Episode 135 – Norm Robillard
What’s up everyone? Drew Manning here from Fit2Fat2Fit. Thank you guys for tuning in to the Fit2Fat2Fit Experience Podcast. I really appreciate it. Today is Episode 135 and I have a special guest on, Dr. Norm …. how do you pronounce his last name? I’m going to mess this up! I know it! *chuckles* Um, I think it’s pronounced, Rob-O-lard? We actually didn’t talk about how to pronounce his last name. I just call him Norm on the Podcast. Dr. Norm Robillard is a PHD, founder of the Digestive Health Institute and is the leading gut health expert. I am a big fan of gut health and the gut microbiome. What is that? It’s basically our gut bacteria and over the years I’ve learned how important our gut bacteria is and how certain foods affect our gut bacteria. On today’s episode, I wanted to bring on an expert to talk about the foods you eat and how they impact your gut bacteria, which then impacts who you are, right? There’s over a hundred, trillion bacteria in our intestines, right? And in some cases, we are more bacteria than we are human. So the foods we eat impact those bacteria, which then impact us. Does that make sense? So today we go into some ‘sciencey’ stuff, talking about the gut bacteria. We talk about fermentable carbohydrates and how those can manifest themselves in some pretty bad symptoms. Auto-immune issues, acid reflux, digestive issues, like gas and bloating and diarrhea and constipation. We kind of nerd out a little bit about gut bacteria. And how those foods that we eat affect those and affect us as a whole and our health. We talk about SIBO, which is small intestinal bacterial overgrowth. I’ve had some friends get tested for this and some have been diagnosed with it. He talks about his Fast Tract Diet, specifically for these symptoms that some of you might have already. Or you may know someone who has digestive issues. We talk about other specific symptoms. This is a really important episode for everybody to listen to. Make sure and share it because I think everybody is impacted by some type of digestive issue at some point in their life.
Drew: Alright Norm, welcome to the show. How are you doing today?
Norm: Hi Drew, thanks for having me. I’m doing alright, except we are sitting in the middle of a blizzard at the moment. *chuckles*
Drew: That’s what I heard. I heard you guys were getting dumped on out there. *laughing*
Norm: Oh yeah. Hopefully spring is just around the corner.
Drew: Yeah, well we are here in Utah and it’s sunny and 60, so all the skiers here are disappointed though. *laughing*
Norm: Oh yeah. Oh well, it’s nice.
Drew: Anyways, first of all, thank you for coming on the Podcast. I really appreciate it and I’m super excited to talk about this topic, because it’s something I’ve kind of done a little bit of research in. I am fascinated by it, because there is a lot of new and emerging research in studies being done on this. It seems like we are discovering so many new things about the gut microbiome. Let’s kind of start from the beginning though, introduce yourself a little bit to my audience and how you got started in this field.
Norm: Sure. Yeah and I appreciate that. Hey, before we get started, I have one question for you. I know it was some time ago when you did your experiment, when you basically ate any kind of junk food in the world and gained a bunch of weight. During that time, did you develop any digestive issues?
Drew: For sure. Obviously eating processed food for six months straight, a lot of digestive issues. There were times when I was constipated, there were times where, not to be too specific, but diarrhea or upset stomach almost all the time. I always felt bloated. I mean you can imagine eating processed carbohydrates, refined sugars all day, everyday, what that does to the gut.
Norm: Well, you will see from my story, that I was in the same boat but not as an experiment, it was just my way of living back in the day.
Drew: Yeah, so tell us, go ahead ….
Norm: Yeah sure. My background is microbiology and I spent most of my career as a research microbiologist in Biotech. But what was interesting, is that during part of that time, I think I was in around my mid 30’s to early 40’s, I started suffering from my own chronic digestive health issue. It was acid reflux or GERD, gastroesophageal reflux disease. To me it came out of nowhere, because I really remember being able to eat whatever I wanted when I was younger and all of a sudden …. I just had this constant heartburn and regurgitation, reflux coming up into my mouth even. It was affecting my work and my well being, even my sleep. Some nights it would be so bad that I would reflux and aspirate it into my lungs and just wake up shocked. Even being in some of the microbiology and biotech industry, I didn’t know what was causing this problem. I tried some of the medicines, the proton pump inhibitors, H2 blockers and they gave a little bit of symptomatic relief, but you could tell it was still going on. It was still refluxing. It could have gone on like that forever except that my older son, who was a trainer, one day approached me. We were both in Southern California at the time and he said, ‘Hey dad, why don’t you go on a low carb diet with me and we’ll lose some weight and get a treadmill.’ So I said ‘Sure, why not.’
