The Food Medic - S8 E6: The power of fibre and the fibre paradox with Dr B

Episode Date: August 4, 2022

In this episode Dr Hazel is joined by Dr Will Bulsiewicz (or "Dr. B") to chat about fibre, bloating and the key to optimising your gut health.Dr. Will Bulsiewicz is an award winning gastroenterologist, internationally recognized gut health expert and the New York Times-bestselling author of Fiber Fueled and The Fiber Fueled Cookbook. This episode covers:*Fibre and the fibre paradox*30 plant points per week and how to get there*signs your gut is not in a healthy place*bloating and constipation*probiotics - to use or not to use?*gluten free diets are harming your gutIf you loved this episode make sure to give it a review, rating (hopefully 5 stars) and share it with your friends and family. Thank you to our season sponsor WHOOP. Right now, you can get your first month free when you checkout through join.whoop.com/thefoodmedic@thefoodmedic / www.thefoodmedic.co.uk Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Life's a trip. Make the most of it at Best Western. Book, direct, and save at bestwestern.com. What's better than a well-marbled ribeye sizzling on the barbecue? A well-marbled ribeye sizzling on the barbecue that was carefully selected by an Instacart shopper and delivered to your door. A well-marbled ribeye you ordered without even leaving the kiddie pool. Whatever groceries your summer calls for, Instacart has you covered. Download the Instacart app and enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart, groceries that over-deliver. Hello and welcome back to another episode of the Food Medic Podcast. I'm your host, Dr. Hazel.

Today, I'm on my own in the studio, but I have a very special guest calling in from over the pond to chat to us all about bloating and gut health. Dr. Will Bulsiewicz, or Dr. B, is an award-winning gastroenterologist, internationally recognized gut health expert, and the New York Times bestselling author of Fiber Fueled and the Fiber Fueled Cookbook. You might know him as the gut health MD on Instagram. I hope you enjoy this episode as much as I loved speaking to Will and I hope it answers a few of your questions. Today's podcast is brought to you by our seasoned sponsor Whoop. Whoop 4.0 is a 24 7 digital fitness and health coach that provides actionable insights to help you recover faster, train smarter and sleep better. And unlike most other wearables in the sense that it doesn't just tell you what you've done,

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first month free when you check out through join.whoop.com slash thefoodmedic. Will, welcome to the Food Medic podcast. Oh, thank you, Hazel. Glad to be here. Very excited. I know. It's really nice to have you virtually with us in the studio. For people who don't know who you are, can you tell us a bit more about yourself and what you do? So I'm a US-based gastroenterologist. I am someone who, I didn't expect to be in the position that I'm a US-based gastroenterologist. I am someone who it's, I didn't expect to be in the position that I'm in now.

This was not a plan. This was not a goal of mine. And I'm a super goal-oriented person. Anyone who knows me really knows that. But about 10 years ago, I had a personal health crisis and I was, it didn't happen overnight. This is something that built over time.

Going through the rigorous training program that you and I have both been through to become medical doctors, I was forced to make compromises. And the spot where I made my probably biggest compromise was in terms of my diet. I was living off of fast food. And if it wasn't fast food, it was junk food. And it fit so perfectly in my life. It was cheap. I mean, I literally, I had no money. It was quick. It was easy. It tasted good. And I knew it wasn't healthy, but I also didn't think that I would pay a price. I kind of felt

invincible. And then this kind of slowly snowballed to where in my early 30s, it kind of feels like I woke up. I mean, it didn't come out of nowhere, but I feel like I woke up, and I'm looking at myself in the mirror, and there's this man who's 20 kilos overweight. I mean, that's hard for me to swallow. I was a high school athlete. There's a gut sagging over the belt. There's blood pressure pills on the sink. I'm depressed. I'm anxious. My career is actually taking off. I have no self-esteem. I have zero. And I knew that something needed to change. I tried to exercise my way out of it, thinking like if I work hard enough, then I can eat whatever I want. And that was a failure. I mean, I did get stronger and faster and things like that, but I did not lose this 50 pounds, this 20 kilo gut. And so my life changed when actually I met the person who's now my wife

and we have three kids together now, not expecting anything. We're just on a first date, but we're sitting there at this restaurant and she orders up things that are not like traditional food on the menu. She basically says like, let me just take three sides, you know, collard greens, mashed potatoes, black eyed peas, put this onto a plate for me, please. And it's like, who, who are you? Who is this person? Never been around anyone like this. This is like roughly 2012 and 2013 actually. And, um, but it, it opened my mind to the possibility that maybe food was my inherent issue because she looked amazing and she seemed to have her health completely aligned and it was effortless for her. And she had tons of energy and I was

exhausted and felt like I needed to go home as soon as we finished dinner because I was so tired. So anyway, the story of it is that I started with one small change. And one day, instead of picking up fast food for dinner, I went home and I pulled out the blender and I threw a bunch of stuff in there and I pressed the button and it turned into a smoothie and I drank it and I felt instantly energized. I felt great. And it was enough for me to want to feel that way again, because I had been feeling so unwell. So I came back and I did it again and again and again. And then I looked for, well, what's the next thing that I can do to sort of level up and get that, get sort of that, you know, increased energy that I'm looking for. And so this was just small changes over the course of time, over years that started adding up in my life. I got my health back completely. I feel younger in my 40s than I did in my early 30s.

