebody else's microbiome is working less efficiently, which is better and worse for body composition? Well, for body composition, perhaps it would be not to extract as much energy from the diet you're eating, just because that will mean that you will need to consume less calories in your diet in order to keep the same body composition. But yeah, so basically, let's say two people are consuming the same calories. So let's say you and I are consuming 2000 calories in a day, but my gold microbiome can extract, I don't know, let's say 1800, whereas your gold microbiome can extract 1900. So that's 100 calories more than you're capable of extracting that I am not.

Starting point is 00:17:40 And in a day, probably that's not a lot, but in a week, in a month, in a year, that accumulates. Yeah, that makes sense. Thanks for clarifying that. And you had mentioned also with the bread, the study with the different types of bread and how there was a different glycemic response to the types of bread. And could you just explain briefly to people listening how that could influence body composition? Because it would be an indirect influence, right? Many, many people have heard if they kind of are just new to all of this, like, oh, high GI is bad and that just makes you gain fat. Well, of course that's not exactly true, but. Yeah. So this effect of the brain on glucose is mostly important for people who have insulin

Starting point is 00:18:22 resistance and people who have some sort of either prediabetes or... Which is a lot of people who are overweight and, you know, trying to get fit. Yes. But also it has been suggested that perhaps if you want to keep a healthy BMI, you want to try to keep your glucose as constant as possible, just because every spike you have, you have to have a contra-regulatory response of insulin. And insulin is an anabolic hormone of excellence. So it activates lipogenesis, protein synthesis, glucogenesis. It activates all the synthesis of the different macromolecules we need in our body.

Starting point is 00:18:59 So in doing so, yeah, it can cause lipogenesis. It can activate lipogenesis. Also, to me, it would mean that if you have a higher glycemic response, for example, maybe it would mean that your gut microbiome is able to extract more glucose molecules from the bread you're consuming. And perhaps that could relate into higher caloric intake. This was a short-term study. So they only consume the bread for one week, one short period, and then the other bread for a week. It was a short-term study so they only consume the bread for one week one shot period and then the other bread for a week it was a cross-sectional study so basically they grew up some it was 20 participants they were randomly assigned to one of the two groups and then they had a one shot period of two weeks and then they were assigned to the opposite

Starting point is 00:19:38 side so it was a very short intervention i cannot tell you with certainty if that would affect their body composition but what we know is that you want to try to avoid spikes. And are there potential effects on the appetite as well, where if somebody's having spikes and then dips? It could be. I mean, particularly when you have a spike of glucose and then you have a spike of insulin, to contrast the glucose, right? Sometimes the insulin makes the glucose drop and then a person has like a desire to eat or a desire to get more glucose. And so that can translate into hunger. And it's one of the mechanisms that could help us explain why it's recommended to consume a diet that doesn't have those spikes. Yeah. Anecdotally, of course, I mean, I'm sure you've heard that from many people. I've heard that from many people over the years. They've just learned that certain foods or certain amounts of certain types of foods

Starting point is 00:20:39 leave them feeling hungrier than they should be or hungry sooner than they should be. And it's just very, very important for us to understand that complexity because for decades, we have been prescribed these nutrition guidelines by the government and they are trying to do their best and that's the best we can do right now. But what this is going to look like in the future is we are not going to have a one-size-fits-all diet. We're going to have the need to do a personalized diet because obviously what we have right now is not working. Because perhaps something that is beneficial for me is harmful for you. And so we are hoping that by doing so, we can have more success with dietetic and exercise interventions. And the evidence says that by doing these microbiome-prescribed diets, the success is higher compared to following the general guidelines.

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Starting point is 00:24:11 someone's going to, if it isn't already written, it's coming. But that already, I'm sure you've seen the marketers are already there. There already are services that purport to test your microbiome and then give you very detailed do's and don'ts for eating and exercising. And what are your thoughts about if you've looked into any of these, the state of these services and just the state of the research? Are we at that point? We can confidently and honestly tell people, hey, just take this test, get your result. And here's your personalized plan that's going to be far superior to any cookie cutter thing anybody wants to give to you. I personally think that we're not there yet. I think that results and research are very

Starting point is 00:25:00 exciting, very, very interesting. And I think in the following years, probably within five, exciting, very interesting. And I think in the following years, probably within five, 10 years, hopefully, we are going to get there. But right now, I cannot say with certainty that we are there. And I cannot say that the benefits are going to be enough to compensate the cost. And I do know that there's at least a company that does this, that analyzes the gut microbiome. And based on this machine learning algorithm that was created by a scientist, they prescribe some sort of diet. But I personally think that there's a lot that needs to be done before we get to the point of personalized nutrition. And based on where we're at right now, are there any interesting piece of advice that you could share to people to help? Because where this discussion, kind of the