Norm: I bought the book, “Protein Power” by Dr. Michael and Mary Dan Eades. My first entry into the low carb world. And I tried eating low carb, high fat and forget about weight loss, what really surprised me is in just a couple of day, my reflux symptoms dramatically improved. I just could believe it. Why didn’t anybody tell me about this? *laughing* And some people were saying the same thing online. Cut my carbs and my heartburn is better. The guys down at Duke University had done a small clinical study, a pilot study, and had some good results. But one thing nobody was asking about was why. Why does this help? Why would it improve reflux? I really got curious about that and I wanted to know why. So I started reading about reflux and the existing theory, which had to do with these muscles in the top of our stomach called lower esophageal sphincter muscles. The theory went like this, these muscles spontaneously relax and sometimes they become weakened, and it might be in response to some mysterious trigger food or alcohol, and that’s why we reflux. That theory stood for sixty years, unchallenged.
Drew: Wow. *chuckles*
Norm: So I thought, how do carbohydrates fit in to this equation? So I started researching digestion. I thought how complicated can this be, right? You’ve got fats, proteins and carbohydrates. As you digest them, what is it about carbohydrates, could carbohydrates somehow be the cause of acid reflux? And I wanted to know why. I started thinking about ok, you take a bit of food, you chew it up in your mouth and you break it into small parts. Your saliva has amylase enzyme that begins to digest the starch. Then you swallow it. It makes its way to your stomach where you produce stomach acid that denatures the protein and proteases and other protein digesting enzymes, as well as some lipase in the stomach, starts working on the fat. And then after the stomach churns it around a little while, it moves to the small intestines. Then some bicarb is released to neutralize the stomach acid, some bile comes in to help solubilize the fats and some more digestive enzymes. But right when I started reading about that, a light bulb went off in my head. Because I started thinking about gut bacteria. Some microbiologist had grown bacteria for many, many years for different research purposes. Even when I was at Tufts University as a post doctorate fellow, I was even working with strains of gut bacteria, like bacteria fragilis and e-coli. Two things popped into my mind about bacteria, they love carbohydrates, that is their preferred fuel source, for most strains. And most of these bacterial strains produce a lot of gas. And it just hit me like that, what if, you know especially now that I’m in my mid 30’s, I’m wasn’t digesting these carbohydrates that well. I was consuming too many of them. I was on a high carb diet. And in a lot more of these carbohydrates, than in maybe Paleo days or whatever, was escaping digestion and absorption and was overfeeding blooms of gas producing bacteria.
Drew: Uh, hu. Hmm.
Norm: So, it was a new competing theory against this LES theory. So I’ve written a couple of books on it. There is actually quite a bit of evidence for this theory. It’s a new way of looking at acid reflux, which the great thing about it is, it provides for some new treatment options. Like diets that limit fermentable carbs and techniques to improve how efficiently we digest carbohydrates and so forth. Then also, it’s not just acid reflux. This very similar compelling evidence now exists that excessive bacteria fermentation in intestinal gases are literally behind all of these functional gastrointestinal disorders. So reflux, but also IBS, things as simple as bloating and distention, with excess gas. Diarrhea and constipation, which you mentioned, dyspepsia, just kind of an upset stomach and so on. And I also realized that it’s really the hardest to digest carbohydrates that are really going to be the biggest problem. And what are those? Lactose, fructose, resistance starch, fiber and sugar alcohols. And so that’s where I started keying into this thing.
Drew: Interesting. Wow, first of all, that is really powerful that you were able to self discover this yourself because of the problems you had. Had you not had those problems, you probably wouldn’t have been interested in this field and gone down this rabbit hole, if you will, to figure out what was causing this. You mentioned you wrote a couple of books, what were the names of those books that you wrote?
Norm: The first book, and you can still get the e-book out there on Amazon, it’s out of print now, it was called “Heartburn Cure.” You can tell I was a little excited about it. *laughing* And it was a self published book that I was writing, I just wrote it at night. I was at a job, a biotech company in southern Cal, just late at night, I was cranking out this little book. I just wanted to get this theory out there and so that was the first one. But as I refined this whole approach, I ended up writing, “Fast Tract Digestion” Series. So the first one was on heartburn and now I’ve also written another one on IBS.
Drew: So going back into this a little bit, what do you think about these medicines out there to treat heartburn, tums or you mentioned some of the prescription pills some people take for heartburn? Are these helping the problem or are they just putting a band aid over the bullet hole if you will? *laughing*
Norm: *laughing* Yeah, I mean none of them address the underlying cause, if you think about the theory and what’s driving it. However, I think of these in terms of varying invasiveness. So, antacids will neutralize your stomach acid and then it comes back in 30 minutes or an hour, so it’s not too terrible. You really do want your stomach acid, it’s important for absorbing a whole variety of nutrients and minerals and vitamins. So people who don’t have stomach acid, oftentimes will end up being deficient in calcium, magnesium, vitamin D and vitamin B12, anemias common. You want your stomach acid. Then we move to the more invasive medicines like the H2 blockers, those histamine antagonist, they block not the production of stomach acid but the release of it into the stomach. So they are good for about six hours. Now the proton pump inhibitors are much more powerful and they figured out a way to really shut down the acid pumps that literally make stomach acid. So those are very powerful and some of those can go 12-24 hours. You are literally knocking out your stomach acid with these. It’s as if you had hypochlorhydria, low stomach acid or achlorhydria, no stomach acid. Certainly these might be ok for a short period of time. They’re only recommended, ever when your doctor prescribes them, they should be prescribed for only a month or two. But of course people end up on these for decades.
