ZOE Science & Nutrition - Signs of an unhealthy gut

Episode Date: January 26, 2023

Our gut helps fight disease. It processes energy for us and boosts our mood. So, having a healthy gut is extremely important – but there’s still a lot we don’t know. Gut biome tests are a new, ...exciting technology, but are they the be-all and end-all for dietary decision-making? And are there simpler ways — and tastier ways, perhaps — to tell what’s happening inside our bodies? In today’s short episode of ZOE Science & Nutrition, Jonathan and Dr. Will ask: What are the signs of an unhealthy gut? And how can we improve our gut health? Referenced in today’s episode:  The Bristol Stool Scale. https://www.bladderandbowel.org/bowel/bowel-resources/bristol-stool-form-scale/  ZOE’s Blue Poop Challenge: https://www.joinzoe.com/bluepoop Blue poo: Impact of gut transit time on the gut microbiome using a novel marker published in Gut https://gut.bmj.com/content/70/9/1665 Download our FREE guide — Top 10 Tips to Live Healthier: https://zoe.com/freeguide Follow ZOE on Instagram: https://www.instagram.com/zoe/ This podcast was produced by Fascinate Productions.

Transcript
Discussion (0)
Starting point is 00:00:00 Hello, and welcome to Zoe Shorts, the Bite Size podcast, where we discuss one topic around science and nutrition. I'm Jonathan Wolff, and I'm joined this week by Dr. Will Bulsiewicz. And today we're talking about unhealthy guts. Jonathan, our guts help fight disease, process energy and boost our mood. So a healthy gut is hugely important, but there's still a lot we don't know. Our understanding of the gut microbiomes in its early stages. So is it actually possible for us to spot the signs of an unhealthy gut? Yes, it is, but it's not as straightforward as you think.
Starting point is 00:00:37 And interestingly, it involves blue poo. Well, blue is my favorite color. In fact, my wife often says that if I would buy something that wasn't blue, she'd be really happy about it. And I'm actually wearing a green top just because I thought we might be talking about blue today. So let's get into it. So Will, when we say a healthy gut, we could mean a lot of different things. So what do you mean here? First of all, a healthy gut means we have a good balance of microbes, otherwise known as bacteria and yeasts, in our gastrointestinal tract. These microbes help our body to take energy from our food, to clear toxins, fight viruses, and they help produce
Starting point is 00:01:17 the feel-good hormone serotonin. I mean, this is like literally just a minor glimpse into what they do. They do a lot of great things for us. And secondly, it means that we are not suffering from digestive problems that make eating normal food difficult for us. And so do you feel that the digestive problems themselves are somehow linked to this sort of poor situation with the microbes? Absolutely. Now, to be clear, everyone has occasional digestive symptoms. I mean, particularly if you have one too many pints and you load up on the spicy, greasy food. But really what I'm talking about are chronic symptoms that are occurring weekly or even more than that. There are many ways that they could manifest. As a clinician, my first question to the patient is very simple. How do you feel? That's actually
Starting point is 00:01:57 the same question my therapist asked me. So I like that. It's sort of getting straight to the point. So if you're looking for symptoms in this case, and I think you said, look, these are symptoms where you're having this at least once a week, that's where you're starting to say this is not just because you ate something that you're not used to, but this is sort of really starting to be something you might talk to a doctor about. So what are the sorts of symptoms that I or any of the listeners might say, hey, that's a manifestation of an unhealthy gut. Sure. I mean, of course, it could be digestive symptoms. So some of the classic digestive symptoms would be gas, bloating, constipation. But it's important to understand that it also
Starting point is 00:02:33 goes beyond the gut. So it could be issues with sleep, skin changes such as rashes, sugar cravings, or even unexplained mood disorders. I always think about the whole person. You have to think about everything, not just the gut and the gut symptoms. So it's very important to me to think about these things like mood and brain health, where it could potentially manifest with neurologic issues. And I think a lot of people listening to that will be quite surprised that you didn't just limit yourself to a set of obviously sort of gut-related symptoms, but you've sort of said, I mean, you sort of mentioned every part of the body, right, from your mood to your skin, you know, to fatigue,
Starting point is 00:03:11 that actually you can see this in all of these different places is really interesting and sort of shows what a big picture you have in mind here. Well, I think, you know, to that point, Jonathan, what we're really getting at are the connections of these gut microbes to the rest of our body. And so, yes, they are very involved with our digestion, but they're involved with all these other aspects of human health. And this is why they can manifest beyond just gut symptoms. And I guess there could be food intolerances, too, that these can crop up when the gut is
Starting point is 00:03:41 not functioning properly. I mean, basically what's happening when a person experiences a food intolerance, which is where you consume a food in a normal quantity and then you suffer digestive symptoms afterwards. Basically what's happening there is that the gut microbes are not up to the task of processing and digesting that particular food in most cases. Got it. So you've asked this first question.
