Gut Health Revolution and Autoimmune Disease with Dr. Will Bulsiewicz

In this groundbreaking episode of "Thriving with Arthritis," host Dr. Diana Girnita welcomes renowned gut health expert Dr. Will Bulsiewicz. Together, they explore the fascinating connection between gut health, nutrition, and autoimmune diseases, offering invaluable insights for those managing arthritis and related conditions.
Episode Highlights:

1. Gut Microbiome's Role in Autoimmune Diseases: Discover how your gut health impacts inflammation and autoimmune responses.

2. Bridging Science and Patient Care: Learn how cutting-edge research is being applied to improve treatment outcomes.

3. Fiber: The Hero: Uncover the powerful effects of a fiber-rich diet on gut health and immune function.

4. Short Chain Fatty Acids Explained*: Understand these compounds' crucial role in maintaining a healthy gut.

5. Resources for Your Gut Health Journey: Get introduced to Dr. Bulsiewicz's books, courses, and the 38 Terra supplement line.

Dr. Bulsiewicz, with his impressive background from Georgetown School of Medicine, Northwestern Memorial Hospital, and UNC, brings a wealth of knowledge to this discussion. Whether you're battling an autoimmune disease, arthritis or simply interested in optimizing your health, this episode offers a comprehensive look at how lifestyle changes, nutrition, and proper medical care can work together to help you thrive.

 Dr. Will Bulsiewicz Website: https://theplantfedgut.com/

Transcript

 Welcome to Thriving with Arthritis, the podcast that empowers you to live a better life despite all the challenges of arthritis and autoimmune diseases. I am Dr. Diana Gornita, your host, and a rheumatologist with over 20 years of clinical and research experience. With each episode, you will learn the most valuable information, the latest research, and many practical lifestyle options that will empower you. to fight arthritis.  Whether you're newly diagnosed or have been living with arthritis for many years, this podcast is here to support you every step of the way.

Let's begin.  

 Today, I'm very thrilled to have an esteemed specialist in the field, a true gut expert who is not only trained at Georgetown School of Medicine, he was training medicine at Northwestern Memorial Hospital. He did gastroenterology at University of North Carolina, and he also did a master in science, 

it was not enough, and he got a certificate in nutrition from Cornell University. 

It is my pleasure to introduce you, Dr. Will Bulsiewicz.  Thank you, Dr. Diana. This is such a pleasure to be here with you today. I'm excited about our conversation.  I'm also very excited to talk to you because over the last three years I was watching your work.

I know that you are very involved in educating people about the role of the gut microbiome, about the role of nutrition in regulating the gut microbiome,  but  you are also a researcher and you put your life into the the benefit of others.  You are also someone that published books and is also very involved in  bringing people to the roots of the problem, not only treating symptoms, but also treating the roots of the problem. 

Yeah, I think these are things that I know that you can appreciate because this is the, this is what you've done with your own career. That  there's a world that exists in research. Yeah. That is removed from the patients. And there is a world that exists with the patients that's in the clinic.  And it's not very often that those two worlds collide.

, but actually we need those worlds to collide because to really truly understand how to best treat our patients, we have to be with them. Yet at the same time the science emerges from these studies. And so trying to bridge that gap is an important thing. And so to me, one of the things that I'm most proud of in my career is the efforts that I've made.

To try to do that, which includes conducting research, publishing in major medical journals, yet simultaneously not making that the only thing that I do and having experience, one on one in the clinic with patients that really informs a lot of my understanding because I learn from them.  You talk about fiber.

And you talk about fiber rich foods. I hear you talking everywhere about that. And I know that you put so much effort into that. You even publish a book that you have behind you. But also, I was one of those people that, without even knowing who you are, I purchased the book because I wanted to understand and educate my patients.

Now, because you are the expert, can you tell us, how can patients using fibers? Can influence their body immune response and  I would also want you to touch a little bit the role of fiber in patients with autoimmune diseases.  

Yeah these are, first of all, these are complex topics.

And if we knew with complete clarity exactly how to treat these things, I think actually would be a lot easier for our patients. I think that we're still in the process of trying to figure all of this out. And I don't want to any way reduce this down to one thing, make it sound like the gut microbiome is the only thing that matters for people that have chronic inflammatory health conditions.

I think that would be unfair to them. Yet at the same time, there is this. Emerging science that I believe is really exciting and teaching us things about the way in which this works And so I think to have a proper conversation about this and by the way, let me say Deanna Please just jump in if there's anything that you want to add based upon your clinical experience Because you're a rheumatologist you are a true expert in this field  I am a gastroenterologist.

