The Importance of Fiber for Your Health: Dr. Will Bulsiewicz

Welcome back to
the WellBe Podcast and Show. This is your host, Adrienne Nolan-Smith
and thank you so much for joining. I know this will be
an awesome episode and very timely. Today, I have Dr. Will Bulsiewicz, who is double-board certified
in gastroenterology and internal medicine. He’s also the author of a new book
coming out called Fiber Fueled. Will, thank you so much for being here. Adrienne Nolan-Smith, it’s great to be
on this show with you. Should we tell them right after…
– Yeah, totally. What happened was
we did this a week ago, right? A week ago, yeah.

I normally have my Zoom settings to auto record
and I’d also thought I’d double checked that it was recording
and we had an awesome hour-long conversation that was not recorded,
so that was tough but we both… I feel like we’re good friends now.
– I know. Like I feel like we are really connected. Now, we know each other really well,
I was really happy to enjoy talking to you, so doing this, you know,
two hours was fine with me but obviously, Will is a very busy doctor so I felt terribly
that he has to take the time twice but anyway, thank you
for doing this again.

Well, it’s all good and you know,
I was a busy doctor and now, I’m a doctor wearing jeans
and times have changed. It’s a crazy time that
we’re going through right now. Yeah, so of course,
when you watch this episode, it might be, you know,
probably April, May, June. I’m not sure exactly but at the time
that we’re having this conversation, the coronavirus global pandemic
has just really unleashed itself on the US and we’re all quarantined and doing sort of
shelter-from-home type stuff or at least we are in New York State
and Connecticut now with all closed businesses and Will, what’s the situation
down in South Carolina? We’re not under any formal order to do anything
but thankfully, I think people have opened their eyes to what’s going on out there,
so people are definitely doing the social distancing thing,
going into isolation and I feel bad because I know several small business owners
— I’m a small business owner — and it’s not a fun time right now.

The number of people and businesses
that are just completely shut down that I know it’s unbelievable and again,
when you’re watching this episode, things might have played out
worse or better than expected but right now, it seems like it could be a really, really
big tragedy for the entire country and world, based on not just how many people
are going to die and be sick but also, how many people are going to have to start over and shut businesses
because they can’t survive this. No matter how many trillions of dollars they try
to inject into our economy from the government, I know that they’re just businesses
that can’t make it a couple of months being closed or however much it is,
so I feel for everybody. I feel like you’re going to be okay, Will
but that’s just my guess as far as your business.

Everyone needs doctors, for sure. Today, given the coronavirus,
Will and I were thinking it would be best to share with you guys a lot of information
regarding how the immune system and the gut interplay,
which is, they’re very related — spoiler alert. But his focus is really on fiber because he’s done a lot of research into
how that really is, you know, an essential part of a healthy gut
and we don’t talk about it enough.

I think gut health is talked about
quite a lot at WellBe but not specifically about the role of fiber, so that’s why I really want to have him
on the show to get into that more. But we can start with
how did you get into all of this? Because I know that for a lot of us,
it’s really personal. I think you have a personal story too
and there’s not many people who just go through
conventional health care training and then, come out the other side of it
saying that fiber is the answer, so I’d love to have you
share a little bit about how you got from medical school
to where you are now.

I honestly hope that
when people read my book, Fiber Fueled, that there will be people who
when they put it down, they say, “Fiber is the answer,” and it’s more than fiber.
It’s not Metamucil or a supplement. You know, this is about the food that you eat
and the effect that it has on your gut microbiome. But if you go back 15 years ago, when I was in medical school,
we weren’t talking about the gut.

We weren’t talking about the microbiome
and that’s around the time that I decided that I wanted to be a gastroenterologist
and I made this choice because I just loved the different organ systems,
so like if you’re a cardiologist, you just think about the heart all day long. That’s all you deal with. Whereas for me, I’m the expert
on the esophagus, stomach, small intestine, the large intestine — which we call the colon — the liver, the pancreas, the spleen,
all that stuff is my expertise.

Now, when I met my mother-in-law
for the first time, she’s like, “Hold on. You brought home a proctologist?
What is this guy? Who the heck chooses
to be a gastroenterologist?” I loved the balance between
using my mind to take care of patients and also, using my hands to do procedures and really, to make a diagnosis
or to treat something very quickly. That’s where I started. I went through medical school
and felt invincible. I was young.
Everyone in my family had always been skinny. I was a great athlete back in the day
and was working super hard like most residents do, 15-16 hours a day,
six days a week.

I was in Chicago
and I noticed my body was changing. It was getting away from me. I put on about 50 pounds
over the course of a couple of years. I had anxiety, high blood pressure, fatigue,
basically was like, you know, honestly, I could’ve been sponsored by Red Bull,
like I was smashing Red Bulls a couple of times a day
plus Starbucks, at least… Oh, my God.
– I’m not exaggerating. When I was an intern, I was so sleep-deprived. I could literally drink whatever
— Red Bull or a Starbucks — and pass out like five minutes later. So you know, sleep deprived, not exercising,
working too much, not eating well, lot of fast food, lived in Chicago,
so I mean, loved the classic Chicago foods and it caught up to me and here I am
and I’m a doctor but I’m a normal guy too and I am vulnerable in the same way that any other person is
to falling into these traps, to working too hard, to not sleeping,
from them exercising and to eating unwell.

And I really couldn’t find a way out of it. I tried. I’m a hard worker,
so I tried exercising my way out of it and I thought I could outrun it
and it just didn’t work. And so I was like… I’m not exaggerating.
This was after Chicago. I was in Chapel Hill, North Carolina
in my GI specialty training and I would like go
and work out for 30 to 45 minutes and then jump on the treadmill
and do a 5k or a 10 k or jump in the pool and swim 100 laps if it was the summertime
and I would do that like you know, I mean, a lot of weeks,
six days a week, just smashing workouts and I could put on muscle mass
and I could make myself physically strong and I could run a 5k faster and faster or 10k
but I couldn’t lose the gut and my brothers used to make fun of me
because I was only one in the family who had this.

So young, single, like you can take my spleen
if that means that I’m going to be slightly more attractive
to the girls out there. That’s what I was trying to accomplish
and I met the person who is now my wife and I had never been around someone like this before because she ate completely
radically different than me. She ate plant-based,
so we would go out to a restaurant and I would be like, “Hey, give me the porkchop
and some extra sides,” and she would order a plant plate
and she ate without restriction and definitely was eating a solid amount of food
and yet, did not have any issues controlling her weight and in my perspective,
she looked amazing.

