The 4 Food Types That Repair Your Gut Barrier: A Gastroenterologist's Guide To Beating Inflammation For Good with Dr Will Bulsiewicz #677

22:48Okay, so you've mentioned that there are these kind of three things that we need to be thinking about. The gut microbes, the one cell gut lining, and then the immune system, right? And you're saying these three things are all in close proximity to each other. And one of the ways we influence them is through our dietary choices. There are other ways, of course, we can influence them, but that's one of the ways. I really want to talk about lipopolysaccharide or LPS and inflammation. Those two things, of course, are tightly linked together, but how does that fit into this story?

23:24Dr. Will Bulsiewicz:so within within the gut microbiome they again they're just like us most of them are good guys right when we have a healthy society it's filled with wonderful people that are working hard and supporting each other but there still will be crime right there still will be criminals who are causing trouble and so in a healthy society the good ones outnumber the bad ones and they suppress the bad ones they take them out of the equation that's what happens in our gut too But when the gut starts to wear down and break down, then we can have the emergence of these inflammatory bacteria. And they have evolved with a protective shell.

24:04Dr. Will Bulsiewicz:It's like their armor, their coat of armor. And it surrounds their cell, and it's called lipopolysaccharide. And you and I know this because we trained in the hospital with patients who were suffering the consequences of lipopolysaccharide overload. And we call this sepsis. So if you go into the intensive care unit, this is what you see, people on breathing tubes, people on life support. And it's the consequence of bacterial endotoxin, which is the same thing as lipopolysaccharide. All right. This lipopolysaccharide, it's a part of these bacteria. These bacteria are inside of us. Even in a healthy gut, these bacteria are inside of us.

24:43Dr. Will Bulsiewicz:But when we have breakdown of the system, there's more of them. They're more powerfully represented. And simultaneously, the gut microbiome, these microbes are the stewards of the gut barrier. Their job is to constantly maintain and repair that gut barrier for us. So when they're well and they're doing their job and they're properly fed, we have a strong defensive gut barrier that keeps us healthy. as they wear down the gut the gut barrier wears down as well and this allows things to sneak across and this is a very clearly demonstrated physiology and we call it from a scientific perspective increased intestinal permeability but i also accept the term leaky gut because that's what's happening yeah things can sneak across and what can sneak across are these bacteria that have this lipopolysaccharide.

25:46Dr. Will Bulsiewicz:It's in micro doses. It's a very small amount. It's not the same as the person in the ICO. It's a little micro dose. But when they sneak across, your immune system has been pre-trained to identify that specific pattern and to acknowledge it and take it out. Yeah. And react to it very, very strongly sometimes, right? That's right. So the immune system, So imagine that you're an immune cell and you have been, it's almost like Game of Thrones, like you've been set at the wall, right? We're going to set you up at the wall and your job is to protect this body, right? So then you see this thing that got across the wall and you're like, oh my gosh, that's the enemy.

26:27Dr. Will Bulsiewicz:I need to call for help. So these immune cells will then release what are called cytokines. Cytokines, when people hear about this, it's a nerdy term, but these cytokines, basically what we're referring to is communication between the immune cells. And many of these cytokines are to say, hey, I need help. Let's get more immune cells over here and let's protect this body. So basically when the lipopolysaccharide that's coming from the gut sneaks across this worn down gut barrier, it gets intercepted by the immune system. That is inflammation. and that inflammation may be small and we call that low grade but it's ongoing yeah we call that chronic so it's this concept of chronic low grade inflammation which means the immune system is constantly fighting constantly defending and unfortunately the problem is that even though it may happen on a microscopic level in a very small part of our body the problem is as you and are both tall guys.

27:29Dr. Will Bulsiewicz:We could play, we could be great basketball players, right? But the body is one. The body is not walled off or compartmentalized. Things are not kept separate. The inflammation that's occurring in your gut can create inflammation throughout the entire body because you have the activation of the immune system and the release of these cytokines. Yeah. It's the heart, I think, of where things go wrong in the body, isn't it? You know, we started the conversation with the hypocrisy's quotes, all disease begins in the gut. Okay, some people might push back and say, really all? Well, I think what we can say is that, you know, the gut is definitely a player in most chronic diseases, if not all.

28:15I think in your book, I read that you have got at least 130 different conditions or diseases that you have found a direct link between inflammation or chronic unresolved inflammation and all of these conditions, right? 130. Yeah, there you go.

28:35Dr. Will Bulsiewicz:There's over 130. It's in the appendix of the book. So if anyone has your book, flip to page 371 and you'll find it there. And basically what I did here, Rangan, is that I asked this question.

28:53This episode is sponsored by Thrive, the longevity supplement from Heights that I have been taking daily for the last six months to help me with vitality, cellular energy, and longevity. Now there's a lot of noise in the supplement space and it can be confusing to know exactly what to take. Before I start taking something, I do my own due diligence. And for this one, I had a wonderful, enlightening conversation with the research team at Heights. You see, in our bodies, we have something called NAD, which helps to support our cells' mitochondria in producing the energy our bodies needs. But with age, our NAD levels start to deplete.

29:36Thrive helps resupply your cells by combining NR, a clinically validated NAD booster, alongside coenzyme Q10, copper, and resveratrol to provide a powerful combination designed to keep your cells thriving. And I personally am so convinced by the benefits that I immediately recommended Thrive to my mum and brother. If you want to give Thrive a go, Heights are offering my listeners 20 % off their first month at www.heights.com forward slash live more when you use the code livemore20. That's heights.com forward slash live more and use the code livemore20. Today's episode is sponsored by The Way, the only meditation app with a single long-term pathway.

30:27Now if you've tried other meditation apps before, I am certain that The Way will be the one that will finally help you develop a consistent practice. You see, one of the best things about it is that you are not going to get overwhelmed with different options. You simply open the app and do the next meditation, building up your practice step by step. After a few sessions, you will feel as if you've got your own personal meditation teacher, who of course is the wonderful Henry Shookman, who has appeared as a guest on this podcast on two separate occasions. One of my listeners who started using the way following my recommendation contacted me to say, I have tried so many meditation apps in the past, but simply could not make any of them work for me in the long term.

31:13However, using The Way has been a complete revelation. I've been using it almost daily for the past three months now, and it has had a transformative effect on my life. Now, I personally have been using this app for over six months now, and I absolutely love it. In fact, I love it so much that I have invested in the company to join them in their mission to get more people meditating around the world. For listeners of my podcast, The Way is offering 30 free days to establish your own meditation practice, all you have to do is go to thewayapp.com forward slash live more to get started.

31:56Dr. Will Bulsiewicz:How many health conditions can I find? Not just like, I think that there's inflammation there. I need a study that I can cite where if I'm with you or if I'm with a scientist, I can defend my position and say, here's the study to prove that this health condition is associated with inflammation. And I was taken aback because I found, again, over 130 health conditions. Now this includes the classic things that we would think about, Crohn's disease, ulcerative colitis, rheumatoid arthritis. These are inflammatory health conditions, but it also includes things that people may not think about. Yeah.

32:34Well, there's just so many. There's even things like psoriasis, eczema, what my dad had, SLE, you know, colloquially known as lupus, asthma, you know, also immune hepatitis, low back pain. I mean, you've got research to back up all of those statements, which is quite profound, but I think it gets to the heart of something that I think we all really need to understand, which is our gut health and that gut barrier is so important. Because if you've got a good, well-martialed gut barrier, this lipopolysaccharide, that is normal to be there in your gut. I think we're just making that clear. It's not a problem that you've got LPS on those gram-negative bacteria in your gut.

33:21That's not the problem. The problem is when there's a leakiness to the gut and that lipopolysaccharide gets in, it then interfaces with the immune system and leads to this onslaught of inflammation. A couple of things I just want to comment on, Will, is a lot of people have been quite derogatory about the term leaky gut for years. And I'll tell you my stance on that. I have a slight problem with the derogatory nature of comments towards it. And I'll tell you why, because sometimes I think in our profession, we can sometimes be more worried about sounding smart than actually communicating effectively with the public.

34:01Not everyone, of course, but I think sometimes that happens. And I've always thought, well, leaky gut, you know, yeah, we could say to someone, you know, you have increased intestinal permeability in your digestive tract. Sure, okay, that may be technically correct. Or you can say, you know, your gut is a little bit leakier than it should be. So things are going across the gut barrier and starting an inflammatory reaction. Now, I've seen tens of thousands of patients, you've seen tens of thousands of patients, and I think you can sometimes tell when you're talking to a clinician who's actually spent time with patients, because it's about how do you communicate the message to that patient.

34:43So I really appreciate what you said there, that actually, yeah, it is a leaky gut at that point. Yeah.

34:48Dr. Will Bulsiewicz:Well, I think that the issue is we have to separate leaky gut, which is the mechanism. And that is not a diagnosis. No, exactly. To something else that I've seen out there called leaky gut syndrome. Okay. Right. And leaky gut syndrome is where people are attempting to make a diagnosis. But that's where the issue really exists. So we have to be smart enough to sort of separate those things where it can be confusing when someone's talking about leaky gut syndrome. But the concept of leaky gut is 100 % real. And by the way, just to back up everything that I mentioned about the 130 health conditions with inflammation, I also asked a second question, which is really essential for me to write a book about how the gut is connected to the immune system.