I'm in the best shape of my life now. And the point of this, this is not intended in any way to be bragging. I come from a place of humility and being like, yo, I was 5% plant-based. But this is more to say that as a medical doctor, when you discover something that can transform your life like this, there's no turning back. Because when you sit down with people that you care about, your patients, and you look them in the eye, you know that you have something that could change their life. And to deny them that opportunity as a medical doctor would be wrong. And so it changed my medical practice.

And then I felt inspired to share the story. And it led to me starting social media and then subsequently getting a book deal. And now here we are, and you and I are hanging out. Amazing. What a story. At the time of you kind of transitioning into this healthier way of eating, had you already been on your training pathway to be a gastroenterologist or did that come after? but I don't know with sincerity. So in the US, I trained first as an internist. And I was actually board certified in internal medicine, I could have stopped my training at that point, I could have gone into practice. But I was actually moving into my specialty training. So at this time that

we're talking about 2012 2013, I was at the University of North Carolina. And I was in a combined epidemiology program because I actually was very interested in clinical research. So I was in a combined epidemiology program at the UNC School of Public Health along with my training in the hospital as a gastroenterologist. Amazing. You've written two books on fiber, which I'm assuming is your favorite nutrient. Why are you so passionate about fiber? Why is it so important? Well, if we're going to take on issues in popular books, they should be issues that really are not about

whether or not a book sells. It should be about whether or not you could change a person's life. And to do that, you have to identify something that is missing and introduce it or reintroduce it to that person. And right now, fiber is missing from both the American and the British diet. We are both wildly devoid in our intake of dietary fiber. Now, just to define this for people who are curious, like, what are you talking about dietary fiber, Dr. B? This is not, I'm not referring to the orange drink that grandma

would stir so that she could have a bowel movement. I'm talking about real food. And fiber is actually a carbohydrate. And you'll find it in plants. All plants have fibers. So fruits, vegetables, whole grains, seeds, nuts, and legumes. And by the way, mushrooms have fiber, which is kind of cool because mushrooms technically are not plants. They're actually fungi. But anyway, it's not really hard to find. It's just that we're not really eating this food. And when I look at the landscape, I mean, it's like fiber has this reputation of being boring. Gosh, that makes me very sad because we shouldn't look at something that could be life-changing as being boring.

And if you look at the data that's out there in terms of the clinical research, it's completely overwhelming. So as a matter of perspective, here's my favorite fiber study of all time, just so people hear this right up front. This was published by Professor Andrew Reynolds, and it was in the journal, The Lancet in 2019. And it was a systematic review and meta-analysis. So what he was doing is basically

systematically looking through all of the available studies and then pulling them in together and reanalyzing them as a package. And that way, we get the whole picture and we eliminate the bias. That way, people are not cherry picking the studies that say the fiber stinks and is worthless. Let's include those in there. And so when he pulled it all together, he had 130 million person years of data like we have only been on this planet for three million years as humans this is the entirety of human history more than 40 times over and what he discovered is that when people simply consume

more dietary fiber they reduce their likelihood of having a heart attack, their risk of dying of heart disease, their likelihood of being diagnosed with colon cancer, breast cancer, or esophageal cancer, their likelihood of dying of cancer, their likelihood of having a stroke, and their likelihood of being diagnosed with diabetes. These are four of the top 10 causes of death in both of our countries. And there's data for Alzheimer's disease. There's data for chronic kidney disease, for pneumonia, influenza, COVID-19, all with quite simply increasing the dietary fiber in our diet. And yet in the US, 95% of Americans are not just like kind of deficient.