Starting point is 00:04:01 What's the next thing that you're going to ask our sort of hypothetical gut patient who's coming to see you? The second thing, it may be a bit taboo for a lot of people, but as a gastroenterologist, I found this to be incredibly important, and that's bowel movements. Will, we've talked about this before. Normal people, when you first meet them, you don't ask them how often they go to the toilet. In fact, it's something that lots of people don't even want to talk about with their family or their partner. So why do you have to ask them this? Cardiologists look at blood pressure and heart rate. As a gastroenterologist, I look at bowel movements. This is my vital sign. And I see it as a window into digestive health.
Starting point is 00:04:43 When things aren't working the way they're supposed to within our gut, it's typically going to manifest in the toilet bowl. And so what kind of things do you talk about with patients, Will? So the first thing that I look at is rhythm. Very similar to the heart. If you knock it off rhythm, then things just get disrupted and they don't work the way they're supposed to. So we're supposed to have a cadence.
Starting point is 00:05:01 And that means that we should be pooping on a regular basis. That's a real thing. As a doctor, it's not just something that maybe we just all like to have a certain rhythm to our life, like we'd like to know what we're having for breakfast and that we're going to watch this particular show at 8 p.m.? I mean, rhythm is an innate part of the way that our biology was designed to function. We think about things we've talked about on this show, time-restricted eating or intermittent fasting. And that's just a manifestation of our circadian rhythm. And what I'm saying here, what I'm here to say today is that our gut has a rhythm too. And it's important that that rhythm actually be manifest with routine regular bowel movements.
Starting point is 00:05:43 I guess as well as rhythm, there's something about the whole experience being easy, you know, like you're sort of strutting out of the bathroom with a smile on your face, not like you've just done, you know, five rounds in the boxing ring. Certainly not five rounds. Maybe we're not supposed to say this, but you're allowed to feel good. You're allowed to feel well after a good, healthy evacuation. You know, as a medical doctor, that's where I want you to be. And the bathroom experience really should be something that's positive and relaxed.