Drew: Yeah. *chuckles* And what about the bio individuality of all this, like some people who may eat processed carbs and don’t have IBS or terrible bloating. Because I know some people can eat that food and maybe don’t have the same symptoms. Where does that factor into all this? Have you kind of found a pattern there as to why some people are affected by this severely and why some others might not be?
Norm: Yeah, I mean it’s a great question. There are many answers to that. One is, I think just being young and healthy, your probably at a great advantage. Some people can have some of these conditions as teenagers, even some infants and children can have reflux. But for the most part, most people in their teens can eat whatever they want without too many of these problems. It could be a factor of just sheer digestion isn’t quite as efficient as you start to get into your 30’s and 40’s and 50’s. That’s one issue. But then there are certainly specific problems that can come up that will make you susceptible to these. We haven’t really introduced or talked about SIBO and dysbiosis. I was talking in general terms about excess fermentation, but now they’ve got some names on these and specific conditions that involve bacteria overgrowth and cause these problems. There are a lot of reasons that you can become more susceptible to that. One is, you are just eating too many carbohydrates and you can’t process them all. But of course, people that take a lot of antibiotics, they are going to deplete their macrobiotics, so they will have a lot less diversity. They might be left with not as many bacteria strains and some of the ones that are left might produce more gas. Anybody that has pancreas issues, or they don’t produce enough digestive enzyme, some like kids with cystic fibrosis will constantly have these problems because they are not able to release the digestive enzymes from the pancreas. It just goes on and on. Most people around the world are intolerant to lactose, so unless you have a Northern European ancestry and a few other pockets around the world, most people are lactose intolerant, so that’s something genetic. You can’t really control it. There’s a general idea about as you get older, but also a whole variety of specific problems that could contribute to this.
Drew: Yeah. Kind of going back to your stories, it wasn’t until your 30’s or 40’s that you started noticing these symptoms. Even though you had probably eaten similar your whole life, right?
Norm: I had. I remember …. I really wasn’t …. I didn’t understand Keto dieting. I didn’t understand blood sugar issues. I just never really thought about any of it. So I would make big dishes of pasta for my family at night. I was oblivious, I honestly was.
Drew: Let’s talk about the Fast Tract Diet. I want to get to SIBO at some point, but let’s jump into the Fast Tract Diet for now and what that consists of, of these fermentable carbohydrates that we’re trying to limit, right?
Norm: Yeah, sure. And maybe we can weave SIBO into it a little bit. So, the Fast Tract Diet, it was designed …. this is after I had this light bulb moment and refined this diet. It was designed to address SIBO and other microbiota imbalances, we call it dysbiosis, by limiting bacterial fermentation. Essentially, and there is a way, I will talk about it later, to target the specific carbohydrates. Lactose, fructose, resistant starch, fiber and sugar alcohols. That was the way I designed the diet. Before we get too far into it, what is SIBO and dysbiosis, let’s just talk about that for a moment.
Most of our gut micros, and of course we have bacteria, viruses, fungi, parasites, there is all kinds of things that live in our gut. Hopefully not too many parasites. But it’s mostly bacteria and most of them reside in our large intestines, some hundred trillion or so bacteria from 500-1000 different species and many more subspecies. You’ve got your rain forest of bacteria in your large intestines, you’ve got smaller populations of different varieties of bacteria in your small intestines. Not nearly as many and their mostly towards the end of the small intestine. But in the large intestine, where these hundred trillion are, if function …. we have all kinds of functions regulating our immune system. How we store fat and regulating appetite, and on and on. A whole list of things they do, but one of the most important things they do is quite simple. They turn fiber and other undigested carbohydrates into fats. And those fats can nourish us, or they can metabolize those. Like butyrate, Lactate, Propionate, those fatty’s, short train fatty acids are fats and we can get energy from them. So it is an energy capture system and it’s so important that literally all the animals on earth have evolved the same mechanism.