Starting point is 00:25:53 next phase of it is, all right, so we understand now some direct and indirect ways that our microbiome can influence our body composition. Most people listening now are probably wondering, okay, so how do I influence my microbiome in a way that positively influences my body composition? And so this concept of the microbiome diet, does there appear to be some universals that like these things tend to always work well from what we're seeing and then different categories of things with certain types of people and so forth? Yeah. So as you mentioned, there was a bi-directional communication between different categories of things with certain types of people and so forth? Yeah. So as you mentioned, there is a bidirectional communication between the gut and the human body. And so we want to keep our gut microbiome healthy so that it can

Starting point is 00:26:36 keep us healthy. The reason why I say healthy is because we have not yet defined what a healthy gut microbiome looks like. We have been able to show that a high alpha diversity is related with positive health outcomes. And we have been able to identify several probiotic bacteria and several potential next generation probiotics. However, there are still a lot of unknowns. And probably a healthy gut microbiome is not going to look in one way, but in hundreds or even thousands of different combinations. It's going to be extremely complex for us to get to define what a healthy gut microbiome looks like. I mean, ultimately, it's probably going to result in similar bottom line results that are maybe more

Starting point is 00:27:21 traditionally associated with good health, right? That you could detect in blood tests and so forth. Yes, exactly. And so exactly what you're saying, a lot of the recommendations to have a healthy gut microbiome are the same recommendations that we already knew we needed for our health. So for example, have high variety in your diet. That's extremely important to have a healthy gut microbiome. And I know that's extremely difficult for people who do meal prep, but somehow we need to be creative into adding variety into our diet so that we can feed different bacteria, different species of bacteria. And can you speak a little bit more to that point? Because people hear that, you know, maybe they've heard like, oh, eat the rainbow or just eat a variety of foods. But I just know because people have reached out to me asking for something a bit more prescriptive, you know, like, OK, what does that mean exactly?

Starting point is 00:28:13 Yeah. So we just want to have a high variety. And that is just what it sounds. I mean, you don't want to have either a carnivore diet or a ketogenic diet. have either a carnivore diet or a ketogenic diet. You want to have all the groups and you want to have a high variety, not always in the same vegetable or the same fruit. You want to vary because all of these different fruits and vegetables have different molecules. Yeah, you call it fiber, but not all the fibers are created equal and they feed different bacteria in our gut depending on the molecular configuration. And so you need to vary. So there's no need for us to stress about which enzyme and

Starting point is 00:28:52 which bacteria species digest every molecule, but you can ensure that just by having high variety in your diet and don't eliminate any macronutrient, I would say. And so if I'm hearing you, then you're referring to not just a variety of fruits and vegetables, which is what people have often heard, but also a variety of foods, different types of proteins. So have some dairy and have legumes and seeds and have different types of whole grains. Yes. And I have liked on process because there has been very new research showing how emulsifiers, for example, have a very detrimental effect in our gut. Emulsifiers are used to basically create a solution from a liquid and a solid state, if that makes sense.

Starting point is 00:29:38 So like it is used in mayonnaise, in butter, in ice cream. Isn't it to like suspend molecules in or am i am i wrong in my definition yeah so you you want to prevent the separation of the liquid and the solid phase and it and this emulsifier helps the kind of the the merging of both if that makes sense because there are like phospholipids and whatnot so they have a polar and a lipid part basically. So that helps with the dissolving. And colorants, for example, also have a negative effect in the gut microbiome. And so you want to try to consume unprocessed foods and just add high variety. Now with regards to other things we can do to help the gut microbiome or physical activity, we still don't

Starting point is 00:30:24 know with certainty if there's a difference in the effect of doing strength exercise versus cardio. So I think a lot more research needs to be done in that area so that we can better understand if they influence the gut microbiome differently. But doing exercise as a whole and sleeping is important as well. Just trying to keep the circadian rhythm. And by that, I mean not only your sleep, but also your meals. You want to try to keep your meals in the day, not at night. And try to prevent the consumption of antibiotics unless it's really necessary,

Starting point is 00:30:58 because antibiotics are going to delete not only the bad bacteria, but also the good bacteria. And that is going to allow for the arrival of and colonization of potential pathogenic bacteria. So the way how it works in our intestine is that we, let's think of the intestine as a community, right? So every bacteria has their own house. And when pathogenic bacteria comes there, they cannot get into a house that is occupied. And so they cannot infect. Maybe they find a house or two, they can stay there, but that doesn't mean that it's going to cause an infection. That's why you hear, oh yeah, that, I mean, you can have, for example,

Starting point is 00:31:36 Helicobacter pylori or Clostridium difficile, yet not have an infection because you have it in very small amounts. And that is because you have all the houses occupied. But when you consume antibiotics, you eradicate the good bacteria, you empty the houses. And so now they can grow, they can cause infection. So yeah, you're probably treating an infection, but you might end up with a worse infection. So you just want to be careful when you take an antibiotic, not take it just because there's a little cough. Yeah. Many people over the years have been a little bit alarmed at how eager they are to just take an antibiotic or give an antibiotic to their kid when the kid just has a cold even. Like, oh, take him to the doctor. The doctor does antibiotic, give him the antibiotic. It's a cold.

