Your Gut Needs More Than Probiotics! | Dr Will Bulsiewicz

Key Takeaway

At your next meal, add one extra plant food—beans, vegetables, fruit, nuts, seeds, herbs, or whole grains—and aim for greater variety over the week rather than perfection. Diverse plant fibers feed different gut microbes, which produce short-chain fatty acids such as butyrate that support the gut barrier and help regulate immune activity. If fiber currently triggers symptoms, start small and build gradually instead of cutting plants out completely.

Episode Overview

Dr. Will Bulsiewicz explains why gut health is about far more than digestion: the microbiome, gut barrier, and immune system work together to influence inflammation throughout the body. He outlines four “workhorses” of an anti-inflammatory diet—fiber, polyphenols, healthy fats, and fermented foods—while emphasizing that lasting healing may also require addressing stress, relationships, trauma, and emotional health.

Full Transcript

Transcript of Your Gut Needs More Than Probiotics! | Dr Will Bulsiewicz from Feel Better, Live More. Auto-generated from episode audio; may contain minor errors.

I wanted to start off by putting to you something that Hypocrisy said over 2,000 years ago. All disease begins in the gut. What's your take on that? I think he was right. And I and I do think that there's ancient wisdom there. To me, and I'd be curious what your thoughts are on this. Science is the art of observation, right? The the world is going to carry on. Things are going to happen. And science is how we start to observe what's happening. And it took us so long to finally circle back to this.

Now, Hypocrates is not the only one, right? Ayurveda has a strong tradition of discussing the ways in which things focus through the gut. But what we have now is finally the scientific tools that we need, the power in our computers in order for us to finally study these microbes that we were unable to get access to. Mhm. And we're discovering that this is the interface between not only our body and different health systems within our body, but it also is the interface with the outside world.

And so everything that we're going to discuss today, it converges in this location. And I think Hypocrates was exactly right. Yeah. Yeah, it's interesting to me that so many ancient traditions have spoken about the importance of the guts. For me, growing up as a kid and in an Indian family who immigrated to the UK, so many things that I now write about and talk about that modern science is confirming. It's kind of what mom and dad used to do with me when I was a kid, which I actually find very liberating.

But I sort of feel that as a profession we've denigrated so much stuff that has existed for many many years because we never had the evidence. Meditation is an example, right? Meditation was looked down upon for many years by western scientific culture until we got the evidence go oh actually there's a lot here. Do you know what I mean? So I kind of I think we have to acknowledge that as western trained medical doctors that what we're talking about both you and me is stuff that other cultures have sort of had an instinct towards for many years.

I think what you're getting at is the humility of being a medical doctor, the humility of being a scientist, to not believe that I'm absolutely correct, but instead to say that there is this bigger story and what I'm trying to do is put the pieces of the puzzle together. And and you know, going back to these ancient traditions, uh my definition of like what is science being the art of observation, they were observing too. They just weren't doing it with a laptop, right? And it was more over the case of thousands of years that they're collecting their observations and building their system of how they approach health.

Yeah, absolutely. Well, let's get into gut health. This is something you've been talking about for years, all of your books, I guess, in some way, you know, touch on the topic of gut health. How do you think about this for someone who's never heard of the term gut health before? Well, there was a time where this interview, you know, there would be people that have never heard of this. I'm pretty sure you've at least heard a little bit about this, but I would love to apply my definition of what I see.

Sure. Which is that, you know, we think of the gut as being uh where digestion occurs. But I think there's a much bigger story there. And when we talk about gut health as as the version that I see, we're talking about the story of the gut microbiome and how those microbes which are they're not a part of our body. They're not human yet they are there in staggering numbers more than the number of cells that we have in our body. more than 99% of our genetic code deeply intertwined with our human physiology to the point that we I would argue are 100% dependent on them in order to be healthy.

And the story of gut health is that those microbes, they have a powerful influence over our digestion, but also in my new book, our immune system, inflammation, and we could go beyond and talk about our metabolism, our hormones, our mood, our brain health. So, u to me like this is the command center for human health. And when we talk about gut health, that's what we're talking about is the gut microbiome and how that impacts our health throughout our entire body, not just our digestion. Yeah. One of the things I enjoyed reading about in your latest book is an idea that I don't think people think about enough.

You write about this idea that the job of the microbiome is to train the immune system and I think it's something we should absolutely explore. I don't think that has been covered that much so far on my podcast. I think, you know, I'd love to hear you talk about what that actually means. Sure. So, let's let's start by imagine for a moment that we pull out our microscope and we're going to zoom in on this part of our body because there are things that exist there that we can't see with the naked eye.

Yet, we are filled with life. These microbes, 38 trillion is the number that we estimate for our gut microbiome. And these 38 trillion micro, by the way, that number is crazy. Yeah. All right. We have to pause and say that like you would you would you would need to literally take 380 galaxies full of stars and insert that into your body 380 times to equal the number of microbes that we have living inside of us right now as we sit here and talk to one another.

Yeah. So as we zoom in and look at them number one Rangan they are just like us. They um they have unique skill sets. They have different jobs. They have different personalities. They're sort of clicks. Like there's certain ones that hang out and there's friends. There's sort of frenemies or people that don't get along with each other. They go against each other at times, right? They are just like us. And I think sometimes about this when I'm up on an airplane and I look down and I see down below, I can't see the people down there, but I know they're there, right?