So that when times are lean and we don’t have any animal kills and we have to dig around and dig up some root vegetables, even if we don’t digest all of those carbohydrates, the bacteria collaboratively can break them down and produce these fats. So this is survival advantage. However, over time, for these different reasons we were talking about and more, things can become unbalanced. You can get overgrowths, even in the large intestines, kind of a dysbiosis. When you have a lot of bacteria there, it can make its way into the small intestine, past this ileocecal valve that connects the two. And when these bacteria start to thrive and grow in the small intestine, especially in the early part of the small intestine, it causes a lot of problems. Because what’s in the early part of the small intestine, are these critical digestive structures, cilia and microvilli. Kind of these microscopic hairs on top of microscopic hairs, and on the tips of the microvilli they are releasing these little enzymes, disaccharidase, lactase, sucrose. So, it’s all about making sure the food is broken down completely and absorbed in the blood stream. Now imagine all of these bacteria in this area producing toxins and causing inflammation and producing these acids and probably most importantly, producing their own protein enzymes. Because bacteria do need some nitrogen themselves and they get that from the amino acids from proteins. So they are out there forging for proteins to break down for their own needs. Well, if they run into these little disaccharidases, they are going to break them down and then what you have is damage to this area and loss of these enzymes and you have what?
More malabsorption, especially in these carbohydrates, which feeds even more bacteria. And you’ve got this vicious cycle, a good term coined by Elaine Gottschall who wrote “Breaking the Vicious Cycle”. Now things are turning into a mess, right? But what happens when this goes on, is you start to have symptoms, right? In my case, my big problem was acid reflux. But many people have SIBO and they have things like abdominal pain, cramps, you mentioned diarrhea and constipation, right? Alterations in your bowel consistency. Some simple ones like, just a lot of gas and bloating is very common in people I work with and they just don’t know how to control it. Flatuence, nausea, dehydration, fatigue, and if you don’t take care of this, it can turn into a more severe condition, where you actually start having unusual amounts of weight loss. You can’t digest fats properly. You might have developed fragile bones, due to calcium and magnesium loss, leaky gut and autoimmune issues. So that’s the problem. So the fast tract diet, here’s how …. it was really designed in three parts. We want to put these microbes on a diet and we want to do it in three ways. One is controlling these five types of carbs. And this is something I struggled with for, I’d say two years, on just this one problem. This thing called fermentation potential. I want a measure of all these hard to digest carbohydrates in any food and how the heck do you do that? Even if I was the Einstein of nutritionist, it’s impossible to figure out how much fructose, lactose, resistant starch, fiber and sugar alcohols is in every food you eat.
Drew: Yeah. *laughing*
Norm: Well, how do you do that, right? *laughing* One day, I stumbled across an idea. There is something called the glycemic index, alright? And I’m sure that’s something you are familiar with in your world, because it’s something that measures how quickly carbohydrates, the glucose from any carbohydrates, goes into the bloodstream. Compared to glucose, which is absorbed very efficiently, right? That’s why glucose is considered a 100%. So, we have this glycemic index value for all these different foods, thousands and thousands of these GI values. So I thought, if that can measure how quickly carbohydrates go into the bloodstream, I should be able to mimic the equation to determine how many of these carbohydrates have persisting in the gut. I developed this calculation, so all you need is some glycemic index and the nutritional facts from any food and you can calculate the FP.
Norm: We can compare a few of those later. So that’s the first, but that gives you a systematic, quantitative measure of these hard to digest carbs in anything you eat. You want to control these FP’s ones. The other one was identifying and addressing any possible underlying cause or condition that could contribute to this problem. And we talked about some of those, right?
Norm: When I work with people, we very meticulously go through those and try to rule out as many as possible. And there’s lots of them because its an active area of research. The last thing is gut friendly behaviors and practices you can embrace to improve digestion. So whether that’s just eating slowly and chewing well, to give this amylase enzyme in your saliva more time to break down the starch. Maybe it’s taking a lactase supplement if your lactose intolerant, so it’s that behavioral thing. Good thing about this diet is no food is technically illegal. It’s not an elimination diet, but you need to control these points, if you want to put your microbes on your little microbe weight watchers. For more info, people can download the e-book on DigestiveHealthInstitute.org. It will tell you all about his diet.
Drew: Yeah. We will put that link in the show notes. I’m definitely interested to know about that calculation that you do. I think people love quantifiable measurable things that they can implement in their new lifestyle. The glycemic index is a great concept to help give people an idea. One of the questions I have is about the glycemic index. My friend Robb Wolf wrote a book called “Wired to Eat” and in his book he talks about how certain people have different responses to certain carbohydrates, right? So you measure your glucose 2 hours after you’ve eaten 50 grams of carbs from different sources like rice and beans and white bread and cookies and bananas, different sources of carbohydrates and how those impact your glucose levels. He and his wife did some experimenting and for example, his wife would eat a bowl of rice and then she would drink a glass of water and it had zero impact. But him, he was almost prediabetic, right? Eating 50 grams of carbohydrates from rice, kind of like going back to the bio individuality in all of this. I don’t think everyone is going to do that type of self experimentation, but I think there is something to be said as far as that goes. But, getting back to the Fast Tract Diet, unless you wanted to comment about that?