I still think she looks amazing
and she did it in large part with her diet, like she wasn’t, you know,
smashing workouts the way that I was and so, it just opened my eyes.
It opened up my mind. Adrienne, you know this about me,
I’m a science guy. I love science, worked really hard
to get a Master’s Degree in Clinical Research and I did fellowship at
the University of North Carolina in epidemiology in addition to doing my GI fellowship.
For me, the science has to be there. If the science is there, I’m onboard.
If the science is not there, then I can’t do it. And when my mind opened up
to this possibility that, you know, “Maybe, I wasn’t taught everything
in medical school.” When my mind open up to this possibility
and I started to look, I found literally thousands of studies
and it sent me on this path where I transformed my own health.

I lost 50 pounds, reversed the anxiety
and the blood pressure and the fatigue issues. I honestly feel like I reversed aging. I feel younger now than I did
when I was 30 and I brought it into my clinic
with amazing results. Yeah and I forgot to mention
at the very beginning where you’re talking about Chicago,
that we both went to Northwestern a couple of years apart.
I know. Very excited to ever meet a fellow Northwestern grad, especially
a fellow Northwestern grad for grad school because we both went there for grad school. You said something when you were
describing your journey here that I thought was interesting
and worth coming back to which is that, you’re a doctor but you’re also a human being
and you know, if you look at the science actually, there’s a lot more unhealthy doctors than
there are healthy doctors as far as lifestyle habits. And I wonder if the conventional
medical school system and residency programs kind of instill these bad behaviors
because it’s so much fast food and lack of sleep and this kind of gunner mentality,
which then they could carry on the rest of their lives, I would assume but it happens for all kinds of different
health care professionals and it’s a really interesting thing
because a lot of people get into health care because it’s a good job,
it’s good pay, it’s interesting, not necessarily from personal experience
and so, they’re not really thinking about their own health or they don’t think
they’re worthy of good health or things like that or it’s something that they can do later
— this is just like a business or a job.

I think a lot of patients forget that
that’s the situation and so, just because somebody works
in health care, doesn’t mean they actually know anything
about taking care of themselves, which I saw when I worked with hospitals,
a lot of the administrators, especially, had you know, nurses,
nurse practitioners and things like that were obese, would joke with me
if I didn’t bring in donuts for a meeting, had lots of complex chronic health conditions
and were still talking about patients in a very patronizing way, like they didn’t know
how to take care of themselves, which I thought was interesting
because I’m looking at them like, “It doesn’t seem that you know
how to take care of yourself either,” but food is a huge piece of that
and I saw really unhealthy food behaviors and I felt like if you could just get to people
and help them understand how much the three meals a day, 21 meals a week
impacted their health outcomes.

Like you said, everything else, you don’t have
to kill workouts seven days a week. You don’t have to do all these other
natural therapies that are available to us. The majority of your health can be pretty good
just from what you eat and then maybe, there’s a little bit further that you can go
with some of the other things that we know about and so, a big part of that is the gut
and big part of the gut is the fiber component. Very simply. Will you help our audience
understand exactly what fiber is and it isn’t and why it plays such an important role
in gut health overall? Let’s take it from the top.
I want you, listening at home, and you too, Adrienne, to erase
from your memory the mental image of your grandma stirring
the orange Metamucil drink, so that she could have a poop, okay?
– Well, and also, the one I have is like its written on some really
sugary cereal box, you know? Like, “The best form of fiber,”
like, “This many grams of fiber.” I mean, my family even eat well but I still think of fiber associated
with breakfast cereal.

So fiber, just taking it from the top
and I’m not talking about the supplement here, I’m talking about fiber as it exists in nature,
fiber is a part of plants. They all have it. Every single plant has
a mix of fiber and the plants have a monopoly. This is where you will find fiber
and if you want to get it, this is where you have to go to get it. This is the plant.
Now, there are many different types of fiber. We have no clue how many types
of fiber exist in nature. We have no clue. There’s not even an estimate
because it’s so structurally complex. I mean, I’ll spare you guys
the biochemistry nerding out crud but just suffice it to say
that fiber is not fiber.

Counting grams is not the same. Source matters a lot and when we start
to think about fiber, for simplicity sake, given the complexity of the whole thing,
we start to break it down into two main categories and that is soluble fiber,
which basically means that if you stir it up in a beverage,
it will actually disappear. It will dissolve. And insoluble fiber, which is the roughage,
which is the stuff that’s always gritty and it will never dissolve, whether you boil it,
no matter what you do. You know, they have a little bit of
different properties. We have been taught that fiber goes in the mouth
and it goes through the intestine and it will launches out
the other end like a torpedo. That’s what we’ve been taught and that is probably a fair way
of describing insoluble fiber. That’s what happens but soluble fiber
is like the secret of nutrition that people are not talking about and they should and the reason why
is because soluble fiber is prebiotic.

People have heard of probiotics,
which are the live, active microorganisms and I know that they’ve been discussed
on your show many times, so I won’t belabor your audience. This is the prebiotic and the prebiotic is
what feeds and nourishes the healthy microbes. Every type of fiber that exists is
going to feed these microbes. It passes through the small intestine
untouched, unsullied. By the way, for you guys listening at home,
if you wonder about resistant starch, the story that I’m about to describe
is exactly the same with resistant starch. Resistant starch is not fiber
but the story is the same. They’re both prebiotic
and they behave the same way.

The resistant starch is actually
a form of starch. It’s not actually a fiber,
which is a different chemical structure but resistant starch is not digested
by our intestines. You know, other starches
are broken down very quickly and can be broken into sugar molecules. We think as starch as a course like potatoes
or spaghetti, macaroni or things like that. Resistant starch does not get broken down. Resistant starch passes
all the way through the intestine. Now, you’ll find resistant starch
in a lot of places. White potatoes are actually a great source. People who trash White
potatoes, “there’s no nutritional value there,” it’s actually a fantastic source
of resistant starch. Whether we’re talking about
soluble fiber or resistant starch, it passes through the small intestine unsullied, enters into the colon
— this is where the microbes live.