35:36Dr. Will Bulsiewicz:The second question was, can I prove that there's dysbiosis. And can you explain what dysbiosis means if people don't know? So we've touched on it lightly here, but let's get very direct with this. Dysbiosis is referring to this community of microorganisms, our gut microbiome, and it falls out of balance. And when it falls out of balance, then what we have is we have a loss of gut diversity. So earlier I said more diversity is good. So now I'm saying the opposite is bad. When we lose gut diversity, The system is not as strong and resilient as it used to be. And simultaneously, you will see a smaller representation from the anti-inflammatory beneficial gut bacteria.

36:15Dr. Will Bulsiewicz:The ones that we celebrate, the ones that people take as probiotics, they're getting diminished. They're not as well represented. They're not as capable as they used to be. And you see a bloom or emergence of what we call these inflammatory bacteria that include E. coli or other gram salmonella. these other bacteria that we're discussing now within the context of lipopolysaccharide. So basically dysbiosis means that the gut microbiome is not as healthy as it used to be. That's the simple term for this. A bit like this neighborhood analogy, right? Let's say in your neighborhoods, let's say you're lucky enough to live somewhere safe, right?

36:57Where, yeah, there are probably some untoward things going on, but you don't really see it much, right? Because generally speaking, everything's okay, right? That's a well-functioning neighborhood, a well-functioning gut. Could we perhaps look at it like a dysbiotic gut? It's maybe like a dysbiotic neighborhood where there's high crime and there's a lot of problems, right? That's right. Yeah, it's just the balance has shifted. A hundred percent.

37:22Dr. Will Bulsiewicz:And that doesn't mean that there aren't good people in that challenged neighborhood. Exactly. Right? There are good people there. But the problem is those good people, they're kind of in hiding. Yeah. Because of the chaos, because of the violence that exists within that neighborhood. So it's hard for them, right? So what we want to do is we want to repair and restore that neighborhood and build it into one of these safe communities that really is productive and a great place for people to live. So that's kind of what we're getting at here. And as I looked at those 130 health conditions, not only did I prove that every single one has inflammation, I also proved, again, with references, every single one of them, when you look at the gut microbiome, what you discover is dysbiosis in every single condition that's listed.

38:07Dr. Will Bulsiewicz:Yeah. 10, 11 years ago, when I was starting to write my very first book, I went into a lot of the research on lipopolysaccharides. And for a condition that's called type 2 diabetes that many people know about, I think this was done in animal models from recollection now. it was a 2012 study which seemed to suggest, and I was quite convinced actually, that the lipopolysaccharide transfer across the gut lining might be the primary insult that then leads on to insulin resistance. Which is really interesting, isn't it? Because I guess what we're saying is that if you've got a well-protected gut barrier, because chronic unresolved inflammation and dysbiosis is linked with so many different conditions, instead of treating them all separately, if you are able to have a lifestyle as much as possible that supports healthy gut bugs, a healthy gut lining that is not leaky and therefore you're sending the right or the better helpful signals to your immune system, you're going to dramatically reduce your risk of getting a whole variety of different conditions?

39:26Dr. Will Bulsiewicz:Yes. Yeah? So the answer is yes. And I know that you, like we could do an entire podcast on this topic, right? So these are complex topics that we're discussing. And I know that if we did a whole podcast, you and I would be talking about all of the different inputs that create, for example, insulin resistance or metabolic disease. And the gut microbiome obviously is not the only one. Of course. So there's other aspects to this. But what you're getting at is that we have overlooked these microbes and the impact of chronic low-grade inflammation on the development of metabolic disease. Yet everything that you're discussing, so number one, the four pillar plan, food, sleep, exercise, movement, and relaxation, those are the exact same things that I'm discussing in my book because they impact the gut and ultimately impact the immune system.

40:26Dr. Will Bulsiewicz:So it's the same story. It's just told a different way. Yeah. Right. But also what you're getting at that you saw in that early data has now been completely, completely validated and backed up with everything that we see through visceral fat, where visceral fat is the fat, not the fat that's superficial, that's on like your arms or under your skin. This is fat that wraps around your inner organs and it creates inflammation. And it's connected back to the gut microbiome and this lipopolysaccharide. And this ultimately, you know, Rangan, you might be taking care. I'm not a primary care doctor. I'm a gastroenterologist.

41:04Dr. Will Bulsiewicz:But you might be taking care of someone who has high blood pressure, high cholesterol, type 2 diabetes, obesity. And that's four different diagnoses according to your job. And what you and I are doing is sitting here right now and saying, but it comes back to one root cause. Yeah. And how do we affect that root cause in a sustainable way, I guess, right? Well, I think the gut microbiome is the opportunity that we have because that's the part that can be manipulated, right? So we've already established that the choices that you make with your diet will start to change your microbiome by tomorrow.

41:40But if we look at the four pillar plan, because that's food, I would also, there's a clear argument with exercise.

41:46Dr. Will Bulsiewicz:We could talk about different forms of exercise and what the data suggests with the gut microbiome and inflammation. There's clear evidence with sleep, which is discussed in chapter six of my brand new book. Sleep is completely free, often overlooked and critically important to all of us. Right. And then my favorite chapter of my new book is chapter eight. That's my favorite chapter in it as well. It's the best chapter that I've ever written. And it's the brain-gut connection. And it's about stress and human relationships and spiritual connection. Yeah. I want to talk about chapter eight. before I do that though I want to make sure that we've covered these four work courses of an anti-inflammatory diet right that you write about so beautifully okay so I think we've set out the problem okay we could of course spend another two hours discussing more of the nuances about the problems in the guts but I think we've broadly speaking set out that many of us are living in ways that mean that our gut microbiome and our gut barrier has been disrupted.

42:48So the question then becomes, what are some of the things that we can do to improve it? Especially because we said before, some people have had loads of antibiotics, which will have had an impact. Certainly some people are more susceptible than others, but that will have happen. Some people will have been born by cesarean and not vaginal delivery. Okay, fine. These things happen. Some people will have been bottle fed and not breastfed. Okay, so we've all got a different starting point in life. Both you and I are very passionate about saying, yeah, okay, fine. Whatever's happened, this happens, what can we do now?

43:24So through the lens of diet, and of course, as you mentioned, there are other pillars of how to look at when we're thinking gut health. Diet can be a very powerful way to influence our gut microbiome. I quite liked your framing. So can you tell us about these four workhorses? What are they and why do you think they're so important?

43:45Dr. Will Bulsiewicz:Sure. So diet is probably the most powerful ever, but not the only one. More than kissing? More than kissing, but kissing is great. We want to bring together all of these different things and have them all working for us. So, um, diet is probably the most powerful lever on average. There are definitely listeners to the show that diet is not what they need. There's other things. We'll get into that. But for the average person, I look out and I say, culture has failed us both in the UK and the U S if you accept the, like, if you're just going to accept the norm, we're in trouble. Oh, yeah. Right?

44:25Dr. Will Bulsiewicz:So ultimately, you and I, our platforms are about disrupting that and asking people to do something radical, which is to go their own way and choose health. And so as I step into a conversation about nutrition, the way that I think about this is like this whole world of dietary tribalism where people are fighting on the internet about like, you know, standing behind some name for a diet, whether it be carnivore or vegan or plant-based or keto is silly. Who cares what you call it? There's these basic things that we need. That's what this conversation of the four workhorses is. Here are the four basic things that we need.

45:08Dr. Will Bulsiewicz:And not only do we need them, but I'm choosing the things that are missing from the average British person, from the average American's diet. Because that's where the opportunity exists. If I ask you to do the thing that you're already doing, that doesn't give me any advantage. But if I take the thing that you're not doing, for the average person out there, if I take the thing that the average person out there is not doing right now, and I change that because the change is going to transform their health, that's my goal. That helps me to accomplish what I'm trying to accomplish, which is to make people healthy.

45:44Dr. Will Bulsiewicz:So these four things, they are what I have seen come and emerge in the data in all of the major healthy dietary patterns. So I spend a chapter basically saying, hey, look, there's data for Mediterranean, but there's also data for a pescatarian diet. There's data for a flexitarian diet, which includes red meat. There's data for a vegetarian and a vegan diet, if the vegan diet is properly done. right so these are choices these are all options even though we may see them as different maybe they're coming from the same place maybe here's these four things that are the are the core that make them healthy this is the engine so uh the four number one and i i guess let me last point on this is that i see it as um it's a little bit i call them workhorses because i have this sort of an American vision of settling the West, right?

46:42Dr. Will Bulsiewicz:Where not that long ago, people were going to these remote places where no one else really lived other than the native tribal people. And to get there, you needed a horse to pull your wagon, but you were in a better position if you're going up a hill facing a challenge, which is what facing sickness is, is you're running uphill. You're in a better position if you got four workhorses pulling you compared to one. Yeah. So the four are number one fiber. Of course, I can't get past fiber. I wrote an entire book about my passion for fiber. Was that your first what fiber fuel? Fiber fuel is my first book.