So, and these microbes, they are they are performing really essential tasks, which includes maintaining our gut barrier. So inside of us, our intestines is coated with this single layer of cells that is the the gut epithelium. And that single layer of cells has a really important job. Allow the good stuff in, keep the bad stuff out because on the other side of that single layer is where 70% of our immune cells live. So just to set this up, we have our gut microbiome, we have our gut barrier, and we have our immune system.

70% of it and they're all right next to each other in close proximity. And these microbes, you know, we're not born like completely totally sterile, but that's as close as we'll ever be to that. And from that point forward, from the moment that we're born, we are acquiring and recruiting our microbiome that starts to develop during those first three years of life. Where by the time a person is a child is 2 to three years of age, they have a basically fully formed adult-sized gut microbiome.

It's during this time that the immune system is simultaneously learning. Yeah. And understanding like what is good, what is bad because the immune cells, they have a complex problem too. they they don't want the immune system doesn't want to react to things that it shouldn't react to but it has to be properly trained. So it's the gut microbiome particularly during this period of time but then carrying on throughout the rest of our life that those microbes are ultimately having an impact directly on those on that 70% of those immune cells that are just right there in close proximity.

And we see this because if we take a step back and we think about this, you know, for the listeners at home, I want you to think about the child who's exposed to repeated courses of antibiotics, right? Or think about uh bottle feeding instead of breastfeeding, which is a modern concept, or uh cescareian section, which again, that's also a modern concept that didn't exist that long ago, right? And these are things that sort of disrupt the development of the gut microbiome. antibiotics, bottle feeding, cescareian section, and each of those three things has been associated with immune mediated health conditions further down the line.

So that could be allergic like food allergies or eczema, but it also could be autoimmune type health conditions. Yeah, I mean, there's so much to cover there. This idea that when we're born, our guts are as close to sterile as they will be, I think it's worth us all reflecting on. And of course in the olden days, you know, everyone was born via vaginal delivery. And my understanding is that one of the first or one of the most significant inputs to our gut is us traveling down the vaginal canal before we're born.

Right? That is starting the process of training our immune system. Even that idea that the immune system is something that is there to be trained, I I just absolutely love it. It's not this static thing that you, you know, you're born with it. You have your immune system. No, the the inputs you give your uh your body through maybe dietary choices, maybe stress, maybe the the wrong type of sleep, whatever it might be, that is all information your immune system is constantly trying to learn and adapt.

So I think that's a a really beautiful thing for us to think about. I I want to make sure we we don't have to necessarily cover it now but we must cover it at some point because there will be people will who just heard what you said and they'll be thinking oh man well well my child had recurrent ear infections and they had loads of antibiotics or I had problems with my pregnancy and I had to have a cesarian section right which maybe was the best thing for me and the child.

And so some people will be thinking, "Oh my god, are you saying that I'm destined to have gut problems because of that?" And I'm pretty sure you're not saying that. No, I'm absolutely not saying that. And it is it is a delicate thing because that is sort of the way that many people will react. I understand that. All four of my children, I have four kids, they were all born by cescareian section. It is not what I wanted uh or my wife, but it's what happens.

And um you can absolutely have healthy children uh regardless of the way in which they were born regardless of whether they're breastfed or bottlefed, regardless of uh exposure to antibiotics as a kid. If a child needs antibiotics in my own family, 100% my child will receive those antibiotics if they need them, right? I push back against unnecessary antibiotics, which is what we should do. Um so and these these risks are not absolute risks. So, you know, as as as we know from listening to your show, as we know from reading your books, uh the choices that we make in life or the things that maybe we don't have a choice over, but they do occur, they impact our health, right?

But at the same time, you could do everything right and still struggle with your health. Or there are those people that they, you know, they they they do things that neither of us would recommend and they still end up living to 90 years old and we can't explain it. So these things are complex is the point and it's not it's not so simple as oh this one thing and therefore I'm I'm in trouble. What one of the most empowering things I've heard you say will is that and you can you know clarify the exact time frame on this but the choices we make today can literally lead to a different microbiome within days.

You know I I mean I guess the the question being how quickly can the choices we make influence the state of our gut microbes, our gut lining and our immune system. the three things that you've been talking about. Literally by tomorrow, literally by tomorrow, there's already changes that are underway. Now, are we installing a brand new gut microbiome? Are we completely transforming it in 24 hours? Absolutely not. That would be that would be, you know, oversold, but it it goes back to a study from 2014.

And in fact, this is a study that I personally love because it changed my life and really set me on this trajectory where it was published in Nature, uh, the top medical journal on the planet, and it was the the lead author. If anyone wants to find this study, it's not hard. You go to Google and you type in Nature David 2014. Okay. Okay. And this will be the first thing that pops up. and the the lead researcher, his name was Lawrence David out of Duke University.

Here's what they did. It prior to you have this wasn't that long ago, but in the world of research, it seems like it was a lifetime ago. Prior to 2014, we did not have h clear human research showing that you could change the gut microbiome with food. We had mouse studies. So what they did was to ask the question, can we pull this off? Can we change the microbiome by manipulating the diet? Mhm. And the way that they approached that was to create two diametrically opposed dietary patterns.

