From Polyphenols to Butyrate: A Clinical Framework for Feeding Keystone Species with Dan Sipple

What if your gut symptoms aren’t about what you’re taking, but who you’re feeding?

Gut change doesn’t start with a supplement aisle sweep. It starts with the small but mighty species running your internal ecosystem. In this episode, functional naturopath Dan Sippel joins us to unpack how keystone bacteria shape gut barrier integrity, immune tolerance and metabolic health, and why the right polyphenols, fibres and bile acids can stabilise a volatile gut without triggering flare-ups.

We explore short-chain fatty acids, especially butyrate, as the microbiome’s currency, influencing inflammation, insulin sensitivity and even brain signaling. Dan shares a laddered strategy for IBS- and SIBO-prone patients: start with low-aggravation polyphenols like pomegranate peel and green tea to lift Akkermansia and Bifidobacterium; introduce partially hydrolysed guar gum as tolerance improves; then progress to resistant starch once the gut lining calms. Along the way, we break down cross-feeding, when direct butyrate makes sense, and why single-strain probiotics only work when you know the strain’s job.

We also dive into bile acids as the missing link in many stuck cases, including constipation, fat maldigestion, hormone symptoms and perimenopause transitions. You’ll learn how dysbiosis disrupts primary-to-secondary bile acid conversion and how to run a practical gut oil change using choleretics, ox bile or TUDCA. Plus, we cover iron repletion without microbiome damage, the role of sleep and melatonin in T-reg signaling, vagal tone support with L-theanine and kava, and a simple daily polyphenol five you can rotate with patients: cacao, blueberries, pomegranate, raw carrot and green tea.

If you’ve cycled through fibres, probiotics and antimicrobials without lasting results, this conversation offers a sequence that sticks. Build the terrain first, protect keystone species, match fibres to the phase, and retest to prove progress as SCFAs rise and inflammation falls. 

Connect with Dan: The Functional Naturopath

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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health

Transcript

Setting The Gut Health Agenda

SPEAKER_01 0:11

Welcome to Wellness by Designs. I'm your host, Andrew Whitfield Cook, and today we're speaking with Dan Sippel, a functional naturopath. I'm going to be talking today about polyphenols, fibre, and keystone bacteria. Welcome to Wellness by Designs, Dan. How are you going? Doing well, my friend. Good to see you again. It's been a while. It has been a while. You're in a lovely part of the world down there in Mollival. Well done. Yes.

SPEAKER_00 0:36

So jealous. The sun is shining today, so we uh we can't complain. It's been a little bit topsy turvy with the wind and the south, the subtleties, but um now we're good. We're looking good heading into Christmas.

SPEAKER_01 0:45

Yeah, beautiful, beautiful place in the world. Okay, so let's dive in. I mean, this is just such a it uh it's such a crucial topic, but it's bigger than Ben Hur. So yeah, I thought you know, it'd be nice to do it in one part of podcast, but I look forward to seeing you in more podcasts to sort of delve in later, delve in further. So let's start with the foundations. Uh and I guess start with the bacteria. If we start with the keystone beneficial bacteria, why are they so crucial to human health?

Keystone Species And Systemic Impact

SPEAKER_00 1:18

Yeah, sure. So excuse me. So keystone bacteria are always something, Andrew, that we that we look at when we're doing a gut microbiome profile, particularly on a new patient. And um, we're trying to understand what the ecosystem is is looking like at the foundation. Um, the keystone bacteria, although they've got um a relatively small abundance within that actual ecosystem, they have a pretty proportionally large influence, um, not only within the gut, but it's they sort of set the tone for how the whole microbiome behaves, if you like. And then they definitely extend over to other areas of health like the metabolic side of things. So it's a really exciting area. Um, and the the testing that we utilize, pretty much regardless of which company is your preference, um, these days actually zooms in quite well, I think, and gives us that really good understanding and snapshot as practitioners as to how that ecosystem looks. So when we're thinking about the the terrain of the host and their short chain fatty acid production and their keystone bacteria, we're we're wondering, you know, are they there to keep that gut lining intact, to, to lower inflammation, um, to then go on to produce beneficial compounds like butyrate, um, which we know help regulate the metabolic health and regulate blood sugar and you know, protect against insulin resistance. And so the, as I say, the effects are pretty wide-reaching. But when these keystone species, if you like, thrive, um, they tend to create a really nice, I guess, like downstream ripple effect. So the more harmful species within the gut, the pathobions, they tend to lose their foothold. Um, digestion can improve from there, immunity becomes more regulated and more uh intelligent, if you like. And the gut, I suppose as a whole, just becomes more resilient under any sort of stress. Um, and then, you know, in the opposite, when the keystone species decline through, you know, means of poor diet or antibiotics or um what else, sleep disruption, stress, you name it, you know, the whole ecosystem tends to lose that stability. So it's kind of like the keystone species of the gut, they're not just nice to have in there. It's kind of like they're the foundation of overall good gut integrity, um, immune tolerance, protection against allergy and autoimmune. And then, as I say, even now extending over to long-term metabolic health. So pretty far wide in reaching, which is nice.

SPEAKER_01 3:40

Can I ask, with regards to I guess not just keystone bacteria, but but you know, the good guys, quote unquote? Seeing as like after like the first one to two years of life, our our bacteria tends to be sort of imprinted, if you like. Um, can you get or have you seen patients where you're doing everything right, you're feeding good polyphenols and good fiber, and still you get this aberrant uh or different um set of bacteria being a hallmark? And something where we might go, oh no, I want it to be different, but that's them. Do you ever see that?