Starting point is 00:06:11 I do think it's really interesting. You know, so I have, we both have relatively young kids as well as older kids. And, you know, we're all too young to remember being toilet trained, but you sort of see it with your children and you realize that there's a huge amount of shame wrapped up in this experience right because it's so important and i think you do build into that therefore the sense that if you don't do it right it's really bad but you can sort of see how you can end up feeling a lot of shame it's not something you talk about if things aren't going quite right then actually you're sort of failing. And I can see how, you know, maybe I'm traumatizing my little girl already by the very fact of going through toilet
Starting point is 00:06:52 training over the last few years. You know, look, I do think that that's part of this. I think that also we need to be talking more openly about these things. And also, I think that the process of toilet training brings up an interesting point, Jonathan, because there is a conditioned aspect to this. So the conditions, the circumstances within our life do ultimately affect our ability to go in and have that effortless, satisfying bowel movement that I'm trying to guide people towards. So we've talked a lot about, you know, is it easy and effortless? Tell me what else you ask at this point. Yeah, so rhythm is one thing. I'm going to also look at things like the form of the stool,
Starting point is 00:07:28 form meaning the shape or the way that it visibly appears. And the way that I typically will approach this is using something called the Bristol stool chart, which classifies the poop into specific types based upon its shape. So there's seven different categories within the Bristol stool chart. And we'll put a link in the podcast notes so you can look up your own stool based upon this. Now, Bristol is a city in the UK for those listeners from around the world who don't know that. And I don't know how good they feel that now across the world, they're actually most famous for classifying poop. However, they are in luck if they would like that to move on because the latest
Starting point is 00:08:03 science suggests that there may be a new way to measure a healthy gut that isn't named after Bristol, and that is gut transit time. Gut transit time is how long it takes for food to travel from your mouth to the other end. Will, can you tell us a bit more about that? Zoe actually did some exciting research into this, and by simply eating food that contains this blue dye coloring, and then tracking how long it takes from when you first eat that food to when it ultimately comes out the other end with a blue bowel movement, the blue poo, as we like to say. What's really interesting about this is like, it's curious, it's cheeky, but also it's science based. The blue poo we have discovered is actually correlated with characteristics within your
Starting point is 00:08:44 microbiome. We found that transit time can actually be a better measure, believe it or not, of your gut health than looking at things like your stool consistency or the frequency or even the Bristol stool scale. And I think there's something quite fun about something that seems really fun and light on one side and on the other hand, went into one of the top peer-reviewed journals and basically saying that actually this time it takes, as you said, Will, really gives us some additional information, which I love. So what's next? So we've talked about symptoms. How do you feel? We've talked about looking at your bowel
Starting point is 00:09:16 movements. Now, the third thing that I really would want to focus on as a medical doctor is potential conditions that might be associated with an unhealthy gut. When the bacteria in your digestive tract become unbalanced, Jonathan, it can lead to something called dysbiosis. So, well, dysbiosis is not a word most of us use regularly. You know, hey, honey, I've got some dysbiosis has never been said by anyone ever. Could you turn that sort of medical jargon into something more understandable? You know, dysbiosis, what it means is that your microbiome is out of balance.
Starting point is 00:09:53 So when you measure it, it would look different than a person who has a healthy gut microbiome. And typically what you would see when there is dysbiosis present or this loss of balance is that there's a lower diversity of the different species. You have less of the beneficial gut microbes. And unfortunately, you have more of the inflammatory or non-beneficial gut microbes. Some of the effects of dysbiosis could be things like your stomach gets upset after you have food poisoning. And in this particular setting, it's temporary and mild. Really what I'm trying to get at here is that there are these serious chronic conditions that may be associated with dysbiosis. And so what are you looking for in this case, Will? So, you know, much like when we were talking about the symptoms, how it can affect the
Starting point is 00:10:30 whole body, I'm looking at this through five particular types of conditions that can be manifest as the result of dysbiosis. So, you know, first, obviously, would be digestive issues. This is what I do as a gastroenterologist and includes things like irritable bowel syndrome, Crohn's disease, ulcerative colitis, just to name a few. But particularly with our work at Zoe, we're looking at metabolic issues. This is through the lens of the gut and things like obesity and diabetes or high blood pressure and high cholesterol, they have all been connected back to loss of balance within the gut microbiome. There's also the immune mediated conditions involving the
Starting point is 00:11:05 immune system. So really I'm talking about allergic diseases or autoimmune diseases. The fourth category, Jonathan, would be hormonal issues. So like in women, this would be things like your regular period, infertility, endometriosis, polycystic ovary syndrome, or in men, it could be the most dreaded condition that a man could have, erectile dysfunction. And finally, the sort of fifth place that we think about medical conditions being the manifestation of dysbiosis is in the brain, believe it or not. This is part of the brain-gut connection. And it can include things like mood disorders, but it could also include things like chronic migraines or even Parkinson's disease.