47:21Dr. Will Bulsiewicz:Yeah. It was a few years back now, right? That was 2020. Yeah. Yeah. And I'm happy to see that fiber is like finally starting to get the attention it deserves in 26. But the story of fiber for those that haven't heard it is that what we were sold, what I was taught in medical school is not the whole story. That fiber is not just this thing that sweeps through you and that you poop out. That there's specific types of fiber, mostly the soluble fiber that dissolves in our drink that comes into contact with our gut bacteria and it becomes their food because fiber doesn't get digested in the small intestine.

48:02Dr. Will Bulsiewicz:So it makes its way all the way through, comes into our large intestine, the colon. That's where these 38 trillion microbes are. And this becomes their food source. And then they unpack it and it actually stops being fiber and it is radically transformed like a phoenix into what are called short chain fatty acids. There's three main ones, acetate, propionate, and butyrate. And there's, you know, each of them are a little bit different. We could get into the details if you want to, but that's getting a little maybe too nerdy. But the point is they get produced naturally by our gut bacteria from fiber.

48:40Dr. Will Bulsiewicz:They are the most anti-inflammatory thing that I've ever come across. If you were going to ask me the question, what is the number one thing to repair the gut barrier, my answer would be butyrate. And that's one of the short chain fatty acids that we get from fiber. I literally wrote down this quote that I found really powerful in your book. Short chain fatty acids, especially butyrate, are the most anti inflammatory thing I have ever come across in my career. That's a powerful statement. That's 100 % true. And I would challenge anyone to try to prove me otherwise, because this to me is the most anti-inflammatory thing.

49:21Dr. Will Bulsiewicz:It's repairing the gut barrier, but not to mention it's also crossing the gut barrier to influence our immune system that we've been talking about. It does a number of things to cool off and relax the immune system, but we're not sacrificing our immune system. We're not suppressing our immune system. We're organizing it to make it strong, to make it tactical, right? So to me, and I'm sure you would share a similar view, I don't really like the idea of boosting the immune system. And I also don't like the idea of making it sound like we should suppress our immune system. I need my immune system to do its job.

49:55Dr. Will Bulsiewicz:I just want it to do its job the right way. I don't want it to be out of control and picking fights all over the place. So that's what these short-chain fatty acids allow us to do. And it comes from fiber. And this is an important conversation to me and continues to be like, I'm not going to back off of this probably ever until we fix this fiber deficiency problem that we have in the West, where in the UK, 90 % of people, 90 % are deficient in fiber. In the US, 95 % are deficient in fiber. So this essential nutrient that feeds our gut bacteria, makes our gut microbiome healthy, repairs and restores our gut barrier, and optimizes our immune system, the entire conversation we're having today, it's missing for most people.

50:42Yeah, this is really, really important, isn't it? Just to sort of make sure that we're sort of looking at that through the lens of what you've been talking about so far, Will. It's these kind of three things, the gut microbes, the gut lining, and the immune system. We want all three of those things, in a verse of commas, functioning well, right? Or being as optimal as they can. And you're basically saying that one of the many ways you can do that is by increasing the right types of fiber. We can find what the right types are in just a moment, but that fiber is going to interact with the gut microbes.

51:28So it's going to have an improvement with the gut microbes. The gut microbes are going to make short chain fatty acids like butyrate. And you're saying that that butyrate is going to repair the gut lining. So if we have a slightly leaky gut, right, the butyrate is directly going to help close it, which in turn is going to mean there are less signals to the immune system, which will cause inflammation. So the converse is true, it is kind of in many ways anti-inflammatory. Anything that you would reword or have I got it right instead of what the argument you're trying to make.

52:08Dr. Will Bulsiewicz:So you got it right, but it also goes beyond repairing the gut barrier to protect the immune system. Yes, we need to protect the immune system. Yes, we need to stop triggering the immune system. But it also, there's the direct effect on the immune cells by these short chain fatty acids that basically help to, for example, increase the representation of something called T regulatory cells. Yeah. And these T regulatory cells, they're like the peacekeepers. Exactly. So if our immune system is the military, we don't want our military picking fights. I mean, I know it's not the ideal time to be using this analogy, right?

52:46Dr. Will Bulsiewicz:But we don't want our military picking fights and starting wars when it's unnecessary. Okay. Yeah, let's just part the timing of that. But I think we understand the point you're trying to make, right? We want the immune system to police the correct things and act appropriately when it's necessary. And our immune system is not just in our gut lining. So it may be concentrated in our gut lining because that's where we're interfacing with the outside world. 70 % of our immune system gets deployed to the gut barrier because that's the spot where the action is that we need to protect. But Rangan, it's throughout our entire body.

53:24Dr. Will Bulsiewicz:Our immune cells are throughout our entire body, including our brain. And increasingly, neuroinflammation, and I'm sure that you've had esteemed guests who discuss this. Neuroinflammation is increasingly being recognized as the root cause of many of our cognitive and mood-based health conditions, including depression, anxiety, Alzheimer's disease, Parkinson's disease, multiple sclerosis. And what I'm saying to the listeners is this is not just a gut story. This is a whole body anti-inflammatory story because those short-chain fatty acids circulate throughout the entire body and they've been shown to cross the blood-brain barrier and actually reduce neuroinflammation.

54:06Dr. Will Bulsiewicz:And this is part of the reason why we can address those health conditions. But this is so, so powerful, isn't it? That if you can increase the amount of short chain fatty acids in your body, like butyrate through increasing the fiber in your diet, yeah, your gut linings are going to be healthier. Your gut microbes are going to be healthier, right? Your immune system is going to have better signaling to put it in a very colloquial way. But that is also going to travel through the blood-brain barrier. You know, you wrote about, I think you wrote about this in Chats of Race, actually, this mythical chat we're going to get to shortly, that short-chain fatty acids can actually cross the blood-brain barrier, which is very, very empowering, isn't it?

54:52Dr. Will Bulsiewicz:And yes, they cross the blood-brain barrier to basically help to protect our brain, reduce aging in those locations. because to me, aging is inflammation. That's what produces aging. Is that the reason you call fiber the longevity nutrient? Yes. Yeah. Because if it's the most anti-inflammatory, then it would also be the most anti-aging. But also a different short-chain fatty acid, let's shine a light on propionate for a quick moment because that was one of the three that I mentioned. Propionate is the metabolic short-chain fatty acid. So you and I were talking about insulin resistance a moment ago.

55:28Dr. Will Bulsiewicz:if we want to enhance insulin sensitivity, the opposite of diabetes, propionate is the one to get the job done for us, right? If we want to enhance satiety through the release of GLP-1, which is popularized, and everyone's hearing about GLP-1s now thanks to the drugs, makes it easier for me to explain what's happening because it starts in your gut. These are gut hormones, right? And the body naturally produces GLP-1. And that's in response, one of the ways in which we get full is because of fiber. and short-chain fatty acids that stimulate the release of GLP-1. So we could go down many different strands of thought and different systems.

56:08Dr. Will Bulsiewicz:I mean, I could get into hormonal as well if we needed to. Yeah, so the first workhorse is fiber. And there's a couple things I just want to talk about through the lens of fiber. Okay, so as you say, it's been misunderstood for many years. A lot of us have just thought about it as roughage. It helps you go to the toilet. But of course, we're seeing that there's so much more to it than just that. What are these different types of fiber? And I'm particularly interested at the moment in resistant starch. Because I heard you recently, as part of my prep for this conversation, I was listening to you talk.

56:44And I think you might even have spoken about bread. If you buy fresh bread and slice it, put it in the freezer, take it out and then when you want to eat it you know toast it at that point the whole sort of makeup of that bread has changed right and then now it has become resistant starch so is that more fiber is that a different type of fiber but one thing I'm tracking at the moment with my CGM which I don't wear all the time but when I do wear it I'm like ah I wonder if the same piece of bread will have a different impact on my blood sugars when it comes out of the freezer compared to when it hasn't.

57:27Dr. Will Bulsiewicz:I would expect it would. I would expect it to as well. I think a lot of us have heard that before with rice that gets cooled down and put in the freezer and then you reheat it or potatoes, right? Potatoes, yeah. But I hadn't really thought about it through the lens of bread. Yeah. Any starchy food. So legumes as well. Any starchy food, if you heat it up, you're heating up the starch and then when you cool it down you develop what's called a retrograde starch which is that the chemical structure of the starch actually changes so during that cooling process and this is part of the reason why i think the the listeners and i'm sure you as well can relate to this that like uh heated rice doesn't taste the same as cooled rice right uh warm mashed potatoes don't taste the same as cooled mashed potatoes there's a consistency difference that's there as well.

58:16Right?

58:16Dr. Will Bulsiewicz:The cooled mashed potatoes, they're much stiffer. But what is that resistant starch in particular doing in our guts?