SPEAKER_00 4:24

Like it's where the results are sort of um just not what you expect, not textbook, not classic. Yes, yes. I mean, yeah, we do see that from time to time, and that's where you know it's it pays to go over all those foundations to check that they're just not still receiving some sort of insult that you're unaware of. Yep. Um, secondary to that, when you get thrown that sort of curveball, I always think about um the bile acids as well, the primary bile acids, secondary bile acids, and whether there's some other loop that's inadvertently coming back in and you know, trying to, or not trying to, but offsetting whatever you're doing. And and although it's well intentioned, yeah, in those scenarios, that's sometimes been the case, I've found. That's such a great point.

SPEAKER_01 5:07

And like we it's really interesting how our focus can sometimes shift to looking at the gut and forgetting that well, you know, our liver plays an important role in this.

SPEAKER_00 5:18

Yeah. Yeah, the good old entrahepatic recycling, you know, that term that gets thrown around a lot. But this is what we're talking about, essentially. Anything just getting spat back up through the liver and dumped back into the gut and recycling. So, yeah, it pays it pays to look at that. And that's what I really love about some of these newer tests is that they're looking at stool omics, which is the, you know, the um, I guess the presence of primary bile acids and the presence of secondary bile acids. And I'm sure we'll get into what they do and and how that all works today. But as I always say to nearly every patient, it's like every year the gut microbiome and what we know about it just keeps extending, you know, it blows you away. Five years ago, wouldn't have even been thinking about this stuff, or 10 years ago, wouldn't have even known the names of some of these bacteria, what they do.

SPEAKER_01 5:59

So no, that's right. That's exactly right. I mean, uh, you know, back in the early days of of my sort of career, it was uh, you know, Lactobacillus acidophilus was the only one. And then this Ramnosis poked up. What? Yeah, so it was, yeah, it's evolved like you wouldn't believe. Um, let's talk about short chain fatty acids, because that's something that interests me as well. As I guess if we want to look at beneficial byproducts, does it matter how we get there as long as we get these short chain fatty acids? So I guess let's go into them first, but let's unpack them. Um, which bacteria produce them and some of the benefits that they deliver.

Testing, SCFAs And Butyrate Strategy

SPEAKER_00 6:44

Yeah, sure. Yep. So I mean, as far as I understand, there is a litany of them, but the three that you will see on still reports and what we most talk about are the classic butyrate, acetate, and proprionate. And these are like the currency of the microbiome. So produced by these beneficial keystone uh species of the gut when they've got enough dietary input of fermentable fibers and resistant starches. Um, but you know, we're we're even looking at roles outside of the gut now, too, in terms of how they exert their effect. So if we take butyrate, for example, which is kind of like I always say the VIP, you know, it's like the rock star of the gut. We know that once that's been produced endogenously in enough quantities and utilized by the colonocytes, it then gets spilled over into the bloodstream and can even travel up into the blood brain barrier and pass and have a dampening effect on neuroinflammation markers. So, again, that's just another example of a few years back that would not have even been thought of being possible. So again, um, whilst we're, as I said earlier in the chat, we're looking at the the presence of keystone species, but are those keystone species being fed? And if they are, what's the production capacity like of these short chain fatty acids? And to your point, does it matter how you get there? Potentially maybe not, because we do have uh butyrate, for example, as a supplement now. So there are cases where a gut will be, for instance, really beat up. It might be, you know, after an IBD flare or a cocktail of antibiotics. And sometimes I'll I'll actually accelerate that. And rather than using the polyphenols and the prebiotics immediately, I'll just stack a lot of butyrate into that gut just to get the inflammation down so it can get to a position where it can then handle the fibers and the starches and whatnot.

SPEAKER_01 8:25

And do you find, as you were alluding to there, do you find there is sometimes a profession, a procession of what gets made first by a certain bacteria? Uh, and that might be setting up the foundations for the next bacteria to come along and take its place and the next one and so on and so forth.

SPEAKER_00 8:45

We do, we see that crossfeeding. So it's kind of like these guys uh pass the ball to one another, which is really interesting. And you know, and when when they do that, it's almost like then the gut, you know, the gut brain access, you could even argue that that's then taking that information and passing it. So it's this big communication highway that that runs both ways, which is super fascinating. Um, in terms of the the individual species, we're thinking of as far as butyrate goes, for calibacterium prosnitia. And I have to say, I have a pet peeve because a lot of practitioners still can't produce that bloody species properly. Fecal bacterium, it's for calibacterium. I just want to make that clear and go on the record for calibacterium. Uh rant rant over. I'll keep going. Um, but yeah, it's like the old it's like the old thing of famicutes or fermicutes. I said that once recently at a uh at a talk. I I looked at Brad Leach in the crowd. I said, Brad, is it famic firmicutes or firm? What is it? What is the it's like tomato tomato, yeah?

SPEAKER_01 9:42

Well, well, I think we can get away from with it, uh get away from it now because they've renamed, they've reclassified the whole clade, if you like the whole tacta as um, what is it, bacillotta? It's probably a good thing. So stop the arguments over dinner. That's it, that's it. Um so feeding the bacteria, you mentioned that. Let's go on this. I mean, this is a huge topic. Um where to start? So let's start with a more pragmatic question. Feeding too much. You know, the old days of using fructooligos saccharides FOSS, and 40% of your clients end up with massive amounts of wind. So we've decided to look into different um um uh fibers and uh and polyphenols as well that'll that um help benefit beneficial bacteria without those sort of adverse effects. Take us on this journey.