I know that your listeners already know this. The colon is the predominant place
for your microbiome — 38 trillion in this location of bacteria. They get into a feeding frenzy
and they basically just devour this food. This is their food, not ours.
This is theirs. They devour it, chew it up,
they get stronger, they multiply. There’s more of these anti-inflammatory microbes
and then what they do is they turn around and they pay us back by releasing what I think
is the biggest secret in all of nutrition, which are short-chain fatty acids:
butyrate, acetate and propionate and I’m happy to talk more about them
but before we go anywhere like that, just know, every type of fiber is unique.

This is the general way that it works,
the soluble fiber is prebiotic — that’s the general way that it works — but every type of fiber
feeds different microbes. They’re not all eating the same fiber
and so that makes it unique because every plant has its own mix of fiber. If every type of fiber feeds different microbes,
if every plant feeds different microbes, then what we have identified is that
one of the ways that we can support many different types of microbes is
with different types of plants because they have
different types of fiber — diversity.

Yes. I remember when we chatted the first time,
one thing that stuck with me is you know, sometimes you know something
and you really need to hear it in a different way for it to open your mind
or to stick with you and when you were explaining how much diversity is important and why,
I immediately ran to my husband that night, it was just like, “Next time we go to the store,
we are not buying anything we have ever bought for.
It has to be different. We have to have more diversity,
blah-blah-blah-blah.” Does he hate me?
How much does he hate me right now? I apologize.
– He kind of got it. I mean, he’s a creature of habit in certain ways
but once I explained it to him because I think you explained it very well
and again, it’s not like I hadn’t heard that diversity was important
or that different colors of foods had different… Eat the rainbow, right?
– Right, exactly. Everyone’s heard that but I think that
what’s most important about health content for me as a consumer and also as a producer
and actually, this is not even a health content.

This is everything in life really
but to understand the why behind something, it makes it a lot easier to have that conversation
in your brain as to doing it why it’s important. It’s almost like you can
convince yourself more easily. The same thing with what
you talked about that the science isn’t there, it’s hard for you to implement it into your life
because that naysayer part of your brain is saying, “But does this really work?
Does this really matter?” and I feel we all have that
and so when you can understand more about the why and put it together, at this point,
I think a lot of us know that gut as the basis of all health
and we know that there are probiotics which are the good bacteria
that we want to get into our guts and that we know that there’s
microbes already there and they need food. It should be obvious but a lot of
people don’t think about that. And then when you think about you want
many different kinds of bacteria, right? That’s how healthy microbiome looks. Of course, you would need
different kinds of plants in order to feed them.

Why would they all eat the same thing?
That doesn’t make sense. And of course, different kinds of plants
will have different kinds of fiber. It all makes so much more sense. I’m going to retire. I’ll kick back and relax and you can take it from here
because you’ve got this. No, I just wanted to reiterate it
because it’s a big part of your book. It’s a big part of understanding fiber in general
and it’s a big part of understanding the gut microbiome which is
not talked about nearly enough.

I think a lot of gut health content today
just revolves around like which probiotics should you take
and drink more bone broth and these other things but…
– Marketing. We were talking about marketing. We’re all going to eat
three meals a day, right? Most of us, unless maybe you’re
experimenting with intermittent fasting, which is a whole other topic
but let’s say you do eat three meals a day, each one is an opportunity to introduce
so much great food for your gut bacteria or not or so much damaging food
and so, why aren’t we starting there? Why are we always going to the supplement side
or the things you’re going to add in as far as like, “Yeah, just go ahead
and eat your really beige style food or whatever or microwavable
and then like have bone broth afterwards.” No! Let’s roll that back.

Now, that we’ve hammered home what fiber is
and insoluble and soluble forms of fiber, now can you help us understand
what happens if people aren’t eating enough fiber
to those important microbes in their gut? I think it’s a critical issue because one of the big points
in my book is diversity, abundance, right? And this is the philosophy that
I’m trying to instill in people but that is actually quite divergent
from what we’ve been told for the last 15 to 20 years with most of
the popular diets that people have been doing. What we’ve been handed
for the last 15 to 20 years is a list — not this, you’re not allowed to eat this
— and I’m kind of coming in and saying, “There’s one rule.

It’s simple.
You don’t need to count your calories. You don’t need to weigh your food.
You don’t need to worry about macros. You just need diversity of plants.” Let’s break that down
and look at both sides of it. Diversity of plants, you’ve already explained
the reason why this makes sense, the reason why it’s so intuitive. I don’t need to go there
but let me just back it up with the science because like I said,
I’m a science guy. The single biggest study to date
to correlate our diet and our lifestyle to the health of our gut microbiome, specifically looking at the diversity
within our gut microbiome, which is a measure that all scientists agree
— more is better. You want more diversity. In this study, more than 11,000 people
— again biggest study to date — they found one factor that was
the clear cut number one thing associated with a healthy gut microbiome and that was
the diversity of plants in your diet. The science is backing it up.
It’s not just intuitive.

It’s not just you and I agreeing that
that makes sense. This is actually the biggest study,
the highest quality of research that we have to answer this question,
“What actually predicts a healthy gut?” This is the number one thing. The flip side is what happens
if you start eliminating foods. Now, there are 300,000 edible plants
on this planet. Adrienne, just give me an estimate,
whatever number pops into your head, in a given week, how many different types
of plants do you think you would typically consume prior to our first call,
may the record reflect — prior to our first call? Maybe like 50 or 60?
– In a week? You’re Wonder Woman. Maybe 40? I don’t know.
Well, that’s a lot. Maybe like six different ones a day and…
I don’t know, times seven… 40-ish? Okay. I love that.
You are way ahead of the curve. You are at the top of the class when it comes to
this diversity of plants concept already. Most people are getting less than 30. Let the records show we have no way
to actually prove this so I could just be with like 24 or something.
– Twenty-four would be pretty good, still.

I mean, to a lot of people,
their concept of a salad is iceberg lettuce and with one tomato that you cut four ways
and then you smash it with blue cheese dressing
and bacon and cheese and honestly that was the salad
that I was eating 10 years ago, you know? I’m certainly not casting stones but the point is that there are
so many different plants that exist. Getting rid of one plant, you say,
“Look, I want to do nightshades, so I’m going to get rid
of tomatoes and eggplants.” Okay. I honestly don’t think
that’s the end of the world. If you focus on plant-based diversity, if you’re focused on getting more
variety of plants in your diet and you get rid of one or two,
it’s not the end of the world, okay? But what I really want to discourage people from
is categorical eliminations.