So they did one that was completely 100% plant-based and one that was completely 100% animal-based. And it was 5 days on each of those dietary patterns for each individual person. and they measured on a daily basis the gut microbiome. So one of the key findings from that study was that they could detect differences within the microbiome in the first 24 hours that already changes were underway. The changes at day five are larger than the changes on day day one. Um and you know there's other findings that came out of that study as well that were quite interesting.

But the the point though is that that alone was enough for us to see that the food that you're eating today by tomorrow it will impact these microbes. And Ran there's there's a there's an explanation for this which is that these microbes their superpower is their ability to reproduce. Mhm. So it's kind of like uh like gerbles like mice like or or there's many other animals out there where it's just like they produce so many offspring and that's how they beat the system. Uh these microbes, it's estimated that about every 20 minutes they may be producing a new generation.

Wow. So it takes us 30 years, it takes them 20 minutes. And if you were to take that and basically like do it over the course of a 24-hour period, you could kick out enough generations that if it was humans, it would bring us all the way back to the pyramids. So a 24-hour period for them, it's like the movie Inception. a 24-hour period for them is a profound amount of time because time runs differently for them. When you were chatting a few minutes ago, Will, and talking about you see it a bit like when you're on a plane and you know you're traveling and you can't see the detail of what's going on down below, but you know, oh my god, there are tens of thousands, hundreds of thousands, millions of humans over where I'm flying, but I can't see them, but they're doing something.

It was very evocative for me. And the thing that came to to to my head there was this this thought about community, right? Because it's not just about nurturing our relationship to other humans. It's about nurturing our relationship to this huge community that most of us are not aware of. Even if we're aware of it, we're aware of it cognitively that oh yeah, you know, gut health is important. Yeah. But how often do we think about that when we go about our our everyday life? But what you're saying is really quite profound which is that there are trillions of organisms inside you.

That is your community. And if you look after this community, this community is going to help look after you as well. That is a first of all 100% true. Um and when they are built to support our body, we are at our best as humans. And they want that to be true because then we become the vessel by which they continue to carry on, right? They can continue. So they they they're looking for us to be successful. It's a true symbiotic relationship. But there's also a gut microbial conversation that exists in terms of our human connections which is that they they have studies run where they have found that you share more microbes with the people that you live with than you do with your siblings.

All right. And like that's not necessarily a dietary pattern because they actually control for dietary pattern. They really 100%. Because the initial thing could be, well, you're gonna maybe eat the same kinds of things as the people you're living with. So, of course, that's going to reflect some of the micro run. But you're saying that's been controlled for that's being controlled for. And in fact, it gets even better because they've looked at partnered relationships and ask the question and I just it's it's mind-blowing how great this is that they ask the question, okay, like is this a productive relationship where you are like happy and and um bonded together or is this like an advers adversarial relationship where you're not getting along, right?

And what they actually found is that the gut diversity, which is a measure of health within the gut system. So more diversity is good. They found that the gut diversity was enriched among people that were in partnered bonded relationships where they were in love. I This is crazy. Yeah. Oh, we we keep going. Uh why do we kiss? Why do we kiss? What? To exchange gut microbes. I think that there's a story there because to exchange microbes, I should say. Obviously, they're oral microbes um as opposed to gut ones.

Uh yes. And and they're not they're not the same, but they're there is some there are some connections there that do exist. So So So what you're effectively saying is if your partner has phenomenal gut health, kiss them more. Yeah. I'm I'm 100% in favor of that. Um, but also there's clear-cut data that uh a not a grandma kiss, but a passionate kiss has actually clear exchange of microbes that exist that occurs. And there's the ongoing theory that perhaps like um smells, right? The the the [clears throat] attraction to certain smells, there's microbial or origins to that.

Yeah, there's so so many rabbit holes we could go down and and I love going down rabbit holes. the whole gut brain piece. I wanna I want to definitely get into let's just part of that for a moment because I want to make sure we've totally got everyone on board with this idea that actually what happens in the gut barrier and the gut lumen is very very important. Okay. So you've mentioned that there are these kind of three things that we need to be thinking about the the gut microbes, the the one cell guts 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 I really want to talk about lipopolyaccharide or LPS and inflammation. Those two things of course are tightly linked together, but how does that fit into this story? 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 they have evolved with a protective shell.

It's like their armor, their coat of armor. Mhm. And it surrounds their cell and it's called lipopolysaccharide. Mhm. And you and I know this because we trained with 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 of bacterial uh endotoxin which is the same thing as lipopolysaccharide. All right, this lipopolyaccharide is a part of these bacteria.

that these bacteria are inside of us, even in a healthy gut, these bacteria are inside of us. So, but when uh when we have breakdown of the the system, there's more of them. They're more powerfully represented and simultaneously the 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 defens defensive gut barrier that keeps us healthy.

Mhm. 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 demonstrative 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 with that have this lipopolysaccharide. 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 uh 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, imagine that you know 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 [snorts] 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. I need to call for help." So these immune cells will then release what are called cytoines.