Crossfeeding And Naming Pet Peeves

SPEAKER_00 10:37

That's a really interesting point. And because we we I think there's there's an art in that too, Andrew, with like recognizing where your patients are at without necessarily months and months of data to study them. I mean, you get that later through seeing them inadvertently, but when you start out out with them, the worst thing that can happen is you put them on a fermentable fiber that doesn't agree with them. Um, and they're just going to interpret that as that naturopath made me feel worse. See you later, you know. So there, like I say, there is a bit of an art form to matching the fiber to the person as well as their um, you know, their stage of progress with gut health. But on that note, this is where I get really excited about the use of polyphenols as opposed to actual fermentable fibers. Um, one sort of that sticks out that I use quite a bit and actually has really good RCTs, human design trials with really good results is um a pomegranate extract called Pomella. And um, I think they it was a 2023 study off the top of my head. Uh 14 participants fed 250 milligrams of permella daily for a total duration of about four weeks. And these these were um people in the group with really severely damaged gut biomes. So, you know, very much that mixed case of IBSM. So mixed constipation, diarrhea, SIBO, you name it. But intervening just with that one type of polyphenol was a really low-risk intervention. And what we actually seen was there wasn't an aggravation like you'd expect with some of those inulins and FOSS and Goss and types of fibers. Um, but instead, we've still seen an overall rise in the keystone species. We've seen rise, particularly in Achamantia and bifidobacterium. Um, no major shift in overall diversity. But the really cool thing about this study, as well, is they did look at urolithin A production. So this is that compound that our own resident biome will make once it converts those elagitannins from pomegranate. And that's connected to a whole host of metabolic improvements. And we'll, I'm sure we'll see in coming years that supplement um hit the market. And it's already starting to in different parts of the world. But if we can produce uh our own, you know, endogenous butyrates and our own endogenous uh urolithin A's, then I think that's obviously uh a better solution. But um, this is this is a really good example of something you can use in that, you know, really sensitive, inflamed type of almost SIBO-prone patient where you're concerned about fermentable fiber. And you can make some really good headway with that intervention just alone. So often I'll actually say to patients, all we're doing, apart from a few polyphenol adjustments in your diet for the next two consults, which might be six to eight weeks, is I'll say get yourself a bag of pomegranate extract and just add it to smoothies daily. And um I've found that that lays really good groundwork. Um, and from there you can start almost on like a scale of least, you know, um offensive in terms of the fibers and work them up and just work out what's their sweet spot. So one you might sort of go to after that might be the guagum, the partially hydrolyzed guagum at a low dose, and then scale it up. But I've had patients, you know, over the years that'll come to me eating three or four foods only, you know, no fiber at all. They're gonna that inflamed and dysbiotic that they just cannot tolerate it all the way to be able to be up to handling 10 grams of inulin, for example, months and months down the track with a really diverse diet. So the the microbiome can can shift, but you've just got to get in there with with the testing and obviously good clinical intake and and understand where they're at to match them to that intervention.

SPEAKER_01 14:05

And do you find that things like the polyphenols might be better suited to somebody who is a gas producer or having a problem with wind because of that astringency to do with the polyphenols?

Feeding Without Flares: Polyphenols

SPEAKER_00 14:16

Oh, absolutely. And you often will find that in your IBS IBSD patient um, you know, group that they will they will do better on that type of intervention where you're not asking for too much in the way of fermentable fiber, you know, to um to raise bacteria, but inadvertently through um a polyphenol, it's happening, you know, and you are getting increased butyrate. So the theoretically, when the host conditions change like that and some fermentable fiber then starts to come in and feed up those beneficial species, and they do do produce more hydrogen sulfide and more methane gas. By then you would hope the lining of the gut is less sensitive and can actually handle it and utilize it.

SPEAKER_01 14:54

You mentioned hydrogen sulfide then, and I I help me here. I have a very dim, blurry memory um of a paper once discussing that the puric acid. Oh my god, I got off pieces here, but anyway, um that it was sort of a um it was almost like your body trying to heal itself. Um but help tell me if I'm right or wrong here, but it was a sort of like scrabbling for healing and that it needed assistance. It was trying to do its job to protect you, but it was on its way out. So it was sort of like um a canary in the gold mine, in the coal mine. Is that where you'd go with like um the hydrogen sulfide and things like that to say there's something going on here which I need to address?

SPEAKER_00 15:57

When I see a high hydrogen sulfide producing microbiome that automatically you know raises alarm bells for um, you know, you start to question is this okay, so we're seeing that down in the colon. Is that possibly happening upstream too in the small bow? Um, and it's the same obviously for for for methane, but these are sort of clues where you might say, all right, so more fermentable fiber right now might not be a good um a good intervention strategy. Yeah, I'm not sure if that answers exactly what the the example you gave, but yeah.

SPEAKER_01 16:28

Yeah. All right. So more on the polyphenols. What other you you know, we've spoken about, oh, I I know where I want to go. I want to ask this. We tend to concentrate on these polyphenols and fibers for the gut, but we we sort of forget about that reflex action, if you like, not just for the lungs, which is the first one you think about, but also the genito-urinary system. Ah, right, right. Can we discuss this a bit? Um, because I like I'm aware of, say, pomegranate with Lactobacillus plantarum, certain species, certain strains. Um and I've got allergic acid on the brain, but it's not. Yeah. But basically helping to make like an antiseptic almost.

SPEAKER_00 17:08

Yeah, that's that's really interesting. And and when you said genito urinary, I straight away thought of cranberry extract, which is a polyphenol, after all, as well. So, yeah, I mean, highlighting, if anything, that they're, I mean, they're antioxidants at the end of the day. They're polyphenols, what are they? They're the color on different fruits and and plant matter and vegetables and fibers and whatnot. And we also sort of recognize them as generally good for health for their antioxidant capacity. But it's it's also a case that they're working more in a deeper layer, a deeper layer within the gut microbiome, and then potentially other areas of health that maybe we don't know as much about right now. But that reflex, that gut lung reflex or gut liver reflex, that's really exciting and interesting.

SPEAKER_01 17:51

Cool. So, more about polyphenols. What do you tend to use? What and where and when? And take us through how you use these.

