Dr. Will Bulsiewicz: Why your gut runs your immune system

Steven Bartlett 0:00 What's a fecal transplant?

Dr. Will Bulsiewicz 0:01 You take a healthy person's poop and you transfer it into the person who's sick. For example, a patient of mine took an antibiotic which wipes out your gut, which became life-threatening. And so our choices were to remove the colon or give her a fecal transplant. And so I delivered a fecal transplant to her. By the next day, the entire infectious issue got shut down. So this is a great example to show how important our gut microbiome is, because 60% of the weight of your stool is your microbiome.

Steven Bartlett 0:27 Really?

Dr. Will Bulsiewicz 0:28 Yes. But it's not getting enough attention, and we need to talk about that.

Steven Bartlett 0:31 World-renowned gastroenterologist Dr. Will Bulsiewicz is back.

Dr. Will Bulsiewicz 0:35 This time he's sharing brand-new information regarding the gut microbiome...

Steven Bartlett 0:39 And how poo might actually be the key to your health. 60% of people that listen are currently struggling with some kind of gut problem.

Dr. Will Bulsiewicz 0:46 And it manifests in these subtle ways, like bloating, increased fatigue, difficulty concentrating, you don't sleep well at night, skin issues. So it flies under the radar, but ultimately leads to other health-related problems afterwards.

Steven Bartlett 0:58 So I've got so many questions.

Dr. Will Bulsiewicz 0:59 Totally.

Steven Bartlett 1:00 What's the cause of bloating?

Dr. Will Bulsiewicz 1:01 So constipation is the number one cause, but people who are bloated, please don't sip through straws, drink carbonated drinks, chew on gum, because you just make it worse.

Steven Bartlett 1:10 Next, are there decisions that you make as a parent that will have a lasting impact on a kid's gut function?

Dr. Will Bulsiewicz 1:15 Yeah. By three years of age, you are basically fully adult-sized in terms of your microbiome. But antibiotics, bottle feeding, and birth by Caesarian section are associated with an impact on the microbiome, such as an increased risk of allergic, autoimmune, and metabolic diseases. And I'll explain why.

Steven Bartlett 1:30 And then, can I repair the gut?

Dr. Will Bulsiewicz 1:32 Yeah, 100%. And every three to five days, you build a new gut barrier. And so I've identified four things missing in our diet, as well as a daily routine that can optimize our microbiome. And when you do these, you will thrive, and you will live longer and you will have less disease. And I'm gonna take you through all of these steps right now.

Steven Bartlett 1:49 I see messages all the time in the comments section that some of you didn't realize you didn't subscribe, so if you could do me a favor and double-check if you're a subscriber to this channel, that would be tremendously appreciated. It's the simple, it's the free thing that anybody that watches this show frequently can do to help us here to keep everything going in this show and the trajectory it's on. So please do double-check if you've subscribed, and, uh, thank you so much, because in a strange way, you are- you're part of our history and you're on this journey with us, and I appreciate you for that. So yeah, thank you. Dr. Will, before we started recording, I asked you about this new book that you've written, and the way that you spoke about it was incredibly passionate. Why?

Dr. Will Bulsiewicz 2:33 I, I sincerely believe that if people take the advice that's in this book and they actually follow it, which is the hardest part, I'm completely convinced it will transform your life. And that's because we all are struggling with the same problem. We manifest it in different ways. But there's this common issue, which is inflammation. And it's the health story of our time. It's not getting enough attention, and this book is not only about shining the light on that, it's about providing people with the evidence-based tools that they need in order to be successful and to live an anti-inflammatory life. And when you do that, you will thrive, and you will live longer and you will have less disease.

Steven Bartlett 3:15 Can you explain inflammation to me like I'm a 10-year-old?

Dr. Will Bulsiewicz 3:18 Steve, you have an immune system that protects your body.

Steven Bartlett 3:22 Mm-hmm.

Dr. Will Bulsiewicz 3:23 And inflammation is when we turn that immune system on, we make it active. And sometimes that's a good thing. Right? If you had- if you had a tummy bug, you want to clear that infection. Right? If you hurt yourself, you want to heal that wound. That's when your immune system is really good, it's working for you. But the problem that we have these days is that we're turning on the immune system when we don't need to, and it's staying on 24 hours a day, seven days a week. And that ultimately creates problems, because it leads to new issues, new health conditions.

Steven Bartlett 3:59 The word inflammation sounds like something has inflated or become swollen.

Dr. Will Bulsiewicz 4:03 Yeah.

Steven Bartlett 4:04 Is that-

Dr. Will Bulsiewicz 4:04 Well, it is a part of the process. For example, if you hurt your knee, right, there, there will be inflammation in your knee and it will get red, it will get swollen, it will become tender, and, like, those are the typical characteristics of inflammation when it arrives. But what we're talking about is chronic low-grade inflammation, and this is a tricky thing because it can fly below the radar. It can fly below the radar where you don't realize that it's there. Your doctor may not realize that it's there. And it's- and it manifests in these subtle ways where it's like you have increased fatigue, you have difficulty concentrating, you don't sleep well at night, you wake up with aches and pains or you have joints that hurt a little bit, or you've had skin issues, right? And it's like, well, we all have those problems. But that's inflammation. Inflammation is driving many of those issues. And so it's important for people to be aware that, you know, you may ... Like, these, there's so many patients that go to their doctor complaining of these symptoms, and the doctor's kind of not really sure what to do about that. And I think it's time for us to, like, open our mind and bring awareness to the possibility that there is this issue, inflammation, that's driving that problem, the symptoms, the health conditions, of which there are many, and ultimately we need a plan to address that.

Steven Bartlett 5:23 And is - can you be, like, skinny and in shape and still have inflammation?

Dr. Will Bulsiewicz 5:27 Oh, 100%.

Steven Bartlett 5:28 So it's not just a weight thing?

Dr. Will Bulsiewicz 5:30 No, it's not just a weight thing, because if you, if you think about, you know, people who are competitive bodybuilders. They look amazing on the outside, and they're falling apart on the inside. And these people often suffer with digestive health problems. I know because they reach out to me. Including many people that are well-known who look incredible, and they're suffering with gut issues, and then ultimately they're at risk for other health-related problems afterwards.

Steven Bartlett 5:58 So on this point of inflammation is when your immune system kind of stays on. Why does it stay on?... and, uh, I mean, how do I turn it off?

Dr. Will Bulsiewicz 6:06 Well, we have, we have to start with, uh, acknowledging that the reason why this causes problems is that it, let's, like, sort of use an analogy of the immune system is your small army, and they're there to defend you. And when we activate the army and they're actually going to war, you have to expect that there's going to be damage to the surrounding areas.

Steven Bartlett 6:29 Mm-hmm.

Dr. Will Bulsiewicz 6:29 Right? Like if pe- if, if there's a war occurring, of course there's decimation and damage that occurs, and it's brutal. And the problem is that if we're activating the immune system, the par- the areas that are surrounding it, that's your body, right? And the decimation and destruction that's occurring is within your own tissues, within your organs. As I was researching this book, I, I, I actually took three years to understand this topic. And what I discovered is a connection between your immune system and

Dr. Will Bulsiewicz 6:59 your gut that is undeniable. And that connection becomes the powerful fa- factor that allows you to understand why it happens and how we can fix it. We have, uh, our gut microbiome, and there are 38 trillion microbes that live inside of our large intestine, and they include bacteria and yeasts and, and archaea, which are these things that have been on the planet for four billion years, and possibly parasites. And so, in this entire community of microorganisms, they're there with a purpose, and that is to support you and your physiology. One of their key jobs is actually to, uh, basically feed the gut barrier that lines your entire intestines.

Steven Bartlett 7:46 Do you wanna show me, um, using this?

Dr. Will Bulsiewicz 7:48 Sure.

Steven Bartlett 7:48 Is this, uh, the right part of the body?