Starting point is 00:32:22 Kids get colds. What are you doing? Yeah, exactly. And what is very concerning right now is that we are presenting every time more antibiotic resistance. So the bacteria are creating mechanisms to prevent being killed by our antibiotics. And we're not developing new antibiotics. And so that is extremely concerning for humans. There is, however, the development, development, several labs around the world are working in development of phages, so bacteriophages, which are viruses that can target specific bacteria.

Starting point is 00:32:52 And this is great because what that means is that they're going to create viruses that are going to attack specifically Clostridium difficilei or a specific strain of helicobacter pylori rather than attacking your whole commensal bacteria. And so we are going to get there hopefully within the following years. But going back to what I was telling you, so other things that can affect the composition of your gut microbiome is hygiene. So I know for many years, infections were one of the first three causes of that, and it still is in some countries. And so we have been moving slowly to being every time more hygienic. And that is a problem because both extremes are a problem. You want to stay somewhere in the middle.

Starting point is 00:33:40 That's like a plot twist. People are thinking like, okay, very hygienic, very good. Like, wait, what? Did I just hear you right? Yeah. Unfortunately, that is not the middle. That's like, it's like a plot twist. People are thinking like, okay, very hygienic, very good. Like, wait, what did I just hear? You're right. Yeah. Unfortunately that is not the case. So you don't want to be very hygienic to the extent that is going to affect the composition of bacteria and the number of bacteria you have in your skin, in your lungs, in the gut, et cetera. Can you explain a little bit more what that means? Like practically speaking, because also when people think of hygiene, they just think of cleaning themselves and not being stinky and gross. So, for example, a lot of parents are very, very careful with their kids.

Starting point is 00:34:18 They don't want the kids to get and play with the dirt or they don't want the kids to touch pets. And that is actually very helpful for the kids, not only for the gut microbiome, but for the correct activation of the immune system. And so I'm not a person that has pets inside the house. I don't like it, but if I ever have a kid, you bet I'm going to find a way to get him or her in contact with a pet and to allow them to play in the third and whatnot because that helps them with the correct activation of the immune system and the correct colonization of the gut microbiome so those things is is what i'm talking about maybe not being crazy about having the cleaning them every second and that apply to adults too like one of the guys who works with me, he he has a compulsion to clean it. He probably washes his hands like 30 times a day, probably. Yeah. So, you know, it's very difficult for me to come here and after COVID say, oh, don't don't use, you know, alcohol or don't use

Starting point is 00:35:19 antibacterial or whatever to wash your hands. But you just want to be mindful of when you actually need it and when you don't, when you're being a little bit too extreme. So that is going to look different for different people. And we don't know how that middle ground looks like, but we do know that being too hygienic is detrimental. And potentially all this hygiene that we just went through in these last years is going to have an effect, particularly in those kids younger than three years old, because that's when you are basically setting up your gut microbiome that is going to live with you the rest of your life. So yeah, you can do small changes to it, but around 60%, if not more of the gut microbiome that you establish in those first three years of age is going to remain with you the rest

Starting point is 00:36:03 of your life. Wow. I didn't know that. Can you speak briefly to what are some of the negative consequences of excessive hygiene in the context of what you just explained? Yeah, so excessive hygiene would just mean that you're not in touch with different bacteria. And so perhaps I can either keep a low level of bacteria in your skin, in your gut,

Starting point is 00:36:27 and a lot of the bacteria, most of the bacteria are not harmful. They can just get and colonize our gut and have some sort of function. And it also helps with the correct activation of the immune system. So what we know, for example, is that, just to give you an example, with babies, when babies are born through C-section, everything's extremely hygienic. And so the babies don't get in touch with the bacteria that moms have, for example, in the vagina or, I don't know, it's just very hygienic, right? And so when there's the natural delivery, the baby's getting touched with all those bacteria. And that helps with the setting up the gut microbiome of the baby.