58:38Dr. Will Bulsiewicz:So we'll expand. Let's dive into resistant starch first since we're there, and then we'll expand into the fiber conversation. So resistant starch is technically not fiber, but we're going to qualify it as fiber. We're going to count it as fiber because it ends up behaving the exact same way. We call it resistant because most starch is a simple carbohydrate that your body has the capacity to digest in your small intestine. So like basically really quickly, you know, whether it's potatoes, rice, whatever it might be, a slice of white bread, really quickly, your body is able to break it down, absorb it, blood sugar gets into your bloodstream.

59:13Dr. Will Bulsiewicz:This is the reason why with the CGM, you can actually see that signal. But resistant starch is different. That resistant starch, your body doesn't have the ability to break it down. so it continues down this journey through your small intestine which is roughly five meters long and then it enters into the large intestine the colon which is where your microbes live and it's the microbes that have the ability to actually process and digest the resistant starch but actually there's a more interesting part to this rungan even beyond that they've actually studied where in the colon different things get digested, different forms of fiber or resistant starches.

59:56Dr. Will Bulsiewicz:Where do they actually get broken down? And what they've discovered is that most fiber gets digested in the right colon. Okay. So right now for the people who aren't watching on YouTube, but are listening, I'm actually touching the right side, right lower part of my abdomen. All right. That spot in the right lower abdomen, that's where your small intestine, it's called the terminal ileum, connects to your colon. So that's the last part of the small intestine and the first part of your colon. And in that location, that's where the majority of fiber actually becomes short-chain fatty acids. They get digested.

1:00:30Right in the first part of the colon.

1:00:31Dr. Will Bulsiewicz:Right in the first part of the colon. Wow. So whereas the resistant starch does not get digested there, it continues its journey even further and it passes on to the left side of the colon. So now I'm touching up by my spleen or on the left side of my belly. And it's in that location that this gets broken down. So in a way, it's kind of interesting because what I'm talking about is even from an anatomical perspective, different forms of fiber, and even though resistant starch is technically a starch, we're counting this as a fiber, different forms of fiber, including resistant starch, they feed different microbes in different locations within your within your colon.

1:01:13Dr. Will Bulsiewicz:And this is how we create health throughout the entire system. So we have a need for all of the above. Yeah. It's like that analogy that you were talking about before about, you know, all these bugs, they've got different roles, right? So Michael Ash, this brilliant immunologist who, you know, I guess would be one of my mentors when I first got into this entire space many, many years ago now, he would talk about the gut microbiome as it's a factory. You've got all these different departments and all those departments need looking after. If all of those departments are appropriately looked after, they're going to do their job for you.

1:01:52But I'm just looking at it now through the lens of, you know, we're thinking about this factory and we've got different workers. Resistance starch is particularly going to maybe feed a particular department that maybe was neglected. It wasn't getting it. So the other ones were they were getting their delivery every day when the lunch came but actually resistance now allows that neglected part to also be fed and and the other thing just to say well is that when you are pointing to the left you know the descending part of your colon yeah on left side of course that is one of the areas where when people feel constipated they will feel a fullness there or a discomfort there because it's like that final bit that they can't for whatever reason, eliminate from the body.

1:02:41Obviously, you're a gastroenterologist. Do you see resistant starch as having particular benefits for constipation or is it a bit broader than that? And it kind of depends on the cause off that constipation.

1:02:52Dr. Will Bulsiewicz:Well, I wouldn't discriminate and say like, we need this particular form of fiber, but not the others. I think that's sometimes the mistake. So let me just point of clarity for the listeners. So I'm the founder of a supplement company called 38 Terra. And our first product is called Daily Microbiome Nutrition, and I'm the one who formulated it. And the thought that I'm describing right now went into this formulation. And I just want to like sort of explain what I was thinking about. So I think that the mistake that's often made in fiber supplements is the idea of a monofiber. So you get this one type of fiber, and then you just give more and more and more and more.

1:03:34Dr. Will Bulsiewicz:And what do you think happens using your factory analogy where you have this big expansive factory, but you're only using one department within that factory? It gets imbalanced. It gets imbalanced. You're overworking those guys and you're ignoring everyone else, right? So this brings us back to the concept of diversity. Tim Spector has been on your show a number of times. Tim and I, we discuss the same topic of 30 plants a week. The idea with 30 plants a week is that by getting a wide variety of different plant-based foods, you're simultaneously, naturally, going to get a wide variety of different types of fibers, including resistant starches.

1:04:14Dr. Will Bulsiewicz:So whether it's a supplement or it's through our diet, and even as the founder of a supplement company, I say diet comes first, right? Supplements come second. But if we're going to formulate supplements, let's make them the right way, which includes a wide variety of different types of fibers and includes the resistant starch that feeds the whole colon. Presumably, resistant starch comes from other parts of our diet as well. I guess what I'm thinking, Will, is through an evolutionary lens, before we had refrigerators and freezers, right? Yeah, of course, you know, things could be heated with fire, they could cool down if we were storing them.

1:04:53But does resistant starch come in other forms without us actually refrigerating or freezing the food?

1:05:00Dr. Will Bulsiewicz:Yeah. So like the resistant starch that's in our 38 teraproduct is from a potato and it's not a retrograde starch. So this is an RS2 starch, which means resistant starch 2, which is the kind that's native to a potato and it has a specific impact on the gut microbiome that's been studied in humans. So certain potatoes, actually, even if you don't freeze them or refrigerate them, have got high levels of resistant starch. 100%. You could just eat them like an apple, right? And it already has the resistant starch. Another example of this is a banana. Think about, so we've all seen it. The green banana, that's too stiff, not sweet, not particularly enjoyable to eat.

1:05:41Dr. Will Bulsiewicz:But the green banana is a great source of resistant starch. and then it goes through its maturation process, which by the way, like ripening of plants, that is actually informed by microbes, right? So the microbes are everywhere involved in everything. So that banana goes from a green banana to a perfectly yellow, sweet, but slightly firm banana. It still has resistant starch, but not as much as it did when it was green to ultimately a brown banana, which is too sweet, too soft, not really much resistant starch there. Yeah. One thing I just want to pause on is this 30 plants a week. And the reason I do is because one of the things that I'm sure you've seen as well is that on one hand, the explosion of health information online has been a really good thing because it has empowered so many people around the world to take control of their health.

1:06:36They go, oh, I didn't realize I could do that. Okay, I'm going to do this. I'm going to try and do that. One of the downsides, of course, though, has been that different experts have different perspectives, which then becomes confusing for the listeners, let's say of this podcast, for example. So a few months ago, I had on, you may know that she's a brilliant dietitian and microbiome scientist researcher, Emily Leeming.

1:07:01Dr. Will Bulsiewicz:I know, Emily. Emily's great. Emily wrote this sub-second article a couple of years ago, questioning the research upon which that 30 plants a week recommendation is made. It's not that she's against people eating 30 plants a week. I don't think she has any problem with that. She's simply saying, I think, and I don't want to misquote Emily, but my recollection is that she's saying, listen, for some people, that feels like quite a tall order to get to. And I think the point she's trying to get across is, sure, aim for that, but it's okay to aim for 15 or 20. Like just wherever you are, try and increase it.

1:07:40So could we just clarify that point? Because I don't want anyone thinking, well, hold on a minute. Will is saying eat 30 plants a week. Emily, he had a few months ago was saying, do you know what I mean? I'm just trying to make sure there's a clear message for people. Yeah, yeah. So first of all, I know Emily really well. And these are conversations that I've had with her offline. Yeah.

1:07:59Dr. Will Bulsiewicz:And not in any sort of adversarial way. No, I get it. Actually, we're total agreement. Yeah. Yeah, yeah. because it's, you know, the, I guess here's what I would say. First and foremost, you alluded to this earlier. You've seen tens of thousands of patients. I've seen tens of thousands of patients. I don't know what the number is, but it's really like, for a lot, it's a high number, right? And one of the things that you realize, at least for me, one of the things that I've learned, there's a difference between projecting advice based upon what you think is best versus being in the room one-on-one with that person and guiding them.

1:08:27Dr. Will Bulsiewicz:Right. I've learned I have to meet people where they are. So when I say 30, this, First of all, this is not an absolute number and it's not a magical number. Yeah. And we can talk about where that number comes from. And there are scientific flaws that exist, which is what Emily's getting at. There are scientific flaws. But what I would argue, and I think Emily would 100 % agree with me, is that the core concept that is guiding people towards is the right concept, which is that variety within the diet is of benefit to your health, including your gut microbiome. So if you were to take me personally, 15 years ago, I was a mess, right?

1:09:09I was the guy who needed

1:09:12Dr. Will Bulsiewicz:nutritional advice. I was the guy who needed a nutritional overhaul and my health was suffering as a result of that. So for the majority of my life, I ate an unhealthy diet and it was my own personal transformation that ultimately started to lead me to this place. So when I talk to people, I understand where they're coming from because I used to eat the same way probably worse so I don't want to put pressure on a person when they hear this to say well if I'm not 30 then I'm a failure right what I want them to hear is no matter where you are every single meal is a small opportunity to add one or two more plants and if you do that if you start to think about it that way when you're at the dinner table when you're in the kitchen cooking when you're in the supermarket at purchasing your food, if you just think, hey, my goal is to get more plants and variety into my diet, you will definitely be successful and you will receive the reward that comes from that.