I've taken care of patients with ulcerative colitis and Crohn's disease and celiac disease and many other related type conditions, but it hasn't, like I haven't stepped outside the box of that in the same way that you have. So I respect your expertise and opinion. I  think if we zoom out for a moment, we have to start with the emergence of these conditions. 

Correct. They're rising at a rate that is like quite concerning. In the Western world, we, if you track over a period of years, growth rates that are on the order of 20 percent per year.  Correct. And so the question is like, how could this so rapidly emerge?  And we have to wait, what are the possibilities?

And naturally one question is this a genetic issue?  And the problem is that when it starts to emerge at this rate of 20 percent per year, It's impossible to say that's genetics.  Our genetics don't drift and shift that quickly. The things that do change are our environment  and our environment.

When I say our environment, many people will interpret that to be like things along the spectrum of global warming or, deforestation or things of this variety. No, I'm actually just referring to the world in which you exist.  You, the listener at home,  the house that you live in,  the what's outside of your home in your yards, what you're exposed to on a daily basis when you drive your car to work or wherever you may go, the food that you put into your body, which is your fuel, the way in which you sleep, the time that you spend with digital technology devices.

All of these things create our environment.  And our environment ultimately becomes reflected  in our gut microbiome.  So our gut microbiome is the product of everything that I just described. And more. We could go even further with that but, and this this community of microorganisms  that covers all parts of our external body, our skin, eyes, our nose, mouth yet is most concentrated  inside of our large intestine, which is what we call the colon.

They, this. Community of microorganisms is the product of an, of our environment.  And I believe that it is the shifts in our environment,  the changes in our diet and lifestyle that have occurred over the last 100 years, where I would argue Deanna,  the life that I lead quite clearly  is extremely different than the life that my grandfather led.

When he was a child, 100 years ago,  and I might even argue, go so far as to argue that you could tell us about how your life has changed coming from Romania and moving to the United States.  I have many stories about that, and I can tell my listeners, and I can tell you, that moving at the age of 28 from Europe to United States was a dramatic shift in my health.

Very rapidly, I gained weight. Very rapidly, I started to feel very fatigued. And I thought at that point that I'm too worked out, that I don't sleep enough, and I was eating poorly. But then I realized that, that change probably happened because I was exposed to a completely different environment than what I used to have at home.

The food was different. My schedule was different. My sleep pattern was different. But not only that, I think that the fact that I was living in a different environment, my body had to adjust to that. My microbes, my gut microflora had to adjust to that. And it took me years until I understood that, but I have to agree that, changing the environment, even from a continent to another continent, it will change the way that you feel.

Yeah. And we've seen this by the way, with other studies that have looked at immigrants to the United States or people that leave third world countries and move to industrial countries or even people that leave the countryside and move into cities,  we see that those changes in environments towards a more industrial environment do impact the microbiome.

And it's not to make an argument that the the food doesn't matter, that it's just the microbes, right? I'm not arguing that it's just the microbes and it's not the food and the sleep and the exercise and all these other things. What I'm saying is that this is the package.  This is the package. The way in which we live our life, it impacts our microbiome.

And our microbiome becomes this important part of our immune system.  The reason why is because  our gut is actually our most vulnerable part of our body. So our skin is actually more like a barrier. It's like a wall to keep things out.  Yet, the things that we are willing to consider bringing in,  we choose to put into our mouth.

It's a choice. Put into our mouth, we chew, and we swallow.  And we are exposing ourselves in a vulnerable way to whatever it is that we just chose to do that with.  And it enters into our intestinal system and the intestinal system is a tube that never breaks. So whatever goes in the mouth will come out the other side  unless it gets absorbed. 

And in that process, whatever it is that we put into our mouth, if it's not absorbed, it comes into contact with our gut microbes.  And it will change those gut microbes  and and those gut microbes, they are the first actual layer of defense for our body from my perspective. So before we ever get to the immune system,  our first part of our defense is actually the microbiome.

And it's been shown through, for example, many different types of infections that we are protected against.  Simply because we have a microbiome that protects us.  That's very true. And and now the second layer of defense, even before we've gotten to the immune system,  is the gut barrier.  And the gut barrier to me is a fascinating thing  because it's so small and microscopic that most physicians would never consider this to be an organ. 