Starting point is 00:37:13 And even when, what research has shown is that even when the babies are breastfed for six months to a year, if that baby was born through C-section, breastfeeding them is not going to fully correct the damage created by C-section. So you want to do both. You want to try to have natural delivery and then breastfeed. However, it's important to know that doing breastfeeding is not going to fully prevent the damage created by C-section. And that's a way for me to explain to you, okay, this is a very hygienic condition and this is a non-so-hygienic condition, yet we need it in order for our immune system to

Starting point is 00:37:50 be active. What we have seen in research is that babies that are born through C-section, they're more likely to have, for example, obesity, diabetes, autism, and even psychological problems and autoimmune diseases. Yeah, I was going to ask that because you have so many more problems now, allergies and so forth in young kids. Yes, yes. And that is because either one of these things that I just mentioned

Starting point is 00:38:14 did not happen when we were born or extremely hygienic mom, you know, that you think you are doing the best for your kid, but you're really harming them. What are your thoughts on, I'll let you decide how extensively you want to answer it, but there's this ongoing controversy about artificial sweeteners and the microbiome. What are your thoughts based on your understanding? Look, up to one or two years ago, the evidence in non-artificial sweeteners was mostly based on animal research and using very high doses. So it was not really something applicable to humans.

Starting point is 00:38:53 Yeah. And that's often what you saw on social media, people dismissing it for that reason, saying, oh, yeah, well, that's the equivalent of drinking like a dump truck worth of Diet Coke a day. So who cares? like a dump truck worth of Diet Coke a day, so who cares? Yes. There was recently a study in humans using a smaller dose, or I will say a real-life dose, which was basically six packages of either saccharin, Splenda, stevia, aspartame, or glucose. And they had another control group. So they have 20 participants per each of these

Starting point is 00:39:26 groups. And they provided the non-artificial sweeteners, six of those packages. So like two in the morning, two in the afternoon, two at night for two weeks. It was just for two weeks. And what they measured was, it was postprandial glucose tolerance test and insulin concentration. And they also measured the gut microbiome. So basically what they were able to see is that Splenda and Cycorin, these two, increased the glucose tolerance test. However, they did not increase insulin. However, they did not increase insulin. The ones that increased insulin was stevia and glucose, which was a little bit off because usually what you see is an increase in glucose and an increase in insulin in the same ones.

Starting point is 00:40:15 But it was a little bit weird that this happened. And they were able to see that not everyone responded in the same way. So again, there are differences and these differences are based on the gut microbiome. So there were some people, and I think it was like 60 and 40% or something like that, that responded in a favorable and unfavorable way to the same artificial sweetener. And again, by analyzing the baseline gut microbiome, they were able to predict how a person was going to respond, whether that artificial sweetener was going to be neutral for them or whether it was going to have some sort of effect.

Starting point is 00:40:51 So we cannot do a general statement again because for some people it might be detrimental, for some people it might not. Also, perhaps eating one or two or three even per day might not be a problem, but we don't know that for sure. And there is a big limitation though in this study that I would like to address. And that is that usually artificial sweeteners are very sweet, like several hundreds or thousands of times sweetener that glucose. And so companies have to use a very small amount and they use another powder to dissolve it. So usually the other powder they use to dissolve it is some sort of carbohydrate. And so the packages that you see of Splenda is like a very small percentage of actual Splenda. And there's, I'm sorry, I'm using a brand, Sucralose.

Starting point is 00:41:39 So there's a very small amount of Sucralose and the majority of the other powder is actually maltodextrin, for example. And one of the big limitations is that you don't know if that increase in, for example, postprandial glucose is caused by the carbohydrate itself and not the actual non-artificial sweetener, because there's evidence showing that when that non-artificial sweetener is not dissolving with a carbohydrate, it doesn't cause that glycemic response. To me, that is concerning. And I wouldn't do a statement until we see that effect without dissolving the non-artificial sweetener in some sort of carbohydrate, if that makes sense. Now, that's the way how we find it in the supermarket. So I can see how they just went ahead and did the experiment that way. But it is true as supermarket. So I can see how they just went ahead and did experiment that way.

Starting point is 00:42:26 But it is true as well that we can just see that non-artificial sweeteners are added to, for example, soft drinks or bubble gums or something like that without the need of having to add carbohydrates. Because not always we consume non-artificial sweeteners in this package's presentation. Yeah, yeah. And that would, though, be separate from potential impacts on the microbiome, right? Meaning that the glucose response and the insulin response is one thing, but then how it may impact or not impact the microbiome would be another consideration. Yes, it does seem to impact the gut microbiome. And based on the gut microbiome, we can predict what person was going to respond in one way or another.

Starting point is 00:43:10 And in the cases where it has a negative impact, is there something else happening in the microbiome? Like some people will say, for example, that it can kill good bacteria or it can help bad bacteria gain more purchase in your microbiome? Some people make these claims. I believe that this study is when they found a significant increment in flavonoid-consuming bacteria. And it has a different name, but basically what they do is degrade flavonoids. But basically what they do is degrade flavonoids. And so by supplementing with flavonoids, you can potentially reverse that effect. But I'm not 100% sure if this is a study or if it's a different one. It's from the same research group.

Starting point is 00:43:57 Yeah, I understand. And you're going off memory. I can't remember with 100% certainty. But more than likely, it's an effect in the gold microbiome. And if we are seeing, for example, a change in a bacteria, potentially we can supplement either the bacteria or we can use, for example, bacteriophages to kill a specific bacteria that potentially could be causing that glucose intolerance. Or skip the energy drink or diet soda. That's also an option. As well, as well.