That’s where I get nervous.
I don’t like it. Categorical eliminations means that
you take an entire category of plant food like whole grains, like legumes.
You know, just recognizing that those have probably been the two biggest categories
that many people are looking to get rid of. You know, the studies are
very consistent in their findings, whether it is looking at a gluten-free diet,
whether it is looking at a low-FODMAP diet, where people restrict FODMAPs
and then don’t reintroduce them or whether it’s looking at the paleo diet,
where people eliminate grains and legumes. What we consistently find is that
it actually damages the gut. It actually damages the gut microbiome
each in their own unique way. There are specific microbes
that exist within your gut that thrive when you consume legumes and if you get rid of the legumes entirely,
you can’t replace that. Now, can you say,
“I don’t kidney beans but I’m going to do lentils?”
Yeah. You can totally do that.

If you take whole grains
and you eliminate them entirely, there are microbes that thrive
on the consumption of those whole grains and there’s also microbes
that are suppressed by those whole grains
that frankly, you don’t want. To kind of unpack that one a little bit more,
there was a study looking at the effects of the paleolithic diet
on the gut microbiome. This was out of Australia, by the way.
They looked at three groups of people. They looked at hard core paleo. Those are the people that are like, “No beans, no grains,
not near me, not on my watch.” They look at the more moderate paleo people
who are employing the concepts, many of which by the way, many of the concepts I love,
like the elimination of processed food.

I’m with you.
Elimination of dairy, I’m with you. But also elimination of grains and legumes
they looked at… This other group — this camp,
that’s moderate paleo, not as hard core and then they compared it to people who are just eating
a regular not-a-plant-based diet but just a very regular balanced diet
and looked at the changes in the microbiome, what they found is that the people
who followed the paleo diet, actually had a less healthy gut microbiome. It actually increased the production
of something that’s been very hot in the scientific literature recently
called TMAO. TMAO is produced by the bacteria in our gut and it’s been connected to heart disease,
the number one killer. It’s also been connected to stroke
and to kidney disease. It’s not good.

You don’t want it.
You don’t want TMAO. It’s produced by our gut microbes
when we consume red meat. Red meat contains carnitine.
Carnitine basically starts this all in motion. What was interesting about the study is that
the group that had the highest TMAO production. Again, everyone in the study ate meat. It was not looking
at vegan or something like that. The group with the highest TMAO production
was actually the hardcore paleo people and their meat consumption wasn’t any different.
They’re even eating the same amount of meat, so the people doing the study said,
“What’s the deal with that? They’re not eating anymore meat. Why are they getting more TMAO.
We don’t want that. That’s bad.
What’s the problem here?” And what they found is that
when you cut out grains, you increase the production of
a microbe called Hungatella and Hungatella is the bacteria
that produces TMAO. I find it interesting, at a minimum or mind blowing,
whatever you want to call it, that in this study out of Australia, look, I’m not claiming that this is literally
the top study of all time, all right? It’s interesting.
We interpret this as part of the broader picture.

But I find it interesting that in this study,
they find that the group that eliminates whole grains produces more TMAO,
which is associated with heart disease because of changes their microbiome
and here we are, and we have all of the studies that show us that
when you consume whole grains, high quality research,
systematic reviews with meta-analysis, what they find is that
when you consume whole grains, you reduce your risk of death
from cardiovascular disease, you reduce your risk of having a heart attack. On both the larger level, population-based
and on the smaller level, microbiome, we’re finding that the arrows are pointing
in the same direction — whole grains protect. This is such an interesting topic
and I think it makes a lot of sense to me what you’re saying because I’ve always been
skeptical when people remove things that not only are like the basis of,
you know, like one of the key fundamentals, like beans, like you’re talking about
from the diet but then there’s also such conflicting research
about how great it is. For example, beans, the blue zones of longevity,
which are something I talk about a lot.

That was one of the fundamental
common foods between five different, very geographically and ethnically
different blue zones around the world they all had this in common,
which is that their diets were largely plant based
but had a daily bean piece. And then to say that those are absolutely
something to get completely rid of, I’m like, “How can these both…”
whenever something is so drastically different and the science on both sides is
so drastically different, my inclination is like trust
the 1000-year-old wisdom, like go to the godfathers or whatever,
like the people who have been doing certain things for thousands of years
with good health — not what our parents have been doing.
They’re the unhealthiest generation in history but the ones that have lasted
the test of time or passed the test of time, that where I tend to go,
like the new-fangled science, that’s great but no, I’m going to look to
like the Buddha and see what they were doing. And so that makes perfect sense
to what you were saying, especially about all grains or all legumes.

I will say though that we have
a large autoimmune population in the WellBe audience
and that autoimmune paleo has been, you know, one of the most healing diets I’ve seen
or one of the most effective healing tools that I have seen for people with like two decades
of second degenerative MS, where they’re in a wheelchair
and they just fix it all, like they don’t even have the markers
for MS anymore and that’s completely based on… going to this autoimmune paleo diet.
I wonder how does that happen? Is there something that maybe needs to be done
for bodies that are quite damaged versus just what’s healthy for most people? There are many different diets that exists
and there are many different ways to be healthy and we don’t all need to agree
to do the exact same diet, okay? But I think that the way that I think about this
is that number one, the autoimmune paleo diet, there’s a lot that’s really good there
and the part that’s really good maybe the key piece,
specifically for auto immune disease.

Elimination of processed foods, there are many different diets
that eliminate processed foods. You know, which one does not
eliminate processed foods? A vegan diet. There are a lot of people
who are at junk food vegan diet. And so that is not a healthy diet
from my perspective. The elimination of processed foods,
just to speak for a moment about what’s in our food supply,
there are literally in the United States 10,000 food additives approved
to be a part of our food supply. None of them…
Do we have long term studies in humans? None. The few that do have human studies,
which the estimates are usually about 20%, that actually have human studies at all,
it’s like a short term like, “Oh, you eat this for a week and you’re cool.
All right. We’re good.” You don’t know what that does
when someone eats that way for 10 years. That’s the problem.
– For a lifetime. Yeah. Right. You know, you talk about
the 1000-year wisdom. These foods didn’t exist 100 years ago,
forget a thousand years, right? I think that there’s a lot of good
that exists in those diets, in the removal of those foods from the diet.
I’m happy to unpack gluten in a little more detail if you want me to but let me just say that I think that you can be
a perfectly healthy person.