And I consider it to be  perhaps our most important immune organ.  It is a single layer of cells  so thin that the naked eye is not able to detect it. Again, this is probably why we don't really think about this when we compare it to a big thing like the liver or the heart or the brain.  So small that we can't see it yet.

This is what protects our body and keeps things in the intestines that we want to stay in the intestines and not allow them to get access.  To our bloodstream, because if it did get access to our bloodstream in a matter of literally seconds,  it will be pumped throughout the entire body and be everywhere.

Our gut barrier protects us and keeps things where it's supposed to be. And when it breaks down,  then things start to sneak across and we've heard this referred to as leaky gut which is an expression that I don't particularly have a problem with. I just think we need to be careful about what we, Read on the internet.

A lot of what we read around leaky gut isn't what I would characterize as accurate. But to call it leaky gut, to me, I don't have a problem with that. We could also call it increased intestinal permeability.  Either way, it's a broken gut barrier.  And this barrier it refreshes itself every three to five days. 

So it's fascinating to consider that this part that I'm describing is, I think, our most important immune organ  is actually completely redoing itself on a three to five day basis. Thanks.  What that means is that every three to five days, we have the opportunity to make it really good if we want to on the other side of that barrier  is where you are first entered into the actual body. 

And it would make sense that in this place, this is where we would set up our main defense systems.  So 70 percent of our immune cells actually live within the lining of our intestines.  And the reason why they're there is because if something were to break this barrier or come across and it's not supposed to be there, then the good news is we got basically the military in place.

They're ready to protect us.  And that's a good thing. When. It's an acute thing like a bodily injury or an infection, like this is good. We want our immune system to step up and protect us.  But unfortunately, a big part of what we're facing these days, Dr. Diana, and I know that you would agree with this,  is not acute inflammation. 

It's chronic, chronic, unremitting activation of the immune system. That's frankly and this is creating chronic inflammation  and chronic inflammation has consequences. And these consequences can be felt throughout the entire body in a number of different ways. But to me, this is the the prelude  to how a person moves on to ultimately develop autoimmune disease. 

I'd love to hear how you would expand upon that or take that.  Thank you very much for explaining these three layers. I do use the same kind of explanations for my patients because they don't know, they think about the gut microbiome, they think about the immune system, but they don't understand how they play, how they interact together.

So the fact that you started from the microbiome and then you explain very nicely the the how this mucosa is there and is there for a reason. And the fact that you brought into the discussion the leaky gut, again, like you, I don't have a problem with that concept, but the reality is that when I was trained and through my training, it was not taught to me the way that it is taught.

Today or understood today and probably because it was not very well understood. I did my PhD in immunology In the 2000s and at that point we knew very little compared to what we know today We knew about th1 th2 type of cells We didn't know about th17 and you know All the other army of cells that can eventually lead to autoimmunity and that kind of understanding  Is evolving It is important for patients to know that their immune system starts there at the gut level.

It's not only in the lymph nodes. It's there for a purpose, and like you said, it's there to protect us.  But if you continuously stimulate the immune system, it will lead to inflammation. And I think our biggest enemy today is the chronic inflammation. We now understand that chronic inflammation impacts the risk for cardiovascular disease, impacts the risk for developing diabetes impacts the risk of us gaining weight.

We talked today about how increasing the weight will impact inflammation and the other way around. But I think in medicine, most of us, we were not educated enough because it was not the data there or because we tend to look at the big picture. More than the small things like microbes and and the immune system.

And I do feel like in traditional medicine, we focus too much on one organ. Like we focus on one tree from a forest and we forget about the forest. I see that all the time, patients are moved from doctor to doctor because everybody focuses on only one problem or only one organ, when like you said, all of these things are interconnected and it makes sense to be like that. 

Yeah, I think that there's a historical reason for some of these things that have taken place, to be totally honest with you, and it may be beyond the scope of what we specifically want to get into here, but I guess just to summarize real quick my thoughts on this so that your listeners can hear it, I think that what happened is that the current, the modern healthcare system in the United States developed after World War II,  And there was a major discovery in World War Two that is a complete, like literally the greatest discovery in the history of medicine,  which is the discovery of penicillin. 

And that's a funny thing for me of all people to say, because I also am the person who simultaneously pushes back against antibiotics. And so it's to be clear drugs when appropriately used are life changing. And when appropriate, when inappropriately used, they're highly problematic and it can cause severe harm.