Starting point is 00:44:28 But, you know, whether that is better than consuming sugar, I don't know. I mean, if you're going to stop consuming the Diet Coke to drink water, go for it. If you can do that change, go for it. But if you're going to stop consuming the Diet Coke to go into regular sugar, like, I don't know. I don't think we have evidence to support that action.

Starting point is 00:44:47 Yeah, agreed. Agreed. I want to come back briefly to the different types of foods, eating a variety of foods. I'm just curious, are there any foods that, in your opinion, do appear to be especially beneficial for most people or likely all people? If people want to, if they're just wondering like are there a couple things i could just make sure i'm eating every day that seem to pack a lot of

Starting point is 00:45:10 microbiome punch to so to speak so we do know that for example fructooligosaccharides oligosaccharides are pretty good for the gut microbiome and you can find them for example in onions and garlic asparagus bananas green bananas particularly oligosaccharides, for example, in onions and garlic and asparagus, bananas, green bananas, particularly oligosaccharides. And for example, in yogurt, fermented yogurt. I mean, that has the leaf bacterias. Kefir, if I'm pronouncing that correctly. Yes. Fermented foods are also extremely good for the gut microbiome.

Starting point is 00:45:41 And they actually, there are some studies showing that they actually have a stronger effect than consuming high amounts of fiber. So you do want to include fermented foods in your diet. And there are different presentations. So you can just try to choose the one you like. Not everyone likes fermented foods, but you can just try different ones,

Starting point is 00:46:01 different presentations. I mean, you can also, so my brother, he gets this kefir i might i think i'm pronouncing it correctly and and i think he only has i think it's like four ounces a day or something like that and i've tried it and it doesn't taste good but who cares it's four ounces you just drink it just like yeah exactly so there are different presentations of these products and i hope that in the future we can have more presentations of fermented foods.

Starting point is 00:46:28 But ideally, you want to do a combination of high-fiber diet plus fermented foods. Great. And can you comment on probiotics, another just controversial topic whenever microbiome is discussed? microbiome is discussed? Yes. So a lot of people ask me if they should consume probiotic just because or to keep a healthy diet or a healthy state. And the reality is that if you have a healthy gut microbiome, there might not be a need for you to consume any probiotic. And probably you don't want to consume them because that can change the composition of your gut microbiome. Now, something that is quite concerning and a lot of people don't know is that probiotics have a very transient effect in the gut microbiome. And what I mean by that is that usually the small benefits you will see are usually present only while you're taking the probiotic

Starting point is 00:47:26 and you stop seeing the benefit once you stop taking the probiotic. And in part that is because a lot of people are not thinking about consuming a healthy diet that will nourish that probiotic. And so they just take the probiotic and continue with their Western diet and they don't see that

Starting point is 00:47:44 that is not gonna feed the probiotic. Just dump it into the cesspit and then it gets eliminated. Exactly. And so you want to be mindful of that. But also, as I was telling you, with the houses for each bacteria, what we have learned in science is that perhaps we need to do a little bit of an antibiotic intervention and then a probiotic in order to have spaces for the probiotic to get there and colonize. Because otherwise, this niche or niches, however you want to pronounce it, of spaces for each bacteria are going to be occupied and the probiotic is not going to be able to stay there.

Starting point is 00:48:22 Basically, commensal bacteria are not very welcoming, even if you are a probiotic. And so what we have seen, even for fecal microbial transplants, when we do fecal microbial transplants, you have to do an antibiotic first to get rid of the bacteria that is there because it's causing a disease or because the person has a very bad infection. And then you want to give the fecal microbial transplant so that the houses are pretty much empty and then you can colonize. So this is called colonization resistance. So colonization resistance is present

Starting point is 00:48:55 because the houses are occupied, so the space is occupied. And by that, I not only mean the physical space, but the nutrients they get, the metals they are utilizing because they utilize metals, the oxygen they are utilizing, because they utilize metals, the oxygen. So all of that is like occupied already. There's not enough of that for all their new bacteria that get there. But also the bacteria that are there, they produce

Starting point is 00:49:15 bacteriocins. So molecules that attack the other bacteria that are coming, and they also get in touch with the immune system. So the immune system attacks these bacteria. So there are different ways how they don't allow all their bacteria coming just to get there and colonize. We are learning that if we want, perhaps if we want probiotics or FMTs to be more successful and to have engraftment, we need to provide a little bit of antibiotics at the beginning. Now I'm not telling you, go ahead and take antibiotics and then take your probiotic. There's still a lot of research that needs to be done before we can get to that point. But when there's a disease, for example, Clostridium difficile, I don't know if you have heard about it, but it causes around 15,000 deaths in the United States alone every year. So it's a bacterial infection that

Starting point is 00:50:05 causes very bad diarrhea, and sometimes it is antibiotic resistant. And so it is the only clinical condition for which fecal transplants are approved by the FDA to be performed in a clinical setting. And they have a success of 90-something percent. So it's a crazy success that you cannot get with a combination of antibiotics. And that is because you give antibiotics first and then the fecal transplant from a healthy human and then the person recovers. But going back to the probiotics, I think there's a lot that we need to do in order to improve the current probiotics we have. Because usually in the market, we have either one species to 12 species per probiotic, and we have hundreds of species in our gut.