SPEAKER_00 17:59

Look, as far as diet goes, I keep it really simple, Andrew. I say the five polyphenols. I say between again, between now and next time I see you, all I want you doing is adding these polyphenols. Oh, what's that, Dan? Is that boring? No, just hear me out. Cacao? Oh, great. Yeah, because the half of them already do it, you know. Blueberries, the pomegranate seed, um, even raw carrot, you know, uh, and then green tea. So I just say pick those five, put them on your fridge, and I want you to do one of them every day and you just rotate it. Oh, it sounds too simple. And it's like, no, no, just stick with me and actually execute that, and I'll see you in four weeks. All right. Green tea, how do you take it? Yeah, so green tea, I mean, we can use it as a liquid extract, which is neat. You know, if we're doing a herbal formula and we want to sneak it in that way, um, and it's obviously very, very concentrated, we can do it like that. Often, though, in the sensitive patient, I will often just say, you know, let's just go tea bags for now. And I had a case the other week where I actually said to a guy, listen, where you would normally have that third coffee and fourth coffee for me, ditch that. Have your first and your second between you know 9 a.m. and 11 a.m. And I said, if you want to have six cups for the remainder of the afternoon of March or green tea, go for gold. It just looked at me like it was, it was like, aren't I gonna be off my head with the caffeine? I said, not necessarily. Look into L-theanine, you know, this compound that comes in and kind of just suppresses the the um adrenalic response from caffeine. So um that's often how I will sneak it in, yeah, through through just tea bags. And then I'll have patients that are already doing it with, say, Marcha. So great, keep doing it, just make sure you're using an organic form. Um, but yeah, polyphenols, I mean, I I I try and steer patients uh towards healing as much as I can with diet before we go in with with supplements. Um, and I'll probably sound like a broken record right now, but the the amount of times I've used as a brand that just does organic pomegranate peel extract. I was like, throw that in your smoothies, you know, a tablespoon, up to two tablespoons, even. Um, but obviously, in in new patients with really severe dysbiosis, we're going in really low. Slow, like one eighth of a teaspoon to start off with.

SPEAKER_01 20:02

Yeah. Yeah.

SPEAKER_00 20:03

And building up.

SPEAKER_01 20:03

Yeah.

SPEAKER_00 20:04

Yeah. I've learned that lesson too. Yeah. Yes.

SPEAKER_01 20:08

Um, what about the old adage? You know, we we in the olden days we used to use bacteria and you'd put it in, does a does a job and never stays there, it goes out because of that. We spoke about it earlier, that bacterial imprinting, that sort of genetic imprinting, if you like. Uh, but now what we're trying to do is feed the bacteria. Have you ever looked at using the polyphenols and the fibers, resistant starches, that sort of thing, to, as you mentioned, heal the terrain so that any probiotic uh supplement that you give is going to have a longer-lasting effect. And have you been able to track that?

Sensitive Patients And Gradual Dosing

SPEAKER_00 20:50

Well, that's I feel like that's what we used to do before all these polyphenol extracts and prebiotics were available to us. I mean, you know, you could argue that you could do them with the diet, but we didn't know as much about them back back then. So we did have a lot more probiotics, you know, at our um disposal. And you would remember as well as I do in that five, 10 years ago space, there were so many probiotic cocktails where it was like 12 to 15 different species. And um, I I personally have have moved a lot away from that that approach. And I still do use probiotics, but I will often use single strain probiotics only. Okay. I could count them on one hand. Um, so to your question, yeah, I definitely leverage uh the gut microbiome with with polyphenols and preabiotics far and wide more so than I do with with probiotics, but I will I will use probiotics for their action, you know, for treating diarrhea in this case or increasing motility in this case, improving mental health here, um, you know, reducing um osteoporosis risk over here, you know. So we I use them single strain in that, in that sense. And there's probably a couple of products that might combine one or two strains or three strains max, but certainly moving away from those big you know cocktails. I just never felt like they gave us measurable outcomes. And it was it was quite of a mixed bag and a bit a bit vague in terms of what they were doing. Um, and a lot of those strains probably, now that we look back, did pass through and and do their thing on on the way, which is cool. Um, and and we certainly now now know that most probiotics don't stick, some do. Um, but I just find you find you you get better, more tangible results when you know what the probiotic's doing. Firstly, you're aware of the action of the strain, not just the species. And um, and yeah, you're thinking about that with regard to your follow-up sessions and reporting back on their original presentation.

SPEAKER_01 22:43

Yeah. I I like the way that you're thinking because like I like you, I was more of a shotgun. Well, you know, we're putting this bacteria into a cocktail of bacteria in your gut. What's wrong with using a multi-strained probiotic, a multi-species probiotic? But I get where you're going, is because you're using mainly diet, mainly dietary or supplements in that realm and using the probiotic to just as a linchpin.

SPEAKER_00 23:09

Is that correct? Totally. Yeah, it's like the icing on the cake, you know, the probiotic, the foundations. We always say you want your microbiome to produce all of these things itself. You want it to produce the short chain fatty acids, the butyrate, the urolithin, you know, the postbiotics. You want your gut doing that because when it does do that, you don't have to do, you know, it's like when you get a patient and they they come to you and they've just done six months of antimicrobial treatment with hardcore herbals. And there's still a place for short-term use of that. But um, you know, another good example is um two fucos or lactose. That compound is really exciting, and I'm using that quite a bit. So that's almost like the the breast milk prebiotic, if you like. Yeah. You know, we know with a lot of those studies that um the use of 2FL is getting the biome to a point to where it's upregulating enough of those endogenous species to have its own antimicrobial effect and have its, you know, permeability um uh action, you know, anti-permeability action itself. So the gut's doing the work itself and and moving away from the you know, the blasting effects, like if you like, of um of antimicrobials.

SPEAKER_01 24:15

Yeah, yeah, yeah. So so that sort of alludes to that precession thing that we spoke about earlier, although albeit you you're fixing the terrain. Tell us about the the 2FL, because um, like is there any condition that you think where it sings, like um reflux, IBS?