Dr. Will Bulsiewicz 7:51 So, now the large intestine, um, is the home to your microbiome. So these 38 trillion microbes, this is their, this is their residence, this is their domain where they live. Now, this entire system, which is, like, on the order of 20 or 25 feet, so, like, something on the range of six to eight meters, it's coated with a single layer of cells, which we call the epithelial layer, and that is your gut barrier. And it's a quite fascinating part of your body because this is like the castle wall and keeps the bad stuff out, but simultaneously needs to allow the good stuff in. And these cells, they turn over every three to five days. So, it's a beautiful thing actually because every three to five days, you have an opportunity to create a brand new gut barrier. So within the system, the microbes that live inside your colon, their job is to basically repair and restore the gut barrier. And when the gut barrier is intact, it's gonna do its job of protecting the immune system. And when the gut barrier starts to break down, then things can sneak across, which we would refer to as increased intestinal permeability, but the common language is leaky gut. The immune system will see and recognize things that aren't supposed to be there, and so the immune system then steps up and wants to take it out, and that basically means it needs to get activated and attack, and that is inflammation. So the breakdown of these three systems that start with the microbes, microbes are actually your first layer of defense, and then leading to the breakdown of the gut barrier is what ultimately activates the immune system, when we have things that are sneaking across that are not supposed to be there. The reverse can also be true, and that, to me, is where the exciting opportunity exists is that if you can heal the gut microbes, then the gut microbes can get back to work and do their job of repairing and restoring the gut barrier. And when you create a strong gut barrier, then basically you're protecting the immune system, and then what you see actually as the immune system cools off, and it becomes more tactical and capable of doing its job.

Steven Bartlett 10:14 Okay. And when we're eating lots of bad stuff, and, you know, many of the things we're gonna talk about today are causing a breakdown in those microbes, which is causing the gut barrier to worsen, which is causing the immune system to kick in, which is causing the inflammation, and the inflammation is therefore causing our cells to be damaged.

Steven Bartlett 10:34 What's the i- immune system overfunctioning causing? Like, you s- you were talking about the army analogy where there's an army and they're at war and some of them are damaging the surroundings.

Dr. Will Bulsiewicz 10:46 Mm-hmm.

Steven Bartlett 10:47 How is it damaging my surroundings, my immune system being on all the time?

Dr. Will Bulsiewicz 10:52 Well, so what ends up happening is it sets off this sort of chain reaction which can have an effect throughout your entire body where the immune cells, it's not just a couple of immune cells. They start to basically send out signals, and these signals, we call them cytokines. So you can measure those cytokines and those are basically communication tools that the immune cells are using with each other to basically call for help. So, and as they get revved up, these cytokines start to go out and then this leads to a cascade of even more immune cells releasing even more cytokines, and so, and then you kick off this wave. And, uh, this is what ultimately you can feel throughout your entire body, um, and it, and it has these consequences of basically causing damage to these individual tissues. So it depends on which tissue we're referring to. Inflammation in the liver we would call hepatitis, right? But at the same time, we have overwhelming evidence at this point that inflammation in the brain, which we call neuroinflammation, has been associated with mood disorders, so, like, major depression. Inflammation in the brain has been associated with cognitive disorders like Alzheimer's disease, Parkinson's disease. So, and it's not to claim,

Dr. Will Bulsiewicz 12:04 it's not to claim that all disease...... literally is related or caused by the gut microbiome. That's not the call. It's more so to say that we need to understand that our immune system is so powerfully connected to our microbiome that you cannot separate the two. And there's evidence to suggest that we can, we can manipulate. So whether it be antibiotics which decimate the gut, or the alternative, the, the opposite, would be a fecal transplant, which rapidly reinvigorates the gut and restores that gut architecture and ecosystem.

Steven Bartlett 12:39 What's a fecal transplant?

Dr. Will Bulsiewicz 12:40 So a fecal transplant is where you take a healthy person's poop and you transfer it into the person who's sick.

Steven Bartlett 12:47 And w- where are they administering it?

Dr. Will Bulsiewicz 12:49 The way that I've always done the fecal transplant, 'cause I've done many throughout my career, is during a colonoscopy. So if, in theory, I want to-

Steven Bartlett 12:58 A colonos- What's a colonoscopy?

Dr. Will Bulsiewicz 12:59 Yeah. So a colonoscopy is, is a medical procedure where typically you would be asleep. And while you're asleep, I take a long, flexible tube that is about the size of my index finger, and I can pass that, with control, all the way through the entirety of your large intestine, which is about five or six feet long. And I can actually dip into the last part of the small intestine, which we call the terminal ileum, which is down here in the right, the right lower part of the abdomen. You're administering the fecal transplant because they, they have this vicious infection called C. diff. And, uh, and again, those infections, this infection can be life-threatening. And you're administering the fecal transplant because the antibiotics are not working. So you need an alternative where the idea and goal is to restore balance within the gut ecosystem.

Steven Bartlett 13:56 Yeah, you're putting good bacteria in, not taking bad bacteria.

Dr. Will Bulsiewicz 13:59 Yeah.

Steven Bartlett 13:59 Not taking all bacteria out, I guess.

Dr. Will Bulsiewicz 14:01 So you put... And you put the good bacteria in, and when this happens, you're actually all at once reinstalling potentially hundreds of species in balance in the right amounts. So it's like an entire ecosystem transplant. It would be like us being like, "Okay, uh, here's this forest that's not doing well. We're gonna take the Amazon and we're gonna transplant it into this space." And now that we have all these animals that, like, do well in this space, the forest is lush and it's, it's vibrant again.

Steven Bartlett 14:34 So going back to our point about the immune system, the reason why the immune system is staying on is because I have damaged my gut, and it's essentially trying to repair my gut. And so if I live in a permanent state of a damaged gut because of what I'm consuming, then I'm gonna live in a permanent state, theoretically, of inflammation.

Dr. Will Bulsiewicz 14:51 The thesis from my perspective is that the modern world and the way in which we live is damaging our gut, damaging our microbiome, and then we're suffering the consequence of that, which is disruption of our gut barrier and ultimately the activation of our immune system in this forever war, which is chronically great inflammation.

Steven Bartlett 15:13 How is cancer

Steven Bartlett 15:14 associated with this? We... You talked, uh, about 130 different diseases. And in your book, uh, I think it's around page 22, you mention, I think it's chemotherapy, where you're making an analogy between how chemotherapy kind of wipes everything out and how, uh, a poorly kept gut is associated with an increase in cancer, uh, likelihoods.

Dr. Will Bulsiewicz 15:34 Let's start with this. Your body produces 3.8 million cells every second. Your immune system has the responsibility of identifying where there's a problem and taking it out. You can't possibly create 3.8 million new cells and not have some genetic abnormality that could turn into cancer. Right? So the responsibility of the immune system is to basically be perfect every day of your life and remove those problematic cells before they turn into something bigger and badder. It's an impossible task. There's an entire story that's unfolding now in this conversation about how the gut microbiome is connected to our immune system and the way in which we treat cancer. And it's, it started really in melanoma. We have been using sort of immune manipulations for a very long time to treat melanoma, but what changed is they were using these things called immunotherapy. To be more specific, immune checkpoint inhibitors. So it turns out that your immune cells have, like, basically a kill switch. If there was a problem, you could, like, flip it off immediately. And that specific receptor is called PD-1. And the tumors, they're so nasty, because they produce this protein that basically activates the kill switch.

Steven Bartlett 17:00 Turns off your immune system.

Dr. Will Bulsiewicz 17:01 And it turns off your immune system. So the immune checkpoint inhibitor, the idea is to basically flip that switch back on, and by flipping it on, activate your immune system, which will then wake up, see this cancer, be like, "Okay, that needs to be taken out," and go after it. If someone received antibiotics before the immune checkpoint inhibitor, they didn't do well. So then it raised the question, maybe this is a bi- microbiome thing. So they said, "Okay, well if antibiotics do this, what happens if we move in the opposite direction and basically act... like, restore the microbiome with a fecal transplant?" And what they discovered was incredible results. There's now multiple studies in melanoma where they take people and they give them a fecal transplant from someone who was a responder and give it to the person who's about to go get treated. And that's what they did, and, and with incredible results. Like, literally twice as many people were beating cancer relative to the expectation. The fascinating thing about

Dr. Will Bulsiewicz 18:06 that is that...It's not just a cancer story. There's research now in Parkinson's disease. So Parkinson's disease is a neurocognitive disorder, so that means basically it's a, it's a brain condition.