I am 100% plant-based.
That works for me. Full disclosure. But my book is not about turning you
into 100% plant-based. My book is about meeting you where you are,
recognizing the healing benefits of whole plant foods and trying to move
the needle and ramp that up. The average person in United States is 10%. If you’re doing AIP and you’re 60% plant-based,
I love that but what if we meet you at 80%? There is no evidence that
autoimmune disease would flare by becoming progressively
more plant based. If anything, the evidence is on the other side,
which is that we have many studies, whether it’s thyroid
or rheumatoid arthritis or even MS, Crohn’s disease in my field, where a plant based diet
is good for these conditions as well. I guess the point, Adrienne, is that,
I think that there are many different ways to approach nutrition
for specific disease states. I celebrate people who engage in nutrition
for the purpose of trying to heal themself no matter what diet they choose because that takes will power, so I celebrate
those people no matter what they choose.

I believe that the path to better health is
through a predominantly plant-based diet. It does not need to be necessarily 100%
but I do believe that the closer that you move and you make the choice for yourself,
I think the better off that you’re going to be. My concern with these types of diets like AIP, goes back to the paleo study
that we were talking about a moment ago, which is that you don’t necessarily
pay the price in the short term and I’m not trying to be fear-mongering
but there is a risk of heart disease.

That’s real. The risk of heart disease is real
and that won’t manifest in one year. Any study that looks at one-year data,
unless you use an adequate biomarker, like perhaps TMAO, any study that looks
at short-term data is not going to tell you whether or not this increases
your risk of heart disease but in today’s world in 2020,
we have to see the big picture.

There’s a short term gain
but we shouldn’t necessarily take short term gain at the expense of long term loss
if it means that we are exposing ourselves to the number one killer, which is heart disease
or cancer, which is the number two. I have so many questions. I think I’m going to do
some rapid fire questions about fiber because I have so many
but I don’t feel like I have enough time.

First, I know I know the answer to this
but just want to hear you say it. The fiber that exists in these processed
and packaged foods like cereals or whatever, breads and stuff, your thoughts are? I don’t like it.
It’s a processed food. Why would you go there for your fiber.
Many times they’re just adding it in. I mean, why don’t you just take
the supplement then, honestly. And the supplement is not the path. My second question,
if people are in a state of their lives or are actively working to heal
or improve their gut health because they can tell
— I shouldn’t even say ‘improve.’ They know they have some gut issues
and therefore want to work on healing their gut more than just the average person would be doing
and want to really ramp up the amount of fiber that they’re getting and either they’re traveling
or for some reason, they’re not able to eat as many plants as they would be if they were
home or in their normal environment, do you suggest taking a prebiotic supplement? I actually am a huge believer
in prebiotic supplements.

I take them myself.
Full disclosure — I don’t take a probiotic. I do take a prebiotic.
There’s a hierarchy from my perspective and I would have to unpack the specifics
of someone who has a damaged gut a little bit more if you want me to
but to be as simple and as short as possible, the hierarchy is diet comes first,
prebiotics come second, probiotics come third. There is value to probiotics but don’t buy the hype
because a lot of it is, honestly, marketing. I have patients who benefit but I have way
more patients who benefit from a prebiotic and if you really want to transform your health,
you can’t go from a C-minus gut to an A-minus just by taking a supplement,
whether it’s prebiotic or a probiotic, anything. Since you’re on that topic,
I know there is something that you’ve talked about
in your book called postbiotics.

Can you touch on that quickly? We talked about this
a little bit at the beginning of the episode, which is that the fiber enters into the colon
and the microbes get into a feeding frenzy, then they release the short-chain fatty acids. Short-chain fatty acids
are an example of a postbiotic. Basically, anytime our microbes create
a, what we would call in medicine science — I’m nerding out — a metabolite. A metabolite basically means that
they’re changing it. They’re actually changing the chemical structure,
so it’s not fiber anymore. Now, it’s a short-chain fatty acids and it heals.
The key is it has to heal. That’s a postbiotic.
Short-chain fatty acids are an example. Most people don’t realize this. We all agree, like resveratrol in wine,
it’s good for you, right? Beta carotene in carrots, good for you.
Great for your vision. There’s all of these plant
chemicals that are polyphenols and most people don’t realize, polyphenols in their natural state,
do very little for health. They are transformed by our microbes. They pass through all the way to the colon too
and then they are transformed and activated by our microbes
and so, those are postbiotics as well.

This is why pomegranate juice is great for the gut and the reason why it’s great for the gut is because the polyphenols in pomegranate,
there’s no fiber in there. The polyphenols in pomegranate are prebiotic
and can alter the gut. We also think that there’s… I’m going to give a little shout out to everyone
in your audience who is like, “Okay, red wine…” I don’t want you to drinking it every day
but red wine has prebiotics, so of all the alcohol that exists,
it’s actually the resveratrol that’s prebiotic.

Chocolate has prebiotics too
and in each of these cases, the prebiotic I’m talking about is not fiber. The prebiotic is a polyphenol
but again, these are coming from plants as well. So when you eat diversity of plants,
you get all of them. Well, that is great news
because those are two of my favorite foods. Okay, next question I have for you.
Raw versus cooked? I don’t like when people limit themselves
to just one thing. Raw can be very hard on the gut. If you have a damaged gut
and you’re starting to ramp up your plant-based diversity,
you get more plants in your diet, then you may find it’s easier to cook your food
or do it in like soups and stews and things like that. But what we have found is that the fiber in raw
actually changes when you cook it. What does that mean?
It actually means that you get different effects. I think a cool, little health hack is
if you’re cooking your food — let’s pretend that
you’re going to sauté some kale.

Sauté your kale, it’s delicious,
it’s good for your gut but nibble on a little bit of raw kale
because then you’re getting that different type of fiber
for your gut microbes too — more diversity. Interesting. One further question on that
because it was something that came up in an interview I did several months ago with Dr. Vincent Pedre who is gut health
specialists but he talked about, just like you said, that raw food
can be quite hard in your gut and there are some people who are raw foodist
or there’s a general perception that food has more nutrients
when it’s raw than when it’s cooked. In some ways that’s true
but I don’t think people realize, one that if you have an impaired gut,
it can actually be sort of harmful or difficult to then throw food down
with these strong plant walls that your body doesn’t have the enzymes
or the microbes to actually break down properly
because your gut has been so impaired.