Norm: Sure, I will. By the way, I keep meaning to get that and read it. I’ve got his other book and he’s awesome. That concept came from a study that was done in Israel a few years back, where they did find that different people reacted differently, had different glycemic tendencies. So instead of thinking of it just associated with food, there’s also this idea of people are different. And that makes sense just from some of the things we were talking about. Like somebody who is lactose intolerant, right? Their glycemic index for milk is probably going to be lower than somebody who is not. Now in these GI values, they try to recruit, they are supposed to recruit healthy individuals, so the FP calculations derived from the glycemic index is, should be based at least on healthy people. Now of course it will vary from person to person, but they do this test in several different people and they average the results. So there is some accuracy and precision estimates and they are always trying to make it better. But the point that I have, it wasn’t that it would not work for some people and work for other people and just leave it at that. But was really to just compare the foods. So for instance, getting ahead of myself a little bit, but if you just look at rices and you compare basmati rice to jasmine rice, jasmine rice has a very high glycemic index. It’s not always going to be the same, in one case it was over 100, in another case it was 80-something and so the average is 94. From several different determinations, each with many people. Basmati rice, the same way, consistently tests much lower, around between 50-60 for the glycemic index. So when you convert that to FP, the jasmine rice has the lower FP, most of the carbs are absorbed. Basmati rice has a high FP, so something like for 1/2 cup of basmati rice, 10 grams of carbohydrates will persist in the intestines.
Drew: Yeah. What other foods should people avoid to make it easier? Your saying you don’t have to technically, but maybe to people who want some kind of protocol to follow, like ‘Ok, what types of foods should I avoid on the Fast Tract Diet?’ To make it easier for them?
Norm: Sure. Well, and this is where there is a lot of overlap with Keto, right? Because if you just stick with green leafy vegetables, I mean the book and the Fast Tract Diet books and the mobile app, list foods in tables and we’re updating the Fast Tract Diet mobile app. It will have over a 1000 foods and this list with the FP values. But when you just look at the vegetable list, I mean there is almost a hundred that are 5 points or lower. The vegetables can be quite low, the leafy greens. Your pretty good with those. I think you have to watch it when you get into the more starchy vegetables, which makes sense. Corn, one ear of corn has 13 points, a 1/2 cup of yam, has 11 points. And you’ve really got to watch the wheat based pastas, a 1/2 cup of cooked pasta is 12 depending on the pasta type, 12-15 grams. Remember, I forget if I mentioned it, 30 grams, right? 30 grams can allow bacteria to produce 10 liters of gas, so if you keep that little equation in your mind, 30 grams of carbs, is only a little over an ounce, 10 liters of gas. If you have some pasta and your 15 grams of FP, then you can make 5 liters of gas from that 1/2 cup of cooked pasta. Now if you chose rice pasta over that, that same 1/2 cup is only about 3 grams of FP. So you can play around with it. And legumes, legumes, other than soybeans aren’t as high, but legumes across the board are quite high. 1/2 cup of cooked beans, depending on the type, is somewhere between 14-20 points. So really watch the wheat based pasta and the legumes. They will give you some symptoms.
Drew: Yeah, so this does sound similar to a Ketogenic diet where your limiting your total carbs, 30 grams or less. And what I tell people is mostly, get those carbs from leafy green vegetables, which the quantity of 30 grams of spinach verses 30 grams of pasta ….*laughing* …. it’s hard to chew 30 grams of spinach or kale verses 30 grams of pasta you can inhale.
Norm: That’s a great point. And by the way, when your talking about Keto you reminded me of that last point. And that point was simply, I was eating a Keto diet at the time, when I created this new diet. What I found was there was a population that I was targeting that really didn’t need the diet so much. I went on one of those low carb cruises and started talking about my diet and those people didn’t have many digestive health problems because they were already eating a really low carb diet. So I started to realize that I needed to target the audience that was still suffering and most of those people weren’t on Keto. A whole lot of people, I mean not everybody needs to be on Keto. Some people tolerate carbohydrates better than others. Even from a blood sugar perspective and they don’t need to be on a Ketogenic diet all the time or they just choose not to do it. So I wanted this diet to be flexible enough so that anybody could use it. Regardless of what they’re eating, or their preferences were, or what kind of diet they were on. So I even work with vegetarians now, it’s challenging as you can imagine! Your eating all plants. *chuckles*
Drew: Yeah. *chuckles*
Norm: Plants equal FP basically. *laughing* There’s a lot of things you can do to help.
Drew: Yeah, that’s so true. Especially the fructose, right? And obviously the fiber. What sugar alcohols do you find to be the most troublesome for people? Are there some that are better than others? Safer than others or are all sugar alcohols bad?
Norm: That’s a really good question. In fact the FDA.gov site has some great literature on sugar alcohols, sorbitol is one of the worst. They even quantitative it in terms of how many grams you can consume and how much gas or bloating you can expect. Xylitol is probably not as bad, but all of these sugar alcohols with one exception, are fermentable, so they will cause gas and bloating and flatulence and often times, diarrhea. So they are very fermentable, they are not digestible. But there is one friendly sugar alcohol and it’s called erythritol. It’s a naturally occurring sugar alcohol. It’s in some fruits. They produce it through a fermentation process with fungi to produce erythritol. But it’s natural molecule is very safe, well studied, it’s not digested affectively, I forget how much can get into your bloodstream, but anyway. It’s eliminated from the body, it’s not metabolized. It’s not metabolized by bacteria, so you can consider it for gut health. Yeah, so erythritol is the one big exception and it’s totally, totally ok.