Starting point is 00:50:50 So considering that the stronger indicator we have of a healthy gut microbiome is high diversity, you want to have also high diversity in the probiotic you're taking, and also high concentration. One million is not going to cut it, and it's not going to do anything to your gut. So there was actually a couple of months

Starting point is 00:51:10 probiotic approved by the FDA. And this probiotic is based on fecal microbial transplants. So basically healthy donors provided bacteria and the capsules are now, I believe they are already on sale, but it's the first one approved by the FDA. And that is where I can see the future going. It would be gross to receive a fecal transplant, like nasogastric, having to be, you know, anesthesia and everything to be able to receive a fecal transplant that way or colonoscopy or something. That's why, so these

Starting point is 00:51:41 are poop pills. I'm hearing you right, right? Oh yeah. But it has to be from the right donor. It has to be from the right person. I know he's very gross and I hope people are not eating while they are listening to the podcast, but... Eat your vegetables or you might have to be

Starting point is 00:51:57 taking poop pills one day. So you can choose. You can have the spinach or you can swallow poop pills. Yeah. So we are now discovering what we call next generation probiotics. And next generation probiotics are probiotics that have shown to have either a stronger role than the probiotics we have identified so far.

Starting point is 00:52:18 So the probiotics we usually hear about are different species from lactobacillus or bifidobacteria. Now, next-generation probiotics are none of these, and they have shown stronger effects in our body. For example, Acromantia mucinifola or Fecalobacterium persnitzii. These are anaerobic bacterial species that have shown very positive effects and very strong effects in the human body. And for example, Acromantia mucinifola has been associated with better body composition. And so for example, when a person has higher Ackermansia musinifola at baseline before a diet, they lose more weight. And higher concentration of Ackermansia musinifola protects animals from high fat diet induced obesity and supplementation in humans also has

Starting point is 00:53:03 shown some benefits at the body composition level. So in other words, I think we're moving there. But to my knowledge, there's only one supplement that has Saccharomyces mucinifola. There's none that has Speculobacterium prosnitzi. Why? Because they are anaerobic bacteria. So they get in contact with oxygen, they die. So they need to be produced in a quite complex way. They have to

Starting point is 00:53:26 be, I think the process is called leophilization. And so they need a different process in order for them to be produced. And also next generation probiotics involve microorganisms and bacteria that have been genetically modified to exert a specific action. And I think that is going to be very beneficial for us. For example, if you're lactose intolerant, well, we can just create a bacteria that can help you break down lactose and problem solved. Or if you are not capable of activating, for example, a specific molecule in chemotherapy, for example. Well, you can have a specific bacteria that can help us process that. And so the current probiotics, they can be used, but there are limited effects that have been shown because of the transient effect and the need to continue

Starting point is 00:54:16 taking it to see the effect. And I think we're moving in the right direction with next generation probiotics. Now, can they make you lose weight? The evidence says that no, apparently not. I mean, you're going to see probably one or two studies that show a small effect, one or two studies that show weight gain, and a couple of studies that show nothing. And so as you can see, the evidence is pointing in all directions because different effects are going to be noticed based on the strains and species used, based on the concentration, based on the person receiving it. And what we know is just like it happens with diet and exercise, your baseline gold microbiome is going to predict whether you reject or not the probiotic you are consuming. So in the future, that also will have to be

Starting point is 00:55:02 personalized. Yeah, your friend, possibly colleague, actually, Dr. Grant Tinsley worked on a probiotic supplement for my sports nutrition company, Legion. And so he went through and it was interesting to learn about a lot of what you explained and getting very specific on the strains. And so there are several patented strains that I give him all the credit that he wanted for very specific reasons and similar strains. It had to be this specific patented strain and this is why, and it had to be this combination together. And this is why if we can't do that, it doesn't work. Now, fortunately we were able to do it, but I knew going into it that

Starting point is 00:55:42 your typical off the shelf-shelf probiotic that you might just pick up at Whole Foods is, in my opinion, almost certainly not going to help most people with anything. Yes. And you want to be very specific. So if you see in a scientific study that a specific supplement was good for chronic constipation or for IBS or IBD or colitis, you want to prescribe the same specific species and try to provide the same dose, the same length of intervention, because otherwise, I mean, they perform different actions. So it's just like taking a medication for cholesterol when what you have is high blood pressure. You know, it's just like that. You have to be very specific imitating what you