For somebody that’s actually healing their gut
versus just a general person eating normally, is there sort of an order, would you say,
you really need to eat raw food until the gut has healed
and then you can introduce raw? Or is it just kind of want to do
both all the time? I agree. I think that there’s a process.
I think there’s a process. When you’re in the process
of healing your gut, it’s about… and you and I have talked about this
a little bit before but we haven’t really talked about this
yet today, it’s about ramping up. It’s about exercising your gut.
You treat your gut like a muscle. What does that mean?
It means that your gut can be stronger. It means that you can exercise. It means there’s a certain amount of exercise
that feels really good and there’s also a certain amount exercise
where you’ve gone too far and you hurt yourself and that’s true
with the food that we eat.

You know, if you have a damaged gut, you can’t go and pound and smash
the Five-Bean Chili. You’re just not built for that
but you may be able to do some lentils and you start there and then you expand
and you do more and more. I think intuitive is completely fair
when it comes to this type of stuff because you can’t like ramrod it down
and say, “This is what I’m going to do and I’m going to force it on my body,” because you’re not going to
feel well when you do that. It’s about finding what
you’re actually capable of and sometimes this is where
a nutritionist or a dietician can help and honestly, this is where my four-week plan
in the book is designed. It’s not meant to be a four-week plan
like you just do it. It’s meant to be a four-week plan
where you learn something about yourself.

You identify where your food sensitivities lie and then you understand better
how to make adjustments. On the topic of food sensitivities
because you’re right, we do talked about this the first time
we had a conversation and I thought it was fascinating and then,
haven’t touched on it as much today but if somebody is doing
an elimination diet, say, and they remove all foods categorically
and start adding things in and have some beans and feel bloating,
feel gas, do not feel good, they’re probably thinking as they’ve been told
in the process of the elimination diet, “That food is not for you,”
so they’re thinking, “ok beans are off the table or eggs are off the table.
I just have to avoid those.” That kind of contrasts a bit with the idea
that you got to work your gut the same way that you would work into an exercise routine.

You’ve got to push it along and not to
remove everything completely categorically, so how do you reconcile those two things
for someone who does an elimination diet, doesn’t feel well in re-introducing beans
and then says, “I guess I can’t have beans,” but you’re saying that could be quite detrimental
to their gut so how does that…? If I’m speaking to that person right now,
the first thing I want them to know is when they eat those beans
and they feel unwell, that is not inflammation. There is no evidence that that is inflammation. The evidence is that
that is sloppy digestion — sloppy processing. You see this occur in people
who have a damaged gut. It’s food sensitivity. And so,
if you eliminate that food entirely, I’m going to tell you how this plays out, okay? This is conceptually similar to
I just tore my ACL. My knee hurts. If you injured your knee, you have two choices. Now, I realize most people will think, this is ridiculous that I’m even
posing these options but this is conceptually similar to
what’s going on here.

If you injure your knee,
you can either stop walking, get a motorized scooter,
you will never feel pain in your knee again. I can assure you, if you stop walking,
you won’t feel pain but the problem is your health will suffer,
your legs will get weak, you’ll gain weight, potentially, you get metabolic issues
like diabetes, high blood pressure. That’s not a good path. We all know that.
So what do you do? You get the surgery and you rehab your knee
and you build the strength to back up, so that when you’re done with that rehab,
you’re jumping, you’re playing basketball, you’re skiing, you’re doing whatever it is
you enjoy doing.

That’s the path that most people choose to take.
They choose to rehab. They accept that’s not necessarily
going to be easy and there may be some pain with it but it, ultimately, will get them
to where they want to be. With the gut, the science is clear. If you eliminate the food,
when you reduce the diversity in your diet, you are going to basically cause the
species of bacteria that thrive on the consumption of legumes,
which is what we’re talking about in this case, they’re going to die
and they’re going to disappear. They won’t be a part of your microbiome anymore
and now, you have a less diverse microbiome. Loss of diversity is what’s associated with the manifestation of disease
as a result of the gut microbiome. You have not made yourself more healthy and you have not improved
your digestion in the process. These people, I see go deeper and deeper
and deeper into food restrictions and they may feel better on a temporary basis
but they’re not better long term.

This is not fixing their issues. The elimination of the food is not getting rid
of their gut health issues. They’re just kind of covering it up because they’re not testing the gut
with the food anymore, right? I guess the answer of what you kind of
eluded to is that there’s a difference between digestive challenges and inflammation
but if you think about how… we say, “Listen to your body.
If you’re getting mucus after you eat dairy or even a stomach upset or whatever,
cut dairy out of your diet,” but then we’re saying,
“Listen to those same cues for, let’s say beans but don’t do the same thing.” It’s like a little confusing to people, so I feel like that would be
helpful to explain the difference.

We could go scenario by scenario, okay? Let’s take gluten for example. One in three people are trying to be
gluten-free right now. It’s way more than it needs to be. Let me preface this by saying,
“I’m not saying here and telling you that I want gluten to be
the centerpiece of your diet. It’s only 1% of people
that actually have celiac disease. It’s only 1% of people have a wheat allergy
and that leave 98% of people who are left over and yet, one out of three
— about a third of people — are trying to eliminate gluten right now. There are some people who exist
when they consume gluten, they get a rash. If that’s reproducible,
you should eliminate gluten. There are some people who exist
when they consume gluten, they will get joint pain. If you eliminate gluten
and the joint pain goes away and you reintroduce gluten and the joint pain comes back,
you should eliminate gluten. By the way, both of those scenarios
I just described, the studies would say that at least
80% of those people actually have celiac disease, so it’s not just an isolated rash
or an isolated joint pain.

It’s actually that they have
this genetic condition. That’s a genetic condition. If you eliminate gluten casually,
if you’re not a nutritionist and you don’t know how to replace for it,
we have studies that show that the people who eliminate gluten from their diet increase their risk of having heart disease
later in life and the reason why is because they have eliminated their number one source
of whole grains, which is wheat. Again, I’m not saying that
I want more gluten in your world. I’m saying there are
forms of gluten-containing foods like Ezekiel or a sourdough. They are actually really good for us
and when we categorically eliminate the food, we throw the baby out with the bathwater and potentially, suffer the consequences
of that categorical food elimination.