1:10:12Dr. Will Bulsiewicz:And 29 is just as good as 30 and 31 is a little bit better. And so it's not the number that really matters. It's the idea. Yeah. And one of the things that was really close to me, Will, as I was reading your book, which is I think one of the reasons I enjoyed it so much is that you're clearly a clinician. And I'm not sure people really understand this enough that there is a big difference between researchers and clinicians. Totally. Okay. And I remember actually years ago when I spoke to Dr. Sachin Panda from the Salk Institute. Sure. Sachin's been on the show, I think two times, maybe three. He is the guy who probably has done the most research on something called time-restricted eating.

1:10:53Yeah. And I remember in one of our conversations, he said, Rangan, I love hearing your stories about time-rich-rich-rich-eating and what that's done with patients because it helps to validate, for me, what I'm seeing in the research. And I think that's a great researcher who's like, listen, I'm studying this stuff, but I want to know from you guys, is this actually working? Because otherwise my research doesn't have any real world application. And it's very clear that the nuance with which you write is that you're someone who has seen a ton of patients and you recognize like me that there is no one right way for everyone, right?

1:11:31But these are principles that we want to share with people and they can then personalize those principles within the context of their life. But on that point, before we leave fiber, there is a lot of people these days who are gaining benefits from going on, let's say, a low carb diet. Sure. Okay. maybe they've got significant insulin resistance maybe they've got type 2 diabetes and this is a therapeutic way of them actually lowering their blood sugars and of course there are many different ways to do a low carb diet it can be a junk low carb diet it can be a low carb diet with a ton of plants in it sure some people who are quite restrictive with their plants or let's say they're even on a ketogenic diet, which a lot of people will say that they feel better on certain diets like this.

1:12:24I know you cover elimination diets and overly restricted diets in your book. One of the things they will tell you is that, hey, listen, you're saying that short-chain fatty acids like butyrate are important. Some people will say, yeah, but on a low-carb diet or a keto diet, I'm making beta-hydroxybutyrate, right? So let's just cover that because I know there'll be some people listening who are thinking that. I say, well, do I really need to increase my fiber intake or does the beta-hydroxybutyrate cover it for me?

1:12:54Dr. Will Bulsiewicz:Yeah. So first of all, this is a fascinating topic. And I - I know you didn't go there because I don't want to go down a rabbit hole, but I know there'll be some people listening who are thinking and I don't want them getting confused. I think it's important. I think it's important. And I think there is a good conversation here about this because also my views on this have evolved through the years, which is that I used to be more adamant that, no, this is a horrible mistake. What are you doing? Right. And yet now here I am. And I would say that for the person who's thriving with that diet, I celebrate that.

1:13:26Yeah.

1:13:26Dr. Will Bulsiewicz:Right. And I don't care whether it's the diet that I recommend or don't recommend. I would, you know, there's a caveat, which is that there are dietary patterns that can make you feel better in the short term, but you, I'm worried would pay the price in the longterm. That's my concern with the carnivore diet. It's like a short-term carnivore diet doesn't bother me at all. But people who are thinking that they're going to commit to this long-term, I do worry about that. To answer your question, we're talking about, again, the three short-chain fatty acids that come from fiber, acetate, propionate, and butyrate.

1:13:59Dr. Will Bulsiewicz:All right, now let's name the two main ketones that the body will produce when it is deprived of carbohydrate and therefore flips into this metabolic mode of ketosis. Acetoacetate, it's like acetate. And beta-hydroxybutyrate, it's like butyrate. Okay. They're not exactly the same. If we were to say, how does beta-hydroxybutyrate compare to butyrate. It's like the lesser version of a similar concept. It doesn't achieve the same significant benefit as you get from the full force of the butyrate. But if you want to activate that receptor on some level through beta-hydroxybutyrate, you can do that.

1:14:53Dr. Will Bulsiewicz:But it also doesn't behave within the body exactly the same either. So it's not a one-to-one thing. There are certain things that these ketones are doing. But when they do activate a similar receptor to the short-chain fatty acids that come from fiber, the evidence would suggest that it does not activate in the exact same way that's to a lesser degree. So if you want those benefits, if you want the full throat benefits from the acetate, the butyrate, fiber is the way to go about doing that. To me, a ketogenic diet or a low carb diet, when we're talking about the elimination of refined carbohydrates, I 100 % celebrate that, right?

1:15:36Dr. Will Bulsiewicz:I don't, so to me, like that's an approach that makes a ton of sense to me. And a real ketogenic diet isn't actually looking to eliminate fiber. No, I agree. So that they actually remove that from the equation. That's not counted towards your carbs. So if you were, diet was being informed by a true nutrition expert, they would ensure that you are reducing your simple carbohydrates, which are the refined carbohydrates, flour and sugar, and simultaneously making sure that you are sufficiently achieving your fiber and your resistant starches. Did that answer your question? Yeah, absolutely. I think certainly what I get from you is that, listen, we're all in different state of health.

1:16:28It may be that a particular point in your life, you are benefiting from going on a particular diet because suddenly your symptoms are getting better. And of course, many people on the carnival diet will tell you that their autoimmune symptoms and their joint pain and their skin problems have gone, which is one of the reasons they want to stay on it. But the case you're making in your book is that great in the short term, but over time, what if we could help you repair your gut barrier? What if we could help you broaden out your diet and introduce some things in that maybe you couldn't tolerate before, but maybe with a better work, you can tolerate now.

1:17:08Is that a fair reflection of your take?

1:17:11Dr. Will Bulsiewicz:Yeah, it is. Can we unpack this real quick? Please. Okay, cool. Because the issue is, so first of all, diet is not like a moral conversation, right? I'm a medical doctor. I'm trying to help people get healthy. And when a person gets healthy, I celebrate that. A person whose body is being torn up by an autoimmune disease, who's managing to get their disease into remission through whatever dietary pattern, I celebrate that. But what do I think is actually going on there, right? Because I think that's the key piece. Is that if we look at what the average person, whether it's in the UK, okay, UK, the average intake of ultra processed food is about 55 % for adults and going up.

1:17:55In the US, it's about 60%.

1:17:59Dr. Will Bulsiewicz:And for US children, it's about 70%. Oh, man. Okay. Of the calories are coming from ultra processed food. Let me be clear on something, well, ultra processed food. I'm not talking about like ground beef, right? I'm not talking about making bread. I'm talking about ultra processed, something that you don't have the ability to make. You can't get access to the ingredients that are in ultra processed foods because those are industrial. They're not sold in your supermarket. You don't have the tools within your kitchen to actually prepare these foods even if I gave you the ingredients. They have to come from a factory.

1:18:42Dr. Will Bulsiewicz:So that's a totally different thing than a processed food. Processed to me is not inherently bad. We process when we chew our food. Okay. So with the carnivore diet, we start with a diet that's dominated by ultra processed foods. And I'm of the belief, Rangan, that it's the ultra processed foods and the chemicals that exist that we don't really know much about that have been introduced during our lifetime, you and I. Yeah. Into our diet. and that are creating a disrupted microbiome, creating a broken gut barrier and a confused overactive immune system that has the ability in a person with genetic predisposition to turn on itself and have an autoimmune disease.

1:19:27Dr. Will Bulsiewicz:So if you take a person who's on average more than 50 % of their calories coming from ultra processed food and you withdraw what I think is driving the problem, it doesn't surprise me that we ultimately do see an improvement within their autoimmune health condition. Simultaneously, by going on a carnivore diet, it's a zero carb, you will get into ketosis, you will get the acetoacetate and the beta-hydroxybutyrate. So this is why that makes sense within the short term and why it can induce remission. When someone says, I fixed my gut problem by going on a zero carb diet. No, you didn't actually fix your gut problem because if I give you food, you'll have symptoms again.

1:20:20Right?

1:20:21Dr. Will Bulsiewicz:So the person who says that they fixed their gut problem, that I would actually make an analogy to being much more similar to, I hurt my knee and now I'm laying on the couch. And because I'm laying on the couch, my knee doesn't hurt. Right? So that's what they really mean. But the problem is that if I want to actually make you strong, so like I, you and I are both tall, I enjoy playing basketball with my son. Right? If I hurt my knee, that's a hard thing to do. I need to rehabilitate the knee. I need to restore function to the knee. When I'm truly healed, I'm able to get back on the basketball court and play.

1:21:07Dr. Will Bulsiewicz:And so there's a process that you have to go through in order to accomplish that. So what I worry about with a zero fiber diet, fiber to me is exercise for your gut microbes, right? Everyone agrees that exercise is good for the human body. not everyone agrees the fiber is good because i think the argument is oh well that causes symptoms yeah but what i'm saying to you is exercise can cause symptoms too when it's too much so when we're rehabilitating a damaged gut we need to gently introduce the fiber to to exercise and work that gut muscle right because no one in their right mind would ever argue that the solution to like, you know, I hear things sometimes people say, oh, well, fiber is not essential.

