Speaker 1: Why is it so hard to get real answers about
Speaker 1: your health? If you've been told that everything looks fine,
Speaker 1: but you know that something is off, well, you're not
Speaker 1: imagining it. That's why I created Vitality three sixty to
Speaker 1: help you better understand what's going on inside your body
Speaker 1: so that you can take the targeted action needed. With
Speaker 1: a functional health approach plus testing, we go beyond the
Speaker 1: guesswork to uncover the root causes of your symptoms. I've
Speaker 1: teamed up with Doctyesmina, an incredible integrative GP and together
Speaker 1: we will help you decode your body's signals and answer
Speaker 1: questions like why am I always exhausted? What's really causing
Speaker 1: my stubborn weight? Am I inflamed? Insulin resistant? Or maybe
Speaker 1: missing key nutrients? Because when you understand your body better,
Speaker 1: you can transform your health. Visit v three sixty dot
Speaker 1: health or check out the show notes for more. For
Speaker 1: a time, after having each of my kids, when they
Speaker 1: were really newborn, I seem to go through the short
Speaker 1: term bout of ibs and I have this really clear memory.
Speaker 1: In one particular occasion, it was with angus so baby
Speaker 1: number three, and I was sitting at the library one
Speaker 1: day ironically studying.
Speaker 2: My masses of nutrition, and I had.
Speaker 1: Him in the purpoose snoozing, and I was working on
Speaker 1: my laptop and I'd just eaten something and then suddenly
Speaker 1: that gut gurgle happened and I literally had to run
Speaker 1: through the middle of this library. I left my laptop
Speaker 1: at the desk with this poor bouncing baby in the papoose.
Speaker 2: I hope I didn't give him whiplash.
Speaker 1: I had to bolt to the bathroom and I literally
Speaker 1: just made it and it was not pretty and it
Speaker 1: was just.
Speaker 2: It was awful.
Speaker 1: And after that, I was really I had a lot
Speaker 1: of anxiety around going out, and I had a lot
Speaker 1: of anxiety around what I could eat. Anyway, I went,
Speaker 1: and you know, I did some investigation, I did some
Speaker 1: in depth testing, kind of got to the bottom of
Speaker 1: what it was, went through a bit of a protocol,
Speaker 1: and it resolved itself.
Speaker 2: And now I've got guts of steel.
Speaker 1: So I've certainly been through my own gut journey, and
Speaker 1: I have to say that when you're in the thick
Speaker 1: of it, it ain't pretty at all. This is healthy
Speaker 1: her with Amelia Phillips. If you're a woman in midlife,
Speaker 1: chances are you've noticed some gut and digestion changes happening,
Speaker 1: with the most common symptoms that we hear about being
Speaker 1: things like bloating, constipation, diarrhea or sometimes a mix of
Speaker 1: both a combo abdominal pain, reflux, heartburn, gas, and often
Speaker 1: new food sensitivity is popping up as well. But some
Speaker 1: of the other symptoms we might not associate so much
Speaker 1: but are or can be related, are things like low
Speaker 1: mood and anxiety, which can sometimes be linked to gut health.
Speaker 1: So what is causing these not so nice symptoms making
Speaker 1: us more sensitive to foods we used to tolerate well and
Speaker 1: possibly taking some of the joy out of eating. To
Speaker 1: help us understand why this is happening and how to
Speaker 1: get to the root cause through testing plus the best
Speaker 1: strategies for restoring optimal digestive health, I am joined by
Speaker 1: gastro entrologists doctor Paul Frooms. Doctor Paul is Board certified.
Speaker 1: He treats patients with gut issues in both the public
Speaker 1: and private practice and is known as the microbiome doctor,
Speaker 1: which I really love and I want to drill into
Speaker 1: the microbiome today. He also trains other doctors and practitioners
Speaker 1: in IBS management through his microbiome treatment program, which is
Speaker 1: called Best Gut Medical Doctor. Paul, thank you so much
Speaker 1: for joining me on Healthy Her.
Speaker 3: Oh, You're welcome to me. It's very nice to be
Speaker 3: asked to join you.
Speaker 1: I just love talking gut health, and I love your
Speaker 1: positioning being a gastroentrologist but also a microbio I am
Speaker 1: specialists as well, which I'm super keen to drill into.
Speaker 1: Now I've just listed off some of the top symptoms
Speaker 1: that I hear of.
Speaker 2: What are you.
Speaker 1: Seeing in your clinic, particularly for women in midlife around
Speaker 1: that perry and menopause transition, and maybe those five years
Speaker 1: post menopause as well.
Speaker 3: Well. The volume of women that I see in their
Speaker 3: forties and fifties presenting with new onset gut symptoms or
Speaker 3: worsening of gut symptoms has significantly increased, I have to say,
Speaker 3: in the last decade, probably because of my interest in
Speaker 3: the microbiome, and probably because they really struggle to actually financewers.
Speaker 3: And so what's striking is a lot of these women
Speaker 3: have had, you know, perfectly normal guts, good digestion, not
Speaker 3: too many food intolerances in their twenties and thirties, but
Speaker 3: then often around postpartum as so after pregnancy things change
Speaker 3: suddenly the different there. So what they complain of is
Speaker 3: they bloat with food whereas they didn't. Bow have its
Speaker 3: change and they can swing either way. Constipation diary, they
Speaker 3: get gas distinction, nausea, reflux, and this is often happening
Speaker 3: for the first time, and they're going, what is wrong
Speaker 3: with me? And they've been seen by GPS, they've been
Speaker 3: tried various dants, told that there's nothing really wrong, and
Speaker 3: yet these symptoms are still persisting. So I see a
Speaker 3: lot of these sort of you'd sort of call it
Speaker 3: IBS symptoms emerging or quite often in that middle age group,
Speaker 3: all the postpartum patients, and they also come with other symptoms,
Speaker 3: so a company and gut symptoms are also that is
Speaker 3: gut brain axis problems. So they always complain of enough
Speaker 3: and say this to them without them even asking, do
Speaker 3: you also have fatigue, brain fog, low mood, anxiety, poor sleep,
Speaker 3: aches and pains, and they go, how did you.