Starting point is 00:56:25 can see in the scientific article. And I'm curious, has Grant finished the study? They found something interesting? Oh, so this was more desk research. So he was formulating. So he was going through existing research and the formulation. Yeah, I'll send it to you. You can check it out. Would love to hear your thoughts. But it was very much that process what you're describing is being very specific very specific amounts like you said like it needs to have billions of these little guys in here uh not millions and there needs to be a certain you know where there are three and then yeah so three specific ones that were chosen. And they were chosen for specific reasons,

Starting point is 00:57:09 and they go together and so forth. Well, this was very informative. Those were all the main questions that I had. Is there anything that I should have asked or anything that is still kind of in the back of your mind that you feel you should mention before we wrap up? I don't think so. I thought of something, actually.

Starting point is 00:57:27 I thought of one final question, actually, that occurs to me is, so if somebody has, through just poor lifestyle, bad diet, have not been exercising, they have not been healthy, they haven't taken care of themselves, their microbiome is not in a great state either. You had mentioned that you can get into a situation where most of the houses are occupied and they're occupied by, in this case, delinquents by bacteria that are having negative effects. So practically speaking, to get them to a better state, obviously you said like, don't just go take an antibiotic and then take probiotics. That's not what you're recommending, of course. I'm assuming though that

Starting point is 00:58:09 through consistency of the things you've talked about, that in time, your body will be able to modify your microbiome positively. You just have to stick with it or do you have something else to to say about that yeah probably and and we don't know these research because usually we we try to well not always but either we recruit a person with a healthy person or a person with obesity and other comorbidities and whatnot so it's difficult for me to do a generalization, but perhaps if they have low diversity, low richness, that there are empty houses, perhaps it will be good for them to consume, for example, a probiotic that would have those spaces

Starting point is 00:58:56 colonized by bacteria that we know are not going to be harmful for them instead of having the empty spots that can be occupied by potential autogenic bacteria. Now, there's debate as to whether or not we should consume a probiotic when taking an antibiotic. And my personal point of view, and not everyone agrees on this, is that you should take a

Starting point is 00:59:20 probiotic when you are taking an antibiotic. Even when this can slightly modify or delay the gold microbiome going back to where it was pre-antibiotic. And the reason for that is that, as I mentioned, when you consume the antibiotic, you eradicate good and bad bacteria. So you can have a potential pathogenic bacteria causing an infection after whatever infection you were fighting. And you want to try to avoid that. So probiotics, when taken, antibiotics have shown to reduce most of the symptomatology, such as diarrhea, bloating and gases, nausea, all of that.

Starting point is 00:59:58 But also when you consume both probiotics and antibiotics simultaneously to fight an infection, the success of eradication is higher. So like if you are dealing against Clostridium difficile infection or Helicobacter pylori or some other sort of infection, if you're consuming both simultaneously, the success rate is higher. And there are also studies that have shown that by consuming the probiotic while taking antibiotic, the potential development of antibiotic-resistant bacteria is going to be also lower. I would say that in those cases, I would personally recommend to consume a probiotic when taking the antibiotic,

Starting point is 01:00:36 especially considering that, as you mentioned, 74% of the population in the United States has either overweight or obesity. Even when you are eradicating a good part of the bacteria, it would be probably a good idea to try to replace them with healthier versions. Yeah, that's interesting and kind of counterintuitive because you could assume, well, isn't the antibiotic just going to kill all the good bacteria as well? But clearly it doesn't work exactly like that. It doesn't kill all of them. And so what you're trying to do is you're trying to replenish as many houses as possible

Starting point is 01:01:12 while the antibiotic is doing its action. And you might kill as well some of the probiotics you're taking. But that's why usually when you take the probiotic, you continue taking it for at least two weeks after you stop the antibiotic. Yeah, that makes sense. And I don't think I asked my question clearly enough. What I was referring to is, okay, so you have somebody and they're overweight and they've done various things that have put their microbiome into a not so great place. They want to make some changes. So they start following the various advice that you've shared

Starting point is 01:01:45 in this podcast. So they're eating better now and they're doing their exercise and so forth. They're getting better sleep. And how much can those things influence the microbiome to what degree? Because you had mentioned earlier that the first couple of years are very important and there seems to be an immutability to the microbiome to some degree. So do those people have a generally positive prognosis, so to speak, where if they're doing the right lifestyle things for long enough, then can that significantly improve the makeup of their microbiome or not? Or if you screw it up too much, it actually is very difficult to fix.