1:21:57Dr. Will Bulsiewicz:It's not required. Yeah, walking is not required either. You don't need to be able to walk in order to live. But we all agree that it's good for you. We all agree that that's like an essential part of being healthy. And I would make the exact same argument for fiber. Fiber is necessary to support and nurture your gut microbiome. And it's just the way in which we go about this. So I hope that explains that. Yeah, I think it was really great the way you put those ideas across. And yeah, as you say, fiber may not be an essential nutrient, but if you look at the bulk of the data, it seems to support that it's a pretty helpful one for a variety of different things, right?

1:22:38So is it possible that someone might be okay without fiber? Yeah, I think it's possible. I guess what we're trying to do, we're trying to reduce risk. if you walk regularly you're going to reduce your risk of getting sick doesn't mean you're never going to get sick I can't say that but your chances are going to go down and I guess you're making that same case with fiber you're just stacking the odds in your favor

1:23:02Dr. Will Bulsiewicz:stacking the odds in your favor and also I have longitudinal experience meaning multiple visits with patients where I've seen how things evolve over the course of time as a medical doctor I don't bring something into a consultation unless I wholeheartedly believe that it's going to work because I don't want to waste their time. And they're going to be ticked off at me if I'm not helping them get better, right? So ultimately the tools that I bring are the things that I've seen work with my own eyes. And the problem, Rangan, is that I've seen a bajillion people that as a gastroenterologist, like dealing with the sickest of the sick when it comes to their gut health, who can't eat anything, they can't tolerate anything.

1:23:45Dr. Will Bulsiewicz:And it's really hard for them. and I sympathize with them. And the problem is, it's the restrictive diet, Rangan, that led them into that. Yeah, literally, I'm just pulling back your introduction. I underline something. Yeah, this book was inspired by my patients with Crohn's disease and ulcerative colitis. I felt they deserved a solution beyond lifelong medication that often has nasty side effects or a hyper-restricted diet that's 50 % red meat and eliminates whole categories of fiber rich foods. I mean, you literally wrote about it, didn't you? You said you want to help people not be on these hyper-restricted diets if at all possible.

1:24:30And some of the questions that came into me when I said that you're coming on the show is kind of, well, maybe this is the time to talk about Crohn's. Someone actually asked, can you ask Dr. B, what is the outlook on Crohn's? how can we facilitate a remission?

1:24:46Dr. Will Bulsiewicz:Yeah. Okay. I'm throwing lots of things at you. No, no, that's great. That's great. Just closing real quick my thought from a moment ago because I just want to make sure that that's totally clear. I have seen ultra-restrictive diets lead people into food intolerances. That's my concern is that I've seen where you start with this restrictive diet and then you restrict it further and further and further because your symptoms feel just a little bit better for a short period of time. you feel better when you do that. But then the problem is the symptoms get worse because ultimately your gut microbiome is becoming less competent.

1:25:20Dr. Will Bulsiewicz:So the solution is not further restriction, right? The solution that I've seen that works is to gently reintroduce, rehabilitate the gut. So now to answer the question about Crohn's disease, all right. So just to clarify the term, because to a person who has Crohn's, they know this, but the listeners at home may not. When we use the word remission, that means the absence of detectable disease. So like remission for cancer is the absence of detectable cancer. We celebrate that. In a person who has Crohn's disease, this is a vicious inflammatory health condition. And it affects their whole body, but it tends to be most concentrated in their gut where anywhere from their lips, where they can get ulcers, all the way down to their bottom, where they can get these really horrible things called anal fissures that just tear them up, they can have inflammation.

1:26:15Dr. Will Bulsiewicz:All right, so that's what Crohn's disease is. And it's an interesting thing, Rangan, because I used to think of Crohn's and ulcerative colitis, we call these inflammatory bowel diseases. I used to think of them as autoimmune. I don't anymore. Because the immune system is not actually attacking the body. In fact, the immune system is not targeting the intestine. The immune system has rejected the microbiome. And because the immune system has rejected the microbiome, the thing that it's supposed to be at peace with, the thing that you basically they came up together right from birth. And now it turns on that microbiome and says, no, no, no, you're the problem.

1:26:57Dr. Will Bulsiewicz:I'm taking you out. And stuck in the middle is your intestine. And this leads to the manifestation of Crohn's disease or ulcerative colitis. these forms of inflammatory bowel disease. My approach, which is detailed in Plant Power Plus, is that number one, I want to get people into remission. And that will often require medicine. I am not, you know, just like you, I am pragmatic. I'm working towards results. And there are tools that are on the table and I don't come at things from some sort of, you know, dogmatic view of you can only do diet, you're not allowed to do medicine. That's not how I see it.

1:27:37Dr. Will Bulsiewicz:So we need to get people into remission. And many times medication is necessary in order to do that. But when they're in remission, now we have the opportunity for healing. You can't heal a forest when the forest is on fire. You have to put the fire out. And then when the fire finally goes out, which is typically medication putting that fire out, you start to rebuild the forest. You start to plant the trees. You bring the life back. And that takes time, right? The damage that's done real fast does take time to actually heal from. So what we do is we start to incorporate these principles that we're discussing, including the four workhorses and including anything else that we're going to discuss, circadian rhythm and sleep, time-restricted eating and human connection and spiritual connection and meditation and relaxation.

1:28:30Basically, the four pillars that you talked about in your first book, you incorporate those elements.

1:28:37Dr. Will Bulsiewicz:Each of them impacts the gut microbiome. And because the gut microbiome is being impacted by all of these things that you're doing at the same time, you start to actually rebuild that forest. And it may take time. Yeah, it's a A very hopeful and empowering message. Yeah, sometimes drugs are needed. It is also amazing how sometimes actually, I've certainly seen with some cases, you can do a lot with lifestyle, right? You really can. And it's clearly not something we were conventionally taught, but it's stuff I figured out through the course of my career that, hey, maybe there's another way here.

1:29:13As you say, you do to tell it in the book. Well, we could go in a million different directions and there's no way we're getting through everything on this podcast. So you have an open invitation to come back on to talk about other stuff. I do want to get to chapter eight because it was my favorite chapter because it's very much where my interest lies more and more these days and has done for many years. Before we get to that, can you just, because we mentioned these four work courses, we've only covered five. Can you just top line two, three, and four? Let's go into detail because I think some of them we have covered before on the show.

1:29:47Top line, what is two, three, and four and why they're beneficial? All right.

1:29:53Dr. Will Bulsiewicz:So number two are the polyphenols. Polyphenols are the colors of our food. You step into any supermarket, literally across the globe, guess what they're putting right in front of you, right at the door? The fresh produce. And the purples and the reds and the yellows and the oranges, every single one of those is powered by some sort of phytochemical, plant-based chemical called a polyphenol. And it's got an anti-inflammatory effect on the body. So polyphenols are activated by our microbes. Only about 5 % to 10 % are naturally absorbed. Doesn't mean that we poop out the rest. What happens to the rest is it comes into contact with our microbiome and things like resveratrol and quercetin and curcumin from turmeric.

1:30:38Dr. Will Bulsiewicz:These things, they ultimately are activated by our gut microbes and then they go into our body and they have effects on our body as a result of that. and our microbiome is different as well. So the colors of our food, when someone says eat the rainbow, that's like a coded way of saying eat more polyphenols. Number three are healthy fats. I'm like certainly not anti-fat, but I believe that whether we're talking about carbs, protein, or fat, there's an opportunity for us to improve the quality of our nutrition. that a healthy diet is in simple terms, high quality nutrition for all of those. So my argument is let's try to optimize the fat that is in our diet.

1:31:23Dr. Will Bulsiewicz:This is where a Mediterranean diet really sort of stands out because they're able to get the beneficial fats that come from extra virgin olive oil. And also Mediterranean style puts a focus on fish and shellfish, which provides the long chain omega-3s that we need for our immune system, that we need for our brain. Yeah, and of course in Mediterranean diet and many other diets, there is a diversity of things like nuts. And I was actually watching one of your YouTube videos this morning where you were talking about this study where if you have walnuts every day for two years, you significantly reduce markers of inflammation in the body.

1:32:05Do I remember that correctly?

1:32:07Dr. Will Bulsiewicz:Yeah, it was a handful of walnuts. and walnuts can be a decent, not the best, but decent source of the plant-based omega-3s. There's an issue though, Rangan, which is that the plant-based omega-3s, the ones we get from chia seeds, flax seeds, hemp seeds, and also from walnuts, they're good for us, but they're not the same as the final form that our brain needs, which is called DHA. And there's a conversion that the body can make, but actually in men, it's not so good. And in women, once they go through menopause, it's also about the same as men. So estrogen seems to be an important component of helping to create those beneficial long chain DHA omega-3s.