Speaker 2: Know that perfect storm? Isn't it?
Speaker 3: You got it? So I'm seeing both of those sort
Speaker 3: of groups of symptoms or clusters of symptoms in my practice.
Speaker 1: More and more what is happening mechanistically or what is
Speaker 1: happening inside our bodies that is triggering these changes and
Speaker 1: therefore these symptoms.
Speaker 3: There's a few things, but fundamentally, it's a change in
Speaker 3: the composition of the microbiome that then affects their bodies
Speaker 3: and their guts on multiple levels. So firstly, post pregnancy
Speaker 3: and midlife, there's a definite reduction in both microbial diversity
Speaker 3: and the biomass. So the populations of gut bacteria, which
Speaker 3: are so important and critical for gut function and physical
Speaker 3: and mental well being. Through the gut brain axis, they
Speaker 3: change from healthy probotic populations to what we call disbotic populations.
Speaker 3: And you add to that the overall biomass of the microbiome,
Speaker 3: so the size of it shrinks, so it's smaller, it's
Speaker 3: become inflammatory, it's less probiotic. That then triggers inflammation or
Speaker 3: what you call gut barrier changes, and then that spreads
Speaker 3: through the gut and the gut brain axis.
Speaker 2: What is driving those changes.
Speaker 3: Hormonal fluctuations is one, So as you many of your
Speaker 3: listeners will understand, the hormone fluctuations prepregnancy, pregnancy postpartum are
Speaker 3: massive and there's a subset of gut bacteria, probotic bacteria
Speaker 3: that significantly impact estrogen and progesterone metabolism. It's collectively it's
Speaker 3: called the estrabolome or the progesterbolome. So these bacteria change right.
Speaker 3: What they do is they produce an enzyme it's called
Speaker 3: a gleucuronidase or a beata glucuronidase enzyme. It deconjugates estrogen
Speaker 3: and progesterone in the gut, so that allows reabsorption of
Speaker 3: estrogen progesterone, and so that helps balance out and modulate
Speaker 3: a normal cyclical estrogen progesterone cycle in women. And that
Speaker 3: changes when the microbiome changes, so that alters normal hormone regulation.
Speaker 3: That then, of course feeds back into all these many
Speaker 3: or many of these symptoms because estrogen progesterone both modulate
Speaker 3: gut motility, so you can swing from one to the other.
Speaker 3: So if your estrogen falls, you often experience leaky gut,
Speaker 3: which drives bloating, food sensitivities, inflammation, aches, pains, and progesterone
Speaker 3: when it drops, removes its relaxing effect on smooth muscles
Speaker 3: of the gut, so then they get constipated. If they're
Speaker 3: just fluctuating all the time. Then of course the belle
Speaker 3: and the digestion become very erratic.
Speaker 2: Yeah, it's very destabilizing, I can imagine very much.
Speaker 3: So then they get stressed. So the gut microbiome is
Speaker 3: supposed to produce a lot of lovely precursor amino acids
Speaker 3: that your brain uses to make neurotransmitters like dopamine which
Speaker 3: makes you happy, serotonin which makes you calm, melatonin helps
Speaker 3: you sleep, acettle, coline good memory. So you often lose
Speaker 3: those critical nutrients. Plus there's inappropriate activation of the vagus nerve,
Speaker 3: which connects your gut to your brain that sends messages
Speaker 3: straight to your stress centers in the brain. So you
Speaker 3: get quite a lot of cortisol, surging, stress, anxiety, all
Speaker 3: of that steaming from dys biosisycle it of the gut microbiome.
Speaker 3: And that's changed because of the stress on the body
Speaker 3: of going through the aging process plus pregnancy.
Speaker 1: Yeah, I was going to touch on the aging process
Speaker 1: as well, because you were speaking around you know, those
Speaker 1: hormonal changes. How much of these symptoms can also be
Speaker 1: a process of aging. For example, things like our ability
Speaker 1: to digest food out that you know, the quality of
Speaker 1: our digestive enzymes, the integrity of our gut lining, you know,
Speaker 1: all of the neucosal membrane. Is there those factors that also,
Speaker 1: you know, play into this picture of gut dysbiosis.
Speaker 3: Yeah, it's a double whemy. So it's one. It's living
Speaker 3: in the West where the diet is pro despotic bacteria.
Speaker 3: It's way too high carbs, sugars, chemicals, preservatives, pesticide residues,
Speaker 3: chlorine in the water, antibiotic resides in meats.
Speaker 1: Gosh, when you list them like that, it's amazing that
Speaker 1: we're even sitting here with any gut microbiome.
Speaker 3: So it's pretty hard in the first place. So you
Speaker 3: see the deleterious effects of that on the microbiome anyway.
Speaker 3: But then you add aging to the picture, and the
Speaker 3: gut ages just like any other organ ages. So you
Speaker 3: see the ability the ability of the gut to secrete
Speaker 3: digestive enzymes, to secrete acid, both of which are absolutely
Speaker 3: critical to normal gut function, to secrete the neurotransmitters that
Speaker 3: promote regularity of the gut to make sure there isn't
Speaker 3: any altered gut permeability. You know, it's harder to maintain
Speaker 3: those nice tight junctions they're called that stop permeability. So
Speaker 3: that creates an inflammatory state, in depletion state, and you
Speaker 3: pair that with a microbiome that's already starting to take
Speaker 3: hit after hit. Then aging plus dysbiosis basically just keeps
Speaker 3: rolling on and makes it very difficult to have a
Speaker 3: very robust, healthy, strong gart and feel terrific.
Speaker 1: But the great news is that we can restore balance,
Speaker 1: and that you have seen in the work that you
Speaker 1: do and in your clinic that it's not a life
Speaker 1: sentence that we have to live with this poorly performing
Speaker 1: digestion and taking the joy out of eating. Is there
Speaker 1: a lot we can do to help buffer these effects
Speaker 1: of hormonal shifts and aging? Is there a lot that
Speaker 1: we can actually leave as we can pull to help?