Steven Bartlett 18:22 Mm-hmm.

Dr. Will Bulsiewicz 18:22 Well, it turns out that Parkinson's probably starts in the gut, and this is actually a disorder of the gut-brain connection, because both parts are involved. It's not just the brain condition. The brain condition is actually the more severe part. So for the people who are listening at home, we have a model out (laughs) and I have just lifted their skull like, uh, Hannibal Lecter and exposed their brain tissue, and what we wanna talk about is the brain-gut connection, the connections between the brain and their intestines. And so we have classically thought of Parkinson's disease as being a brain, a brain health problem, but I'm here to tell you that this problem begins down here in the gut, and involves the connections between the two, because every single person that I've ever seen with Parkinson's dis- disease, they're constipated. All of them. And what's interesting is that they've now shown that the constipation comes before the Parkinson's disease. So now this doesn't mean for people who are constipated, there's a lot of you out there, this doesn't mean that if you're constipated you're going to develop Parkinson's disease. There's a very small percentage of people. But it's important to understand that the m- the manifestations of this health condition actually start in the digestive system before they actually transfer up to the brain. And so now in this study, Steve, what they did is they took these people who have Parkinson's disease, they gave them a fecal transplant.

Steven Bartlett 19:59 They gave them a poo transplant?

Dr. Will Bulsiewicz 20:00 They gave them a poo transplant.

Steven Bartlett 20:01 Hmm.

Dr. Will Bulsiewicz 20:02 And what they found was a year later, they had a durable continued benefit in terms of their movement issues. There are now other studies with Parkinson's disease that are showing benefit both for the brain and the symptoms of Parkinson's disease, but also for the gut in terms of that constipation that I was talking about.

Steven Bartlett 20:28 I mean, it begs the question, these poo transplants sound great. Can the average person go and get one?

Dr. Will Bulsiewicz 20:33 Well, I think we need to talk about that.

Steven Bartlett 20:35 (laughs)

Dr. Will Bulsiewicz 20:35 Yeah, we need to talk about that, 'cause there was a Netflix special where they made it sound like, uh, you should just do it at home. Do not do that. Please do not do that. So number one, we need to study and adequately understand what the risks are. The, the fecal transplant makes it sound like this is, like, the quick, easy thing that you do and you fix your entire life, but that's not the same as rebuilding your microbiome using the lifestyle, uh, and diet tools that actually are going to give you the meaningful health impact that you're searching for.

Steven Bartlett 21:07 Over the long term?

Dr. Will Bulsiewicz 21:08 Over the long term.

Steven Bartlett 21:09 A huge

Steven Bartlett 21:10 percentage of the population struggle with gut problems. We asked the Diary of a CEO audience and, uh, roughly it was over 60% of people that listen said that they're currently struggling with some kind of gut problem, whether it's bloating or some kinda discomfort or just, uh, digestion issues generally. Now, that's 61% of people responding to those three words, bloating, discomfort, irregular digestion. Then about 15% of people said that they have IBS. Like, 14%, 15% of people said, self-diagnosed, that they think they have irritable bowel syndrome. Am I right in thinking the causes of what they're saying they have are wildly different potentially? Or is it, like, one or two things? 'Cause I'm trying to figure out how I help those 61% of people that, like me, have... Eat something sometimes and then feel shit, and then not really sure what it is, feel a little bit bloated, might feel a bit gassy, um, might have strange digestion, but not necessarily sure what's causing it and when.

Dr. Will Bulsiewicz 22:11 Yeah. I mean, this is the same issue that I struggle with, right? So I- I- I write a book with the goal of trying to help as many people as possible knowing that you can't... there's no one-size-fits-all, right? So ultimately it's about empowering people with the right information and helping them to identify... I literally wrote about this in my author's note right in the front of the book, which is basically to say, "You're all gonna read the same book, but the way in which this book touches you is going to be unique to you." There's gonna be something in there that you're going to find that you're like, "That's my moment. That's my aha moment," right?

Steven Bartlett 22:43 Mm-hmm.

Dr. Will Bulsiewicz 22:43 And for many people, like, just looking statistically, looking at the average American diet, there's a huge opportunity when it comes to diet, and that is where I put a lot of energy and attention because I just, I know what the stats say, so I know America needs this. But at the same time, there's a conversation that gets into other topics that... Look, the way that we live is different than the way that our grandparents grew up when they were kids.

Steven Bartlett 23:08 Mm-hmm.

Dr. Will Bulsiewicz 23:08 To me, it's more about, like, helping people to see, like, what is that one thing for them? There's some people who are gonna be listening to this that it's not their diet, it's not sleep, it's not circadian rhythm, it's trauma, and I think that these are things that need to b- like, we need to shine a light on that.

Steven Bartlett 23:23 We'll do all of

Steven Bartlett 23:24 that. On this point about bloating, discomfort, irregular digestion, if I have one of those things, does that theoretically mean that something is not right?

Dr. Will Bulsiewicz 23:33 Everyone gets bloated once in a while. So I think, I think it would be unfair to make it sound like you should never have any adverse symptoms at all, right?

Steven Bartlett 23:41 But if it's prolonged?

Dr. Will Bulsiewicz 23:42 But if it's prolonged, if it's a chronic health issue, if you're the type of person who you wake up in the morning and you say, "I hope today's gonna be a good day. I hope I don't have to deal with that specific issue," you are, you have a problem. Like, we already know, and then we have to work on that to address that issue, and how we go about that, I think, needs to be on some level personalized. But the tools that are at our disposal remain the same, so it's just a matter of, like, let's put it on the table....here are your choices, you pick which ones are most applicable to you. Where are the opportunities for you? And I, I can't tell you that without knowing more about you.

Steven Bartlett 24:17 What about this issue of people getting gassy, like farting a lot?

Dr. Will Bulsiewicz 24:20 Yeah.

Steven Bartlett 24:21 Is that typically associated with one particular gut issue? Or is that, again, could that be a plethora of issues?

Dr. Will Bulsiewicz 24:26 So it could be a pl- it could be a plethora of issues. This is, (laughs) this is a common problem. If I have to, like, start with what is my number one thing, it's constipation, for sure, 100%. There are so many people who are listening right now that are constipated and they don't even know it because they poop every day and they think that how often they poop is the definition, and that's not true. So constipation is what happens when you're not adequately emptying your bowels and that could be a frequency problem, but it could also be that it's a partial poop.

Steven Bartlett 25:04 Oh, okay, 'cause I thought constipation was if you just haven't been s- you can't go, you go to the toilet and nothing comes out.

Dr. Will Bulsiewicz 25:09 Look, don't get me wrong, if you, if you don't poop for a week, I know you're constipated. I don't need to ask any more questions.

Steven Bartlett 25:14 Mm-hmm.

Dr. Will Bulsiewicz 25:14 If you go a week... But if it's, there are people who they poop every other day, that's their normal, they feel fine, they don't have any gut symptoms, they don't have a constipation problem. We're okay. Right?

Steven Bartlett 25:25 So frequency is not the be all and end all?

Dr. Will Bulsiewicz 25:28 It's part of the, it's part of the equation, right? But there's also people who, they poop, and I w- I wanna sort of paint the picture, and f- forgive me, like, I feel very comfortable talking about poop. This is what I, I've done for a living.

Steven Bartlett 25:40 Mm.

Dr. Will Bulsiewicz 25:41 But they, they go to the bathroom in the morning, they struggle, it's not satisfying, they had to work really hard to get a little nugget to come out and then they feel like they still have to go. And maybe 45 minutes later, they poop again. Okay, that's not a new poop. You're doing partial poops. You're probably doing a 20 or 25% poop so you could poop three, four times during the day. You might not still be fully emptying your bowels, right? And so that, so that's an example of a person who can actually be struggling with bloating and constipation and not think because they're like, "Doc, I'm pooping three times a day."

Steven Bartlett 26:21 Where is the gas coming from in that s- why, why do people f- y- you eat something and then you fart a lot? W- what's going on?