They're wildly deficient in fiber. And in the UK, y'all are a little bit better than us. You guys are consistently better than us. We're finding that in microbiome research too. But in the UK, it's not like this is a radical difference. Probably 90% are deficient in fiber. So this is to me a, I don't want to go so far as to say public health emergency, but this is a public health opportunity. I don't understand why we haven't shifted gears

in terms of the conversation about why this is so important when if we could just get people to eat this way, we would make healthier populations and we would reduce our costs of healthcare. Yeah, absolutely. I think it's so important what you mentioned in our idea or understanding of fiber, you know, typically it was seen as this very boring, unsexy thing that only older people who have diverticulitis need to consider when it is more important for things beyond even our gut health and it's far reaching in terms of its benefits. So thank you for listing all of those benefits. It's so important. Like you said, it's such an opportunity for health promotion there. In the introduction to your book, you talk about the fiber paradox and I want to talk about

that a little bit and what you mean by that. Yeah. So fiber paradox, the thing about fiber, let's explore what happens when we consume dietary fiber. Let's just say we're eating a salad, right? And it's this variety of different plants and each one of those plants that has fiber as a part of it. You chew it, you swallow, it goes down. Well, it's actually going to pass through your esophagus, your stomach and your small

intestine and it's going to be completely unchanged. And the reason why is because we as humans actually lack the enzymes necessary to break down and process fiber, which is bizarre. We're so, first of all, egotistical. We think that we're like clearly the apex predators out there. Why would that be? Why would we not be able to process fiber? Well, the reason why is because our gut microbes are completely capable of processing and digesting fiber. In fact, they're more well-designed than we are to process and digest fiber because they're so adaptable. So as humans, you know, originated in Africa and spread out across the globe, they ran into different ecosystems and different environments and different foods.

And we needed an adaptable digestive system. And the gut microbes allowed us to be more adaptable than we could be as humans. So basically, we farmed this out. We allowed this other party, these gut microbes that are concentrated in our colon, 38 trillion of them. We allowed them to take up this act for us of breaking down and processing our fiber. And so fiber doesn't just come out the other end. Fiber is actually metabolized by these microbes. And in doing that, they are releasing what are the most anti-inflammatory molecules that exist, which are short chain fatty acids, or at least these are the most anti-inflammatory that I've ever come across, Hazel, in my 20 years of study in medicine. So the short chain fatty acids are butyrate, acetate, propionate, and these short chain

fatty acids have healing effects everywhere. So when I just listed all those benefits to fiber, if we looked under the hood, like why does fiber protect us from heart disease or cancer or stroke? I'm giving you the answer right now. Itation, you need these short-chain fatty acids. This is actually the way to heal the gut. We have clear research to say this, but the challenge for that person who struggles with these foods is that their gut microbiome is not in a good place. That's why they're struggling with these foods is that we as humans are not capable of processing the fiber. So we are 100% dependent on the gut microbes to do it for us. And what happens if the gut microbes are not in a good place?

What if they're hurt? What if they're struggling? This is the issue with the consumption of fiber, is that people who have the most damaged guts, they're going to struggle with dietary fiber. That's me being upfront and honest. I'm acknowledging that this is going to be a challenge. But the flip side is that this is what you actually need to heal and optimize your gut. So if you run away from fiber because it causes gas and bloating, you're not actually making

yourself more healthy. But if we could work through a process, which is what I'm all about, what is the process to actually bring fiber on board so that like, I'm not sitting here telling you to just inflict harm on your body. I'm saying this can be done in a systematic way to heal. And this is what you actually need fiber. So the fiber paradox is that the people who struggle with fiber the most are the ones who actually need it the most. Yeah, absolutely. And what is the process then? How do you start and how quickly do you go to avoid causing really kind of disruptive symptoms like gas and bloating and pain? so in my new book, the fiber fields cookbook, I laid out a step-by-step protocol for how to go about doing this. And it's called the growth strategy, G R O W T H. And I'll just kind of run through those letters real quick so that people can hear what it sounds like and kind

of process like how this might make sense. So G stands for Genesis, the first step in healing in all cases, whether it's someone who's, you know, with me or they're working with you, Hazel, or any medical encounter, whoever it may be. The first step needs to first, it has to always be, what are we trying to treat? G stands for Genesis. You have to start there, lean into that. Don't, don't start with the plan. Start with what are you trying to fix? And then you move into the next part, which is, can we understand where our food intolerances come from? There's no reliable blood test or poop test or any sort of test to tell us which foods we should and should not eat in terms of food

intolerances. What we need is we need a temporary elimination diet. So ROW are three letters that I pair together that effectively are the approach that you would take here to identify your food intolerances. Restrict, observe, work it back in. When you do that, restrict, observe, work it back in, then you are effectively able to identify, okay, like, do I struggle with garlic? Do I struggle with wheat? Do I struggle with fruit? And once you know which foods you struggle with,

then you work into T, train your gut. I'm going to talk about that more in a moment to answer your question. But the last letter might be my favorite letter, so I don't want to forget it, which is H stands for holistic healing. And this is my friendly reminder that this is not just biochemistry. You are not just digestive enzymes meeting carbohydrates, proteins, and fats. We are complex human beings. We are a complete human and our environment or how we feel affects our digestion. Holistic healing means going beyond the digestive system and looking