Beyond The Gut: GU And Lung Links

SPEAKER_00 24:36

What anything? You know what brings to mind, Andrew, is not so much a condition, but we we do know that FUT2 non-secretors, so people that don't secrete the FUT2 gene. Yep, so they're not able to utilize prebiotic dietary prebiotics as as well. Um, and so that is that is a really good if you know that information, of course, and and you've got to have you know the that situation where the patient has happened to do have done genetic testing and identified that they're a FUT2 non-secreter, that's where they won't be able to produce their own 2FL. So giving them 2FL. And I've I'm thinking of an eczema case right now where where we did that. We went in after a certain point, did genetic testing, found out all of this information, and I put her on 2FL, and it was like by the next uh consult, a massive corner turned, visibly, you know, and she was ecstatic. And when I sent her the research about, you know, the the two non-secretors and the 2FL, yeah, it was pretty pretty interesting.

SPEAKER_01 25:30

It's really interesting how medicine finally catches up to what NatchPass have been doing for decades. Um, I recently read uh uh an article and it was saying uh talking about um the systemic uh influence of um on on uh dermatological conditions. And it was like, really? Who who would have thunk, really? Catch it up there. Yeah, um it was this was mainstream medicine.

SPEAKER_00 25:58

It was like we've been doing it for decades, but it's like when you hear them say intestinal permeability, or dare I say leaky gut on TV. We're under that.

SPEAKER_01 26:07

Well, it's really interesting. Like I remember supporting a pharmacist who had a complaint raised against her by a dietitian, and um, and it's because she used the word leaky gut. No, she used the word leaky gut, not syndrome. And it was serendipitous that that month in Nature magazine, in Nature Journal, and I'll always remember it could because it was weird. The picture was of a great white shark. I don't know why, but that's how I stuck in your mind. Yeah, that's why it stuck in my mind. And um, and so I supported her with not just that, but the countless other articles, and it was just quashed. Yeah, but it but it's really interesting how we've turned the corner in mainstream medicine. Oh, yeah, yeah, yeah, sure, yeah, sure. Yeah, yeah. It is interesting.

SPEAKER_00 26:53

That's it. Yeah, I've I've found a few um doctors to uh reaching out to to say, hey, can you can you include me? Can you share that report you did recently, that gut test that I'm you know co-managing that pipe that client with? It's like, yeah, sure, have a look. Don't know how much of it you're gonna be able to understand, but great, have a look.

SPEAKER_01 27:11

But I I like the way that you're backing up your clinical decisions with evidence so that you can say, I can show change on a laboratory thing. That that to me is the where you know it's it's not just confidence, it's where let's call it confidence in the profession advances.

SPEAKER_00 27:32

Um you need that that backing, and that's that's really helpful not only in the the medical space, but for a patient too. You know, you say we're gonna test you when when we first start, but have it in your mind that six months down the track we're gonna have a look at it again and we'll line up the two reports and and we'll show you, you know. And yeah, the the the mental um leap that you get when a patient confidently can see the changes, they can see the data. So then it goes away from just being subjective. Like, am I imagining that I'm I'm better from all of this stuff? It's like, no, no, your bifidobacterium is now threefold what it was when we started. Look at your short chain fatty acids, yeah.

SPEAKER_01 28:05

Yeah. Okay, so uh not all fibers are created um equal. We've spoken about a few here, but can you break down which fibers you use, where and when, covering resistant starches as well, um, to support, I guess, especially the keystone species, but the health of the patient.

Daily Polyphenol Playbook And Green Tea

SPEAKER_00 28:24

What have you seen? I use um, I have to say, more and more options these days. Again, like I'm thinking back to maybe four or five years ago. It was if I could get a patient on partially hydrolyzed guagum and and they'd stick on it and I could get them up to the 10 grams a day I was cheering, you know. Now that we know a lot more about and we just have a bit more confidence of, you know, using when and where to use different things, like inulin, for example. Inulin was one back in that time that I rarely touched, you know, but I'm a lot more confident with these days. But there is still that hierarchy where I'd put, you know, the polyphenols in the first position, then the 2FLs and you know, guargum, and then you start getting down the chain into which I'll talk about like gold kiwi fruit um extract, um, as well as, you know, um uh what else have we got? You know, inulin, as I say, goss, partially hyped guagum, we ticked off as well. Um, so there's there's that whole sort of combination, and um it depends on the presentation. So, like I still do want to say that there are patients that will I'll start off with, and based on what I can see, um, and maybe I've got the advantage that they've done a recent uh microbiome screen. So I can kind of look at that and and leave it from there that I can say, all right, I can confidently go in with, yeah, like a gold kiwi fruit extract, for example, or a resistant starch type two from from potato starch. These are the types of patients usually that are going to have a depleted microbiome with with low butyrate and low short chain fatty acids, um, low for calibacterium. That's the big clinical indicator I look for as well, particularly with those two aforementioned fibers. So uh resistant starch type two, um, I use an extract called solnule. Um, and then there's that that other one from the gold kiwi fruit extract. They can be really, really good for your IBS C patients. It's not to say that you can't use them in IBSD, you just wouldn't go in initially with host. Hardcore. Yeah, and hardcore, exactly. So you'd look for a bit more terrain balance first before you can start using it. But coming back to the guagum, there's there's been countless studies now where they will say it kind of doesn't matter where your patient falls in that IBS spectrum, it'll have a stool normalizing effect. So it'll be great for diarrhea, prominent IBS and conversely constipation predominant IBS as well. Um, but as far as regulating the keystone species, linking it back to the original topics here and increasing short chain fatty acid production, lowering colonic inflammation, um, those are my favorites. I'm probably using less of, say, Goss and Inulin these days, and more so focusing on um those two I just mentioned, as well as the pomegranate and the 2FL. But I use all types. We've just got to match the patient at the right time. And a a really tricky one I'll just go into quickly is there's a bit of a nuance with with patients that'll come in that'll have consturbation predominant IBS, where that's being caused by a methane overgrowth, or it's or it's just plain old, you know, um, what's a good example, you know, lack of dietary fiber, or, you know, um lack of movement or lack of you know any other sort of influence that can create poor motility. But what I'm getting to is if it's driven by methanogenic overgrowth, this is where we you say if we do go in with inulin, for example, or resistant starch, we can actually worsen it. The methanogens can actually utilize that to their benefit and and grow further. Okay. And again, learnt that one the hard way. We didn't know as as much back then. And um, it's kind of like, hang on, shouldn't more fiber be better for these constipation patients? And you'd see them get worse with more fiber. So to just be that paradox. So I'd say that's probably 10%, maybe, maybe like that one in 10, give or take, um, of IBSC patients where you have to, you know, think of that and go, that's why it's good always to start with the testing with a new patient, because you can identify that straight off the bat and go, okay, so we'll withhold fibers for you in that case. Instead, we might work over here with this probiotic, you know, L. reuterai, for example.