Dr. Will Bulsiewicz 26:27 So gas, so gas travels with poop. Um, uh, you may, I don't mean you specifically, Steve, people listening may notice this, that you wake up in the morning and you're farting like crazy and that farting continues until you actually have your morning bowel movement and then once you have your good, healthy morning bowel movement, you feel solid and you're not farting anymore, right? The gas travels with the poop. So, and the reason why this happens is because first of all, your poop is not just the leftover remains of your food. Actually, your poop is predominantly your microbiome. 60% of the weight of your stool is microbial.

Steven Bartlett 27:10 Really?

Dr. Will Bulsiewicz 27:10 Yes.

Steven Bartlett 27:12 S- when you say microbial, you mean like the bacteria?

Dr. Will Bulsiewicz 27:14 The bacteria.

Steven Bartlett 27:15 60% of it's bacteria?

Dr. Will Bulsiewicz 27:15 Let me give you an example. If I took your drink and I added some soluble fiber, which is prebiotic, into your drink-

Steven Bartlett 27:23 Yeah.

Dr. Will Bulsiewicz 27:24 ...there's no grit, there's no roughage, you don't even know it's there and you're gonna have a bigger, healthier bowel movement tomorrow as a result of what I just did. Why? Because I fed your microbes and they grow stronger and then they multiply and because they multiplied, you have a bigger bowel movement.

Steven Bartlett 27:42 Mm-hmm.

Dr. Will Bulsiewicz 27:42 Right? That's the way that that works. Now don't get me wrong, you eat, you know, a salad, you're gonna end up with a bigger bowel movement as well but a big part of that is the fiber i- th- within that salad that's feeding these microbes. They multiply, they grow and you have a big bowel movement.

Steven Bartlett 27:57 So if that was my, if that was my, my stool, my poop, I'm holding a chocolate bar here, 60% of that would be the microbes?

Dr. Will Bulsiewicz 28:05 60% of that would be the microbes. Yes. So for that person, when the poop is in gridlock and it's not moving through, then those microbes are basically sitting there with unlimited time to ferment and produce gas.

Steven Bartlett 28:23 Okay.

Dr. Will Bulsiewicz 28:23 So anything they come into contact with, they're just gonna start working on it. So it, and it's not just, like, a fiber thing. Anything they come into contact with, it could be protein, they will ferment it, they will produce gas. So this is a big part of the reason why constipation is so strongly associated with gas and bloating.

Steven Bartlett 28:39 When people eat dairy and things like that, and s- I think some people that have gluten, they, they often tend to get a little bit gassy.

Dr. Will Bulsiewicz 28:45 Yeah.

Steven Bartlett 28:46 Is that constipation?

Dr. Will Bulsiewicz 28:48 Gas and bloating is not just a constipation issue. I would argue that constipation is the number one cause of that particular issue but there's many potential causes. Number one could be motility. That's constipation.

Steven Bartlett 28:59 What's motility?

Dr. Will Bulsiewicz 29:00 Motility is the way in which your intestines move. So if the intestines move too fast and out of rhythm, you get diarrhea. If the intestines slow down too much, sluggish, you get constipation. We want the intestines in a rhythm because when they're in a rhythm, just like your heart, that's when they perform their best. So in a rhythm basically means predictable, consistent, daily bowel movements. That's ultimately where we would love to be, right? And that, in a way, taps into, like, an entire circadian conversation that we can have later. This is a part of your circadian rhythm is a fantastic morning bowel movement. Motility is just one of the causes of gas and bloating. The second is the microbiome. If you have a microbiome that's damaged and struggling, it's not gonna be able to do its job the way it's supposed to and part of its job is processing and breaking down fiber because the fiber in our diet, we don't have the enzymes to digest it so it works its way through the intestines, comes into contact with the microbes and the microbes, they have literally 60,000 enzymes that we don't have as humans. They go to work as teams, fiber stops being fiber, produces short-chain fatty acids. This is the way that it's supposed to work.... when your gut is not happy, they're weak, the microbes are weak, and you're asking them to do work, and they can't handle that. And you end up with sloppy digestion, and that's gas and bloating. The third thing can be your diet. So you just mentioned dairy, which contains lactose. Lactose can be easily fermented to produce gas. You mentioned gluten. Gluten itself is a protein. So can gluten technically be fermented? Yes, it can be technically fermented, but that's not really the... that's not really what's going on. What's happening is that gluten-containing foods, which are wheat, barley, and rye, also contain these carbohydrates called fructans. And fructans are actually really good for our microbes. They're prebiotic. But if you consume a very large amount of them and you're not used to eating these foods, it can cause gas and bloating.

Steven Bartlett 31:19 These days... When I was younger,

Steven Bartlett 31:21 if I had, uh, if I had pasta, I was fine. If I have pasta these days, I'm gonna feel it for the next, like, two, two days.

Dr. Will Bulsiewicz 31:28 Really?

Steven Bartlett 31:28 Yeah. I don't know. And I don't even know what's going on. But then other people can eat pasta as much as they want, it seems.

Dr. Will Bulsiewicz 31:34 Out of curiosity, can you go to Italy and eat pasta and be okay, or no? Same thing.

Steven Bartlett 31:38 I haven't really... not really tried. Um...

Dr. Will Bulsiewicz 31:40 Okay.

Steven Bartlett 31:41 Anecdotally, I think when I remove... when I have, like, non-gluten bread or non-gluten pasta, I th- I think I'm... I feel much better. But I... but I'm well aware, from speaking to people like yourself, that such a small percentage of the population is actually gluten-intolerant, but we all kind of think we are to some degree. I think it's... What's, what's the, the numbers? Is it, like, 20% of people think they are or something?

Dr. Will Bulsiewicz 32:04 So, like, here in Los Angeles, it's, um, like, probably 80% of people.

Steven Bartlett 32:09 Think they're gluten-free.

Dr. Will Bulsiewicz 32:10 Well, like, e- almost everyone's gluten-free.

Steven Bartlett 32:12 Yeah.

Dr. Will Bulsiewicz 32:12 Right?

Steven Bartlett 32:12 Which...

Dr. Will Bulsiewicz 32:13 They don't need to be. And, and actually, it can cause problems. It can, it can cause problems to be gluten-free unless you know what adaptations to make.

Steven Bartlett 32:23 So what are you... When you asked that question about Italy, what were you getting at?

Dr. Will Bulsiewicz 32:25 There's a processing issue in the United States involving wheat, which is that they allow the wheat to be sprayed with glyphosate, which is Roundup. It's a weed killer. And y- they do that to basically dry it out as quickly as possible. So imagine for a moment that you're a farmer, and you have this, this field of wheat, you harvest it, okay? Here are your choices, Steve. You can wait a couple weeks and let it dry out naturally in the air and, and store it somewhere, or you can spray it with this chemical and it will be dry by tomorrow and then you can ship it out.

Steven Bartlett 33:01 Yeah.

Dr. Will Bulsiewicz 33:02 Right? And the problem is that glyphosate is not on the label. You would never know whether it's sprayed or not sprayed unless you're buying organic. If you buy organic, then by definition, they're not allowed to spray it. You would never know if it's there. The, the, the thing about glyphosate is that it's been approved to exist in our food system under the assumption of safety. Because what it does is it shuts down this thing called the Shikimic pathway, and that kills weeds or it kills plants. And we have a workaround, and it has to do with basically amino acids. We have a workaround where we can basically create those amino acids as humans, but the plants can't. So the plants die, we live. But there's a problem, which is that the microbes that live inside of our large intestine, they don't have the workaround. So that microscopic amount of glyphosate, y- you would say, "Well, us big humans, that's so small." Yeah, well, what do you think happens when it comes into contact with them? We know that glyphosate disrupts the microbiome, that it depletes the beneficial bacteria, and the ones that tolerate it the best are the inflammatory ones.

Steven Bartlett 34:25 The bad bacteria.

Dr. Will Bulsiewicz 34:26 The bad bacteria. So you're shifting the balance, and this is... this is a small thing, but I hear from people, Steve, that go to Italy. They say, "I can't eat wheat in the United States." And then they go to Italy and they're fine.

Steven Bartlett 34:39 And you think it's that glyphosate?

Dr. Will Bulsiewicz 34:40 Yeah, they don't do that there.