Speaker 3: There is a lot you can do. You can actually
Speaker 3: alter the microbiome significantly and rejuvenate it so that the
Speaker 3: populations of toxic bacteria decline, Your probiotic populations can be restored,
Speaker 3: the permeability defects can be repaired, and so you can
Speaker 3: effectively if you work hard on it, you know what
Speaker 3: to do. You can diagnose it and you can then
Speaker 3: reverse most of these changes and then maintain them. So
Speaker 3: it's certainly possible to impact it in a very positive way.
Speaker 1: Yes, And I want to really put that message of
Speaker 1: hope out there for people, because you know, whether you're
Speaker 1: sitting here with a lot of gut issues and you
Speaker 1: know it can be really debilitating for you, or whether
Speaker 1: you're just sitting here and you're not in going Oh, yes,
Speaker 1: all those things doctor Frune just spoke about around hormonal
Speaker 1: changes in aging. It's more about I want to optimize
Speaker 1: and I want to either prevent or just you know,
Speaker 1: minimize the amount of negative impacts. And so you mentioned
Speaker 1: the word diagnosis a moment ago. Yeah, And I really
Speaker 1: want to drill into testing because I know that you're
Speaker 1: super experienced and knowledgeable and being a gastroenterrologist that also
Speaker 1: deals with all the big structural issues of our gut health,
Speaker 1: but that's also very knowledgeable in the microbiome and testing.
Speaker 1: Before we talk about microbiome mapping and what you like
Speaker 1: to test for, I think it's wise to talk about
Speaker 1: the important things to kind of rule out the dangerous things.
Speaker 1: So as a gastroin turologist, if someone comes to you
Speaker 1: and you know they've got.
Speaker 2: Some gut issues. What do you rule out the big things?
Speaker 1: And then let's get into your more detailed microbiome testing.
Speaker 3: So generally, the first thing we do when someone comes
Speaker 3: with chronic gut symptoms is that we do rule out
Speaker 3: the big things. So we check for undiagnosed celiic disease
Speaker 3: with blood testing, we look for a basic pathogen panel,
Speaker 3: which is a pretty standard stool PCR test. We usually
Speaker 3: do a gastroscopy and colonoscopy because it's incredibly important to
Speaker 3: rule out structural pathology.
Speaker 2: What do you mean by that? For an everyday person,
Speaker 2: you've got to make.
Speaker 3: Sure that they don't have something like inflammatory bowel disease,
Speaker 3: Crohn's disease, ulcer of colatis. There's another thing called microscopic colidis,
Speaker 3: which you can only rule out by taking biopsy's. You
Speaker 3: want to rule out refluxusophage artis highness, saying he's peptic
Speaker 3: ulcer disease, celiac disease. So those sort of structural things
Speaker 3: it's very important to first rule out before you go
Speaker 3: down the microbiome pathway.
Speaker 1: All right, So let's say that that all has been
Speaker 1: ruled out, or if they have something they're well aware
Speaker 1: and they're managing it. Let's now talk about the store testing.
Speaker 1: First of all, I think you have a test that
Speaker 1: you like to do. What are you measuring in this test?
Speaker 3: So essentially I like to do two tests in most patients.
Speaker 3: So we like to rule out what's called CEBO, which
Speaker 3: is small intestinal back to overgrowth, because that is very
Speaker 3: common and its major syentom is bloating and just about
Speaker 3: everybody complains of a lot of bloating, and that's bloating
Speaker 3: that decurves quickly. So we do a breath test to
Speaker 3: look at that, and we're looking at breath hydrogen methane
Speaker 3: after ingesting a sugar, So we rule out CEBO with
Speaker 3: a breath test, and we also do microbiome mapping, so
Speaker 3: this is detailed mapping of the composition of all the
Speaker 3: microbes that make up the microbiome from a stool test.
Speaker 3: And so they use PCR or sixteen S RNA technology
Speaker 3: now and there's even DNA higut sequencing they do, which
Speaker 3: will measure specific bacterial species to detect parasites, pathogenic bacteria,
Speaker 3: and then these what are called dispotic bacteria or facultative pathobions.
Speaker 3: There's lots of different names for them. These are bugs
Speaker 3: that if they are allowed to get into a state
Speaker 3: of overgrowth, cause problems like chronic ibea.
Speaker 2: So these are kind of like the opportunists.
Speaker 3: They're the opportunistic pathogens. Yep, they get a chance, they'll
Speaker 3: take over and start to cause absolute habit And we
Speaker 3: can look at all of those, look at whether there's
Speaker 3: inflammation with what's called a calprotect and we can measure
Speaker 3: zoonulin to see if the pulp there's permeability issues. You
Speaker 3: can look at measures or estimates of digestive enzyme dysfunction.
Speaker 2: That's really interesting.
Speaker 1: So when you're not just measuring you know, when you
Speaker 1: talked about the microbiome, you've got the pathogens, which are
Speaker 1: the baddies. You've got the opportunists, which maybe are not
Speaker 1: so bad in low levels but you know, small amounts,
Speaker 1: but if they proliferate, that can cause so they're kind
Speaker 1: of sitting on the fence. Then you've got the good,
Speaker 1: healthy gut bugs. But you're also looking at other things around.
Speaker 1: We spoke about aging a moment ago, so digestive enzymes,
Speaker 1: gut permeability, integrity of the gut lighting that.
Speaker 2: So you're measuring.
Speaker 1: You're looking at it at it quite holistically, You're not
Speaker 1: just looking at the bugs.
Speaker 2: Is that right?
Speaker 3: That's right? Yeah. There are other as I mentioned, biomarkers
Speaker 3: of gut function, permeability, digestive enzome function that sort of
Speaker 3: give you a cluest to just how compromised and how
Speaker 3: severe the the effects of dys biosis are, which might
Speaker 3: zero you went onto extra treatment protocols depending on what you.
Speaker 2: Find, And tell me do you find?