SPEAKER_01 32:26

Right. Yeah.

SPEAKER_00 32:27

Or a phenol.

SPEAKER_01 32:29

In those, in those patients that get constipated with extra fiber, do you tend to sort of go back and look at the liver about the bile acids and what's going on there?

Rethinking Probiotics: Strain Specific

SPEAKER_00 32:38

100%. 100%. Yeah, good point. And that and that's where it comes back to those bile acids. And, you know, is it too is it too much bile? Um, is is it a high fat diet and the you know the gallbladder's working overtime and there's too much bile? Or is it poor motility because there's not enough, you know, good bile, and therefore you start to question that pass off of primary, you know, bile acids being converted by the microbes down to secondary bile acids. And by the way, that if there is dysbiosis, that conversion happens very poorly. And so what we have often see then is signs of fat male digestion, firstly, poor motility. Um, and on testing, it can reveal usually that you'll see an overabundance of those primary bile acids that are conjugated. And then it's up to the microbes, as I say, to deconjugate to turn into those secondary bile acids. And the analogy I use there with patients is like think of an oil change on a car. That's what we're doing with you for this next little while. And I'll use different compounds, stuff that we haven't talked about yet, but I'll use um actual bile acids themselves, like Tudka, for example, oxbile. Tudka? Tudka. Yeah. I won't go, I won't introduce the acronym, it's about this long, but it's bile acid. Gotcha.

SPEAKER_01 33:52

Right. Yeah. Tudka, I'll have to look that one up. Don't know that one. Um, and what about when you might have an accessory condition? So the one that's springing to mind is something like a woman suffering anemia, suffering from anemia. So excessive flow for whatever. You're trying to treat that. But what's happening is the iron that she's taking, uh we could talk about those here a lot with hepcyten, but we'll go off track. Um, but you're trying to intercede in a positive way there. But while you're doing it, the iron that she's taking is causing all of this sort of keystone species and uh and uh uh pathobiotes, let's say, to go out of whack and ending up with horrible wind. Um I mean, you know, I've seen a case with hemorrhoids, for instance, where somebody was bleeding. So it was it it turned out that the what I thought is the uh the bacteria were basically living off the iron using from the hemorrhoids, yeah. Yeah, just using it. So yeah, tell us about that sort of thing where you're trying to intercede over here, but you need to do this, and it's like, aha, what do I do?

SPEAKER_00 35:03

It's how interesting you say it because every every symptom and condition you just listed, I feel like I've seen tenfold in like just the last few weeks. So it's all fresh in my mind. But um, that can be really tricky because that's let's take a case where that's happening in a female that does have like, you know, endometriosis or fibroids or something like that. And so there is that estrogen dominance. Um, you know, and let's let's just say, for example, they're entering that perimenopause phase of life. So this is an interesting point. At that transition, when the hormones start to change, bile regulation just goes topsy-turvy. So we we know from from data that bile, uh, which we need obviously for for good hormone conversion, detoxification, and all of that hepatic stuff starts to reduce in capacity. So from that, we start to get more auto-intoxication, poor motility, you know. So everything sort of slows down during that perimenopause and even andropause. Um, it happens in in both genders. So yeah, that's an interesting um sort of position where you've got to flip back to all right, we've got to regulate the hormones and go in with a lot more gall and bile support and clean up the bile acids, give them that oil change, explain it to them like that. Yep. And that's where, you know, as I say, TUDCA, um, choleretics and cholagogs, although we've got to be careful with those in acute, you know, gallbladder situations and stuff like that. Um, as well as even things like oxbile to take the pressure off their own bile, you know, supplemental oxbile to just help them digest and break down those fats and and clear hormones effectively. Um, but yeah, you you you were mentioning iron in particular. That's an interesting one too, because there is that whole concern about you give them the wrong form of iron, not only is it not getting digested and utilized and you know increasing their levels, but it's also creating dysbiosis at the same time. That dysbiosis is then going to create more inflammation, that inflammation is then gonna go and feed back into you know the initial subset of symptoms. So that can be really tricky. And that's where you know, once once you've once you've stabilized the hormonal flow, for example, in that situation, you might obviously look at the form of iron and change the form of iron. But a a a good way that I like to do it clinically is using beef organs as supplements because it's kind of packaged, it's it's iron-rich, obviously, but it's packaged as like nature's multi-mineral and multivitamin, if you like. And I feel like it's got all the cofactors, and it's a more gentle way of doing it. The only downside to that is you do need to do high doses. So we're talking four to six capsules a day as opposed to you know one 24 milligram capsule of iron.