Drew: Yeah and that’s kind of generally what I say on the Keto diet, is erythritol is probably the safer one of out of all of those. Because on the Keto diet, or people that are just trying to control blood sugar and enzyme levels, there is some studies showing even certain sugar alcohols or even just having something sweet, whether its Stevia or sugar, releases a small amount of insulin, because your body thinks it’s sugar when it first touches your tongue. So there is some interesting research being done there, that even though it’s not sugar, your body thinks it’s getting sugar so it releases a little bit of insulin. Have you seen anything about that?
Norm: I have, I’ve read some of those things and you know it could be, could be. They have an idea around it. Of course I tend to be skeptical. *laughing*
Norm: Some of these new areas of research comparing, like sugars that can boom and really jack up your blood sugar, if you have some Stevia. I just would like to see more work done on it before I really make up my mind.
Drew: Yeah, I agree. It’s interesting because when it comes to the gut bacteria, there is a lot of new research being done, it’s kind of like our body’s second brain. We are more bacteria than we are human cells, technically, right? With the amount of bacteria we have verses how many human cells.
Norm: Yeah. The number of bacteria, turns out that it varies. After a meal, you have more. Before a meal, you might have less than human cells. However, one area that bacteria really blows us out of the water is genes. There’s something like a hundred times more bacterial genes in our body than human genes.
Drew: Which is very interesting. *laughing*
Norm: And almost all of those genes, most of those genes are all about breaking down complex carbohydrates.
Drew: Yeah, and that’s why it’s so important that I try to tell people, it is important what you eat. You know a carb isn’t just a carb, right? So if you have a 1000 calories of donuts and soda, that’s going to affect your body differently than if you eat a 1000 calories of chicken and broccoli for example. Whereas some people in my industry, the fitness industry is like it doesn’t matter, a carb is a carb or a fat is a fat or a protein is a protein. But it matters the quality of the food, because you have got to understand that there is this other second brain we have almost of gut bacteria. The types of foods that you feed it, are information for your body. You kind of become those foods if you will. *chuckles*
Norm: Sure and I couldn’t agree more and there’s an evolutionary perspective there too, I mean people evolve to eat differently depending on where their ancestors came from. Until we understand that better, we probably won’t find the perfect diet for ourselves.
Drew: Yeah, exactly. Are there ways too …. I think now that you’ve mentioned SIBO and I’ve had some friends that had it, are there ways to get that tested to see if you have SIBO? There are tests you can do now to kind of diagnose these issues, whereas before there wasn’t, right?
Norm: Sure and I mean, back in the day, you know years and years ago, when this condition was called Small Bowel Overgrowth, SBO. That was mostly found in association with surgeries that weren’t done correctly and so there was a blind loop left in the intestines and the bacteria backed up. And so back then they were testing with jejunal aspirates where they would go in there with an endoscopy tipped with something that could capture a sample and they would actually try to grow the bacteria. That’s really invasive and it’s hard to do anyway because not everybody has an anaerobic chamber in there. And the culture lab, because most of these bacteria are anaerobic, you can’t just put them on a plate in the incubator under the air, most of them won’t grow. And even if you get the proper conditions, most gut bacteria, simply do not grow in culture, over 90%. So you wouldn’t get a very good picture of what was really in there. The next best thing is to use something that’s less invasive but also you don’t quite get as much information, and that’s breath testing. So you basically, you blow into these tubes and that captures your gases that are from your intestines and here’s how, right? Bacteria can produce hydrogen gas, we’ve been talking a lot about that today. There’s also archaea organisms in our bacteria but they are microbes, a separate branch of life. They take the hydrogen and metabolize it with carbon dioxide to produce methane. So we’ve got these two types of gases, there are other ones too, but focus on these two main ones. These gases when they are produced by microbes in your gut, are absorbed into the bloodstream and exhaled through the lungs. When you blow into a tube, your basically capturing gases produced by your microbes. For this breath test, they will give you a non-digestible sugar called lactulose. We can’t digest it, so it works it’s way through the small and then eventually into the large intestine. The only time you will get a hydrogen or methane gas signal from that sub-straight, is when bacteria metabolize it. And so if you have a lot of bacteria in your small intestine, say they are in the middle of your small intestine, and it takes about 90 minutes for this lactulose to go through your entire small intestine. At about 45 minutes you might see a spike of hydrogen gas and you can conclude from that, looks like there is bacteria gobbling up that lactulose, but half way down the small intestine. There is some challenges with that testing of methane levels, because it’s kind of these archaea using hydrogen that’s already been produced. A lot of people that produce high methane, produce it even before they drink the sugar solution. They are producing it all the time in the gut, so in that case you are just looking for people who have high methane levels, not necessarily in response to drinking the test sugar. The other issue with SIBO testing, breath testing that can be challenging is not everybody’s motility occurs at the same speed. So with some people, this lactulose sugar will reach the end of the small intestine much more quickly, if they have fast rapid motility, then somebody with a slow motility. So you can get some false positives when you diagnose somebody with SIBO, that turns out that lactulose sugar already made it to the large bowel and is being consumed by bacteria in your large bowel. So there is a question between is it SIBO or is it something you might call LIBO, an overgrowth in the early part of your large bowel.