Cytoines when people hear about this it's this it's a nerdy term but these cytoines basically what we're referring to is communication between the immune cells. Mhm. And many of these cytoines are to say hey I need help. Let's get more immune cells over here and let's protect you know 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 lowgrade but it's ongoing 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 I are both tall guys we could play we could be make great basketball players right but the body is one it's not 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 cytoines.

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 hypocrisies quote, 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 [clears throat] chronic diseases if not all. I 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.

That's right. 130. There you go. There goes over there's over 13. 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, Runan, is that I asked this question. 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 the scientist, I can defend my position and say here is the study to prove that this health condition is associated with inflammation.

And I was taken back because I found again over 130 health conditions. Now this includes the classic things that we would think about Crohn's disease, ulcerative colitis, uh rheumatoid arthritis. You know, these are uh inflammatory health conditions, but it also includes things that people may not think about. Yeah. Well, there's just so many. There's even things like psoriasis, eczema, what my dad had, uh SLE, you know, colloquially known as lupus, uh asthma, you know, autoimmune hepatitis, low back. I mean, you've got uh 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 marshaled gut barrier okay this lipopolyaccharide that is is normal to be there in your gut. I think you know we're just making that clear. It's not a problem that you've got LPS on those gram negative bacteria in your gut. That's not the problem. The problem is when there's, you know, a leakiness to the gut and that lipopolyaccharide gets in, it then interfaces with the immune system and leads to this onslaught of inflammation.

Couple of things I just want to comment on, Will, is you know, a lot of people have been quite derogatory about the term leaky gut for years. And and I tell you my stance on that. I I 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. Not everyone of course but I think sometimes that happens.

And I 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 you you know 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.

So I really appreciate what you said there that actually yeah it is a leaky gut at that point. Yeah. Well I think that the issue is we have to um separate leaky gut which is the mechanism and that is not a diagnosis. No. Exactly. To something else that I have 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 that that 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 the 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. The second question was, can I prove that there's disbiosis? And can you explain what dispiosis means that people don't know? So, we've touched on it lightly here, but let's get very direct with this.

Dispiosis 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. 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 coli or other gramnet salmonella these these other bacteria that that uh we're discussing now within the context of lipopolysaccharide. So so basically dispiosis means that the gut microbiome is not as healthy as it used to be. That's the simple term. A bit like this neighborhood analogy, right? Let's say in your neighborhoods you let's say you're lucky enough to to live somewhere safe, right?

Where 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 disbiotic gut is maybe like a disbiotic neighborhood where there's high crime and there's a lot of problems. Yeah. It's just the balance has shifted 100%. 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 and build it into one of these safe communities that really is productive and um uh a great place for people to live. So, so that's kind of what we're getting at here. And you know, as I 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 dispiosis in every single condition that's listed.

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Just scan the QR code on screen or visit hellolingo.com/livemore for more information. Terms and conditions do apply. 10 11 years ago when I was starting to write my my very first book. I went into a lot of the research on lipopolysaccharide and [clears throat] for a condition that's called type two 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 onto insulin resistance.

Mhm. Right. Which is really interesting, isn't it? Because I guess what we're saying is that if you've got a wellprotected gut barrier because chronic unresolved inflammation and disbiosis 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.

Yes. Yeah. Uh so the answer is yes. And now I and I know that you um 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 course, right? So there's 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 for so number one, the four-pillar plan, food, uh, sleep, exercise, movement, and relaxation. Those are the exact same things that I'm discussing. Yeah. In my book because they impact the gut and ultimately impact the immune system. So, it's the same story. It's just told a different way. Yeah. Right. Um but also, um 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. M 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 runan you might be taking care I'm not a primary care doctor I'm a gastronologist 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 as in a 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. But if we look at the four-pillar plan because that's food. I would also there's a clear argument with exercise. 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. Mhm. 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 I've ever written. And it's it's the it's the brain gut connection and it's about stress and human relationships and spiritual connection. Yeah. I want to talk about chapter 8. Um before I do that though, I want to make sure that we've covered these four workh horses of an anti-inflammatory diet, right, that you that you write about so beautifully.

Okay. So I think we've set out the problem. Okay. We we could of course spend another two hours discussing more of the nuances about the problems in the gut, 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. Right? So the question then becomes what are some of the things that we can do to improve it? Okay? Especially because we said before like 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 happened. Some people will have been born by cesarian and not vaginal delivery. Okay fine these things happen. Some people will have been bossfed 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 has happened. What can we do now? So through the lens of diet and of course as you mentioned there are other pillars of health to look at when we're thinking about gut health.

Diet can be a very powerful way to influence our gut microbiome. I I quite liked your framing. So can you tell us about these four workh horses? What are they and why do you think they're so important? Sure. So, um, diet is probably the most powerful lever, but not the only one. More than kissing and more than more than kissing, but kissing is great. Okay, we we want to bring together all of these different things that have them all working for us. So, um, diet is probably the most powerful ever on average.

There are definitely listeners to this show that diet is not what they need. There's other things. [clears throat] 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 US. If you accept the like if you're just going to accept the norm, we're in trouble. Oh yeah. Right. 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 uh step into a conversation about nutrition, the way that I think about this is like this whole world of 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. Mhm. Who cares what you call it? There's these basic things that we need. That's what this conversation of the four workh horses is. Here are the four basic things that we need.