1:32:55Dr. Will Bulsiewicz:So the point is that for most of us, we either need to include fish and shellfish, or we need to supplement. And supplements could be something like fish oil or it could be an algae-based omega-3. But healthy fats, omega-3s, the monounsaturated fats that you find in extra virgin olive oil, as well as avocados. This is where the money is at from my perspective. I don't know that we want to get sidetracked by seed oils, but like the whole seed oil conversation to me has like lost any nuance. To me, it's like, um, I think both sides have legitimate arguments. And I think what I come down to is actually a very simple answer, which is why would we choose the seed oils anyway, when we could choose extra virgin olive oil, right?

1:33:54Dr. Will Bulsiewicz:We have better choices than seed oils. So like this debate of, should we focus on seed oils? I don't know that we need to anyway. Yeah, I agree with that. It's like focus on the stuff that we know is helpful and we've known for years is helpful. Katerine, number four, the fourth work course is fermented foods. Fermented foods, yeah. Anything top line you want to say on fermented foods? Well, real quick, I mean, you know, the good news is that this is becoming more and more part of the public conscious when it comes to nutrition. It wasn't when I wrote Fiber Fueled. No. Right, so I've been pounding this drum since the beginning.

1:34:27Dr. Will Bulsiewicz:I think because I come, I see signals within the gut microbiome that take time to show up in other places. Yeah. Have you had Christopher Gardner on the show? No, but I know Christopher's work super well. Like he and the Sonnenbergs at Stanford did a great study. It was 36 people. All right. 18 people who did fermented food, 18 people who did a high fiber diet. Let's talk about the fermented food because that's why I wanted to lead into, which is that they added a significant amount of fermented food to their diet because they're trying to really see what the impact is. So they were doing five or six servings per day.

1:35:03Dr. Will Bulsiewicz:That's a lot. But still, what they showed is that during the course of eight weeks, they increased the diversity of their gut microbiome and they simultaneously reduced the markers of inflammation like across a wide panel. Okay. so there's two key takeaways from from what i just said number one here's what's exciting we have an interventional human study showing that through your diet you can increase gut diversity and reduce inflammation in a short period of time here's the second thing that i love about this study it proves everything that you and i have been discussing for the last however many you know hour and a half or two hours it just that that that study actually supports 100 the backbone of science that went into my new book because what we're showing here is through diet you can manipulate the microbiome and when the microbiome gets healthier guess what we see in the immune system exactly as expected the immune system is showing anti-inflammatory effect chapter 8 is called body and mind healing nourishing the soul through connection and um I wonder if I could start by reading to you your words from the start of that chat, which I found really, really powerful.

1:36:22Throughout my career, I've had dozens of patients whom even my best medicine failed. I had the perfect plan, the right drugs, the nutrition, sleep, exercise, and other lifestyle factors locked in. Over the course of multiple visits, we progressed in our plan, but it just wasn't working. For some patients it can feel like they've hit a dead end and it's time to find a new doctor. But often we've just hit the line that exists between the body and the mind. We've reached the furthest limit of what we can do to heal the physical body and now we must step into the realm of the non-conscious mind and the core self.

1:37:10Unfortunately, most doctors are not trained to do this. I love it. I absolutely love those words. They're so beautiful. And for me, they are so bang on. Why do we make the choices we make? You mentioned about diet today, right? Again, later on in the chat, so you talk about yourself. You say this, right? Yes, I needed to improve my diet but there was an emotional element to the way i ate junk food was a form of therapy for a soul that was hurting deep down inside that's right there i was and i was the one who

1:37:47Dr. Will Bulsiewicz:was sick and when i wrote fiber fuel in 2020 by the way i have goosebumps and i don't know if you can see that on the camera oh my god i can't you know uh i had them as i was reading it because i I think it's bang on truth. Well, being with you here today, and I think that what that gets at, and I'll get into my own story in a moment, but what that really gets at is that we're human. This is not engineering, right? You can't just engineer health. We're way more complicated than that. And these aspects of who we are as a human and what it means to be a human, these deeper questions that burn inside of us, every single one of us, whether you're willing to take a look at that or not it's there and it impacts our health in a powerful way and uh i'm going to speak first as a medical doctor before i talk about myself which is to say that rungan in my career my greatest moments as a doctor were not the person that i increased their fiber my greatest moments are what you're reading about in this chapter which is that there are people who do everything right they're reading our books they're following the diet they're sleeping they're exercising they're trying to relax and it's not working and there's something deeper that we need to get to and that's what i'm saying in the beginning of this chapter is that if we just treat ourselves as a physical edifice, this body that you can just engineer the health, you're not going to see the full picture, which is that there's a bigger story of who we are, our soul.

1:39:35Dr. Will Bulsiewicz:And what is the status of our emotional health, of our spiritual health? Because that informs what's happening in the body in a powerful way. That's often where we manifest. you know the injuries that we've taken through the years we manifest that in the body but the the actual problem may exist somewhere else so and i learned that firsthand in myself when i wrote fiber field in 2020 i was writing in 2019 there were things in my life that i was not willing to talk about. So it was really easy for me to, you know, as an author, put out this projected image of, I changed my diet and that changed my life.

1:40:26Dr. Will Bulsiewicz:Yes, that is partially true. But at the same time, I had a challenged relationship with my dad that went back to my childhood that desperately needed to be addressed. And the health issues that I went through, he would be totally ignoring the most important part, which is that it wasn't just food. The food was part of the problem because on the inside, I was in pain. And I really needed to ultimately acknowledge that, not ignore that. Stop pushing it to the side. Stop trying to power through. Stop trying to prove my self-worth to everyone else because I feel the absence of love from my dad. And it's when I finally turned to him through the help of my wife, who has been such a wonderful influence in my life.

1:41:27Dr. Will Bulsiewicz:I met her and she told me I needed to repair my relationship with my dad and I hadn't talked to him for more than 10 years. And one day I picked up the phone and I called him and he was completely shocked. But you're a dad and I'm a dad.

1:41:56And becoming a father was one of, I mean, not even one,

1:42:01Dr. Will Bulsiewicz:it was the most important moment of my life because it changed everything. And the, the love that I have for my children, it helped me to understand my dad. And when I called him, he did exactly what I would have done. He welcomed me back immediately because he loves me. I just rejected that love. And so I had my own health challenges that I struggled with. And the body was an outward manifestation of that or my behavior was an outward manifestation of that. But really in order to be aligned and be the best version of myself, I had to fix what was inside. Yeah. First of all, thank you for sharing that.

1:42:52I know from reading that your dad is no longer with us. My dad died in 2013. and there's many things that I would like to say to him if he was here but he's not here but just because someone is no longer here in the physical realm doesn't mean you can't have a conversation with them you know I you know I sometimes will say things also I'll think about things I wonder what dad would say here but I think what's really interesting about this part of the story for me is that these significant life experiences, they directly impact our body and our physiology, but they also have an impact on our behaviors, right?

1:43:41So sometimes people say, you know, I keep trying to change my diet. You know, I tried, did it for two months, did it for three months, but then I flipped back. I ended up where I was before. I have seen that so many times over the years. And to me, it's often because, yeah, because there's another component to this that you haven't addressed yet. There's a reason, there's some sort of deep trauma maybe or emotional baggage that you haven't processed that means you're gonna keep going to the sugar. You're gonna keep going there because actually that's the way that you're dealing with the pain that you're not willing or unable to confront.

1:44:20Yeah. And again, it's like you say in that session, most doctors are not trained to do this. No, we're not trained to do this, but I can tell you in my view, the best clinicians are the ones who figure this out as they progress through their career.

1:44:37Dr. Will Bulsiewicz:Because you realize there's something bigger. Exactly. But also what you said about being able to still connect with your dad, that requires you to believe that we're part of something bigger. And that's a part of the conversation too. So I would love to get into the machinations of all this, right? The physiology that like, there was a time and you remember it too, where we completely and totally dismissed the idea of body mind healing, right? Like there was a time and you, you, you came to this with your books before I did, but I was in the clinic too, dealing with patients and seeing this myself.

1:45:19Dr. Will Bulsiewicz:And I think that the point is like, we can get into the physiology and all those things, but it doesn't really change that this is really a story about being a human, what it means to be a person, what we truly need in our lives to feel loved, to feel safe, and also to live with purpose. And so again, I come back to, it's just kind of interesting

1:45:47how you and I,

1:45:48Dr. Will Bulsiewicz:we're writing the same story. It's just a little bit of a different version of the same thing. Yeah. It's funny today, Will, we were talking so much about the gut and the gut microbiome, the immune system and the sort of things that we can do and what are the four workhorses of an anti-inflammatory diet. And of course, these things are all super important because sometimes the truth is you can start with food, right? You're not ready to deal with that stuff yet. You make some changes to your lifestyle. It builds a certain resilience in you. You have more energy, more vitality, which sometimes then allows you to go into those deep areas.