Steven Bartlett 34:41 So if I tried... I'll try organic pasta tonight, and maybe that will be better.

Dr. Will Bulsiewicz 34:47 Yes. And then, like, the alternative choice is... How do

Dr. Will Bulsiewicz 34:51 you do with bread? Are you okay?

Steven Bartlett 34:53 Uh, not all bread. My, my... Generally, I stay away from bread.

Dr. Will Bulsiewicz 34:59 Okay. Do you ever eat sourdough?

Steven Bartlett 35:00 Yeah.

Dr. Will Bulsiewicz 35:01 Do you do okay with sourdough?

Steven Bartlett 35:02 Yeah.

Dr. Will Bulsiewicz 35:03 There we go. So here's the... here's the second part of this equation. Put the glyphosate, put that to the side for a moment. Let's talk about the fructans that we were talking about a moment ago.

Steven Bartlett 35:11 Mm-hmm.

Dr. Will Bulsiewicz 35:11 When you ferment your, uh, your wheat, when you ferment your dough, you actually reduce the fructan content.

Steven Bartlett 35:20 What's fructan?

Dr. Will Bulsiewicz 35:21 So these are the, the long-chain carbohydrates that exist in wheat, barley, and rye. So if it contains gluten, it also contains these fructans. Like, gluten is not the only thing in wheat, right?

Steven Bartlett 35:32 Mm-hmm.

Dr. Will Bulsiewicz 35:32 And these fructans, again, they're good for you. They're good for your microbiome. But people who have a slightly damaged gut, they struggle to process and digest them. So this would explain why some people, they eat... they eat, you know, wheat-containing, gluten-containing foods, and they struggle, but they do okay with sourdough. Because if you ferment the, the bread, it takes... it reduces the fructan content, and actually then you can tolerate it.

Steven Bartlett 35:58 Oh, okay. So you think it might be the fructan in the bread that

Steven Bartlett 36:01 I have an issue with, and sourdough doesn't have fructan in it?

Dr. Will Bulsiewicz 36:04 Yeah, there was... there was a study that was in Gastroenterology a few years ago. Gas- Gastroenterology is the top journal in my field, where basically they, they sent people home with a bunch of breakfast bars, all right? Not chocolate, but nonetheless, they sent people home with a bunch of breakfast bars, three of them. One of them was a placebo bar, so they didn't add anything special. One of them contained a very large concentration of gluten.And then the third one contains the fructans. And the placebo is our standard. We're gonna compare to that. When people ate the gluten-containing bar, and these were, by the way, people that, um, they did not have celiac disease, they did have gluten problems according to them, right? So, like, this is like the 20% of people that you mentioned a moment ago who think they might have a gluten problem. When they ate the gluten-containing bar, they actually had less symptoms than the placebo. So in other words, the gluten is not the problem. But when they ate the fructan-containing bar, they were triggered. So basically what this said is that we have been taking this concept of gluten intolerance, and we've, we've misnamed it. It's not a gluten intolerance. It's a fructan intolerance. These are people who are t- tending to struggle with these particular parts of that food.

Steven Bartlett 37:25 What foods contain fructan?

Dr. Will Bulsiewicz 37:27 So, uh, wheat, barley, and rye.

Steven Bartlett 37:30 Okay.

Dr. Will Bulsiewicz 37:31 And different... There's, there's many different types of fructans, by the way, so you may not react to all of them. You may react to just some of them.

Steven Bartlett 37:41 Mm-hmm.

Dr. Will Bulsiewicz 37:42 But, like, garlic and onions are also classic. So you hear people who are like, "I can't eat garlic. I feel horrible." Right? That's a, that can be a fructan issue. Teff, amaranth, sorghum, um, quinoa these are, these are whole grains that don't contain gluten, and they also don't contain fructans.

Steven Bartlett 38:03 Hmm. How long does it take to

Steven Bartlett 38:06 repair the gut when you have done damage to it? That's a very broad question intentionally, but generally for the average person who's done, who's sort of irritated their gut, how long does it take to restore and for those microbes to go back?

Dr. Will Bulsiewicz 38:20 It really depends. You have to start with, okay, what's your starting point, right? Like, how deep is the damage? How bad is it? Because for the people who have ulcerative colitis or Crohn's disease, those are forms of inflammatory bowel disease. Those people have the deepest dys- dysbiosis. Dysbiosis is the word that we use for damaged gut.

Steven Bartlett 38:40 Is it possible to reverse that?

Dr. Will Bulsiewicz 38:43 Um, it's possible to put them into remission so deeply that they don't have a flare.

Steven Bartlett 38:50 Is that what the flare looks like on this little model that I have in front of me?

Dr. Will Bulsiewicz 38:53 Yes. So, so going back, for the people who are listening and not on YouTube, you can flip over to YouTube if you're interested. But what I'm showing here is the model of the large intestine, and the model includes a little area that it looks raw-

Steven Bartlett 39:07 Mm-hmm.

Dr. Will Bulsiewicz 39:08 ... ulcerated. It's bleeding. It, if, if you, if you were to bump up against it, it's gonna start to... You'll start to see blood coming out. So it's like a... It's a very vulnerable, sensitive, uh, area. Now, these inflammatory bowel diseases, Steve, I have an interesting study on this topic. They are, to me, the classic gut inflammatory health condition. And what's happening is the immune system is attacking the microbiome. So technically, it's not actually autoimmune because autoimmune would be you're attacking your own body. The immune system's not attacking your intestines. The immune system is attacking your microbiome and rejecting it. And because that's happening, your intestines are in the middle.

Steven Bartlett 39:54 So this here is the immune system attacking the microbiome.

Dr. Will Bulsiewicz 39:58 It's attacking the microbiome, which is in the tube of the large intestine, and the immune system is trying to get at it and kill it.

Steven Bartlett 40:06 Why?

Dr. Will Bulsiewicz 40:06 And... Because it's decided that it's the enemy. So the immune system is confused because when we're born, we don't have much of a microbiome at birth. It's the closest that we will get to not really having anything. And then during the first three years of life, you build your microbiome through your life experience. And by three years of age, you are basically fully adult-sized in terms of your microbiome. During this time, your immune system is learning from and with those microbes. So there's this interplay between the two that is undeniable where when the microbiome is healthy during childhood, during those first three years, it results in a healthier immune system.

Steven Bartlett 40:50 So what's gone on here?

Dr. Will Bulsiewicz 40:51 S- the immune system is supposed to acknowledge your microbiome as being friendly, and it does not. It decides that your microbiome is the enemy, and so it's taking it out.

Steven Bartlett 41:03 So what, what, what

Steven Bartlett 41:04 do you think is... For someone that has, like, irritable bowel syndrome or Crohn's disease and they, or they, you know, they have one of these big sort of ulcers in their small or large intestine, is it because of their lifestyle typically?

Dr. Will Bulsiewicz 41:17 So-

Steven Bartlett 41:17 A lifestyle change or, or is it lots of things? What's the number one perpetrator?

Dr. Will Bulsiewicz 41:22 Okay. There's clearly a genetic component.

Steven Bartlett 41:25 Okay.

Dr. Will Bulsiewicz 41:25 Okay? So we have to, we have to be upfront about that. Like, these are, these are things that are not necessarily within a person's control entirely.

Steven Bartlett 41:32 Because, I mean, there's no evolutionary reason why this would happen. Like, there's no evolu- evolutionary reason why you'd have severe gut digestion problems.

Dr. Will Bulsiewicz 41:40 No, it's not to, uh... There's no advantage to it-

Steven Bartlett 41:42 Yeah.

Dr. Will Bulsiewicz 41:42 ... at all. And, and these things that, uh, that occur, they were quite rare years ago. In fact, in third world countries today, there's not much inflammatory bowel disease. There's not a lot of Crohn's disease and ulcerative colitis in third world countries. If you go to Africa, there's very little. And what then... What you see though is as countries industrialize, there's a takeoff and th- they start ramping up. So within the United States over the course of 40 years from 1970 to 2010, ulcerative colitis and Crohn's disease cases were increasing by up to 55%.

Steven Bartlett 42:18 And you can get that at any age?