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 on like for 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 uh transform their health, that's my goal.

That's what that helps me to accomplish what I'm trying to accomplish, which is to make people healthy. 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 d 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 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 workh horses because I have this sort of an American vision of uh settling the west, right?

where not that long ago, people were going to these remote places where no one else really lived other than the 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 go you're you're you're you're running uphill. You're in a better position if you got four workh horses pulling you compared to one. Yeah. So, the four are number one, fiber.

Um, of course, I can't get past fiber. I wrote an entire book about my passion for fiber. Was that your first what? Fiber Fueled. Fiber Field was my first book. Was a few years back now, right? That was 2020. Yeah. Yeah. Um, and and I'm happy to see that fiber is like finally starting to get the attention it deserves in 26. But the 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. Mhm. Because fiber doesn't get digested in the small intestine. 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. Mhm. 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, propriionate, 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. 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 I 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 and I don't I I I I would challenge anyone to try to prove me otherwise because this this to me is the most anti-inflammatory thing. 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 it we're not 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.

I just want 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 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.

Yeah. In the US 95% are deficient in fiber. So the 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. Yeah, this is 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 this this the these kind of three things, the gut microbes, the gut lining, and the immune system.

We want all three of those things in averse commas functioning well, right? Or 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 we can find what the right types are in just a moment. But that fiber is going to interact with the gut microbes. So it's going to have an improvement with the gut microbes. The gut microbes are going to make short chain fatty acids like butyrates.

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 that the the converse is true that it is kind of in many ways anti-inflammatory. anything that you would reword or or have I got it right in terms of what the argument you're trying to make? So, you got it right, but it also goes beyond repairing the gut barrier to protect the immune system.

Yes, we need to stop triggering the immune system. Uh, 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 the 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, but we we don't want our military picking fights and not I mean I know it's not the ideal time to be using this analogy, right? But like we don't want our military picking fights and starting wars when it's unnecessary, right?

Okay. Yeah. Let's just part the um 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, right? And 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. Our immune cells are throughout our entire body, including our brain. H and increasingly neuroinflammation and I'm sure that you've had uh you know 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 scerosis 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 bloodb brain barrier and actually reduce neuroinflammation.

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 uh better signaling to to put it, you know, in a very colloquial way, but but that is also going to travel through the bloodb brain barrier.

You know, you wrote about I think you wrote about this in chat to race actually, this this mythical chapter we're going to get to shortly that short chain fatty acids can actually cross the bloodb brain barrier which is very very empowering, isn't it? And and yes, they cross the bloodb brain barrier to, you know, basically help to protect our brain uh reduce aging in those locations because to me like aging is inflammation. That's what produces aging. Is that the reason you call fiber the longevity nutrients?

Yes. Yeah. Because if it's the most anti-inflammatory, then it would also be the most anti-aging. So, but also a different short- chain fatty acid. Let's shine a light on propriionate for a quick moment because that was one of the three that I mentioned. Propriionate is the metabolic short- chain fatty acid. So you and I were talking about insulin resistance a moment ago. If we want to enhance insulin sensitivity, the opposite of diabetes, propriate is the one to get the job done for us, right? If we want to enhance satiety through the release of GOP1 which is popularized and everyone's hearing about GOP1's 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 there's, you know, we we could go down many different uh uh strands of thought and different systems. I mean, I could get into hormonal as well if we needed to. Yeah. So, so the first workhorse is fiber. Yeah. 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. Yeah. Because I heard you recently, as part of my prep for this conversation, I was listening to you talk and I think you might even have spoken about bread.

If you buy fresh bread and slice it, put it in the freezer. Yeah. take it out and then when you want to eat it, you know, toast it at that point, the the whole sort of makeup of that bread has changed, right? And then 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." I would expect it would.

I would expect it to as well. I know we I think a lot of us have heard that before with rice that gets cooled down and put in the freezer, then you reheat it or or potatoes, right? Potatoes. But I hadn't really thought about it through the lens of bread. Yeah. any starchy food. So, legumes as well, any 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, right? The uh the cooled mashed potatoes, they're much little stiffer. But what is that resistant starch in particular doing in our guts? Yep. So we'll expand. means we're going to let's dive into resistant starch first since we're there and then we'll expand into the fiber conversation.

Sure. 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 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 the into your bloodstream.

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 um uh roughly 5 m 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 run and even beyond that they've actually studied where in the colon different things get digested.

Different forms of fiber or resistant starches 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. Mhm. All right. That spot in the right lower abdomen, that's where your small intestine is called the terminal illium 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 that get they get digested right in the first part of the colon. 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 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 we're we're 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 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 if you you 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 have been one of my mentors uh 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 got all these different departments and all those departments need looking after if if the if all of those departments are appropriately looked after they're going to do their job for you.

But 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. Resistant starch is particularly going to maybe feed a particular department that maybe was neglected, right? It wasn't getting it through who the other ones were. They were getting the delivery every day when the lunch came, but actually resistant sow allows that neglected part to also be fed. And and and and the other thing just to say will is that when you're pointing to the left, you know, the the descending part of your colon, yeah, on my side, of course, that is one of the areas where when people feel constipated, Yeah.

they will feel a fullness there or a discomfort there cuz it's like that final bit that they can't for whatever reason eliminate from the body. Sure. Obviously, you're a gastroenterenterologist. 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 of that constipation? Well, I wouldn't discriminate and say like we need this particular form of fiber but not the others. I think that sometimes the mistake. So, let me just uh point [snorts] of cl of clarity for the listeners.