And but penicillin was discovered and it like instantly added more than 10 years to people's life expectancy. And so the power that we discovered was so attractive that we decided to build an entire healthcare system around this idea that if you had a pill, That pill could fix your problem. And what we completely lost sight of is that  true healthcare  is not waiting until a person is sick  and then  trying to keep them alive and prop them up artificially true healthcare starts today with everyone who's listening to us right now and offering them the opportunity.

To build health  through manipulation of those environmental things that I was mentioning earlier that I believe are problematic. Because if we manipulate those, then actually we're getting at the root of the issue.  We're preventing disease. And the beautiful thing is, hopefully you never actually need that pill because you never actually experienced the disease in the first place.

And if you do have the disease, I want to mention this as well. Let me just say this. Be the let me just be completely clear, the person who has rheumatoid arthritis or another autoimmune type condition, in no way am I suggesting that you did this to yourself, that would be completely insane. 

Alright, what I am suggesting is that there's a lot that we now know  that we didn't know years ago.  That can be tools and opportunities for us to optimize our gut, optimize our immune system,  starting from where we are today and moving in a better direction and as we do this, we can make progress and progress may be reflected in a number of different ways and one of the ways that I would measure progress is trying to take a person who has active disease and make their disease inactive.

And I would love to take it so far as to make it inactive to the point that it's never active. And if that's the case, if I can drive you into permanent remission,  then that is as close as I can possibly get you to a cure because I can't cure the disease, but I could put you, I could potentially help you get into remission.

And that would be amazing.  I do talk to my patients because you mentioned about that, about the role of medication and the role of manipulation of the diet or lifestyle changes. Like you, I try very hard to bridge these words, these two words because what I see patients getting confused is trying to take only one pill and solve the problem or taking one route of changing their nutrition.

but they don't see the improvement that are expecting. And I always say to them that the research that was done with the purpose to help them achieve remission. But if you bring on top of, this intervention, if you bring the lifestyle that is appropriate for you, then you're going to get to remission faster and you're going to start.

stay in remission for a longer period of time.  Now I'll come back to your favorite topic fibers, and I'm going to ask you to tell us, how can fibers, or eating more fibers, or what type of fibers should people eat to reduce inflammation in the body?  Okay, so between you and I, we have proposed this general vision  of the defense system of our body that has three layers, the gut microbiome, the gut barrier, and the immune system.

Okay, so there are the, these are the three layers. Now let's talk about. What happens when we consume fiber? So first of all, fiber is a carbohydrate. So this is why I get a little upset when people vilify carbs is being categorically bad. I get it when we're talking about doughnuts,  but like carbs can be actually incredibly healthy and important part of our diet because fiber is a carb. 

It's a complex carbohydrate that is found in all plants. So all fruits, vegetables, whole grains, seeds, nuts, and legumes contain fiber. So you don't have to worry very much about saying where can I find fiber? If it's a plant based food, it has fiber. And you can be confident in that.  When we consume fiber,  I mentioned earlier, like things enter into our intestines by choice. 

and part parts of what we consume end up getting absorbed. That is digestion. Digestion is the breakdown of our food and making it accessible so that our body can actually absorb it.  The issue with fiber is that we as humans lack the ability to break down fiber.  We just don't have the enzymes for it.  So fiber is incredibly complex. 

And we would need tens of thousands of enzymes in order to do this properly, which we don't have.  So fiber passes through the small intestine, which is where most digestion takes place. By the way, the small intestine is 15 to 20 feet long  and it manages to survive all of that where all of these other nutrients are getting absorbed  and it arrives intact into the colon.

And this is an important concept because. In the colon is where the vast majority of our microbiome exists. We have  38 trillion microbes  that exist within our colon.  So do we have bacteria in our small intestine? We have some. Yeah, we have some. There's no external part of our body that's totally sterile.

The concept of sterility is like the only places in the world that are sterile are places that we have as humans.  Attempted to make them sterile  through the destruction of microbes. So you could like literally, Deanna, you could go into a volcano. There's microbes there.  You can go to the bottom of the ocean into a rift vent.

There's microbes there. You could take a drill and bore down miles into the earth.  There's microbes there. They're everywhere.  So we microbial world and they've been there since the very beginning. This is the first life on the planet.  And we came along billions of years later and this is part of why we coexist with these microbes is that everything that exists on this planet whether it's us or the squirrels or the trees, everything has a microbiome, everything. 

So now our microbiome is specially evolved to support human health.  So from the very beginning, we've had a relationship with these microbes.  They were there for the good days, and they were also there in the bad days.  And and that evolutionary process that we did together, this co evolution we clearly, I'm saying this as a medical doctor,  we clearly grew to trust them, because we basically outsourced really important things to our microbiome. 