Dr. Will Bulsiewicz 42:20 You get that at any age. Yeah.

Steven Bartlett 42:21 So even if I'm healthy right now, I, I could do a set of things that would give me this?

Dr. Will Bulsiewicz 42:25 Yes. In fact, if you take... So back to our conversation

Dr. Will Bulsiewicz 42:29 about antibiotics. If you take antibiotics, your risk of developing an inflammatory bowel disease in the next year just doubled.

Steven Bartlett 42:36 Oh, gosh.

Dr. Will Bulsiewicz 42:37 If you disrupt the gut with antibiotics, which the antibiotics do, there's nothing...... that will basically, like, decimate the gut faster, reducing gut diversity, disrupting the gut barrier by 50% during the course of antibiotics, and activating the immune system. It really speaks to that, like, if you take antibiotics, these risks of inflammatory health conditions really start to go up. We see this in both adults and kids.

Steven Bartlett 43:02 You had a patient of yours called Michelle

Steven Bartlett 43:04 who took antibiotics and had a life-threatening swelling of her colon. This is, this is the colon, right?

Dr. Will Bulsiewicz 43:12 The-

Steven Bartlett 43:13 Show me where the colon is.

Dr. Will Bulsiewicz 43:14 So the colon is the large intestine.

Steven Bartlett 43:16 Okay, fine, yeah. Okay.

Dr. Will Bulsiewicz 43:16 Yeah.

Steven Bartlett 43:17 And so she took an antibiotic and had a life-threatening swelling of the, of her large intestine?

Dr. Will Bulsiewicz 43:21 So she took an antibiotic, she took clindamycin, which is a classic skin antibiotic.

Steven Bartlett 43:28 Okay.

Dr. Will Bulsiewicz 43:29 And the problem is that clindamycin wipes out your gut, like hard. And when that happens, there's a risk that this pathogenic, like, bad bacteria called C. diff, if it's in there, it can multiply and then you get this infection, the C. diff infection that causes inflammation of the entire colon. So this patient, Michelle, what happened, I was on call and I get this p- text and they say, "You gotta come to this room right now. This patient is sick." And she had just been transferred in from an outside hospital. So I was in the middle of typing up a consultation, dropped that, run through the hospital, walk into the room. She's clut- clutching her belly and she's moaning and groaning and she has no clue where she is. She's sweaty, she's pale. Her vital signs are completely out of whack. Her heart is racing. She's breathing really fast. And, um, and I did a, a little test, which is that I gently bumped her bed, just like that. And if a person has severe inflammation of their intestines, they will jump if you do that, because they have peritonitis, right? Or you could call it an acute abdomen. So just by bumping the bed like that was enough for her to, "Aah!" And she's screaming, right? And clutching her belly. And she has no clue where she is or what is going on. She's completely delirious. Uh, she was maxed out on antibiotics. Our choices were to rush her to surgery, remove the colon, or alternatively to give her a fecal transplant and give her a shot at keeping her colon. So I take her down to the operating room and I actually, um, used a ... I mean, I, I won't bore you with the details, but I used a special technique that's atypical for what I would normally do, because the inflammation was so severe, to pass a scope. So the scope that I used was a smaller scope, to be more gentle.

Steven Bartlett 45:35 A scope being a tube?

Dr. Will Bulsiewicz 45:36 A scope is a tube. And I mentioned that if you get a colonoscopy, it's the size of my index finger, so that's, like, probably about a centimeter across. But I f- I instead went with a smaller scope that's more like five millimeters, six millimeters across. It's more gentle. And it just makes it harder to do, but I, I basically passed the scope through her rectum and all the way through her intestines to get it over here on the right side, so that's basically like I have now passed all the way through her large intestine. And in that location, I delivered the fecal transplant to her. And so the amazing thing is that, number one, that procedure went really well. By the next day, she was a h- normal human being. She was laying in bed. She was able to have a conversation. And after two days, she was so normal that we were able to send her home. So the entire severe infectious issue that she was facing got shut down and corrected by restoring her microbiome. And then when you restore the microbiome, the C. diff basically gets suppressed and the immune system falls back into balance, the inflammation washed away.

Steven Bartlett 46:54 So do you have, like, a, like a fridge full of these fecal matters that you can, like, just tap into when s- when you need it?

Dr. Will Bulsiewicz 47:00 No, but there is a company in, in Massachusetts that does.

Steven Bartlett 47:03 Okay.

Dr. Will Bulsiewicz 47:03 Um, and so ... And that's what most hospitals use is they'll basically have this sent in. But it's actually kinda interesting 'cause there's, there's new development in this space where, for the first time, drug companies are actually identifying how to manipulate the microbiome using things that are not actually a fecal transplant, but sort of derived from the idea.

Steven Bartlett 47:25 Mm-hmm.

Dr. Will Bulsiewicz 47:25 Now what they're developing is a way to rebuild the gut and protect it during this period of vulnerability. So that's the new thing that's coming.

Steven Bartlett 47:34 You must hear about so many different types of diets and juice cleanses and whatever else that influencers and podcasters promote that you absolutely hate, because you have a deeper understanding of the consequences on the gut. What are some of the biggest diets, or, I don't know, the sort of trends that you absolutely despise because they are misinforming people about how to create a healthy gut?

Dr. Will Bulsiewicz 48:00 Well, I think the thing from my perspective is that, um, uh, trends fluctuate hard.

Steven Bartlett 48:07 Yeah.

Dr. Will Bulsiewicz 48:08 Right? In 2020, it was like the vegan diet was in.

Steven Bartlett 48:12 Mm-hmm.

Dr. Will Bulsiewicz 48:13 In 2023, it was the carnivore diet. You couldn't have more diametrically opposed diets.

Steven Bartlett 48:19 Yeah.

Dr. Will Bulsiewicz 48:19 Right? And s- and so the problem is that to the person who's at home and they're trying to get this figured out, it's very easy to get sucked into whatever the trend is because that's what you're hearing about when you open up your social media, right? Whereas as I sit here, the science has not changed that dramatically in the last five years. We are working on this, but these are small fluctuations in terms of our understanding of things. It's not a radical ... We, we don't whiplash like that, right?

Steven Bartlett 48:46 Mm-hmm.

Dr. Will Bulsiewicz 48:46 So nor has your biology. You have the same biology five years ago, so this entire concept of, like, whipping people all over the place is total bullshit from my perspective. I wanna start by saying that...Any person who has the audacity to change their diet in the interest of their health, like I actually, I actually think that's incredible. And it doesn't matter what your choice is because you're just trying to figure it out. And ultimately, I just want people to be better. But the problem is that there's a lot of dietary advice that's insane, and it comes on both sides, Steve. So absolutely, I don't believe that a 100% meat or organ-only diet is in balance or the optimal solution for longevity, but on the flip side, like a fruit-only diet, I would never support or recommend either. That's completely insane. What are we doing? So I think that like these highly... the more restrictive that you get, the more that I think you're drifting away from what is quite simple, which is whole food in balance.

Steven Bartlett 49:50 What about these, like, juice diets and stuff like that people do? People do, like, a seven-day juice diet or water diet or whatever.

Dr. Will Bulsiewicz 49:58 So you will, you will often feel better if you have gut issues and you take away the stuff that's irritating your gut. And so simplifying your diet and doing something like that, you can make yourself feel better on a temporary basis and think that you did something. Generally speaking, that's not really doing much, uh, o- of anything at all.

Steven Bartlett 50:20 How long does it take to both kill and then create new, new gut microbes?

Dr. Will Bulsiewicz 50:24 Well, so the beauty of it is that your gut is very forgiving, so the choices that you make today will be reflected in your microbiome by tomorrow. The beauty of it is that these microbes, like their superpower is that they are able to procreate so fast.

Steven Bartlett 50:40 Procreate meaning?

Dr. Will Bulsiewicz 50:41 Making babies. So they can make... they can create new generations, like estimates are potentially as quick as 20 minutes, and so we can use that to our advantage because if we actually support them with what they need, change can come real quick. And, you know, I get back to every three to five days, you build a new gut barrier, so there's an amazing opportunity that we have to actually see some quick health effects.