Speaker 1: Is there a really common theme that you see for
Speaker 1: our ladies in perimenopause and menopause? Is there like, oh yeah,
Speaker 1: like I can just look at ten results and before
Speaker 1: even I can tell that's a perimenopause a woman or
Speaker 1: is it extremely.
Speaker 2: Unique for each individual.
Speaker 3: So there's some very common things you see, and then
Speaker 3: there's some very unique things you see that are individual
Speaker 3: because everybody's microbiome is very similar, but it's completely unique,
Speaker 3: so they're as unique to you as your retina is
Speaker 3: or your fingerprint. So while we share a great many similarities,
Speaker 3: everyone's microbiome is actually specific to them. So classically we
Speaker 3: see reduced microbiome diversity, so there's fewer spee numbers of species.
Speaker 3: So that's a less resiliant.
Speaker 1: Okay, So these are the common things. This is there
Speaker 1: if we let's look across the board generally speaking for
Speaker 1: this cohort Okay, reduction in the species. So our Amazon
Speaker 1: jungle has just now gone down to Central Park site,
Speaker 1: a lot of squirrels, but not much else.
Speaker 3: Okay, Yeah, And so the overall biodiversity is much smaller,
Speaker 3: the biomass is smaller, and we typically see reductions in
Speaker 3: overall in lactobasaur species and biffidobacteriumicibacterium. They're the sort of
Speaker 3: commonest things you see. But then there's all these other
Speaker 3: very specific abnormalities that might be individually.
Speaker 1: Based, and that's more around like the pathogens or the
Speaker 1: opportunists that might be.
Speaker 3: That's around the pathogens that's looking at which the sort
Speaker 3: of a collective or phylotype is called proteobacteria. But within
Speaker 3: that there are multiple different facultative or pathobionts or opportunists
Speaker 3: that differ amongst people. So we drill down into those.
Speaker 1: I want to ask you just on the pathogens about
Speaker 1: one in particular which can be quite a common one
Speaker 1: where I live, which is called dian to meba and
Speaker 1: Funnily enough, my eight year old so different cohort who
Speaker 1: had some tummy pains recently, just did the standard PCR
Speaker 1: test and she came back with that particular parasite. And
Speaker 1: I know that, like I've never had her gut tested
Speaker 1: when she was healthy. What I'd love just as a
Speaker 1: little side because I know this is quite a common one.
Speaker 2: Is that one?
Speaker 1: Do you classified that as a nasty pathogen or is
Speaker 1: that more one of those opportunists? I know there's a
Speaker 1: bit of kind of you know, discussion around dian to MEBA.
Speaker 3: Yeah, Look, it's probably the most underrecognized cause of ib
Speaker 3: AS symptoms there is. It's common, but it confuses people
Speaker 3: because some people can be exposed to it, contracted and
Speaker 3: asymptomatic and just get rid of it themselves. Other people
Speaker 3: will have a sh short lived mild gastro from it
Speaker 3: and get rid of it. But then there's a group
Speaker 3: of people that have chronic carriage of dying to MIBA,
Speaker 3: and this little protosaur is responded can certainly cause symptoms
Speaker 3: in those people. So if the clinical picture is they're symptomatic.
Speaker 3: So some loose stool bloating, tummy pane, nausea fatigue, or
Speaker 3: any combination of those. Plus you've got don to MEBA.
Speaker 3: The literature says that you can't call an IBS until
Speaker 3: you've eradicated that parasite because it can directly cause those symptoms.
Speaker 3: But there's a bit of confusion around it because of
Speaker 3: the other two presentations.
Speaker 1: All right, well, let's talk about digestive enzymes in our
Speaker 1: age group as well as kind of integrity of the
Speaker 1: gut lining. Do you see quite commonly a reduction in
Speaker 1: the quality of our digestive enzymes.
Speaker 3: Yeah, we have indirect ways of measuring it, so we
Speaker 3: have you look at the stool pancretic a lass dase,
Speaker 3: which is a reflection of how well your pancreas is
Speaker 3: secreting it your own digestive enzymes. Quite frequently that is low.
Speaker 3: And then the stool test also can look at what's
Speaker 3: called the stadecurate. It can look at whether there's undigested
Speaker 3: fats in excess in your stool. So that's another measure
Speaker 3: of maldigestion mal absorption because your digestive enzymes aren't doing
Speaker 3: the job they're supposed to. That's quite hot. I see
Speaker 3: that a lot too. The other component of that of course,
Speaker 3: is the microbiome, because it turns out your gunt bacterior
Speaker 3: do a lot, almost well, a high percentage of the digestion.
Speaker 3: For example, take carbohydrates. Now, pancreas secretes probably I think
Speaker 3: it's about eight or nine different enzymes to break down carbohydrates.
Speaker 3: They're called alderlasers. But your microbiome secretes something like one
Speaker 3: hundred and thirty of them. So who's doing the digestive
Speaker 3: work here? Yeah, we're doing a bit yep for sure,
Speaker 3: but our microbome's doing a lot of.
Speaker 2: It, a lot.
Speaker 1: So when we see that reduction in diversity and just
Speaker 1: overall size, it's going to make a difference. Why is
Speaker 1: it so hard to get real answers about your health?
Speaker 1: If you've been told that everything looks fine, but you
Speaker 1: know that something is off, you're not imagining it. That's
Speaker 1: why I created Vitality three point sixty to help you
Speaker 1: better understand what's going on inside your body so that
Speaker 1: you can take the targeted action needed. With a functional
Speaker 1: health approach plus testing, we go beyond the guesswork to
Speaker 1: uncover the root causes of your symptoms. I've teamed up
Speaker 1: with Doctyesmina, an incredible integrative GP and together we will
Speaker 1: help you decode your body's signals and answer questions like
Speaker 1: why am I always exhausted?
Speaker 2: What's really causing my stubborn weight?
Speaker 1: Am I inflamed in and resistant? Or maybe missing key nutrients?