And one of them is digestion.  And so specifically the digestion of fiber.  Because fiber is so complex, we don't have the enzymes to break it down, but guess who does? They do.  These microbes have tens of thousands of enzymes,  and so when fiber arrives into the colon, they actually work in teams, so it's not just like one bacteria.

Breaks down one piece of fiber. No, this is an entire team of multiple different species and types of bacteria and fungi that go to work together that basically use their tools, meaning the enzymes to break down the fiber. And when they do, the fiber undergoes a transformation. It stops being fiber. We don't recognize it anymore. 

Now it has emerged as something new.  called short chain fatty acids  and the three classic short chain fatty acids are butyrate, acetate, and propionate.  And these short chain fatty acids have, so when we talk about like how does fiber affect our immune system,  the vast majority of my argument  involves what I have just laid out, which are the production of short chain fatty acids as the result of consuming fiber. 

So the microbes produce these three, butyrate, acetate, and propionate.  And if we think about these three layers, of the defense system that I've laid out the quick cliff notes version  of what happens. Number one,  the short chain fatty acids change our microbiome, make it healthier,  suppressing the bad guys, E.

coli, Salmonella, Shigella. We have shown short chain fatty acids actually suppress them,  enriching the good guys. We create an environment that fosters the growth of the anti inflammatory bacteria that want to support us.  So we create a healthier microbiome.  Number two, the gut barrier. When the gut barrier is broken, we need to repair it. 

There's a specific protein that I know that you're familiar with, but I'm not sure if the listeners have heard about it. They're called tight junctions.  Tight junctions are basically the cement that hold the cells together.  If you want to repair the gut barrier, you need to fix the tight junction proteins. 

Short chain fatty acids, specifically butyrate, do exactly that. There is actually nothing that exists that's more powerful for healing and restoring our gut barrier than short chain fatty acids. So if we want an intact gut barrier,  the most powerful thing are short chain fatty acids that we get from fiber. 

And then the last thing is the immune system. Now you're an immunologist, which to be completely frank, is a bit intimidating for me because I'm a humble gastroenterologist. We're like the orthopedics of internal medicine. We're not very bright, but  that's not true. We're not super bright compared to the other internists and specialists, but, I did read your book.

You put a lot of immunology in here. So I was impressed with that. Please when you find things that I've done wrong, please help me do better. But when we think about the immune system, as Dr. Deanna is so complicated and it would,  You and I could talk for four hours and still be touching the tip of the iceberg on this topic, right?

But if we want to really simplify this,  what we do know is this, that there are inflammatory signals that exist within the immune system. These inflammatory signals,  they're manifested through cytokines.  Cytokines are basically ways for cells to communicate with one another.  So when inflammatory cytokines are released, it's like the beat the drumbeat of war, right?

This is the drumbeat of war. We're going to activate the immune system and create inflammation and fight.  That's not what we want on a routine day.  That's not what we want. We want to cool that down.  And so what we do know is that short chain fatty acids help us to suppress those inflammatory signals and to actually release the opposite of this.

very much. Which is soothing music,  the soothing sounds that you would hear if you went into a spa.  That's where we want our immune system to be most of the time.  And that's what we have. I love this. This kind of putting that story, I love this. And I think you, you could, I'm sure you could guess which inflammatory, which is, which cytokine I'm referring to right now, which is IL 10.

IL 10 is a cytokine that is actually pumping the brakes on the immune system and telling it to relax and cool off.  And when we think about these autoimmune diseases, Deanna,  There's so many. The pharmaceutical industry,  the way in which they have created solutions to these diseases is by trying to block the immune system.

And specifically what they're doing is they're trying to block these cytokines. So it could be IL one, or it could be TNF, right? Or like the, we hear both with ra. 'cause actually in many cases, the treatments for ra, they start with RA and then they come to gastroenterology with Crohn's disease and ulcerative colitis later.

We have these anti TNF medications like Remicade and Humira, but TNF is just one of the cytokines. It's just something that is released to activate the immune system. And it shows you how powerful, and how smart the immune system it is to overcome what we are trying to induce chemically.

I do agree with you. I think that first of all, the immune system is complicated. We try to attack one molecule at a time. And it's like attacking one tree in that big forest. It works for a while, but it's not going to work forever. And that's why we are failing in some cases, but it's still better than we had 10, 20, 30 years ago, much, much better. 