Choosing Fibres And Resistant Starch

SPEAKER_01 37:40

Yeah, but but you make a good point because that there's that issue of too much iron, and you get firstly, you get the excess iron not being absorbed by because you're making hep cidon. Um, there's another thing that naturopaths have been doing for decades or over a decade, and medicine has only just caught up in the last two, three, four years. Um, and now it's guidelines. It's like, wow. Um but but um yeah, you might have to use higher dose of something else because it's in because the iron is in a lesser dosage within that thing. But is that bad? Probably not. That's right. Yeah, unless they're unless they're um, you know, critically low in iron, in which case you might look at other forms of administration.

SPEAKER_00 38:22

And it's and it's tricky to explain that one too, because I'm I'm I'm using a broad stroke here, but again, I'm thinking of a recent case where they where the patient said, but Dan, the doctor's saying I need a hundred milligrams per day in supplemental form, and this little 24 milligram thing won't do, won't touch the sides, you know, and that's that's where you need to say to well, actually, the research is changing to your point, and it's saying that lower doses less frequently to avoid hepsidin, yeah, and more clinically effective. But yet you'll still see in every pharmacy 100 milligrams of ferrous fumarate or whatever, you know, very pro-constipation. Exactly. Yeah.

SPEAKER_01 39:00

So 108 milligrams, yeah.

SPEAKER_00 39:02

It's another it's an ongoing battle. Yeah.

SPEAKER_01 39:04

Oh, yeah. Uh now I was also gonna there's something else I was gonna ask you. Oh, that's right. What you were alluding to before, and for our listeners out there, please forgive me for this. I'm going to use an acronym that I learnt way back in nursing, and it's it's going to cause offense.

SPEAKER_00 39:25

Can I can I guess what it is, Andrew?

SPEAKER_01 39:27

With regards to bile gallstones.

SPEAKER_00 39:30

What is it? Oh, it's probably not, but I thought you were going for your old segmented filamentous bacteria.

SPEAKER_01 39:39

I was going to kindly leave that topic out, but unless you wanted to cover it. So the the acronym is to do with gallstones. And it was one, and please forgive me for this. It's just, but it's it's sort of fat shaming. But the acronym was the five F's of Gallstone. So it was like fat 40 female 30. Fertile, flatulent. And I was making I was alluding that back to when you were talking about that when women enter the perimoropause, all of their not just metabolism, their hormones, but also their bile acids decrease. And it just feeds into this whole issue of creating a seed for a gallstone to start to be created.

SPEAKER_00 40:23

Yeah. And this is why we see more galactomies is the term, I think. Gallbladder surgeries essentially postmenopause.

unknown 40:31

Yeah.

SPEAKER_00 40:32

Probably likely due to that. Well, largely due to that, that lack of bile.

SPEAKER_01 40:36

Well, it's really interesting. What I'm seeing is that a lot more younger people are never used to see them.

SPEAKER_00 40:41

Yes. Yeah. Well interesting. Yeah, we can go on that about that all day with Western diet and yes. Microbiome shift.

SPEAKER_01 40:50

Another podcast. Another podcast. Okay. So so what else do we need to learn? Um, you've you've alluded to, you know, obviously diet, but sleep, for instance. Um sleep is such a pervasive issue. Good trying to get good restful sleep is such a uh something that eludes eludes um most of us. Tell us about how important it is and what effect you get from correcting poor sleep patterns into a good night's restful sleep.

SPEAKER_00 41:24

I mean, there's there's my brain shoots straight off into the you know, five, four or five different things, but the the primary one I think about is melatonin. So if we're not sleeping much, we're not producing as much melatonin. So we could argue, you know, a poor production of melatonin, a small melatonin pool, there's there's just less systemic anti-inflammatory benefit going around. So less signaling down to the gut, less T reg production, T regulatory cells. Um, and we know obviously from studies of of shift workers and stuff like that, that that altered circadian rhythm disruption has a massive impact, again, linking back to keystone species. So keystone species will drop very, very quickly under that. And if you take that circadian rhythm disruption, you link it with high stress, processed diet, the wrong types of fats and alcohol, you've got a quick recipe for you know a very angry gut, a very inflamed and angry gut, which by the way isn't necessarily going to manifest as a digestive problem for some people. For some, it will absolutely they'll feel it straight away. My gut is not good when I do shift work, it's noticeably different the next day. And others, it might just be all mood or memory and cognitive deficits, for example. And I think that comes down to genetics, yeah, where it plays out.

SPEAKER_01 42:40

That's really interesting. That's a really interesting point. Um, so would you help these people to start to get a good night's sleep with like using just beautiful, gentle, and I and might I say good tasting things like L-theanine and and things like that, so that you can just really not not ram them in a certain way, but nudge them in a certain way.

SPEAKER_00 43:03

Well, there happens to be a product that I'm that I'm using a lot personally lately and in clinic, and it's literally L-theanine and carver, which I just I said. I said, thank you. Two ingredients for firstly simple, it's chewable, great, you know. Um, so yeah, carver. I I love the the use of carver, L-theanine, definitely. And by the way, I use that for sleep, but I also use it through the day um for patients that they're under a lot of stress. Um, and it comes back to vagal tone as well, you know, if the if the vagus nerve's upset and angry, the nervous system's just never getting that that proper grounding and and and parasympathetic release. Yeah. Um, and and yeah, I mean, we know this just like we know Tuesday comes after Monday, but so many of our our patients that are stressed are going to be just in sympathetic dominance and all the flow on from that. So yeah, a massive just highlighting that link between the nervous system and the environment and stress perception with with the gut, the gut taxa. So we so we know that that's very, very, you know, um prone to create that dysbiosis.

SPEAKER_01 44:07

Can I just ask with regards to these, and I'm gonna say they're mostly women, they're doing everything for everybody else, but they're go, go, go. They're the fine silk iris women, they're warrior women, you know, they're they're always on the go, but they will not slow down. And they eventually start to you, you see this arc, you descending arc of their energy and hormones are changing and things like that. Can you change them? I've never been able to change these type of women. I'm trying to get them to walk along beaches with their husband and the dog and things like that, but their base routine never changes.