So, I'm the founder of a supplement company called 38 terra. And uh our 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. Yeah. So, um, I think that the mistake that's often made in in fiber supplements is the idea of a mono fiber. So, you get this one type of fiber and then you just give more and more and more and more.

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. You're overworking those guys and you're ignoring everyone else, right? So, this brings us back to the concept of diversity. Tim Spectre has been on your show a number of times. Tim and I, we 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.

So whether it's a supplement or is 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 I guess what 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. But does resistant starch come in other forms without us actually refrigerating or freezing the food? Yeah. So like the the resistant starch that's in our 38 terra product is from a potato and it's not a retrograde starch. So this is this is an RS2 starch, which it 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 resistance 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 it's we've all seen it the green banana that's too stiff, not sweet, not particularly enjoyable to eat. But the green banana is a great source of resistant starch. Mhm. 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. Have you tried to meditate before? Perhaps you've heard about some of the benefits like reducing stress and increased focus and you've given it a go and thought it's not the practice for you.

Well, I believe that may well be because you have not tried the right approach. The Way is the only meditation app with a single long-term pathway. You're not forced to make loads of choices each day. Instead, you're guided on an enjoyable and progressive journey that deepens your practice step by step. Since I partner with the way, I have had so much positive feedback. One listener said, "Dr. Chhatty, I came to the way through your podcast. I have tried other meditation apps in the past with limited success and like the idea of following a single guided path.

I'm nearly 2 months in now and loving it. Henry's gentle and concise approach is very calming and the way is now a part of my morning routine. You see, that's the sentiment that so many people report when they start meditating with the way. For listeners of my podcast, The Way is offering 30 free days to establish your own meditation practice. All you have to do is click on the QR code on screen or go to the wayapp.comlivemore to get started. One thing I just want to uh pause on is this 30 plants a week.

And 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 uh 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. They 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 she you may know her she's a brilliant uh dietician and microbiome scientist researcher Emily Leming. Hello Emily. Emily's great. Emily wrote this Subseek article a couple of years ago uh 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 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. Totally. So 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 who you had a few months ago was saying do you know what I mean? I'm just just trying to make sure there's a clear message for people. Yeah.

Yeah. So first of all I know Emily really really well and um these are conversations that I've had with her offline. Yeah. and and and not in any sort of adversarial way actually total agreement. Yeah. Yeah. Yeah. because because it's you know the I guess here's what I would say first and foremost uh 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 it's a high number right and what 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 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, it's 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?

I was the guy who needed uh 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. Mhm. 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 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 you will receive the reward that comes from that." And you know, 29 is just as good as 30 and 31's a little bit better.

And so it's not the number that really matters, the idea. Yeah. Yeah. And one of the things that was really clear 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. Yeah. And and I'm not sure people really understand this enough that there is a big difference between researchers and clinicians. Totally. Okay. And and I remember actually years ago when I spoke to Dr. Sachin Panda from the Soul Institute.

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 timerestricted eating. Yeah. Um and I remember in one of our conversations he said, "Ron, I love hearing your stories about timerestricted 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 stuff, but I want to know from you guys, is this actually working?" Yeah.

Right. because otherwise my research doesn't have any uh realworld application. Yeah. And 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 and you recognize like me that there is no one right way for everyone, right? But these are these are principles that we want to share with people and they can then personalize those principles within the context of their life. But but on that point before we leave fiber there is a lot of people these days who are gaining benefit from going on let's say a low carb diet.

Sure. Okay. [snorts] Uh maybe they've got significant insulin resistance. Maybe they've got type two 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 were even on a a ketogenic diet, which a lot of people will say that they feel better on certain diets like this.

I 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 buterrery are important. Some people will say, "Yeah, but on a on a on a low carb diet or a keto diet, I'm making beta hydroxybutyrates." Right? So, let's just cover that because I know there'll be some people listening who are thinking that say, "Well, do I really need to increase my fiber intake or does the beta hydroxybutyrate cover it for me?" Yeah.

So, first of all, this is a fascinating topic and um and I I know we didn't go there cuz 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 and I and I think there's a 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 right and I don't care whether it's the diet that I recommend or don't recommend I would you [clears throat] 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 long term.

That's my concern with the carnivore diet is 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, propriionate, and butyrate. 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, you know, 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. But it also doesn't behave within the body exactly the same either. So it's not a onetoone thing. There are certain things that these 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 the the acetate, the butyrate, fiber is the way to go about doing that. Um, you know, 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?

I don't I 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. Right. So that they actually remove that from the equation. That's not counted towards your carbs. Mhm. So if you were if your diet was being informed by a true nutrition 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 um achieving your 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. It 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 carnivore 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? Is would is that a fair reflection of your take? Yeah, it is. Can we unpack this real quick, please? Okay, cool. Because the because the issue is so first of all uh um 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 who's managing to uh get their disease into remission through whatever dietary pattern I celebrate that but what do I think is actually going on there right cuz 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 ultrarocessed food is about 55% for adults and going up in the US it's about 60%.