at the whole person to understand how to properly heal. So when we are trying to have a systematic approach to healing and not having those symptoms, Hazel, from fiber, we can use the growth strategy and ultimately we come to T, train your gut. And the idea here is very simple. If you take the food that you struggle with and you reduce the amount and you start low and then you go slow, you can escalate the amount of food over the course of time, and actually your body will become adapted to it. So it's much like exercise. If you go to the gym and you haven't been working out, don't start with the heaviest weight. Start with the lightest weight, and find out how much you're capable of

and then increase it from there. And as you increase it over time, every time you challenge your body, your body steps up and adapts to the challenge, becomes more capable. Your gut is no different. It can do the same thing. Absolutely. So I guess it's like the approach that we take with someone who has IBS and the low FODMAP diet. I think where like a lot of people go wrong is that they take out the foods, they reduce their symptoms, and then they're too fearful to reintroduce the foods. And if you're not working with someone who's a dietician or a nutritionist or specialist in that space, you end up carrying on with this very restrictive, low fiber diet out of fear of bringing those foods back in.

But what you're saying is you can retrain your gut to tolerate those foods. You can definitely retrain your gut to tolerate those foods, and you want those foods. There's a payoff that you receive when you bring those foods back, which is that not only do they contain fiber, but most of the FODMAPs, FODMAPs are the fermentable parts of our food that some people who have IBS, they will struggle with. Not only do you have the fiber, but the FODMAPs themselves are actually what we call prebiotic, meaning that they feed and fuel a healthier gut microbiome. And there's an important study that was done, Hazel, called the American Gut Project. And this is a study that you will hear myself and Megan Rossi and Tim Spector, Alan Desmond, we're all referring back to this study when we tell you that the key to gut health is diversity. It is a wider variety of plants. And that comes from the American Gut Project,

where what they discovered is that those who were eating 30 or more varieties of plants per week had the healthiest guts. The reason why is because it's not just grams of fiber. Every single plant is unique and has unique things to add in terms of your gut health. And so, you know, us collectively, us sort of gut health specialists and experts, myself, Megan Rossi, Tim Spector, Alan Desmond, we're pounding the drum on this concept simultaneously because we all know how important this is. And when we reduce the variety in our diet, such as going low FODMAP and staying low FODMAP or going gluten-free and staying gluten-free, unfortunately, what we see in our microbiome studies consistently is that you actually

are causing injury or harm to the microbiome because you're reducing the diversity within the microbiome yeah and i think i think the i love that study and i love that that message is getting out there but i do think that the target of 30 grams per day or 30 plant points across a week can sound like a lot for someone who may not be getting five portions of fruit and veg in their diet per day which I know includes a lot of people here in the UK and in the US. So what are your thoughts on how we can increase the amount of fiber in our diet, thinking not just as individuals, but maybe on a kind of national, international recommendations? How can we make it easy for people?

I think that what we do is we combine this new microbiome science with proper psychology and mindset science, and we merge them together. And so, yes, the rule is diversity is the direction that we want to go. Okay. And as you said, for a person who's not eating this way, this feels quite overwhelming for me to sit here and tell you that you have to eat 30 plants per week. Hold on. Let me revise this for you. You don't have to eat 30 plants per week. Instead, what we want to do is we want to get the proper orientation in terms of the direction that we're going to go, but we need to start with where we are right now. And we don't want to set expectations that are going to lead to disappointments. So instead, I embrace this idea of progress over perfection.

I was once 5% plant-based. It took me years to change my diet. I come from a place of humility when it comes to diet. This is not about you being perfect or you not being adequate enough. That is ridiculous. This is about meeting you where you are today and saying, what is something that we can do to just take one step in this direction this week? And it doesn't have to be 30. That to me is an unrealistic goal for many people.

But instead, the goal may be one meal, one meal that has, let's say, five different plants. And if you do that, you probably are going to feel really well after that meal. And it's going to excite you. And you're going to feel just like I did, that you're onto something. And then it's going to bring you back next week and you're going to want to do it again. And over time, you'll start to escalate. Next thing you know, you're going to be beyond 30 and not even thinking about it. Yeah. progress over perfection. I like it. I also liked how you mentioned in the beginning that when we talk about plants, which I think between like, you know,

within our circle, we kind of operate in this echo chamber and plants and plant points and things like that is just kind of common chat that we use. But for some people, it may seem like, what are you talking about when you mean plants? But you mean all forms of plant-based foods like fruits and vegetables, whole grains, cereals,

even herbs and spices. And I think once you expand our definition of what it is, it's actually a lot easier than you think. Yeah, I totally agree. And I think if I were to offer up an idea of how this can work, it would be that I want you to hear this podcast. I want you to hear me when you're in the supermarket or in the kitchen or at the dinner table, and you quite simply hear diversity of plants. And if you think that way, then there are going to be simple ways that you can amp your

plate or your dish up. So quick example, the other day, Hazel, it was dinner time. We have a brand new baby at home. Our daughter is nine weeks old. My wife was taking care of the baby. And it was one of these situations where it's like, oh, shoot, it's like 630. We don't have any food. and the other kids are hungry. So what are we going to do?