Speaker 1: Because when you understand your body better, you can transform
Speaker 1: your health. Visit V three sixty dot health or check
Speaker 1: out the show notes for more. And when you just
Speaker 1: spoke about undigested fats and malabsorption, if someone's presenting with
Speaker 1: low nutrient levels like chronically, you know, low iron levels
Speaker 1: or some of the vitamins and minerals they're being tested
Speaker 1: just always low, even though they've got a healthy diet.
Speaker 2: Can that malabsorption?
Speaker 1: If those markers show of some malabsorption, can that be
Speaker 1: a really strong clue as to why these nutrient markers
Speaker 1: are consistently low.
Speaker 3: Yeah. Absolutely. By the time it gets to nutrient deficiency,
Speaker 3: clearly you're not You're not able to digest foods to
Speaker 3: the stage where you can and absorb them properly, so
Speaker 3: you're effectively partially digesting them, but you're rendering yourself nutrient deficient. Unfortunately,
Speaker 3: because you don't forget, you can only absorb nutrients or
Speaker 3: foods that have been broken down all the way down
Speaker 3: to the size of one single molecule. So for protein,
Speaker 3: you know you've got a massive tangle of protein which
Speaker 3: is all of amino acids. You have to break that
Speaker 3: down into a single molecule called an amino acid before
Speaker 3: you can absorb it. And so same with carbohydrates, same
Speaker 3: with fats. You've got to break them down.
Speaker 1: I'm just thinking of that steak sandwich that you smash
Speaker 1: standing up on your bench at home because you've got
Speaker 1: less than five minutes and you've just quickly thrown down
Speaker 1: a steak sangar before you run out to your stressful
Speaker 1: meeting or picking the kids up from school, and you're
Speaker 1: wondering why you're not your iron levels are low even
Speaker 1: though you're eating steak.
Speaker 3: It's not you know, I'm not getting the iron out
Speaker 3: of that steak because you've got to digect it to
Speaker 3: such a degree. You've also got the other thing we
Speaker 3: see is a little bit of low gastric acid secretion too,
Speaker 3: And for to particularly to absorb iroon you have to
Speaker 3: have enough acid because you can't convert the iron in
Speaker 3: food to the absorbable form without acid.
Speaker 1: I mean what I love Like I'm sitting here thinking
Speaker 1: the question isn't should I get this test? The question
Speaker 1: is why haven't I had this test done before? Because
Speaker 1: even if you're in rude health and you get this test,
Speaker 1: you've got this lovely blueprint of what your healthy gut
Speaker 1: looks like. And then if laiter down the trap, things
Speaker 1: go sideways and pair of shaped, you can then, you know,
Speaker 1: come back, and I love that you know you can
Speaker 1: literally then go all right, well, I can see I've
Speaker 1: got a digestive is to you, my microbiome might be
Speaker 1: looking not too bad or you know, like you say,
Speaker 1: a little bit different.
Speaker 2: For other people.
Speaker 1: I wanted to ask, do you look at things like
Speaker 1: toxins or pesticide levels or anything like that in those tests.
Speaker 3: No, that's a completely separate set of testing looking at it, right,
Speaker 3: the complicated exposures to toxin levels and heavy metals and molds,
Speaker 3: that's a whole different field, right, Yeah, okay, but it's
Speaker 3: fair to say that, you know, most of us will
Speaker 3: have some levels of environmental toxins in our bodies because
Speaker 3: we're exposed to those chemicals kind of daily. But the
Speaker 3: most effective detoxification system you've got is your microbiome. They
Speaker 3: will detoxify those chemicals for you in your gut before
Speaker 3: you absorb them. And then the next sort of stage
Speaker 3: of detoxifications if you do absorb those, every molecule you
Speaker 3: absorb from your gut goes to your liver first, and
Speaker 3: then your liver is this massive detoxification organ that will
Speaker 3: try and save you from these or detoxify these these
Speaker 3: chemicals for you. But even then the liver gets put
Speaker 3: under stress and sometimes they get through and yeah we
Speaker 3: have systemic.
Speaker 1: Sinct yes, and cells start behaving badly. Yeah, well, let's
Speaker 1: talk about solutions. So let's talk about when you have
Speaker 1: got this amazing insight through this testing and you're able
Speaker 1: to then make some targeted changes, is there a foundational
Speaker 1: kind of framework or protocol or blueprint that we can
Speaker 1: look at, knowing how unique each result is going to be,
Speaker 1: But how do you tackle this person.
Speaker 2: We've ruled out all the nasties, we've ruled.
Speaker 1: Out, you know, the what we spoke about earlier with
Speaker 1: structural changes and blood in the stool and that sort
Speaker 1: of thing. But looking at this particular stool test, where
Speaker 1: do we go to rebalance.
Speaker 3: Over years of working in this space. I've sort of
Speaker 3: boiled it down to a four phase program framework, if
Speaker 3: you like, with which I tackle everybody, but it's tailored
Speaker 3: to what we find on the stool test and the
Speaker 3: sebow breath test. But essentially it's the first phase is
Speaker 3: you test properly, and we've gone into that. That data
Speaker 3: driven diagnosis then allows you to move forward. Phase two
Speaker 3: is whatever we find that is either pathogenic or is
Speaker 3: potentially toxic, whether it's parasite, bacteria, fungal overgrowth, we will
Speaker 3: literally do it what's called a kill phase, which is
Speaker 3: usually it may be a combination of anti fungals antibiotics,
Speaker 3: but there's also plant based extracts we use, and biofilm
Speaker 3: disruptors and diet so.
Speaker 1: And that's very individualized, like you'll give two women very
Speaker 1: different things.
Speaker 3: Depends on what you've got, So there are some things
Speaker 3: we use in everybody. We always use the same biofilm disruptor,
Speaker 3: et cetera. But what we use to target your bugs
Speaker 3: depends on what we find in the stool test. After
Speaker 3: we do the kill phase, then this third and probably
Speaker 3: even more important phases to then start restoring a healthy microbiome,
Speaker 3: because a healthy microbiome will help you rebuild a healthy
Speaker 3: gup barrier. So this is when probiotics, prebiotics, digestive enzymes,
Speaker 3: other nutrients that we use that stimulate epithelial repair and
Speaker 3: growth are brought into play. And then once you've corrected
Speaker 3: all of that, the final phase is maintained. Because what
Speaker 3: we find is that probiotics are great for getting things,
Speaker 3: and probiotics, et cetera, nutrients like glutamine, et cetera, all
Speaker 3: very good for rebuilding populations of microbes, but they're not permanent.