Starting point is 00:11:41 And I think, you know, tying back to what you said earlier, this is an enormous list of things, right? Touching every part of your body and lots of things I think people, again, might be surprised by when you talk about things like hormonal changes that I think we normally think of as being completely different to the situation about what's happening in our bacteria. Yeah, definitely. And, you know, in my mind, as I'm approaching this as a clinician, what I'm doing is I'm sitting there and I'm looking at this person and they're telling me how they feel. They're telling me about their bowel movements. And I'm thinking about like, is there a pattern within their chronic health history that would help for me to explain what's
Starting point is 00:12:15 going on with them? And so I'm not looking for one thing. I'm looking for the emergence of multiple of these different diagnoses that I just mentioned. And when you see that pattern, then you know that you know that the gut is a part of the issue here. So, so far, we've talked about three ways that you might investigate signs of an unhealthy gut. You've got symptoms, you've got the bowel movements, you've got the related medical conditions. But one thing you haven't mentioned is gut microbiome testing. How comes? I feel that the testing needs to be validated. So for us to have confidence and use these tests within a clinical setting where we are helping to guide patients to better results, we actually need research that validates and
Starting point is 00:12:56 proves that using this test and the information that we get back from it, we can actually get to that place of improving a person's health. So the problem, Jonathan, is that almost all of the microbiome tests that are currently available, they haven't done this. They need to publish papers showing us that they work. Now, a lot of listeners will be a bit surprised about that because Zoe is hosting this podcast. And as part of Zoe's testing at the beginning of the personalized program, we do our own unique microbiome tests. So what are you saying? So obviously I believe in Zoe and the issue is that Zoe is not just a microbiome test. And I think it's very important for people to understand that Zoe is far more dynamic in terms of what it's being offered. And it goes far beyond just microbiome testing in isolation. I mean,
Starting point is 00:13:41 you know, we're looking at their blood sugar response, their blood fat response. We're looking at their complete dietary picture. And I think it's most fair for us to say that microbiome testing is still in its early stages. And we don't know enough as of today to be able to give strong advice based upon the microbiome alone. Well, I think I'm glad to hear you feel it has some place here. And as we've been looking at this, you know, as Zoe, we've sort of come to the conclusion that we don't feel comfortable that just using a microbiome test on its own is enough to advise you on what to eat. And so I think this is, you know, it's a key message to always recognize that you can hear about this incredibly exciting new things sort of on the edge of science. And then when you're
Starting point is 00:14:23 trying to come down and say, well, you know, I want to know what I should eat, or I want to know what my mother should eat, my wife should eat. Then you actually say, okay, what's all the best evidence together? Now, Will, you know, that's us thinking about this as a sort of technology company. As a doctor, is it unusual to say, hey, there's just not like this one test that I would use and give me all the answers? That's, I mean, that's not unusual at all, to, there's just not like this one test that I would use and give me all the answers? I mean, that's not unusual at all, to be honest with you. I think it's important for people to understand that as a doctor, when we attack these problems and try to guide our patients to a better place, it's about integrating all of the available information. or the blood sugar or food intolerances. Really the point here, Jonathan, is that when you see this bigger picture and you integrate more information,
Starting point is 00:15:08 you are able to get more clarity in terms of what defines the individual person. And so Will, what if I've listened to all of this and I think, you know what? I think I might have an unhealthy gut based upon, you know, I'm sort of ticking off the things as you describe them. What should they do?
Starting point is 00:15:22 Well, to be honest with you, even for the listeners who are sitting there saying, look, I feel like I'm pretty good. My gut's healthy. I would say to you, look, this is so important. No matter who you are, we all should start where we are today and strive towards an even healthier gut because this is so essential to human health. And for all of these people who are trying to take that step towards a healthier gut, the most important thing is to make the right diet and lifestyle choices that can lead to better health. This can include things like managing our stress levels. We've not simple things like eating slower, drinking more water and eating a varied diet that's high in fiber and grains and leafy vegetables. Cutting back on all highly processed
Starting point is 00:15:58 foods can be another step that people can take. And if I do all of those things, do you think I would expect to see a change in my gut health if I was exhibiting some of the things that you've been talking about earlier? Absolutely. I mean, remember that, you know, it kind of comes back to this basic first question, which is how do you feel? You should feel better when your gut is becoming more healthy. You should feel better. You should see an improvement of food intolerances. You should have better bowel movements. And over the long run, you may be able to improve your health status in terms of reversing or improving or reducing your risk of these chronic medical conditions that we've been talking about. And one of the things I always love, whether it's you talking about this or Tim or anyone else, is there's a huge amount of positivity because this is an area where you're always saying, you know what, there's a power for us to make changes that can really improve our health. And I think most of the
Starting point is 00:16:45 time, we feel we're sort of stuck in a one way deterioration. So like, it's all like, oh, you know, my body was great when I was 21. And now it's just getting worse and worse. Or, you know, there's nothing you can do, all you do is just sort of holding back the tide. And so I think what's really great listening to this is you're saying to lots of people, actually, you can really improve your gut health, so that it's a lot better in a year's time than it has been, you know, maybe for decades, maybe since forever. Yeah, I mean, Jonathan, you're mentioning a 21-year-old. I'm twice the age of a 21-year-old at this point in my life. And I think I have twice as much health as I did when I was 21 years old.