And for what it’s worth,
just to kind of close that gluten out because it’s going kind of complicated
but just to close that real quick, you can go gluten-free
and be perfectly healthy. If you have celiac disease,
you can be perfectly healthy going gluten-free. The key is that if you eliminate
gluten-containing grains like wheat, which is the number one source of
whole grains in the American diet, you need to compensate by introducing
non-gluten-containing whole grains. You don’t want to eliminate the category. You want to bring in whole grains
but just opt for the ones that are gluten-free like quinoa
and sorghum and teff. You know, there’s like 10 of them. Like you said, I think gluten
is very complicated. We could have a whole thing on it just
because of the autoimmune connection and all these…
– Yes, it is complicated. Yeah. I mean, especially because
like the wheat in America is so different from the wheat in Europe.
There’s all these pieces. That one is a complicated one
but I think in general, just to summarize, I don’t want to confuse people.

I want them to find that they have
some really clear takeaways is that with regard to food sensitivities, your gut actually does need to
be worked a little bit. It doesn’t mean having horrible stomach pains
and continuing to eat that food over and over because you’re trying to work your stomach. It’s about paying attention to,
“I have digestive issues with this food, something is up with my gut.
If my gut was working really properly, it would be able to digest this food well,”
assuming this is also a plant-based food. If this is a heavily-processed food
or a food containing food dyes and additives or maybe
it’s an animal product, that reaction might be
worth eliminating full stop. There’s a difference between,
“This is a plant that exists in nature.” It’s not that there’s
something wrong with the plant. It’s that, “There’s something wrong
with my stomach or my gut for not being able to break it down,”
versus “Captain Crunch does not exist in nature.

I’m getting a reaction to eating it.
I think I should just let this one go.” That’s kind of how I see it
based on what you explained. Those were some of my
rapid fire questions on fiber and I have so many more
but we’re coming up on time and I know you have a family and a life,
so I’m going to get you back to them. But given that we are in the midst
of the coronavirus pandemic and you know, we don’t know where
it will be exactly, when this episode airs but I think it’s worth talking about
because the takeaway after this pandemic for all of us will be, we don’t want to
continue to exist with chronic health conditions, whether that’s just chronic heartburn
or heart disease or diabetes or just migraines, just because they’re not a disease, doesn’t mean that
they’re not a chronic health condition. A lot of people in my audience have said,
“I don’t have a chronic health issue,” and then five sentences later,
they’ll tell me they get chronic acid reflux or chronic migraines or things like that
and I have to say, “Yeah, you do.

You wouldn’t be getting those
if you didn’t have a chronic health condition,” so I think it’s interesting. You know, a lot of people
don’t identify it as being sick necessarily when they have something like that
because they’re functional. But let’s say, whether you have
a full blown disease or just a chronic health condition, either way, if you are dealing with that,
if your microbes, if your whole immune system really is dealing with that,
when something big comes along like the coronavirus,
it doesn’t have the army. It doesn’t have the resources to fight that
and so, you’re much more susceptible. I think the big takeaway
when this whole pandemic is hopefully eventually over will be that we need
to think and eat every single day with our immune system in mind.
– Yeah.

Would you share with us, you know,
kind of a few thoughts or your best tips for eating for your immune system
and especially with regard to fiber. I wrote the book,
there’s definitely a conversation about the immune system in the book and now, here we are and our entire life has been turned upside down
and we’re dealing with COVID-19 and honestly, I feel like the book fits in well
because it’s about optimizing the gut and I’m not aware of a diet specifically designed
to optimize the immune system other than to say that 70% to 80%
of the immune system lives in your gut.

You go down there into the gut
and here is 38 trillion microbes and there’s a single layer of cells
and on the other side is 70% to 80% of your immune system. They’re all hanging out together
and you can’t separate the two. If you damage one, you affect the other
and so, this entire conversation that we’ve been having about
how to optimize your gut health, to me optimizing your gut health is
optimizing your immune system and we actually have studies to back this up. You and I have been talking about postbiotics. We’ve been talking about short-chain fatty acids. Short-chain fatty acids. Without question, there are dozens of studies
looking at the effects of short-chain fatty acids on our immune system
and how they allow it to optimize. Now, I think that the main point
that I would want to make for your listeners is that everyone’s looking
for the hot supplement. Just like in gut health, taking a supplement, you can’t go from a C-minus to
an A-minus with a supplement. The health of your immune system
is going to be proportional to the health throughout
your entire body.

It’s going to be proportional
to the health of your gut and you want to optimize your gut
and so, taking a supplement is simply not going to get you there. What you need to do is
you need to change your diet. And they have this one study — I just want to share real quick,
I hope you don’t mind — a mouse study where basically,
you can’t do this in humans because this would be unethical. They subjected these mice to the influenza virus,
also a respiratory virus and then they basically put them
on two different diets — one was a high fiber diet,
one was a low-fiber diet — and they watched what happened
and what they found is that the mice who received
the high-fiber diet lived longer, had less severe symptoms and when they objectively measured
their lung function, it was better. The investigators were actually quite surprised
because they expected the opposite to be true. They thought the high-fiber diet
would be anti-inflammatory and actually stop them from
being able to clear the infection.

They went and looked at this in more detail
and what they discovered is that the short-chain fatty acids,
which were coming from the fiber in the high-fiber diet
were optimizing the immune system and what that means is that they were activating the CD8 cells,
which are the fighter cells. They were getting more of the fighter cells
in position to take on this virus. Getting the right cells in the right spot
to pick up the fight is what you want. But the flip side of the story is that you don’t want your
immune system to over activate and overactive immune system
is what leads to the acute respiratory distress syndrome,
ARDS, which is what people are ending up
on a ventilator with — ARDS.

That’s the immune system.
That’s not the virus itself. That’s actually the immune system overreacting. We don’t want more immune system. We want optimal and what they found is
the short-chain fatty acids turned up the CD8 cells to fight the virus
but the rest of the immune system it actually turned it down and that’s exactly
the result that you want. From my perspective,
whether we are in the midst of the pandemic or whether you are trying to heal, whether it’s your immune system
or your gut post-pandemic, I honestly think that the answer is the same
and it’s not the supplement.