Methane, Constipation And Bile Acids

SPEAKER_00 44:46

There is a portion of people we can't change for sure. And you know, sometimes you have to have those hard conversations where it's like, you know, either this stuff isn't isn't for you or it's not the right time, you know. It's rare, but but yeah, definitely, and and men as well. In fact, probably more men than than women. Yeah, you do okay. But but to to that sort of you know, archetype of of patient, um obviously once the peri, you know, hits in and then full-blown menopause, um, there's a such a critical place for for hormones. And I I say this openly, I'm not against hormone replacement therapy done done right. Done wrong can be terrible, you know, but done right with the right doctor under the right guidance. Um, I'm all for it because if you get that baseline corrected, you know, and you stabilize things, they're gonna feel everything else we're giving them a lot more and they're gonna see the benefit of it a lot more. But it's hard to appreciate all of those things you're doing when there's just a plain old deficit of progesterone and DHEA, testosterone, you know, and estrogen.

unknown 45:52

Yeah.

SPEAKER_01 45:52

I love your work. Um, can I ask as a final question? This is gonna be a piece of string, right? It's basically to recap what we've spoken about today. So which sort of things would you go first as a generality? Would it be polyphenols and then fibers and then bacteria? I I know that you've been speaking about fit the patient. I get that, but what would be your generalized go-tos be?

SPEAKER_00 46:21

I start with diet. So we have to we have to start with with the diet and get some some leverage there. Um, it's tricky to say, Andrew, because I do I often think of a lot a lot of patients where I do use a combination of of all of these things where it might combine two or three of them. And again, I've I've said it already, but um an example might be the pomegranate extract, the golden kiwi fruit extract, and the resistant starch. Yep. Um, so it's a it's a combination of of things. And the way I work is gut is a big part of what I do, but there's also a lot of other interventions that I do as well. So it can be a little bit tricky to say, you know, what I do mostly or what I see, you know, gives us the most bang for buck. But I will say that most patients, I'd say nine out of ten of my patients, regardless of what they come in for, will start with stool metagenomics. Right. Straight off the bat. Yep. Gotcha. And that some that one is is hard to rationalize sometimes, A, because it's expensive. And if a patient's coming in and saying, but I don't have any gut symptoms, but I've got all this going over here, to convince them that we still need to look in the gut because we're going to get our most purchase on that, um, is is tricky sometimes. But as I say, it'd be probably a good 90% of patients will do a baseline um stool workup and work off that. Um, and a big area that springs to mind is metabolic health, you know. So where one patient might go straight in with the berberines, the myonocitoles, the seleniums, or whatever it might be, I still do all that, but it's it's gonna be very, very gut and bile acid, you know, and hepatics involved with with weight loss and metabolic health in particular, um, to start with. And then obviously gut cases where we're going in with those as no-brainers.

SPEAKER_01 48:02

So I don't know if I answered your question, but no, no, you did, but but I said this is gonna be my last question, but it isn't. I'm gonna have you online for four hours. So, can I ask then? You mentioned berberine there, and this is something that still commonly comes up. If let's say a woman is using berberine and and um myoinostatol for polycystic ovarian health, uh how do you balance that using berberine as a longer-term supplement with aberrations in keystone species like acomantia? And a secondary question, sorry to follow on here, is is there a case where let's say too much acomantia um or focali bacterium proutinitia might be um detrimental?

SPEAKER_00 48:50

Yeah, I I don't know as much about an overabundance of Facalibacterium, probably honestly, Andrew, because I'm used to just seeing it low, if anything. I'm used to seeing that, you know. Um acomantia, sure. I've seen that uh high in multiple sclerosis many times. Yep. And being a mucus sower and feeder, we've got to strike the balance of achomantia. So too little, no good, too much, no good. We need that sweet spot where the tone, the turnover is um, you know, adequate and there's enough protection from that uh that lining. So uh and the first part of the question with with the berberine, you know, I think a good intervention to do alongside that, coming back to where that's where you might use supplemental butyrate to guard against that, you know? Yeah, just knocking out those keystone species potentially. So we're gonna see short chain fatty acids drop. So you're still giving the colonocytes direct fuel.

unknown 49:41

Yep.

SPEAKER_00 49:41

Then we're offsetting again. And again, like if you can, and if the patient is going to tolerate it, spruking in a prebiotic fiber in there as well, just to keep some feeding going on as you're knocking them out, or there's some collateral damage. With berberine, though, I do always, regardless, cycle it. So we might do three months on, one month off, you know, or two months on, two months off. Yeah.

SPEAKER_01 50:02

I love your work. I love your mind how you've always got the patient's health in the foremost, but you're working around trying to juggle things to suit how best to intervene while getting obviously the gut hallmark and and um you know this keystone uh bacteria that we've spoken about, but you're working around it to sort of make it not just pragmatic, um, but also um beneficial in the long term. I love your mind.

SPEAKER_00 50:31

Oh, cheers. I appreciate that. And I think it's um this is where it, you know, a classic example of how what we do has to be scientific because I have to keep those things in mind as I'm sitting there talking to the patient in simple terms. I have to be thinking about these keystone species and what their you know butyrate production is like and you know what tools are gonna uh uh uh best match them. So it's a cool space to be in. And um, I like that we can do the the before and after testing and and clinically validate what we're doing as well. So it's not just all guesswork.

SPEAKER_01 51:01

Love your mind. Dan Sippel, thank you so much for joining us today on Wellness by Designs. Brilliant speaking with you. Pleasure. Good on you, mate. Cheers. Thank you, everyone, for joining us today. Remember, you can catch up on the show notes for this. We're going to be putting up a heck of a lot in here, but also the other podcasts on the Designs for Health website. I'm Andrew Whitfield Book. This is Wellness by Designs.