1:46:25But for some people, it won't start with that. It will start with emotional healing first, which then will naturally change their lifestyle. And I always remember, I think I shared the story once on the podcast before, I always remember a patient of mine who, you know, it's a period of time where as well as NHS general practice, I would also see patients separately for an hour, an hour and a half. Complex patients who couldn't get better with the sort of conventional approach who wanted a more broader approach. And I really enjoy that because these were usually patients who'd been everywhere and were still stuck.

1:47:06And I relish the challenge of trying to figure out what is going on here? what you know that's not denigrating any other doctor just like but what are we missing here why is this patient still sick and there was this young lady who had awful irritable bowel syndrome symptoms okay just really bad it was affecting her life and one of the things i like to do is really understand their entire story okay tell me about your childhood what happened you know when did these symptoms first come on all that sort of stuff and i don't think she'd ever really had the space for that kind of conversation before.

1:47:39And I understand for doctors, it's very hard if you're in a 10 minute consultation to even go to go there. So I totally get that. But she said something to me, which I never forgot, which was I had a really happy childhood growing up in Iraq and, you know, mom and dad were happy. I'd play with my siblings. And then the war started and suddenly out of nowhere, we're getting bombed. and my dad changed overnight because he was suddenly petrified about looking after us and sometimes in the middle of the night, he'd literally wake us up when we go to a bomb shelter.

1:48:15Dr. Will Bulsiewicz:And then when you start to map her symptoms, that's when her symptoms started, right? And she said, my dad's never been the same since then. His whole personality changed. Understandably, if I was a dad and something my kids' lives were under throughout my family, I would probably change. But to think that that isn't a massive cause of your symptoms, yeah, we can dance around with changing your diet and doing stuff. And yeah, I would absolutely help with that. But I had an honest conversation with her. I said, I think the root cause is coming from this. And I think unless you address this at some point as hard as it is, I think where are they going to get so far?

1:49:02What's your take on that as a gastroenterologist?

1:49:06Dr. Will Bulsiewicz:So fascinating because I feel the exact same way. And I said earlier in the show, when we talked about diet, I said, for most people, this is the most powerful level, but for some, there's something else. And here we are, we've come full circle on that concept because for some people, inner healing is what they need so terribly that it doesn't matter. Diet is not going to fix the problem. It doesn't matter what you eat because you have to heal the wounds that's deep down inside. She was suffering with irritable bowel syndrome. Irritable bowel syndrome is not something that you can diagnose on a blood test or a CAT scan.

1:49:46It's a pattern and we have a definition for how yourself or I come to that diagnosis.

1:49:53Dr. Will Bulsiewicz:And that definition was created by my mentor, Dr. Douglas Strassman. Really? And - Wow. Yep. And Douglas Strassman, he was at the University of North Carolina. So he's older now, he's retired, but he was there when I was there. And he's the one who created the Rome Foundation. And the Rome Foundation just released a few weeks ago, their fifth version of their criteria for not just irritable bowel syndrome, but for many other digestive health conditions. Okay. He's the founder. He's the name on the book. They've been doing this since the 1980s. Prior to that, where we were is that doctors would see a pattern of people with pain and either diarrhea or constipation.

1:50:39Dr. Will Bulsiewicz:They wouldn't know what to call it. Oh, they got pain and diarrhea. No, no, that's irritable bowel syndrome with diarrhea, right? So what you're describing was invented by, or like basically created as a diagnosis by my mentor. And let me tell you about how we used to do things in his clinic. It was the most bizarre thing. And it's sad, Rangan, the hospital administration ran him out because he wasn't making money, okay? But here's what happened. We would have in a four-hour block, two patients. Now, let me tell you, I have had periods of time in my career where I've taken care of over 20 patients in that same amount of time.

1:51:20Dr. Will Bulsiewicz:We would have two patients. We would go into the room, we would come out, we'd go into the room, we would come out, and then we would go back into the room the third time. And by the time we got to the third time, that's like a third visit. You would get to a point where you trusted each other and you were ready because there was a bond now. This is the doctor-patient relationship. This is what doctors are starving for. And the system will not allow us to have it. Right? The doctors aren't the bad people. We didn't create the system. We would change it. That's what you and I are talking about.

1:51:51Dr. Will Bulsiewicz:But by that third visit, you would have a bond with your patient that they trusted you. So the guard comes down and the real information comes out. The thing that's been missing this whole time for her, it was this experience with war and with her dad. and even for her just to add that because I completely agree with you well even her having that conversation with me that is therapeutic in and of itself even if you this is something it took me a while to learn even if you don't go and see a therapist or process that right just having someone listen to you hear your story and you as a patient to start making sense oh wait a minute yeah it did start then right because that hadn't even dropped for her prior to that right that in and off itself even if i did nothing else for her and no one else did that is powerful therapeutically in and off itself and i've i've seen that time and time again throughout my career rangan why do you think i wrote about it who was the patient yeah it was me there were things that i had to say and yes i hope it helps other people but there were things it was for me right i was the patient in writing chapter eight so and i've seen other people too i could tell stories all day about people that i have improved that they don't get better until they fix the thing yeah right so i think it's it's really important for everyone to hear this because for some of your listeners it's not 30 plants for some of your listeners it's not food movement sleep and relax no for some of your listeners it starts with i heard this podcast and what dr rungan and dr dr will dr b what they discussed i realized that's my thing yeah that is such an empowering message Will to come on as a gastroenterologist with decades of clinical experience to have written a book your first book back in 2020 or published it then called Fiber Fueled talking about the benefits of fiber to be comfortable enough in your own skin to say yeah and for some people that ain't enough, I think it's really, really empowering.

1:54:29I think there's going to be so many people who listen to this show who are sick, they're struggling with their health. So they're looking, is there a tidbit of information that I've missed that I can apply? Is there something? And I see this all the time where people are hammering the same thing over and over again. I'm thinking, you know, one principle I've always had as a clinician, and I guess you touched on it before, if you've tried it multiple times and it ain't working, maybe that's not the thing we need to address at the moment. I think everything about your work and one of the reasons people are drawn to you so much is because you have a very good grasp of the later science, but you've also got this deep humanity that I think has come from your clinical experience, from seeing sick people, but also from understanding the parts of you that you weren't addressing in yourself.

1:55:27And I want to acknowledge you for that. I think it's really needed. People think these days it's just about information. Yeah, just give people more information. If I know the right diet to follow, that's what I need to do. Sure, but that is only one part of it. That's kind of what I call external information. Great. Very useful. But you also need a bit of internal information, right? What's going on in the inside? Why do I keep making these choices that I know are not helping me? There is a reason for that. And for many people, it ain't willpower. There's something else driving it.

1:56:04Dr. Will Bulsiewicz:Yeah. Well, and I think to put myself into a position where I'm able to write about these things, I could not do this if I didn't have, if I felt isolated. I could not do this if I felt deeply sad. I could not do this if I didn't have the love and support of my family. I could not do this if I didn't believe that there was something bigger out there. Right? So to me, this chapter becomes a conversation, yes, about the brain and influence on the gut and how that influences our immune system and inflammation. Yes, That is like the physiology, but really this is a conversation about emotional healing and having a purpose and spiritual healing too.

1:56:49Dr. Will Bulsiewicz:And acknowledging the importance of that and stop pretending that these things aren't important and aren't real. They are real. And that's part of health too. Yeah. Well, there's so many other things we could talk about. I think there is certainly enough for a part two at some point in the future. The new book, which I think is a really wonderful read, is called Plant Powered Plus. Activate the power of your gut to tame inflammation and reclaim your health. One of the things I really appreciate about it is the nuance, is the patient stories, but also how you're very inclusive. you may have a particular preference for the way people eat let's say but I think you're also very understanding of people who choose to eat differently to that and and I really liked that because that's how you bring people together in a world which seems online at least more and more divided I don't think most of it is necessary it's like there are some common principles that people agree on, that you agree on, and I very much appreciate that about your book.

1:57:58But Will, my final question to you today is, if someone's been listening to us

1:58:07and they've realized throughout this conversation that they've not been prioritizing their health enough, or perhaps relevant to what we've just been talking about, that they have overlooked a certain important parts of their internal landscape, what would you find a worse of them be? Let's imagine that we're in a private space in a clinic.

1:58:37Dr. Will Bulsiewicz:I'm talking to this person one-on-one. What would I say to that person, right? That's my patient. What I would say to them is whether it's your diet and the things that you've been avoiding, whether it's the sugar that's been causing the trouble, whether it's that there's something from your past that's continuing to haunt you and make you feel unsafe. In all of these cases, the solution is not to avoid it. The solution is not to ignore it. The solution is to see it, call it out. That's the problem. and then turn to it. And let's create a plan to get past it. And that's how you win. I love it.

1:59:26Will, you're a wonderful doctor. You're a wonderful human being. Thanks so much for coming on the show. Thank you for having me.

1:59:38Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect.

2:00:24And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com forward slash Friday 5. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change and movement, weight loss, and so much more.

2:01:02So please do take a moment to check them out. They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family, or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts at all, That option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health.

2:01:44Making lifestyle change is always worth it. Because when you feel better, you live more.

2:02:00Thank you.