Starting point is 01:02:28 I don't think we have a very concrete answer to your question, which is a very good question, but I can tell you that based on research, it takes a lot longer to recover the gut microbiome composition than what it took to get you there. And this is based on animal research, but I think my hypothesis is that pretty much the same will apply to humans, although it needs to be replicated in humans.

Starting point is 01:02:53 So basically, when you have mice in diet-induced obesity, the gut microbiome changes negatively, right? And then when you put the mice into a hypogalamic diet the gut microbiome get affected but a little bit so basically everything goes back to normal all the glucose insulin cholesterol triglycerides pressure everything goes back to normal but the gut microbiome is not comparable to the control group and and it is also not comparable to what they had when they had obesity. It remains in something called like intermediate state. So in the middle.

Starting point is 01:03:29 And so when that person is exposed to an obesogenic environment, that microbiome is going to make the person gain more weight than what they had initially. And that's one of the causes of weight regain. And what this study showed is that you can cure that gut microbiome. Basically, you can treat that gut microbiome once you have lost weight, but it takes five times longer than what it took you to change your gut microbiome during the hypocaloric diet. So basically, for the mice, it took two weeks.

Starting point is 01:04:01 Well, multiply that by five, and that is what you are supposed to continue keeping the healthy habits in order for the gold macron to go back and be similar to the control group if that makes sense so i would say for humans it might be something similar in which you want to keep for a long period of time your healthy habits hopefully for the rest of your life so that you can enjoy of of the benefits. That's just a good point because body composition, you can change quickly if you know what you're doing. If you just understand how to manage your calories and get on with it, you can gain a lot of weight and then you can just lose a lot of weight. But then if I'm hearing you correctly, with yo-yo dieting or also the quality of the diet where it's really good for a little bit

Starting point is 01:04:46 and then it's really bad for a period of time that unfortunately, if I'm hearing you right, that the things that we do that negatively impact our microbiome can take a lot longer to undo. Yes. So precisely this study was made to analyze the effect of yo-yo dieting. So the mice were put into like hypocaloric diets and hypercaloric diets. And what they saw is that they were worse than the group that was taking just hypocaloric diets all continuously. And so we know, metabolically speaking, that some things happen when you're in a hypocaloric diet. You lose muscle mass, your base metabolic

Starting point is 01:05:25 rate decreases, need decreases, T3, T4 decreases. So all of those things happen, but also it seems that some changes in your gut microbiome also help you with the weight regain. It's important for us to consider all those things and also consider that you don't want to be doing a diet that you cannot follow for a long period of time because that might be detrimental yeah yeah i think of some research on settling points and i'm sure that this there's some interaction here i'm sure with with people you know with just body weights and body well it's ranges of body weights that they just tend to be drawn to or tend to settle in. And I do believe that that tends to happen. And one of the things that has shown to reset that body weight set point are bariatric surgeries. And that's why they are a lot more successful. So when you do a diet alone, usually

Starting point is 01:06:20 people, 80% of people that lose weight tend to regain it back within five years, whereas a bariatric surgery is you have 20% of weight loss is still present at 20 years after the bariatric surgery. And that's because there's a reset in the body weight performed by, you know, changes in absorption and also in the production of hunger, satiety hormones, et cetera. also in the production of hunger, satiety, hormones, etc. Yeah, yeah. Unfortunately, it's a very invasive intervention. And so, you know.

Starting point is 01:06:51 Yes, yes, it is. It is. And obviously, you want the person first to try to do lifestyle intervention and to stick with it. Yeah, yeah. Well, this was a great discussion. At least I really appreciate, again, you taking the time. And why don't we wrap up with if people, if they want to maybe learn about your work

Starting point is 01:07:09 or read some of your research, or I actually, I didn't look if you're on social media, if you want to share. Yeah, I try sometimes to, I'm not super active, but I try to. I understand. Yeah, I have an Instagram account I believe it's elisa underscore marroquin underscore phd so you will spell it e-l-i-s-a underscore m-a-r-r-o-q-u-i-n

Starting point is 01:07:40 underscore phd so it's a long one sorry and there will be a link also in the show notes, but for people who are listening. And Twitter as well. And Twitter is Elisa underscore M-M underscore PhD. Okay, great. Well, thanks again for taking the time. This was a fun discussion. I enjoyed it.

Starting point is 01:07:59 Thank you. Thank you for inviting me. Well, I hope you liked this episode. I hope you for inviting me. who may like it just as much as you. And if you didn't like something about this episode or about the show in general, or if you have ideas or suggestions or just feedback to share, shoot me an email, mike at muscleforlife.com,

Starting point is 01:08:34 muscleforlife.com, and let me know what I could do better or just what your thoughts are about maybe what you'd like to see me do in the future. I read everything myself. I'm always looking for new ideas and constructive feedback. So thanks again for listening to this episode and I hope to hear from you soon.

Muscle for Life with Mike Matthews - Elisa Marroquin on Gut Health and Body Composition

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