It’s eating a nice, clean diet and then let’s include the other stuff
that hasn’t been put on our gut too because it’s not just fiber. There’s all the things that you can get
without even lifting a fork, like getting a good night’s rest
and exercising and having a way to get rid of your stress. All of these things can optimize your gut. When you optimize your gut,
your immune system gets optimized too. Beautifully said. Can you give a couple
of quick examples of short-chain fatty acids that people can eat today
when they’re hearing this? Any prebiotic fiber and by the way,
every plant has prebiotic fiber, okay? So the beautiful thing is you don’t need to
necessarily go for just one or another. But I am a big believer in legumes, aromatics like onions and garlic
and leeks and shallots. If you love cruciferous vegetables like broccoli,
cauliflower, Brussel sprouts, kale, these are the cancer-fighting foods
and there’s a specific phytochemical found in these cruciferous vegetables
called sulforaphane and I’m totally obsessed
with sulforaphane.

There are hundreds of studies showing us
how beneficial this is throughout our entire body
— the whole body. And the best source
of sulforaphane is quite surprising. It’s not adult, mature broccoli.
It’s actually the broccoli sprout. You take the broccoli seeds
and people at home, you can do this. It’s not hard to do.
You take the seed and you sprout it and it takes anywhere
from four to seven days and it’s the least mature form
of broccoli that exists. That has literally up to 100 times
more sulforaphane than mature broccoli does. It’s very bitter.
I have learned to embrace the burn. You feel the burn like Bernie Sanders.
Feel the burn. And what’s cool is it has these healing effects
throughout the entire body, including… It actually prevents cancer through
seven different mechanisms but what I think is cool about it is that
and I talk about this in the book, it actually also changes your gut in a way
to produce more short-chain fatty acids and so, it kind of comes full circle
where it’s like short-chain fatty acids are the currency of gut health
and when you have them, you’re well and the problem is that
in the United States right now, 97% of us aren’t even getting
the minimal amount of fiber.

I think it’s the CDC’s recommendation,
which you know is below what it should be because they’re just thinking
about averages, right? Not optimal levels is I think
more than I probably get in a day. I mean, it’s really amazing
how many of us are lacking and you know, it doesn’t mean
every day I don’t get it but there are definitely days of the week I don’t
and they’re saying that it should be every day and it’s really amazing and it’s worth looking at
and I’ll put article version of this on GetWellBe.com so that people can really see
what those recommendations are because there’s real science,
which you’ve talked about and it’s very serious and most of us aren’t getting it,
even if we consider ourselves to be quite healthy eaters
because we’re thinking about all the unhealthy things like junk food
that we aren’t eating but that doesn’t necessarily mean we’re
getting enough plants to account for this guideline, which we know was so important
from everything you just said.

So I feel like it’s also a cultural shift for me and for a lot of the listeners of this episode,
to not just think of yourself as well…. “I don’t drink soda.
I don’t eat fast food. I’m a healthy eater then” but no,
it’s also how many plants are you getting and how many different plants
are you getting, to sum up. And to go back to your main point,
which I love, which is that the diversity of
the plants that you eat is really equivalent to the health of your gut, which is equivalent to
your immune system strength. Yup and that’s the foundation
and we don’t have to make it so complicated. It can be that.
– Yeah, exactly. Okay, this is the last question,
which I ask every single guest I have, which is, “How do you #getwellbe?” Get Well-Be is obviously our website
and all of our social channels and the ‘get’ is a big part
of the mission at WellBe, which is that health doesn’t happen
and it takes work.

You have to cut up those vegetables
and shop at the different farmers’ markets and have the willpower to try new things
you’ve never seen before and look up recipes about
how to cook them and all of that and so I want to know the things
that you do every single day that are taking an active role in your health
and when you don’t do them, you noticeably don’t feel as well or you can just tell that
you’re not being your most well self. It can be one thing, it can be two or three
but basically, how do you #getwellbe? I #getwellbe with a great smoothie
in the morning. I #getwellbe when I have a salad at lunch
with as much plant diversity as possible. I #getwellbe when our family
is having home cooked meals for dinner.

I #getwellbe with a great night’s rest. I #getwellbe while I’m exercising. But above all else,
I #getwellbe with real people. Social connection is what we are about. It is really tough right now
with everything that’s happening. We are meant to be together. It’s against our nature — to pull us apart
and this is why this makes it very hard but I #getwellbe by celebrating
the people in my life, the people that I love and I really hope that
going through what we’re going through now, that it brings all of us closer, that we stop hanging out in tribes
and we start looking at each other as people and just loving each other
because I think that’s what we need to be.

Yeah. Gosh. Well, that is extremely timely. I feel very similarly, I feel like
this is the most bizarre situation and I know that it’s the number one tool
for prison-torture to isolate people. That’s how unnatural it is. I think, if anybody listening to this
who’s been isolated for some time and really, isn’t having any
real human interaction like lives alone, for example and it’s feeling depressed
or weird or like something’s wrong, that’s totally normal
because that’s a very human instinct. But also, like you said,
I think just the realization of every single human on the planet,
having the same objective for once has made me realize that some positive things
can come out of this, which is that we’re all going to see
that the tribal instincts are not helpful and can be quite hurtful, especially because
the globe is getting smaller and smaller and that something like this
can spread as quickly as it has and infect us all and destroy communities
and it’s the same everywhere.

You know, when I think it was just China,
Americans could say like, “Oh, that was this foreign disease,”
and then as it spread around, we realize, “No, it’s affecting everybody
the same way everywhere.” We’re all human beings. We all have the same gut health
— the same gut, the same immune systems. That’s true. We have the same microbes.
– The same insides, right? Different microbes in different places
but it’s pretty wild how much this has shown me in just a short amount of time,
how similar we really all are. I hope to get to meet you someday in person
but until then, will you tell everybody where to find you and also,
when your book comes out? My book launches May 12th.
You can come find me at ThePlantFedGut.com.

I have an e-mail list, very active. I’m going to have a whole bunch of stuff,
including all the references to my book. I also have a guide to coronavirus. And then last thing, you can find me
on Instagram at @TheGutHealthMD. Great. Thank you so much. Will, I hope you have a great night cooking
a home-cooked meal with your family. I know that that’s what we’re all doing right now
because we have no other option but it’s also been just wonderful, I think,
to see cooking come back into our culture. It’s been so missing
for so long for most Americans and it’s really the foundation of,
I think a healthy diet is being able to cook for yourself.
– For sure. Thank you again and have a great night. All right. You too..

As found on YouTube

To learn more about gluten free living click the link