But like you said,  The role of fiber in producing short chain fatty acids is so powerful that there is nothing that I know as that will be influencing our immune system towards, getting that smooth vibe from our food.  Is there any other food that will or type of food that will make our bacteria to produce short chain fatty acids?

That's. That's something that I don't know. Okay. So this is where I think things get even more interesting. I hope that they've been interesting so far. We tend to think of things quite linearly in the sense that, if you get, if you eat fiber, you get short chain fatty acids, which give you this benefit.

Okay, cool. That makes sense.  Here's the thing. What if you didn't change your fiber intake?  What if your fiber intake stayed exactly the same?  But you did something that changed your microbiome  in a way where those microbes become more efficient  at producing short chain fatty acids. So now you get more short chain fatty acids from the exact same amount of fiber intake.

You didn't even change your, you didn't even change your diet. Okay.  So let's think about that for a moment.  Tell me more. There's a lifestyle choice  that has been shown to do this.  Which is exercise.  Exercise has been shown to change the gut microbiome in a way where the change specifically that we see is a shift towards more an enhanced ability  to produce short chain fatty acids.

Now from an exercise perspective, in the absence of disease, why would this be true? Why is it that if I go to the gym after we're done with this podcast, why would I receive the benefit of more short chain fatty acids? Why would my body want that?  The answer is that short chain fatty acids actually connect to our muscles  and are importantly involved in the repair of our muscles after exercise.

They're anti inflammatory and they help us to basically heal from the injury that occurs in our body after we exercise. That's why we get sore.  Okay.  So what I'm saying is that if you exercise without changing your fiber intake, you will increase the production of short chain fatty acids.  What is the data on exercise and rheumatoid arthritis? 

There is a lot of data for sustaining an exercise program in patients with rheumatoid arthritis. And we know, like you said, that rheumatoid arthritis, it's a systemic disease, is not only affecting the joints, it could affect the gut. Actually, many patients will exhibit at the time that they come to me, if you do a proper history of review of system, you're going to find out about their gut issues. 

And the data related to exercise is that not only it's going to maintain your muscles, it's going to improve the stiffness that you have. It's actually indicated, although you feel stiff to move, because that will maintain the flexibility, maintain the strength, but it will also improve the mood. And the gut microbiome, I actually tell that to my patients.

Now you mentioned about treating patients with Crohn's disease and ulcerative colitis. Those are two autoimmune diseases that are not very fun to have. And when you recommend fiber or increasing the fiber, what is the outcome of this patients with gut autoimmune diseases? All so I think that.

To present this. So far we have been presenting this in a very sort of mechanistic way.  Now we have to get real with what happens with real people who get motivated and they're like, Hey, I heard this great podcast. Now I want to consume more fiber. How do we do this? All right. Correct. So the truth is that the the gut, I like to think about it conceptually, like it's a muscle. 

And a muscle can be trained,  can be made stronger,  and when injured,  a muscle can be rehabilitated.  For a person who has Crohn's disease or ulcerative colitis,  they have the deepest dysbiosis. Dysbiosis is the term that we use for a damaged gut microbiome,  because it's literally a disease of inflammation.

of the gut microbiome. So these are the people who have the most deep dysbiosis and to emerge from that is actually quite challenging.  Yet the thing about it is that paradoxically  fiber, which actually is very hard for them to process and digest  because bear in mind what I said earlier, which is that we actually are a hundred percent reliant  on our gut microbes to break down and process fiber for us. 

So for the person who doesn't have their microbiome in a healthy place,  It's actually really hard for them to do that. Let's think about this process of the gut is a muscle, but for the person who has Crohn's disease or ulcerative colitis, that muscle, it's not that it needs to just grow stronger. 

That muscle needs to be rehabilitated back to health.  And in order to rehabilitate a body, bodily injury,  we still are going to do the work,  but the work is going to be reduced to a point that is so small that it seems almost silly, right? In the same way, Diana, that if I hurt my shoulder,  then I'm not going to fix my shoulder by taking ibuprofen.

That doesn't actually fix the problem. It masks the pain.  It doesn't fix the problem. I want to fix the problem. I have to rehabilitate it and I'm going to start with basic things and those basic things don't even include me lifting weights. And in the beginning, they don't even include me lifting my arm over my shoulder. 

I have to build up to that.  When it comes to fiber in the gut in a person who has a damaged gut, and this by the way applies to all people who have a damaged gut, including those who have other autoimmune diseases, but particularly true for ulcerative disease, you have to reduce your fiber intake substantially  to a level that you can actually tolerate  and you feel okay. 