OK, we have pasta and we have sauce. Super easy. Dad can handle that. But what if you take that sauce and you view it as not just sauce, but an opportunity to increase the diversity of plants in this meal for both you and the kids. So I pulled my kids into the kitchen, my other two kids who are older, my daughter's eight, my son is five. And we started chopping up. It's just like whip open the refrigerator and see what's in there and start pulling stuff out. And if you think it makes sense in tomato

sauce, you do it. And so we threw in mushrooms, onions, garlic, zucchini, spinach. And then in the, we have a tower garden outside. So we got some basil and some fresh parsley. And the point is that this went from, you know, wheat and tomatoes, two points up to like instantly, it was like eight points, eight different plants. And it wasn't hard and it smelled amazing. It tasted amazing. And my kids were super excited to eat it because they were a part of it. So it's ideas like this that can really take you to a higher level where it's like, all it has to do is be something that it's in your mind, diversity of plants. Maybe it's adding more varieties of beans to your chili. Maybe it's something like that. Yeah. I love that. I also love the concept of like having a fruit or veg of the week

that you've never tried before. So when you go to the supermarket trying something new, whether it's in season or you're just going for a different color pepper or you get mixed nuts instead of just almonds and thinking about ways you can kind of use your usual shopping list and changing it ever so slightly. That's nice. I love that. So we talked loads about fiber. I love how passionate you are about fiber.

But and kind of how it might be difficult for someone who has maybe an unhealthy gut to get up to where we want to be in terms of our kind of targets for fiber. Let's kind of bring it back to basics. What are some signs that maybe you don't have a healthy gut? Well, this is me coming from the perspective of a gastroenterologist. So it's a little bit of have a hammer and see a nail thing. But from my perspective, when people struggle to process and digest their food, and it's not like a one-off thing. We all have bad moments. We all go out to a restaurant and come home and have some diarrhea once in a while. But when you are consistently having trouble where food is causing symptoms, gas, bloating, that's probably the most

common, discomfort, cramps, diarrhea, constipation, perhaps acid ref reflux I think this is where I would start because the vast majority of people where their gut microbiome is not in a good place they're going to experience these types of symptoms and the reason why is because going back to what we were discussing earlier we rely on our gut microbes so much to help us to process and break down our food that if they're not in a good place, then when we're going to process and break down our food, we're going to struggle. And that's the way that we manifest that struggle is through those symptoms. Now, there's no, just to be clear, there's no reliable like poop test that I would personally recommend from a clinical perspective to say my

gut is good or my gut is bad. I also don't think it's like a light switch type of thing, good or bad. I think it's like more like we're all unique. We have strengths, we have weaknesses. And for some people, they may have more things that they're struggling with in terms have weaknesses, and for some people they may have more things that they're struggling with in terms of weaknesses. But there's these other medical conditions that have been associated with a damaged gut. And the reason why this becomes very relevant is that these gut microbes are very much intertwined with human physiology, not just digestion, although that's sort of where i focus but they're also connected to our metabolism our immune system our hormones our mood our brain health um energy

levels so when we see people that have metabolic or immune mediated, meaning like allergic or autoimmune or hormonal or mood issues. You know, I don't want to go so far as to say like, oh, their problem is gut health. I think that's a bit excessive and hyperbolic, but part of the issue is probably their gut microbiome. And part of the opportunity in terms of healing is to turn your attention towards the gut. Because if you can lift up the gut and make them healthy, many times what we discover is that there's healing throughout the entire body because it's so connected to all these different facets of human health. I agree. a lot of people will then turn to things like supplementation um like probiotics and other supplements when it comes to healing the gut is this something how do you feel about probiotics in general like do you feel like it's very should be prescriptive for people in certain

scenarios or do you think it's something that everyone should be considering? I certainly would not go so far as to say that everyone should be considering. I think it would be inappropriate for me to dismiss them independent of the level of clinical research that's currently available. I do think we're sort of in an infancy, like an early stage of really understanding how to use these probiotics. And here's the challenge. This is the way that I see it. So I kind of alluded to this earlier, but our gut microbiome is completely unique, completely unique. There are 8 billion people on this planet. There are no two matches. You take identical twins and you will discover these identical twins that have literally the exact same genetic code, came from the same mother

and were raised in the same household. They only share about 35% of the same microbes. That's how different we are. And so when you take a probiotic, you are introducing living bacteria into this already very much established and very unique community that lives inside of you. And what you hope is that the new microbes will get on really well with your current state, like your current microbiome. But you don't know that until you try. And so I think that the point when it comes to, you know, for example, probiotics is that I have seen many people that they have really helped them. But could I have predicted that the probiotic was going to really help them?