Steven Bartlett 51:10 Are there any big sort of health myths or diet myths that you're concerned about that people are currently following or believe in particular? Is there anything you look out into the world and think, "Oh God, that's going to be awful for the gut"?

Dr. Will Bulsiewicz 51:21 Oh gosh, it's not something that I pay a ton of attention to because I'm not on TikTok, to be honest with you.

Steven Bartlett 51:27 (laughs)

Dr. Will Bulsiewicz 51:27 So, um, it's... I find it interesting that actually, like TikTok, some of the trends that have come more recently are actually on point. So... which feels great because I love it when, like, people are getting excited about stuff that's good, the f- like the fibermaxing

Dr. Will Bulsiewicz 51:41 trend.

Steven Bartlett 51:42 I've not heard about them.

Dr. Will Bulsiewicz 51:43 So fibermaxing, it feels like after not really talking about fiber for a really long time, people are starting to come around to the benefits that come from fiber, and this was really exemplified on TikTok with this fibermaxing trend where people are basically trying to increase their fiber profoundly. So the issue though is that you have to ease your body into it, so I think the idea is the right idea of where people are trying to go, but the execution, I just want people to do it in a way where they feel okay 'cause if they don't feel well, they're gonna bail, and then they're gonna think, "Well, fiber's not for me."

Steven Bartlett 52:23 And what was this trend? It was people trying to just get above their... up and above their daily recommended dose of fiber-

Dr. Will Bulsiewicz 52:29 Yes.

Steven Bartlett 52:29 ... by eating high-fiber foods like-

Dr. Will Bulsiewicz 52:31 Yes, and acknowledging that 95% of people in the United States and 90% of people in the UK are deficient in fiber as we sit here right now, so-

Steven Bartlett 52:39 And what complications or implications does that have for one's gut microbiome?

Dr. Will Bulsiewicz 52:43 Massive. Massive.

Steven Bartlett 52:44 Because fiber's feeding the good bacteria.

Dr. Will Bulsiewicz 52:46 Fiber is the principal food for the good bacteria, and it is the precursor to short-chain fatty acids. So the short-chain fatty acids are what we create when fiber comes into contact with microbes.

Steven Bartlett 53:00 Short-chain fatty acids are the thing we create when fiber comes in contact with the gut microbiome-

Dr. Will Bulsiewicz 53:05 Yes.

Steven Bartlett 53:06 ... bacteria. Okay. And the short-chain fat- fatty acids are really good.

Dr. Will Bulsiewicz 53:10 They're so good. In fact, of all the things that I've stu- studied and learned about, these are the most anti-inflammatory thing that I've ever come across. So there's three of them, three main ones: acetate, propionate, and butyrate. They all have their own distinct effects within the body. They have effects right there in the gut on the microbes, on the gut barrier, on the immune system.

Steven Bartlett 53:37 And these are produced... these three things you just named are produced when fiber comes in contact with the gut microbiome?

Dr. Will Bulsiewicz 53:42 Yeah, so like if you were sterile, if you didn't ha- if you were born without a microbiome-

Steven Bartlett 53:45 Mm-hmm.

Dr. Will Bulsiewicz 53:46 Um, like, do you ever hear about Bubble Boy?

Steven Bartlett 53:48 Oh yeah. The f- it was a film or TV show, wasn't it?

Dr. Will Bulsiewicz 53:50 Yeah, it was like a documentary in the '70s of this kid who was... he was born with this rare genetic immune disorder, and so his family, in order to try to protect him, they isolated him thinking if, if no bad stuff can get in, then he would be fine, right? So, like, he lived in a sterile bubble. So in theory, if you were sterile, you would never get the benefits of these short-chain fatty acids.

Steven Bartlett 54:15 Because you'd never have bacteria.

Dr. Will Bulsiewicz 54:17 Because you don't have bacteria.

Steven Bartlett 54:18 Okay.

Dr. Will Bulsiewicz 54:18 So... but we have the alt- the opposite of that problem, which is that we have bacteria but we don't feed them. We don't give them fiber. You can't create something from nothing, so you have to give them the fiber in order to allow them to create the short-chain fatty acids from it.

Steven Bartlett 54:33 And these short-chain fatty a- so I've got my

Steven Bartlett 54:36 gut microbiome in my gut here. I put fiber in there in the form of what foods are the best foods for fiber?

Dr. Will Bulsiewicz 54:43 Okay, so what we have here is an entire array of choices-

Steven Bartlett 54:47 Mm-hmm.

Dr. Will Bulsiewicz 54:48 ... and the beauty of it is that there's only one thing that I can spot on these two plates that does not contain fiber. Do you wanna guess?

Steven Bartlett 54:57 I guess that it is...Okay.

Dr. Will Bulsiewicz 55:01 You want me to give it to you?

Steven Bartlett 55:02 Let's see what that does. Is it the... It's not the turmeric, is it?

Dr. Will Bulsiewicz 55:06 No.

Steven Bartlett 55:07 Okay.

Dr. Will Bulsiewicz 55:07 But the turmeric prob- probably doesn't have very much.

Steven Bartlett 55:09 Okay.

Dr. Will Bulsiewicz 55:09 No, it's the oil. Because the issue is that this is 100% fat. So you, by definition, cannot have any fiber inside of an oil.

Steven Bartlett 55:21 Okay. So-

Dr. Will Bulsiewicz 55:21 Right?

Steven Bartlett 55:21 ... it's like sunflower oil, olive oil.

Dr. Will Bulsiewicz 55:23 So, yeah, uh, whatever, whatever type. Now, it c- you could have polyphenols. Like extra virgin olive oil has polyphenols that are really good for the microbiome.

Steven Bartlett 55:30 Mm-hmm.

Dr. Will Bulsiewicz 55:31 Extra virgin olive oil is actually incredibly good for the microbiome. But it doesn't have fiber. Everything else has fiber. So we have all these different plant-based foods, and the beauty of it is that it doesn't have to be com- complicated. Fruits, vegetables, whole grains, seeds, nuts, and legumes, they all have fiber.

Steven Bartlett 55:48 Meat?

Dr. Will Bulsiewicz 55:49 Anything that's not a plant, does not have fiber.

Steven Bartlett 55:52 Oh, okay. So if it grows in the ground, it has fiber?

Dr. Will Bulsiewicz 55:54 So if it comes f- if it comes from a plant, it has fiber. And that includes, by the way, the mushrooms. So the mushrooms are technically fungi, um, but they share a lot of the same characteristics that the plant-based foods do. So there's fiber, there's polyphenols. All of these things we want to include in a healthful diet.

Steven Bartlett 56:12 So if I eat these high-fiber foods, they go into my gut. The microbiomes produce this thing called short-chain fatty acids.

Dr. Will Bulsiewicz 56:18 Mm-hmm.

Steven Bartlett 56:18 And the short-chain fatty acids, they produce more good bacteria, but also, they help my immune system calm down?

Dr. Will Bulsiewicz 56:26 Yes. So if you think about... Let's go back to the model that we led off with, which is that there's these three parts to your immune system. Or actually, your d- I should call it your defense system. Because your gut microbes are the first layer of defense, right? That was what was broken down by the antibiotics in Michelle.

Steven Bartlett 56:42 Mm-hmm.

Dr. Will Bulsiewicz 56:43 The second layer of defense is your gut barrier, which is the lining of your gut that protects the immune system.

Steven Bartlett 56:48 Mm-hmm.

Dr. Will Bulsiewicz 56:49 And then the third part is the actual immune system itself. We don't even want to have to activate that. We'd rather the first two parts take care of it for us, right? So the beauty of this is that you eat, you consume these high-fiber foods, they come into contact with your microbes right here in the large intestine, specifically the right colon is the classic spot, and they, they unpack them, and they release the acetate, propionate, and butyrate. And those three things impact your microbes, impact your gut barrier, impact your immune system. Now of the three, my favorite is butyrate, because it's the butyrate that has the biggest effect on the microbes on the gut barrier. Like you literally need butyrate in order to produce the proteins that holds your, uh, your gut lining together. Um, and the butyrate has a direct effect on our immune cells. So these are, again, the most anti-inflammatory thing that I've come across. And part of why we're suffering with these, going back to the original conversation about these chronic inflammatory health conditions, and you asked me, "Where do they come from?" We live in an industrial world where 95% of us, at a minimum, 90% of us are not getting even close to the amount of fiber that we need. And when we compare this to other places... So there was an interesting study that came out recently where they looked at the microbiome of people in Italy, Singapore, and then they had native tribal people in the Bolivian Amazon, and native tribal people in Malaysia. So two indigenous tribes living a, you know, hunter-gatherer lifestyle, against Italy and Singapore. And what they discovered is that there's this radical difference in terms of the diversity of the microbiome, there's a difference in terms of, um, their pro- their ability to produce short-chain fatty acids, and there's this question that sh- comes up about aging.