And for us children it's about 70%. Oh man. Okay. Of your of the calories are being are coming from ultrarocessed food. Let me be clear on something with ultrarocessed food. I'm not talking about like ground beef, right? I'm not talking about uh making bread. I'm talking about ultrarocessed, something that you don't have the ability to make. You can't get access to the to the um ingredients that are in ultrarocessed 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. 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 ultrarocessed foods. And I'm of the belief, Rangan, that it's the ultrarocessed 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 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.

So, if you take a person who's on average more than 50% of their calories coming from ultrarocessed 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. Um, simultaneously by going on a carnivore diet, it's a zero carb. You you will get into ketosis, you will get the accetoacetate and the beta hydroxybutyrate. So, so, so this is why that makes sense within the short term and why it can induce remission.

Yeah. All right. It does not reduce 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. Right? 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 um I you and I are both tall. I enjoy playing basketball with my son. Mhm. 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. Mhm. 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. Mhm. Right. Everyone agrees that exercise is good for the human body. Not everyone agrees that 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 [snorts] too much. So when we 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 it's not required yet 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 um it's just the way in which we go about this.

So I hope that explains that. Yeah, I think it was 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? So 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, right?

If you walk regularly, you're going to reduce your risk of getting sick. Doesn't mean you're never going to get sick. Well, 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. Stacking the odds in your favor. And also, I I have longitudinal experience, meaning multiple visits with with patients where I've seen how things evolve over the course of time. Right. As a medical doctor, I don't bring something into a 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 I've seen work with my own eyes. And the problem, Rangan, is that I've seen a bajillion people that as a gastronurologist like dealing with the sickest of the sick when it comes to their gut health that who can't eat anything. They can't tolerate anything. And it's really hard for them. And I and I sympathize with them. And the problem is it's the restrictive diet, Rungan, that led them into that. Yeah. You you literally I'm just pulling back your introduction.

I I I underlined 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 hyperrestricted diet that's 50% red meat and eliminates whole categories of fiber richch foods. I mean, you literally wrote about it, didn't you? you said you you want to help people not be on these hyperrestricted diets if at all possible. Um and and you know some of the questions that came in to me when I when I said that you're coming on the show is kind of well you know maybe this is the time to talk about Crohn's.

Someone actually asked you know can you ask Dr. B what is the outlook on Crohn's? How can we facilitate a remission? Yeah. Okay. So I'm throwing lots of things at you. So no that's great. That's great. Just 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 ultrarrestrictive diets lead people into food into food intolerances. That's 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. 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. Um 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.

Mhm. 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's 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. Yeah. That just tear them up. they can have inflammation. All right, so that's what Crohn's disease is.

And um it's an interesting thing, Rangan, because I used to think of Crohn's and ulcerative colitis, these 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.

Mhm. And now it turns on that microbiome and says, "No, no, no. You're the problem. 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 in in in plantpowered 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 prag pragmatic. I'm working towards results.

I and there are tools that are on the table and I don't come at things from some sort of you know uh dogmatic view of you can only do diet. You're not allowed to do medicine. That's not how I see it. 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. Yeah. You have to put the fire out, right?

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 workh horses and including anything else that we're going to discuss, circadian rhythm, and sleep, timerestricted eating and human connection and spiritual connection and uh meditation and relaxation.

Basically the four pillars that you talked about in your first book. You incorporate those elements, 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. Yeah. And it may take time. Yeah. It's 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 know, you you really can and it's clearly not something we were conventionally taught, but it's stuff I've figured out through the course of my career that hey, maybe there's another way here. As as you say, you do tease Hill in the book. Y well, you know, we could go in a million different directions. And we 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. Um, I do want to get to chapter eight because I 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 fiber. Yeah. Can you just topline two, three, and four? Let's go to detail because I think some of them we have covered before on the show. Top line what is two, three, and four and why they're beneficial. All right. 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 the fresh produce.

Mh. And the purples and the reds and the yellows and the oranges, every single one of those is powered by some sort of phyitochemical, 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 ceretin and um uh curcumin from turmeric. 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 a way that's like a coded way of saying eat more polyphenols. Number three are healthy fats. I'm I'm like certainly not anti-fat. Um, 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. M 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.

This is where a Mediterranean diet really sort of stands out because they're able to get the the um the beneficial fats that come from extravirgin olive oil. And also Mediterranean style puts a a focus on fish and shellfish which prot provides the longchain omega-3s that we need for our immune system that we need for our brain. Yeah. And and of course in a 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 is it if you have walnuts every day for 2 years you significantly reduce markers of inflammation in the body.

Was it was that correctly? Yeah it was a hand it was a handful of walnuts. Um, and walnuts can be a decent, not the best, but decent source of the of the plant-based omega-3s. There's an issue though, Rungan, 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. Yeah. 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 uh beneficial long chain DHA omega-3s. 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 a uh an um algae based omega-3. M. So, but healthy fats, omega-3, omega-3s, um the monounsaturated fats that you find in extra ver virgin olive oil as well as avocados.