And did I know exactly which probiotic was the right probiotic for them? I don't think that we're there yet. So we're stuck with this situation where there's an element of trial and error in terms of the use of the probiotics. We should be evidence-based. Probiotics that have evidence for a particular indication should be the ones that we use. I also think that we have been to some degree victim of the marketing hype that comes from the supplement industry. And it's not to say that supplements

don't work. That's not true. Supplements can work in many different situations, but there's a difference between like literally how they work and how well they work. And then what you hear from a for-profit industry that's trying to get you to open up your credit card, like, you know, pull out your credit card and send some money their way. So I'll put it this way. I don't believe that you could take a C minus gut and supplement your weight to an A plus. I don't think that's possible. I like that. If you took a C minus gut and you change your diet, change your lifestyle, that's the stuff that really makes a massive impact. You can get yourself perhaps to an A minus, and then maybe the supplements get you to an A or an A plus.

So food first approach? Absolutely. I like that. We mentioned bloating as a symptom of increasing fiber to, let's say, just say an untrained gut. But that's not the only reason why someone might experience bloating. And it's something that I'm asked a lot. It's something that's talked about a lot online. There's lots of different hacks, let's just say, for like beating, bloating and things like that. So let's just kind of set the record straight terms, we sort of use them interchangeably. I'm sure I'm guilty of doing this myself, to be honest with you. But we use terms like gas.

Gas is, you know, I guess in the UK you call it wind, but like we call it flatulence in the US. We have different terms for it. So there's gas and then there's bloating. Bloating is the feeling of like actually being full of gas and it's a sort of discomfort, not necessarily pain, but more of a discomfort. And then there's distension. Distension is when your belly is actually protuberant. And like for some people that have this on a sort of intense level, you find these guys that

they're like, I look like I'm pregnant at the end of the day and I'm a guy. It's not possible. And it's a distended belly filled with gas. So these are some of the terms that we would use. We all pass gas. I mean, that's just a part of human life. Where do we draw the line in terms of when the gas becomes problematic? Well, I would say that for the majority of people, you are the person who decides that. Because if this is negatively affecting your quality of life, this is where I would define it as a medical doctor. When gas or bloating or distention exist, they're a chronic problem, they keep occurring, and they are negatively

affecting your quality of life, then we have crossed the line because now we need to address this. I want to restore your quality of life. That's the goal. Gas and bloating is so common. It's a tricky, like Hazel, we could literally do at least an hour, probably more just on gas and bloating. But if I were to offer up a few suggestions in terms of what I think about, let me just kind of run through real quick some of the things that I'm thinking about as a gastroenterologist for a person who has gas. So going back to the growth strategy, the first letter is G, Genesis. What is the root cause?

We should always start there. Don't assume. Lean into finding an understanding of what is causing your issue because once you understand the issue, then you will really be able to make a targeted strategy to fix it. The number one cause of gas and bloating that I've come across in my experience is constipation. And it surprises people because many of them don't believe that they're constipated because they may poop every day. Whoa, how is that possible? Dr. B, you're crazy. Well, constipation is not defined exclusively by how often you go. I mean, I will say like, if you go once every, you know, seven

days, you're definitely constipated, but there are people who go every day. And the reason that I would define them as being constipated is that they're not adequately emptying. And if you're not adequately, adequately emptying your bowels, then you may be backing up. And so these are people who often struggle to go, or they go once and then they go again 45 minutes later, or they don't feel like they really emptied. They're straining in some cases. And so if this is the case, what I discover, and this is something for the listener, for everyone who's listening to us right now at home, like think about this for yourself. What I discover is that if they have a good, like one of those good bowel movements where they just feel like it was great, they notice that their gas and bloating goes away at least for a few hours.

So if in that person, we could get their bowels moving more efficiently and get them into a better rhythm, then their gas and bloating in my experience, it goes away. Other things that I think about, I think about celiac disease. I think about something called sucrose intolerance, which is people who struggle with sugar, table sugar, but also like sucrose exists in healthy food. I think about FODMAPs and histamine intolerance. The number one symptom in histamine intolerance is gas and bloating. So these are some of the other medical conditions that I would be sort of focusing on. And once you know which one you have, then you can be so much better in terms of how you fix it. Yeah.