And by consistently making a point to consume fiber on that level,  you are allowing your body an opportunity to get better. better and more efficient at processing and digesting fiber, you will make your gut stronger.  You will be rehabilitating your gut and you will discover that you actually will develop the ability to consume more and eventually it will come to a point where it's completely normal levels of fiber intake. 

And if you continue with that, it will eventually exceed what are normal levels of fiber intake. And you will have abilities that you didn't know were possible for your own body even before you had this condition being diagnosed.  So it is entirely possible to start in a place of humility and with challenges and through this process and patience. 

and persistence. But seeing and understanding this analogy, that it's rehabilitation for the gut, and it will take time.  If you can see that and accept that, you will rehabilitate your gut, you will grow stronger, you will normalize that, you will exceed normal, and it will be, like, this to me is the opportunity of hope that exists. 

I do like that, and I do the approach of going slow, but steady, and persevering in these programs. And I know that you do have a program that you teach patients with gut issues. Would you mind telling us a little bit more about your program?  Sure. So there's a number of different programs that I have, but let's get specific about this, which is like a person who wants to add more plants to their plate  and is struggling to do it.

Okay. I wrote a cookbook. So my first book was fiber fueled and in my mind as a medical doctor, when I write a book, I'm creating a tool for healing. That's the way that I see this.  And so fiber field, my first book, which you're holding up right now, Is really to me the, Hey, let me teach you the basics of what we've learned about the microbiome.

It is powerful. Here's the basic tools. Here's how you go about this.  And my second book is the fiber fields cookbook, which I have right here.  And the cookbook it's, it is a cookbook. It has a hundred recipes. They're delicious. You don't have to have any sort of issue to enjoy those recipes. You just have to enjoy delicious food, which I'm pretty sure we all do.

But for people who do want to work on healing in their gut.  There are actually two protocols  that are embedded in the cookbook.  One is a low FODMAP protocol and the other is a low histamine protocol.  And the book actually contains 11 chapters and most of the chapters have zero recipes because basically I'm providing the education. 

And the the program that you need in order to understand how to actually fix these issues. So to me, this is an excellent place to start with this question that you and I are discussing because it's cost effective as well. It's not very expensive.  You can literally borrow it from your library if you want to.

But If you want to graduate to a more college level beyond that, I have courses. So I have online courses of many different varieties, including ones that cover food intolerances. And I have something called my masterclass and my masterclass is my flagship course. So for people who are interested in going beyond what you find in my books, that's what I would encourage you to do because it allows you to take that deeper dive and really dig into this content in a much deeper way.

deeper way for a physician to do so much work, to put their knowledge, to translate the science into general public knowledge. It is very hard. I can tell you that from my own experience, I wrote a book about gout and nutrition, and I'm writing a book about rheumatoid arthritis and nutrition. And like you, I try to pick things that are relevant for me.

for patients to understand and just to translate the language that we use day by day. It's a challenge, but to go even further and provide the online courses, the master class, and also to provide recipes, that's a next level. level. That's an extra level. And I congratulate you for that. I know that there are not many physicians that are doing that.

And I have to tell you, I respect that a lot because I know how much work is behind. If people would like to work with you. Or let's go back a little bit. Do you have any other research coming any other projects exciting projects that you are working on? Yes, I stay quite busy diana. And I do appreciate what you just said that was very nice.

Thank you. So There's a few things. One is the zoe project So zoe is a personalized nutrition company that i'm involved with i'm their u. s medical director You  And I'm quite proud of the work that we've done. We just published in nature medicine,  a randomized control trial  showing, yeah, showing that our product is highly effective and beneficial to people.

So if you want to learn more about that, these are by the way, all resources. No, these are resources. This is not a sponsored podcast for people to know. This is not a sponsored podcast, but I do value the work that certain physicians are putting into it. And, for you to tell me that you are publishing nature, I did not know that.

So for people that are watching this, I did not know that, but I do respect physicians that are working hard to change the outcome for patients. And that's why I invited you. No, I really appreciate that. So yeah, I'm not like, I'm, I totally agree. I'm not here to push anything on anyone at all. The work that I'm involved with, every single thing that I do.

Whether it be free content on online or my books or my courses or Zoe, or I'll talk a moment more in my, about my supplement company. All of these things to me are tools for healing  and it's a buffet and you get to choose what works for you.  And I'm very happy to have you eating at this buffet, no matter which of those you choose, to be honest with you.