Speaker 3: They don't stay or integrate and become part of your
Speaker 3: permanent microbiome. So really, you and I are going to
Speaker 3: still get exposed to stress, We're still going to expose
Speaker 3: to hormone disruptors, We're still going to get exposed to
Speaker 3: chemicals and that kill month the microbiome. And we're going
Speaker 3: to pick up the odd bad bug from other people
Speaker 3: because humans probably know this. Humans are the only the
Speaker 3: only animal that doesn't eat each other's poop to top
Speaker 3: up their microbiome.
Speaker 2: Thank God for that. It's all I can say. I
Speaker 2: love my microbiome.
Speaker 1: I'll pop some probiotics, but no, I'm going to leave
Speaker 1: it there. Leave it there, you know, a transpusian, maybe maybe.
Speaker 3: We have to develop other way. Very we're very good
Speaker 3: at sharing bugs because we don't do that, We've developed
Speaker 3: other ways to share bugs. So you will, you and
Speaker 3: I will get exposed to the occasional faculty of pathobiond
Speaker 3: or pathogen or yeast. So the maintain PHAs is very important.
Speaker 3: So our only defense against that is to continue to
Speaker 3: eat good probiotic foods and to take probiotics. So that's
Speaker 3: what I call maintain.
Speaker 1: If I'm hearing you correctly, it doesn't matter how amazing
Speaker 1: that step two and three of you know, I've heard
Speaker 1: people call it weeding and seeding. Yeah, this idea of
Speaker 1: you know, the kill phase and then and then the
Speaker 1: restoring phase, no matter how perfect that is, and you
Speaker 1: get your beautiful jungle looking at that point. If you
Speaker 1: then don't maintain that great diet and lifestyle habits, it
Speaker 1: will just potentially shift back to it's a reflection of
Speaker 1: what those habits are.
Speaker 2: Is that what you're saying, That's.
Speaker 3: Exactly what I'm saying. And so you know a lot
Speaker 3: of patients will come get fixed because they are feel
Speaker 3: great and then just down a team for follow up
Speaker 3: or just drop their probotics after a while, and sure enough,
Speaker 3: one or two years later they're back.
Speaker 1: And what I'm really hearing you say as well, is,
Speaker 1: you know, in your twenties and thirties and maybe your forties,
Speaker 1: you could probably get away with it.
Speaker 2: But because we've got that layer.
Speaker 1: Of aging on top of it and all the other
Speaker 1: fun stuff that comes with that, we're probably getting to
Speaker 1: a point where we can't just wing it anymore, and
Speaker 1: we have to be a little bit more focused and
Speaker 1: intentional on supporting that gut microbime.
Speaker 3: Totally totally right. Correct.
Speaker 1: It's so encouraging to hear you say that and to
Speaker 1: hear that framework because it really sounds achievable. What length
Speaker 1: of time step two and three? Is it something? Do
Speaker 1: you switch between it is like two weeks of weeding,
Speaker 1: two weeks of seeding, and you go back and forwards.
Speaker 2: Like that, or is it what's the time frame all
Speaker 2: of this takes.
Speaker 3: Well, the initial studies, looking at the weeding phase, we're
Speaker 3: two weeks duration, and so we follow the published literature.
Speaker 3: So it's for dysbiosis, it's a two week kill phase
Speaker 3: followed by a two week repair phase followed by maintenance.
Speaker 1: Is that it, Okay. So it's not like it goes
Speaker 1: for months or anything.
Speaker 3: No, the maintenance should go for months, but it goes
Speaker 3: through a bit longer. If there's some significant leaky gut
Speaker 3: then there's another two weeks of leaky gut repair. So
Speaker 3: that's a six week program and cibo's a six week
Speaker 3: program because that's a little bit harder to.
Speaker 2: Shift, right, Okay, And do you see great results?
Speaker 3: Yeah, we do, we do. We see probably seventy percent
Speaker 3: of people have a significant change in not just their
Speaker 3: gut symptoms, but also those other symptoms I mentioned in
Speaker 3: their fifthic and mental wellbeing as well.
Speaker 1: If someone's sitting here just curious like me, I don't
Speaker 1: have any big issues at the moment, would there be
Speaker 1: any harm in getting mind tested anyway, just to kind
Speaker 1: of get a sense and maybe even as a benchmark.
Speaker 3: Yeah, it's a good idea. It's not a bad idea
Speaker 3: at all to test your microbiome because even if you
Speaker 3: think you're asymptomatic. And this is an interesting thing we've
Speaker 3: found with people is that they come in and say, oh,
Speaker 3: I'm only testing because my wife tested, and I'm okay, no, sure,
Speaker 3: we test them and we say, look, you actually got
Speaker 3: a pretty toxic looking microbiome. Why don't you do a program?
Speaker 3: They go, oh, all right, I'll do it. They come
Speaker 3: back and they say, oh my god, I didn't realize
Speaker 3: what I was putting up with. I feel so much better.
Speaker 3: But even if you are like you and you're good,
Speaker 3: you've now got a good gut. By testing your microbiome,
Speaker 3: there you can pick up what you might be at
Speaker 3: risk of. There are certain bacteria that now strongly associated
Speaker 3: and thought to directly contribute to bow pollups, bowel cancer.
Speaker 3: There are certain bacteria that are now thought to cause
Speaker 3: Alzheimer's rheumatoid arthritis. So you can be sitting on these
Speaker 3: bacteria and have no idea and they're just quietly working away.
Speaker 3: Your probiotics are sort of looking after you. But if
Speaker 3: anything changes, then oh my god, the foundation for problems
Speaker 3: later on. So you can get a window into how
Speaker 3: you're going to age and what you're at risk of.