Starting point is 00:17:23 And that's because of changes that I've made to my diet and lifestyle through the years that have allowed me to get to a better place. And I think it's really a message of empowerment here, which is that you are not a genetically pre-programmed list of medical conditions and health-related problems. That you actually have the power through your choices to make small changes that can actually yield massive results in terms of your health. That, to me, is the important message and it's really exciting. And that's a part of what we're
Starting point is 00:17:47 doing with Zoe. And maybe just to finish up, I'd love to go back to the neon blue muffins that we talked about earlier when we were talking about measuring your gut transit time, because this is something that anyone listening to this podcast can do at home. If you wanted to find out more, there's actually a link. We'll put it in the show notes, but it's at joinzoe.com slash blue poop. And Will, is this something that you tried with your family? We did. Yeah. So we did it and it was, you know, it's quite fascinating. It's quite fascinating just to kind of get the results. But also when you dig into the paper that was published in the journal Gut, it's fascinating to discover the connections that exist between your gut transit time using the blue poop method and your microbiome and even potentially your cardiovascular risk. So you get a lot of bang for your buck by just eating a couple
Starting point is 00:18:34 muffins. Absolutely. And I did this. I enjoy doing it. But my kids really enjoy doing it as well because we got the whole kitchen blue. And then interestingly, we were all fascinated, you know, for the next 24 to 48 hours about, you know, when we were going to find the blue coming out the other side and therefore what this was going to say. As always, I think one of the interesting things is you don't really know your transit time. So you might go regularly every 24 hours, but you don't actually know how long it takes from the point that you eat to when it comes out the other side. It might be that it's actually taking you
Starting point is 00:19:08 two or three days. So I do think it's just this incredibly cheap do-it-yourself experiment. And there's something that's always so interesting about understanding more about your own biology and also realizing that there's this huge variation amongst people. And so once again, this idea that we're all just the same, you know, it's just a little micro example of how that isn't true. Yeah. And I think just to riff off of that real quick, Jonathan, first of all, people who do the Blue Poop Challenge, which you can do at any time, you can input your results and actually will provide, you will receive feedback from our website that allows you to understand even further beyond just like
Starting point is 00:19:45 how much time it was. And I think one of the other things that I would say real quick is that a common question related to this is, well, why don't I just eat some corn? Or why don't I just, you know, drink some beet juice and see when that comes out? And the answer to the question is that those particular tools, they haven't been clinically validated for this purpose. So coming back to the idea of validating our research and publishing it in journals and showing that it actually works, with the BluePoo method, we actually have done that.
Starting point is 00:20:11 We have actually shown that these correlations are real and they do exist. And that's the reason why you opt for this technique as opposed to just drinking some beet juice. Amazing. Well, Will, I think we learned a little bit today about an unhealthy gut, which was a lot of fun. If you have listened to this and you'd like to try Zoe's personalized nutrition program to discover what's going on in your own microbiome and improve your health,
Starting point is 00:20:33 you can get 10% off by going to joinzoe.com slash podcast. I'm Jonathan Wolfe. And I'm Dr. Will B. Join us next week for another Zoe podcast.

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