I think it's really important what you said in terms of it depends on how it's affecting your quality of life. And I think a degree of bloating is to be expected after the end of a day and eating how many meals you've eaten in that day. Would you agree? Yeah, I think that, well, we all, we all have some, we all have some. So I, you know,

you don't want to create such sensitivity to this topic that everyone thinks that they have a medical problem. Like I would much rather a world where we don't believe that we have medical problems and we're just happy people. So, But I do think you're right, Hazel, that when it gets to the point of negatively affecting your quality of life, that's where we have to draw that line. Yeah, 100%. Now, you mentioned celiac disease as one of those kind of common causes. And gluten is something that has been very topical in the last couple of years and there's been a lot of pushback where the assumption that gluten-free is equal to healthy and that we should all be stripping

gluten from our diet. Obviously gluten comes in a lot of high fiber foods which are good for us so I'd love to know your feelings around gluten. How much time do we have? All right. I'm going to try to do the high level summary of how I feel about gluten. And for those who are interested, these are topics that I unpack in a lot more detail,

including all the references to back up everything that I'm saying in my two books, or you can look at some of my things that I've shared online. So I'm not attracted to gluten. I'm not obsessed with gluten. I don't have any relationship with any food company at all in any way. I've never taken a penny, nor do I have an interest in that. I have an interest in that. I have an interest in defining the science with accuracy. And sometimes things evolve and a trend can take

off. And that's an internet thing. That's not necessarily a scientific thing. A trend can take off and it can be hyperbolic with the claims. And yet the science continues to evolve and bring clarity to questions so when it comes to gluten you know if you went back 10 years ago there was a lot of science coming out the saying that gluten is harmful and you know bad for us and people need to understand like particularly when it comes to the gut and gut health you know many people have heard gluten injures the gut we're talking about test tube studies and rat studies. We're not talking about what happens when a real human being like you or

I eats a slice of bread, particularly like a sourdough bread, a healthy form of bread. That contains gluten. Is that destroying our gut? That's the question. Now we have to, you know, this is where the nuance comes in. We have to separate the healthy foods that contain gluten. By the way, gluten is a protein that you will find in wheat, barley, and rye. All right. So like wheat is the big one and wheat is in everything. And we have to separate these unhealthy forms of wheat, which are, you know, in the center of our supermarkets and they come in packages that sit there for two years and you open it up and it's the same thing that like it got packed two years ago, right? That's a, it's a complex food. That's an ultra processed food. That's not just

gluten, but it does contain gluten. And so in that case, gluten is a marker for the consumption of these types of foods. We have to separate that from like a high quality, you know, organic sourdough bread that your baker is producing for you or a rye bread that, you know, contains gluten. These contain gluten. And so when we look at the data, the issue is that most people in both of our countries are not adequately consuming whole grains. In the US, 98%, like it's worse than fiber, 98% are inadequate in their whole grain consumption. Now whole grains, like to me, these are minimally processed grains. And it could include wheat or rye or barley, but also there's a ton of gluten-free options that

I'm completely on board with. I'm not married to the gluten containing ones. I just like whole grains. So that includes quinoa and sorghum and teff and amaranth. Quick little pro tip. If you don't have an instant pot, you need to get one. They're amazing. I feel like instant pots are an American thing because I have one and no one over here knows what they are, but they are great okay um so it's a pressure cooker and the and the thing about it i i've never had one until very recently actually um but like literally you throw you know uh i did amaranth the other day for lunch literally you throw amaranth in there with some water and then you walk away for 10 minutes and you come back and you have the most fluffy and delicious amaranth ever. Yeah. I made a risotto in it last week and it was the quickest risotto I've ever made. And you can't, the best part of it is if you are very busy, you can just leave it and it just does all the cooking itself. No stirring. I feel like we're selling this.

So anyway, the point, but the point, my point is this, we need whole grains. This is my point. Okay. I'm not married to the gluten side. We need whole grains and whole grains reduce our risk of heart disease, of cancer, and many other medical conditions. If you spend any time reading on PubMed about the value of whole grains and what they do to our body, they're so good for us. And again, coming back to where do we define our opportunities? Our opportunities are defined by where people are really missing something in their diet and we have the ability to bring it back into their diet. Whole grains is one of those opportunities.