Speaker 2: Ah, so fascinating, I'm so doing this test.
Speaker 1: Let's shift gears and talk about gut health and mood.
Speaker 1: And you did mention earlier. But if we are living
Speaker 1: a very stress filled life, often not by choice, what
Speaker 1: impact can that have on our gut health and vice versa.
Speaker 3: Well, pretty significant. So this is one of the most
Speaker 3: important and probably poorly understood areas of medicine. Right there
Speaker 3: is a gut brain axis. It's bi directional. It's not
Speaker 3: just your gut bacteria triggering off your vegas move in
Speaker 3: a good way or a bad way. It works in
Speaker 3: reverse as well, So the the brain via the vagus
Speaker 3: nerve and then the what's called the enteric or the
Speaker 3: gut's nervous system can work the work the other way
Speaker 3: and affect it in an adverse way from stress. So
Speaker 3: the connection is very big. There's over five hundred million neurons.
Speaker 3: It's the size of a cat brain. That's the gut's
Speaker 3: own nervous system.
Speaker 2: Sorry, say that again, the size of a cat's brain.
Speaker 3: Yep, the gut nervous system. The gut's got its own
Speaker 3: nervous system, and it's enormous. It's five hundred million neurons,
Speaker 3: roughly the size of a cat brain. And that's why
Speaker 3: we call wow second.
Speaker 1: Brain because the majority of serotonin is produced in the gut.
Speaker 2: Is that correct?
Speaker 3: Over eighty percent? Yeah?
Speaker 2: Serotonin? So that love that feel good? That do you
Speaker 2: know that?
Speaker 1: Just feeling when you're just glowing in just you know,
Speaker 1: gratitude and you're feeling so happy and balanced and calm.
Speaker 1: Eighty percent of that is produced in this organism that,
Speaker 1: if you bundled it all together, is the size of
Speaker 1: a cat's brain.
Speaker 3: That's right, That's right.
Speaker 2: Isn't the body just the most incredible, incredible thing.
Speaker 1: And so if someone's feeling anxious and you know, oh,
Speaker 1: it's perimtopause, it's sad much generation, it's my aging parents,
Speaker 1: it's my nightm teenagers, and then they come back with
Speaker 1: a test like this and there's lots of imbalances and
Speaker 1: lots of things going out. Is there an argument to
Speaker 1: say that once you restore that balance in the gut microbiome,
Speaker 1: the teenagers don't go away, the aging parents don't go away,
Speaker 1: but potentially they will feel better or at least a
Speaker 1: bit better.
Speaker 3: Yeah, so concertainly modulate that. So what you're talking about
Speaker 3: is as we age, not only do we have the
Speaker 3: effects of aging, but stresses pile up on adults. Just
Speaker 3: as you mentioned, there's multiple layers of stress that sort
Speaker 3: of get heaped on you as you age, and so
Speaker 3: that creates a situation of chronic psychological stress. Now, that
Speaker 3: activates what's called the HPA axis hypolamic peturitory adrenal axis.
Speaker 3: So then the adrenals are just pumping out all your
Speaker 3: stress hormones, cortisole. You would have heard about the cortisole
Speaker 3: stress surge adrenaline or adrenaline. So this is sort of
Speaker 3: driving people to almost exhaustion through chronic stress. So that's
Speaker 3: sympathetic overdrive, and you know that leads to anxiety and
Speaker 3: then eventually.
Speaker 1: You know, oh and also scoffing a bag of chips
Speaker 1: and downing their cocktails and all the things that it's
Speaker 1: going to be unhelpful for our guts exactly.
Speaker 3: You try and get a dopamine hit from some sugar
Speaker 3: and some fat, but you're altering your microbiome even worse
Speaker 3: because the cortisol and the stress hormones, they are bad
Speaker 3: for your microbiome. They cause dysbiosis too, They cause altered
Speaker 3: permeability and then more inflammation, and then that drives a
Speaker 3: vegas nerve and stimulates more stress, and it's a cycle
Speaker 3: of never ending stress, worse mybiome, poor out, poor diet,
Speaker 3: increasing all these what are called proteobacteria, you know those
Speaker 3: bacteria that are just sitting on the fence waiting to
Speaker 3: cause a problem suppressing your probiotics. So this is a
Speaker 3: big problem. And then of course if you don't have
Speaker 3: those lovely bacteria, you can't produce the precursors of serotonin
Speaker 3: and gabber and melbotonin and dope.
Speaker 1: Mean for the brain that buffer all of these other
Speaker 1: nasties we've been talking about. Totally, Totally, I think it's
Speaker 1: a really hard concept for a lot of people to
Speaker 1: connect the gut and their mood.
Speaker 2: I mean, I know we have.
Speaker 1: This idea, we get a gut feeling, but the fact
Speaker 1: that if our microbiome is humming away and working really well,
Speaker 1: that we actually will be able to tolerate those external stresses.
Speaker 1: And we've probably got a better handle on being able
Speaker 1: to control our microbiome than we do those external stresses.
Speaker 1: Like teenagers, I think my micromee biome will probably be
Speaker 1: better behaved exactly.
Speaker 3: Good microbiome increases mental resilience basically, and also for the
Speaker 3: for the women who are perimenopausal or menopausal, it's all
Speaker 3: compounded by declining estrogen and progesterone, which I think of
Speaker 3: those hormones as your life force. And you know, estrogen
Speaker 3: normally upregulates your serotonin receptors in your brain, so estrogen's
Speaker 3: very good for helping you handle stress and keeping you calm.
Speaker 3: So if you've you've got less precursors of serotonin and
Speaker 3: things being made in the gut because of dysbiosis, your
Speaker 3: estrogen progesterone declining, so you've got less receptor sensitivity. It's
Speaker 3: a bit of a perfect storm for low mood, anxiety,
Speaker 3: emotional dysregulation. It's just it. It plays havoc with women.