This is where the money is at from my perspective. There is uh like 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 extravirgin olive oil? Yeah. Right. 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. Uh, it's like focus on the stuff that we know is helpful and and we've known for years is helpful. Uh, Katherine, number four, the fourth workhorse is fermented foods. Fermented foods. Yeah. Anything topline 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 uh when it comes to nutrition.

It wasn't when I wrote Fiberfueled. Yeah. Right. So, I've been I've been pounding this drum since the beginning. Um, 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 Stamford 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 what I wanted to weed 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. 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. Yeah. Uh 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 the 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 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 is called body and mind healing nourishing the soul through connection and um I wonder if I start by reading to you your words from the start of that chat which I found really really powerful.

Throughout my career I have 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 [snorts] 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-concious mind and the core self. Unfortunately, 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 that chapter, you talk about yourself. You 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 was sick. And when I wrote Fiberfueled 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. But you know, uh I had them as I was reading it cuz I think it's bang-on truth. well, being with you here today. And I think that what that gets at, and I I'll 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 increase 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.

And what and and and how do we what is 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. Mhm. But the the actual problem may exist somewhere else. So, and I learned that firsthand in myself when I wrote Fiberfield in 2020. I was writing it 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 uh projected image of I changed my diet and that changed my life. 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 um desperately needed to be addressed and the health issues that I went through, it 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 for my dad. And um it's when I finally turned to him through the help of my wife who is has been such a wonderful influence in my life. You know, 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 and becoming a father was one of I mean not even one. 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. Yeah. Because he loves me. I just rejected that love. And so I had my own health challenges that I struggled with and and the body, you know, was an outward manifestation of that or the way of 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. Um, I know from reading that your dad is no longer with us.

You My dad died in 2013. And um, there's many things that I would like to say to him if he was here, but he 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 uh will say things or 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? So sometimes people say, you know, I keep trying to change my diet. You know, I tried did it for two months, I did it for 3 months, but then I flipped back. I I ended up where I was before. I I have seen that so many times over the years. And to me, it's often because Yeah. because there's another uh component to this that you haven't addressed yet. There's a reason. There's some sort of deep trauma maybe or uh emotional baggage that you haven't processed.

That means you you're going to keep going to the sugar. You're going to 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. Yeah. And again, it's like you say in that section, 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 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 uh part of the conversation too. So I would love to get into the minations 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, [snorts] 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.

And I think that the 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, um, and also to live with purpose. And so again, I come back to it's just kind of interesting how, you know, you and I, 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 workh horses 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, right?

But 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 um 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 um 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. And I relish the challenge of trying to figure out what is going on here. What, you know, that's not denigrating any other doctor. I'm 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. 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. And 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 had a really [snorts] happy childhood growing up in in Iraq. And um 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 would literally wake us up when we go to a bomb shelter. 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 uh personality changed. Understandably, if if I was a dad and suddenly my kids lives were under threat in my family, I would probably change, right?

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 and yeah, and I would absolutely help her with that. But I had an honest conversation with her. And 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 we're only going to get so far. What's your take on that as a gastroenterenterologist? 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 lever, 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 wound 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.

It's a pattern and we have a definition for how yourself or I come to that diagnosis. And that definition was created by my mentor, Dr. Douglas Drossman. Really? And Wow. Yep. And Douglas Drossman, he was at the University of North Carolina, so he's he's older now. He's retired. Um, but he was there when I was there. And he's the one who created the Rome Foundation. And the Rome Foundation just released uh few weeks ago their fifth version wow of their criteria for not just irr 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. 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 we here's what happened. we would have in a 4hour 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. 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. 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 will 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? Cuz that hadn't even dropped for her prior to that, right? That in and of itself, even if I did nothing else for her and no one else did, that is powerful therapeutically in and of itself. And and I've I've I've seen that time and time again throughout my career. Rungan, 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 that was for me, right?

I was the patient in writing chapter 8. So, and I've seen other people, too. I could tell stories all day about people that 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's 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 gastroenterenterologist with decades of clinical experience to have written a book, your first book back in 2020 or or published it then called Fiberfueled 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. I 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 they're looking, is there a tip bit 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 think, you know, one principle I've always had as a clinician and and 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 latest science, but you've also got this um 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.

And I want to acknowledge you for that. I think it's it's really needed. People think these days it's just about information. Yeah, just just give people more information. You know, if I know the right diet to follow, that's what I need to do. Sure. But 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 for many people, it ain't willpower, right? It's there's something else driving it. Yeah. Well, and I think to be 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 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 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 the physiology, but really this is a conversation about emotional healing and having a purpose and spiritual healing too and acknowledging the importance of that. and stop 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 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 a really wonderful read, is called Plantpowered 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 uh preference for the way people eat, let's say, but I think you're also very uh understanding of people who choose to eat differently to that.

And 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 and I very much appreciate that about your book. But will my final question to you today is if um if someone's been listening to us and 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 part of their internal landscape.

What would you find a worse than them be? Let's imagine that we're in a a private space in a clinic. 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. Well, you're a wonderful doctor. You're a wonderful human being. Thanks so much for coming on the show. Thank you for having me. If you enjoyed that conversation, then I think you are really going to enjoy this one. that I've picked out especially we need to realize whatever we put into our body is either going to take our health down or build our health back up.

And it all works at the level the defense

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