And so the issue is that for most people, wheat is the number one whole grain. And when they go gluten-free, they eliminate the only whole grain in their diet. They go even deeper into this deficiency of whole grains. And then we have studies that emerge, such as there was a study out of Harvard University that was published a few years ago, where they showed that people who go gluten-free actually increase the risk of heart disease. It's because they're reducing their whole grain intake. That's what they discovered on the secondary analysis. You know, the point from my perspective is that there are different forms of gluten-containing

foods. We all agree the ultra-processed foods, let's minimize those. Let's turn towards these other ones, which are rich in whole grains. And if you want to be gluten-free, by the way, if you have celiac, you have to be gluten-free. That's not negotiable. But if you want to be gluten-free, by the way, if you have celiac, you have to be gluten-free. That's not a gaucheable. But if you want to be gluten-free, hey, I'm here to tell you, you can definitely do that. And you can be perfectly healthy. Just make sure that you're making a focus on these other whole grains like quinoa, quinoa tufts, sorghum, amaranth. But for most of us, that's not the way that we're going to eat.

And so include healthy forms of gluten containing foods like rye bread or sourdough, things like that. Amazing. So top line, gluten is not inherently bad for you, unless you have celiac disease, of course. Exactly. It's been like an excessive thing. And it's a very nuanced topic. As I said, it's hard for me to unpack in a couple couple minutes, but the heat has gone too far. Yeah, I agree with you. There's so many questions I could ask you, but I see that we're coming up on time. So I'm going to wrap this up.

We might have to get you back on the podcast. I'm sure lots of people want to hear more from you. But I've got three questions for you before we finish, which we ask every guest. And the first one is really simple. What's your number one takeaway that you want everyone to take from this particular episode? If I could give you one piece of advice, again, meeting you where you are, not setting any sort of expectation of where you're supposed to be. I don't care about that.

But meeting you where you are, the one tip that I have is, again, in the supermarket, in the kitchen, at the dinner table, hear my voice, diversity of plants and add more diversity of plants to your diet because you will reap the rewards. You don't need to count grams of fiber, count the varieties of plants, it's going to pay off even better. Amazing. I had a feeling you were going to say something along those lines. The next one is about you. What's the most important lesson that you've personally learned on your career so far? Gosh, that's a great question. I think purpose. I think purpose. I have a lot of that comes to mind as you ask me that. But for me, I think it's purpose. What is

your purpose? Because when your career is aligned with your purpose, when you feel like you are doing what you were born to do, what you were put on this planet to do, I have a feeling that you feel that way, Hazel, about your work. It's the way that I feel. And I am inspired every day to wake up. And even when I have tough days and people get mad at me because I post about gluten, I, uh, I still love what I do. And I also feel like I'm serving my purpose. And that's really done well for me. Yeah, that's really important. And the final one is what's your motto in life? You can't say diversity again. No, but I you know what, I will say progress over perfection. And I will say that I will stick with that because it's not just a food thing, by the way, the origins of this idea. And I'm not that I'm not the originator of this idea, by the way, I'm not trying to claim that. Really, I think it kind of started with Carol Dweck, who wrote a book about mindset. And the growth mindset really is what she's talking about. And the growth mindset, you'll hear other people talking about this, where it's about

less of win and lose and feeling bad about yourself when you don't win and instead valuing the process and the effort and seeing that when you have the proper process and the effort, ultimately you do make progress and progress is a win in all cases. So, and that's, that's where progress over perfection is. It could be nutrition, but it could be your whole life. Yeah. I think that's amazing. Well, that was a really incredible episode. Um, I'm sure there will be people wanting to get their hands on your book. Where can they get it? Uh, you can grab my book. And and by the way i managed to write two books where i have words that are spelled differently in the u.s and the uk so both fiber and fueled are spelled

differently but you can have the proper spelling and the proper units for the cooking um it's all available in my two books in the uk and you can get them wherever books are sold so like your bookshop i always am a big fan sold. So like your bookshop, I always am a big fan of going to your local bookshop just because these are your neighbors and we want to support your neighbor who like has a shop that they're trying to keep open through a pandemic. But you know, you can also get it at Amazon UK or wherever the major books sellers are. Amazing. And you are the gut health MD on Instagram and TikTok? I'm the gut health MD on Instagram and Facebook. I am technically on TikTok. I have very few friends and followers

on TikTok. I'm pretty new. So I'm just getting started. I probably have like four posts, but I am the gut health MD underscore. Okay. We just need to get you some followers. So start, everyone can just kind of head over there after this episode and give you a follow. Love it. Thank you so much. Thank you so much for joining us today. It was a real pleasure to speak to you. Okay, everyone, that was Will. I know this is a very hot topic at the moment and everyone seems to be a good expert expert but Will actually is. Thank you so much for tuning in today. If you loved it you know what to do leave us a review

a rating and share it with someone you know will love it too. Quick reminder if you do want to submit a question to Ask Dr Hazel please send your audio recorded files to lindsay at thefoodmedic.co.uk for your chance to be featured. That's all from me see you again next time.