Speaker 1: I'm stopping short of diving deep into key nutrients and
Speaker 1: your thoughts on you know, are these healthy for our
Speaker 1: gut and not? But if I had a dollar for
Speaker 1: every time a woman came to me and said, I'm
Speaker 1: being really healthy. I've gone off gluten and I've dot dairy,
Speaker 1: I would be retired on a donkey farm. But but
Speaker 1: it's a really I find the dairy conversation a really
Speaker 1: challenging one because in the work that I do with
Speaker 1: a functional medicine doctor, we send so many ladies for
Speaker 1: bone density scans and osteopenia osteoporosis. It's on the rise,
Speaker 1: you know, I see on the flip side the outcome
Speaker 1: of you know, low calcium intake and you know, inactivity.
Speaker 2: And so i'd love to get your thoughts.
Speaker 1: On dairy generally. Is it always pro inflammatory? Is it
Speaker 1: you know something that as a guesserentrologist, you know I
Speaker 1: would rather see you know, less of my ladies on it.
Speaker 2: What's your take on dairy?
Speaker 3: Good?
Speaker 1: Bad?
Speaker 3: Yeah? Well, it's very individual because some women literally thrive
Speaker 3: on dairy and many many men and women feel terrible
Speaker 3: on it. So first thing is, do you have lactose intolerance,
Speaker 3: then you've got to eliminate dairy. Second thing is if
Speaker 3: you have an intolerance or some allergy to caseine protein,
Speaker 3: then milk protein intolerance, you can't have dairy. So there
Speaker 3: are those two really clear cut reasons why you should
Speaker 3: avoid dairy because it literally upsets you and you won't
Speaker 3: absorb it properly and it creates a significant gut issue.
Speaker 2: And is that something you would test for?
Speaker 3: Yeah, sometimes we test for it. We do. You can
Speaker 3: do a lactose breath test to see if they're lactose intolerant.
Speaker 3: You can do a trial yourself. You can go, I'm
Speaker 3: going to drink some normal lactose milk and I'm gonna
Speaker 3: drink some lactose free milk and see if as a difference,
Speaker 3: or you do a lactose breath test, which we do
Speaker 3: in many people. If there's confusion about it the caseine
Speaker 3: protein one, you can do a blood test to look
Speaker 3: for that, or you can do your own trial and compare.
Speaker 1: I mean the problem with trialing with milk if someone's
Speaker 1: been avoiding dairy. If I didn't have any dairy for
Speaker 1: a month and then I suddenly drank a glass of milk,
Speaker 1: chances are I'd feel pretty rubbish.
Speaker 3: Well, we're meant to drink milk as infants and then
Speaker 3: wean off it. So most people will be become dairy
Speaker 3: intolerant throughout adolescents and in the early twenties if they're
Speaker 3: not drinking milk regularly because genetically we weren't meant to know.
Speaker 3: We were meant to drink breast milk, and that's it.
Speaker 3: Move on to food. But we have a dairy industry,
Speaker 3: and so if you keep drinking like black to, you
Speaker 3: keep drinking dairy, you can tolerate it into well into adulthood,
Speaker 3: in all your life, unless you know you turn off
Speaker 3: that enzyme or you're become intolerant.
Speaker 1: All right, So basically get tested if you can. And
Speaker 1: you're not sitting here saying yes, no one should have it.
Speaker 1: If you can tolerate it and it works, well, go
Speaker 1: for it. And if you can't, try to get to
Speaker 1: the bottom of it.
Speaker 3: As you know, post menopause women need a lot of
Speaker 3: calcium vitamin D.
Speaker 2: Yeah, more than a whole.
Speaker 3: Lot of it, and there's a lot of that. You
Speaker 3: can get a lot of calcium from milk, but you
Speaker 3: know you don't have to get it from milk. You
Speaker 3: can get Yogurts are great because they're for minted foods.
Speaker 3: They provide do you have a lot of prebiotics. So
Speaker 3: it's nice if you can tolerate that sort of dairy
Speaker 3: or keffea.
Speaker 1: Yes, I love kafirs so yummy, and smoothies so.
Speaker 3: And they're often bitter tolerated than straight cow's milk. Aged
Speaker 3: cheese is also very good because you know they're fermented
Speaker 3: and they have a lot of basically just fat and
Speaker 3: protein which are okay, and they're not associated with the
Speaker 3: increasing inflammatory markers in some people like straight cow's milk.
Speaker 2: Up, Well, we have covered a lot today.
Speaker 1: I would love to wrap this up by asking you, finally,
Speaker 1: doctor Paul, for a woman listening who does want to
Speaker 1: optimize their gut health, what are the most important changes
Speaker 1: that you see that she should make in her diet.
Speaker 3: Well, basically the top four or five maximize plant diversity.
Speaker 3: So there was as a big study published in Cell,
Speaker 3: Host and Microbe. I think remember that study which showed
Speaker 3: if you could eat thirty different plants a week, you
Speaker 3: would have a significantly more biodiverse by a dense microbiine.
Speaker 3: It's one of the biggest things that changes your microbyne.
Speaker 3: So just number one tip, put in a nice variety
Speaker 3: of plants, fruits, and vegetables. Second, it would be prioritize
Speaker 3: probiotic fiber, so onion, garlicly jerusalem antichoke, oats, sparagus. You know,
Speaker 3: they're sort of very that are very high in prebiotic
Speaker 3: sugars and fibers like banana starch. Two that comes to
Speaker 3: mind because these will feed really important probiotics in your gut.
Speaker 3: That's probiotic foods. Three would be eat some add some
Speaker 3: fermented foods. So add a little bit of kim chiese
Speaker 3: and kiffeir sour krawn. They're really good because they're actually
Speaker 3: giving you probiotics. Four would be just drop and get
Speaker 3: out of your diet ultra process foods because they're the
Speaker 3: most chemically disrupted. And five would be sort of in general,
Speaker 3: eat a sort of the Mediterranean diet. So olive oil,
Speaker 3: olive oil, olive oil.
Speaker 1: I love that are such a wonderfully practical note to
Speaker 1: end on, doctor Paul Frunz, thank you so much.
Speaker 3: You welcome.
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