Drew: Interesting. And with that, would there be differences in solving both of those issues, like if they did the Fast Tract Diet, would that be kind of a one size fits all solution for both of those or would there be a different approach?
Norm: That’s a great question because there are some recent studies, one using a smart pill that measures PH. It measures the PH as it goes through the stomach and small intestine and large intestine, measures how acidic it is. And acidity is associated with bacteria fermentation, right? Because they are making these short chain what? Fatty acids. So its becoming acidic when you have this activity. There was this one study with this smart technology that found that people with IBS and presumably those are the people who have SIBO, actually didn’t have changes in their small intestine. But they did have lower PH indicative of more acid in the early part of the large bowel. So they were saying that suggested this, they didn’t call it LIBO, but I will for convenience, this LIBO type reaction might be more important than SIBO, we might be looking at LIBO. Then there was another study that looked at a radioactive tracer molecule, that they could give it to people with the lactulose and then they could literally follow this tracer and they were just assuming that lactulose is traveling at the same rate. What they found was that it was reaching the end of the small intestine that had SIBO earlier than what they thought the cut off should be in the test. So this is two examples of people challenging the SIBO concept. While I think, some more research is needed here, I personally think there is a combination of both SIBO and kind of this LIBO, excessive fermentation in the early part of the large bowel. And there is also some concepts out there that if you have this LIBO, a lot of bacteria past your cecum in the early part of your large bowel, may actually make a lot of gas and push bacteria back into the small intestines so LIBO could lead to SIBO. Scientifically, there is a debate and there is a lot of research going on which is great. Now to your question, what to do about it and what’s going to work. What I found interesting is, if you have this concept that you might have LIBO instead of SIBO, some things will work better than others. One thing that might not work as well is the antibiotic Rifaximin and that is the one that is approved for IBS-D, diarrhea predominant IBS. It’s used routinely anytime someone tests positive for SIBO, it’s often prescribed. But one of the things that has been promoted with this antibiotic, is that it’s only active in the small intestine when bile is present. And bile is reabsorbed at the end of the small intestine, so it can be recirculated by the liver, back to the gallbladder and used over again. So you don’t …. 95% or more of the bile is reabsorbed in the small intestines. So now in the large intestine, you don’t have any bile. So, the idea is that well, Rifaximin won’t hurt your microbiota in your large bowel because it’s not active as soon as the bile is gone. But also wouldn’t be active if you kind of had a LIBO situation there. Now, getting back to how did they test carbohydrate, how did they treat carbohydrate intolerance, for years and years and years? If your just looking at the Merck manual, research on lactose intolerance goes back to the early 1900’s. And what do you do if your lactose intolerant? You avoid lactose or take lactase enzyme, right? And it’s a durable response. People that are lactose intolerant, if they avoid lactose 2, 3, 5 years out, it still controls the symptoms. There is no resistance, there is no problem, its durable. You can apply this to fructose and all of these other carbohydrates and your basically shutting, turning down, not eliminating but turning down the spigot on all these fermentable carbohydrates. So whether they are in the small intestine or the large intestine, it’s going to be helpful to limit the carbohydrate fuel. Whereas not every technique will work but certainly this diet and controlling these fermentable carbs should work on bacteria in the large bowel just as well as the small bowel. One caveat with bacteria in the gut, they …. we talked about them getting their fuel mostly from these carbohydrates, they do ferment certain amino acids. So some of their fuel can come from protein’s, mostly later on in the large intestine, where most of that occurs. But another source of fuel for bacteria that you do need to consider is mucus. So the mucus that’s produced in our large bowels has many functions, but one important one is feeding gut bacteria when we don’t. That’s why I don’t worry too much when people say, ‘We’re starving our microbiota. You need to eat more and more and more carbs and fiber.’ I just don’t believe it because these bacteria there, what was the main purpose we suggested they are serving? That’s to prevent us from starving to death when we need to depend on plant based calories, right? If we’re starving why would bacteria be damaged by starvation when they are designed to protect us from starvation? The other fuel source is this mucus. A lot of people don’t know this little fun fact that mucus is 80% polysaccharide, it’s mostly sugar. Then it has a little bit of a sialic acid on the end and that’s a little bit like a protein has carbohydrate, it’s part carbon and part nitrogen. So, it’s like a nitrogen source. So in other words, mucus is a fuel source for these bacteria. Then of course, when bacteria break down this complex mucus molecule, they kind of share the spoils. So a lot of the bacteria can participate. Some bacteria, you can put them on a plate and just feed them mucus and they survive perfectly fine. It’s a complete food source for them. That’s something to keep in mind when we talk about turning on and turning off the spigot. We think we are playing God, but they do have a back up plan. Hopefully that would feed them at more appropriate levels than us wolfing down on twinkies. *laughing*
Drew: *laughing* Gotcha. Last thing before we go, what supplementation could assist with these issues, if any. I know you mentioned some digestive enzymes, but are there any supplements that you have seen that have helped with some of these issues?