So this is why I said, go to the library if you want to I'm perfectly happy. You don't have to buy it if you don't want to just,  so anyway, yeah. The easiest thing to be totally honest with you, Deanna, for anyone who's like really excited about this podcast and wants to continue the conversation is just quite simply come to my website, Which is plantfedgut.

com  and come to my website and sign up for my email newsletter  because the email newsletter You'll get to hear from me routinely. It's completely free. I break down studies all the time There's tons of stuff that's on there that you and I could talk about and have fun with and you'll hear more about these other things that I'm doing, that sort of what is the ecosystem or the universe that I exist in.

You could hear more about that by going through there. Last thing I will mention just briefly is that in January I launched a supplement company called 38 Tara.  And this is the consummation of three years of work.  And in essence, the short of this is that,  so Deanna, I know that you can appreciate this, that when you work with patients in the clinic there is a role for medicine  and there absolutely is an important role for diet and lifestyle. 

And there also is a role for supplements.  And  from my perspective, the supplements that I used as tools to try to help people were okay.  Yes, they did help,  but we could do so much better. And so I made the decision that part of what I do with my time is that I try to create better tools for healing.

Within the gut health supplement space.  So we have launched our first product, which is called daily microbiome nutrition. I'm by the way, happy to send you some.  And it's a, it's basically the prebiotic that I always wished I could have had. So what that means prebiotic is anything that feeds our microbiome. 

So this is a combination of seven different plant based ingredients with fiber, resistant starch, and polyphenols. Several of the ingredients used at doses that have been clinically proven in prior research studies with humans. And basically the intent is to create something that really can help people.

It's by the way also low FODMAP, so it's gentle on people's guts. This launched in January. I'm very proud of it. We've had an amazing response from people and I don't want to push too hard on that other than just to say that if there's something that you're curious about, just please feel free to check out more.

You can hear more at my newsletter. You can also go to 38 Tara, which is spelled number three, number eight T E R a. I  have to tell you that I am someone that works with patients and works with their needs and their desires. And I, that patients without even telling us will take certain supplements.

And in my opinion, it's better to be the right ones that they have scientific value behind it. And in my YouTube channel. I discuss about the role of supplements offering the scientific value for some and advising patients that other supplements that they are taking are not scientifically proven.

So I appreciate that kind of involvement. I think that it's not easy. to come up with all the science and incorporate and translate that into a supplement. But like you said, I think that it's important for patients to take the right thing in the right doses with the right raw materials because that's another issue that the supplement  200 or 2 billion  industry has.

We don't know where the  raw materials are coming. We don't know for many of the supplement companies, if they have a third party certification. And so the discussion can go on and on. As physicians, we are not trained about supplements. We literally have to take the time to invest in this kind of research project that is not compensated by anyone.

But to come up with a project like you did come up, I think it's very valuable for everybody that is watching and listening to know. So that's why I'm glad that you mentioned that. I'm glad that you are involved in this kind of industry because I know with your background. You're going to strive to do the best that you can for your patients.

Yeah, everything that you just mentioned, all those things are the exact reasons why I felt that this needed to happen. There's no drug developed by the pharmaceutical industry that can be prebiotic. And the way that probiotics work is often misunderstood.  And what we're talking about is a quite nuanced space  and the internet doesn't want it to be nuanced.

There are people who say it's all bad and there's people who say it's all good. And yet in between is this world where it's about navigating to find truths. And this is part of why we've created this product as a premium product. We tested for over a hundred things.  Over a hundred things. And we will give that report to any person who wants to have it.

And we are in like, I've already met with the same, I, with the scientists.  Two days ago, I had a meeting with the scientists. We are our first studies already underway with this product. So we're taking the steps to try to remedy many of those concerns that exist with supplements. I'm a big believer in what we're doing.

I'm very proud of what we're doing. And and I invite people to learn more about that if they're interested.  You should be proud of what you're doing With that I would like to thank you very much for taking the time to Educate people and also I would like to thank you for Taking the time to invest in such big projects And I hope to have you in another podcast soon, and i'm very excited to read more books from you.

That's the perfect opportunity for me to say i'm working on my third book. This is not public information. I've never You  I don't really talk about this, but I think that the conversations that you and I have been having today, people will hear more about that and be able to dive even deeper into these ideas in my next book, which I don't think I think that you can look for it probably sometime in 2025. 

Absolutely great to do that.