Norm: Sure there are. But I have to tell you when I work with people in my consultations program, some people I work with, they tried one supplement and another one and somebody recommended a third and by the time they get to me, they are taking 40 supplements. I’ve had better luck helping people get off supplements than get on to new supplements. *laughing* But having said that, there are some very good supplements and what I like to do is use them in terms of when they are appropriate. So for instance, somebody might say, ‘Well I’m thinking of taking Bitters because I really think I have low stomach acid.’ Ok, well you know, do you have low stomach acid? How do you know that? Have you had a Heidelberg stomach acid capsule test? ‘No. But I did drink the bicarbonate and count my burps or whatever.’ I’m like ok, well that’s not really that accurate. *laughing*
Norm: What we can do is, what drives low stomach acid. There are certain things that are risk factors for low stomach acid. One is having atrophic gastritis, the stomach lining has been damaged. Often times from a long term chronic infection with H-Pylori. Have you been tested for H-Pylori? ‘Yes, it turns out I’m negative.’ Alright, maybe we take that off the table. What else, do you abuse non-steroidal and anti-inflammatories? ‘Nope, hardly ever take them.’ Take that off the table. Do you have any autoimmune conditions? ‘Well, yes, I do have Hashimotos and a few other things.’ Ok, well that’s a risk factor. If you have one autoimmune condition, you may have others, so you could have an autoimmune atrophic gastritis. If you didn’t have other autoimmune conditions, it would be less likely. It wouldn’t really be a big risk factor. So you can tease it apart and then at some point you can make a decision and say you know what, I think you should get the Heidelberg and let’s just find out. Let’s know for sure. But a lot of supplements, it’s not much of a down side risk in trying those. There are certain probiotics, most of the probiotic research has really been kind of a dismal failure. But there are some now emerging that are better than others for specific types of issues. Some probiotics, digestive enzymes, absolutely. We talked about amylase, you have salivary amylase but you also have the amylase secreted from your pancreas. You can take an amylase supplement, you can take a lactase supplement. The problem I have with these digestive enzymes is some of these products have so many enzymes and they are all competing. You have this one and we have this one. We have cellulase. Well I see some of those and I’m like wait, your trying to digest fiber prematurely. Why would you do that? So I look at everything kind of carefully point by point and try to understand why we’re doing it. And then of course you want to make sure you get these supplements from reputable suppliers and that they have an expiration date and you’re storing them properly and so forth. Did that answer your question?
Drew: Yeah, it did. I just wanted to ask that question to see if there’s anything out there that could assist. You know every once in awhile I will take digestive enzymes. I don’t take them all the time. I do take probiotics, but I also eat fermented foods like kimchee and sauerkraut and pickles, as much as I can.
Norm: I’m glad you mentioned that. Because that’s one of the best sources of small intestinal bacterial species like the lactic acid bacteria and you get a nice variety from these lacto fermented vegetables. I have an organic garden and we make these pickles and other fermented vegetables every year. And we love them. Some lactic acid bacteria can make a little bit of gas. Some are homolactic, they don’t make any gas, but some strains make a little bit. With fermented foods, I will tell people I work with to consume one or 1/2 of those big pickles or tablespoon of sauerkraut, not overdo it at first and then see how it goes. Real healthy.
Drew: Gotcha. That’s really good advise. So Dr. Norm, I really appreciate you coming on. Before we go, where can people find your book and you mentioned the free e-book, can you mention that URL one more time.
Norm: Sure. DigestiveHealthInstitute.org, that’s where you can find most of our stuff. Blog, you can find the books there. You can find links to the Fast Tract Diet mobile app. You can, right on the homepage, you will see the spot to get the e-book that tells you about all the diets. It’s about 28 pages long. That’s there and I would encourage people to also join our Fast Tract Diet official Facebook page. We have about 7000 people on there chatting it up and putting up recipes and going crazy. So I love it, I’m on there too, I check in everyday.
Drew: Ok. Well thanks once again. We will put those in the show notes, Dr. Norm. I really appreciate it. Stay safe out there in Boston with the blizzard and I really appreciate you coming on. *laughing*
Norm: Thank you Drew. Great talking to you.
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