Dr. Will Bulsiewicz 58:58 Because as we age, inflammation increases. Is that inevitable? Are we stuck in a position where, like, based upon our age, we should just expect that we're gonna have more inflammatory issues? What they found in the tribal populations is that actually that's not true at all. So they were protected against inflammation regardless of their age because of their lifestyle. But they were living... And it's not just what they eat. It's they, they wake up when the sun comes up, they sleep when the sun goes down, they're connected to their tribe, they're not looking at Instagram. Like, there's so much to that story. The point being, though, that in the industrial world, it's like we're not consuming a sufficient amount of these types of foods.

Steven Bartlett 59:48 I guess they're not also drinking alcohol and vaping-

Dr. Will Bulsiewicz 59:52 No.

Steven Bartlett 59:53 ... which we, you know, do a lot more in the Western world.

Dr. Will Bulsiewicz 59:56 Yeah, we do.

Steven Bartlett 59:57 H- what impact does that have on the gut microbiome? 'Cause I don't typically hear people talking about alcohol in the gut microbiome.

Dr. Will Bulsiewicz 1:00:02 What we know is that it definitely affects the gut barrier-

Steven Bartlett 1:00:07 I guess it's also-

Dr. Will Bulsiewicz 1:00:07 ... with total clarity.

Steven Bartlett 1:00:08 ... wiping up my, my oral microbiome as well to some degree, if I'm pouring vodka into my throat.

Dr. Will Bulsiewicz 1:00:12 Yeah, and it would be the same as, it would be the same as using an alcohol-based mouthwash.

Steven Bartlett 1:00:16 Mm-hmm.

Dr. Will Bulsiewicz 1:00:16 Right? Which, which now we don't recommend anymore. And so yeah, so alcohol, there was a study actually that changed my mind when it comes to alcohol. So I actually don't drink hardly at all anymore. Like very rarely I'll have a glass or two with my wife if we're on a special dinner. And in the study, they, they basically gave people a significant amount of alcohol and then they tracked every 30 minutes the measure of their blood alcohol level and simultaneously the measure of what's called lipopolysaccharide. So it's, it comes from the inflammatory bacteria that live inside of our microbiome. It's not supposed to be in your bloodstream. If it's in your bloodstream, that generally indicates that your gut barrier is insufficient and weak.... because it's ma- able to get across. And the problem is that the immune system has been trained to identify that lipopolysaccharide as the enemy, and so it gets activated. So... And this is where inflammation comes from. So in this study, they had people have a number of drinks, and they start tracking every 30 minutes. And what you saw was that as the blood alcohol level goes up, in parallel, the lipopolysaccharide goes up. When the alcohol peaks, so did the lipopolysaccharide. There was this weird thing that happened, I don't, I can't explain why, but the alcohol level peaked, it started to come down, and then actually it bumped back up. And when that happened, the lipopolysaccharide followed the exact same pattern. And (clears throat) the lipopolysaccharide did not return to normal until the alcohol level was zero. So when I saw this, from my perspective... To be clear, it wasn't a study of one drink, although we do know that one drink is sufficient to disrupt your sleep and cause other health issues. But when I saw this, I saw enough to say, "I don't think there's any amount of alcohol that's safe."

Steven Bartlett 1:02:33 To summarize what's going on there, the alcohol's coming into the body. It is impacting the gut in some way, which is making the gut go into dysfunction, and that dysfunction lasts for a little while. 'Cause I'm trying to understand why you, you looked at that and thought, "Do you know what? Absolutely not. I'm not gonna drink-"

Dr. Will Bulsiewicz 1:02:55 Yeah.

Steven Bartlett 1:02:55 "... as much as I was."

Dr. Will Bulsiewicz 1:02:56 Yeah. So basically, alcohol was causing leaky gut.

Steven Bartlett 1:02:59 Oh, leaky gut. Okay.

Dr. Will Bulsiewicz 1:03:00 Yeah. So alcohol was causing leaky gut. That's what, that's what we saw in that study. And the fact that the amount of leaky gut was proportional to the amount of alcohol in the blood and that the leaky gut did not return to normal until the alcohol level was zero says to me that any amount of alcohol that's detectable in the bloodstream can create this problem.

Steven Bartlett 1:03:24 Which is gonna cause inflammation.

Dr. Will Bulsiewicz 1:03:25 Which is gonna cause inflammation. We know with total clarity that people who are heavy drinkers, their gut is totally destroyed, and that that's actually a requisite step on the pathway towards developing cirrhosis and alcoholic liver disease. So there are some people who seem to get away with it, where they can be a heavy drinker and they never actually get cirrhosis. And it, what-

Steven Bartlett 1:03:50 Cirrhosis is?

Dr. Will Bulsiewicz 1:03:51 Cirrhosis is the... So the liver sits in your right upper abdomen, and its job is to detoxify your bloodstream. And all of the blood that goes to your gut, the first place that it goes after your gut as it returns to the heart is your liver. And it's actually a smart setup anatomically 'cause we don't want toxic blood to get access to the heart and then circulate and ultimately get back to the brain. So we allow the liver to protect and defend it. But the cirrhosis, what's happening is that basically the liver, which is soft and spongy... Like imagine a sponge that you can put it under a faucet, the water goes in one end, wiggles its way through, comes out the other end, okay? Instead of that, it's just a piece of plastic, right? It's hard. It's not letting anything through. That's what d- that's what happens when a person develops cirrhosis.

Steven Bartlett 1:04:54 Mm-hmm.

Dr. Will Bulsiewicz 1:04:54 So... And there's many causes of cirrhosis. Cirrhosis comes from inflammation so all cirrho-, all cirrhosis health conditions ultimately are inflammatory health conditions. Th- they're all part of the 130 health conditions associated with inflammation. But in this particular setting, what we're talking about is alcohol. And what I'm saying is that to create that inflammation in the liver, based upon the available data, it seems that you have to disrupt the gut microbiome in order to get there.

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Steven Bartlett 1:07:11 There's a orangey-looking chemical on the, uh...... plate over there, turmeric. People talk about turmeric a lot when they're speaking about inflammation.

Dr. Will Bulsiewicz 1:07:21 Yeah.

Steven Bartlett 1:07:21 Um, I'm not really sure what the truth is on turmeric and inflammation.

Dr. Will Bulsiewicz 1:07:25 Yeah. You have to be a little bit careful, because you could easily overdo it.

Steven Bartlett 1:07:31 Oh, really?

Dr. Will Bulsiewicz 1:07:31 So, well, so we just have to be smart with the way that we approach, 'cause the turmeric that we're really talking about is if you were to take it on a consistent daily basis, which actually, from my perspective, makes a ton of sense for people that have chronic inflammatory health issues.

Steven Bartlett 1:07:48 So t- turmeric is helping inflammation go down somehow?

Dr. Will Bulsiewicz 1:07:51 It... Turmeric is helping inflammation to go down because it blocks another one of the cytokines. So in the same way we were talking about those walkie-talkies and bas- basically pulling the batteries out-

Steven Bartlett 1:08:00 Mm-hmm.

Dr. Will Bulsiewicz 1:08:01 ... turmeric helps to accomplish that. So there's a specific cytokine that, that turmeric has that effect, and so it's the... You mentioned curcumin. So curcumin is the phytochemical found in turmeric. Turmeric is the root.

Steven Bartlett 1:08:15 Okay.

Dr. Will Bulsiewicz 1:08:16 Curcumin is the chemical-

Steven Bartlett 1:08:17 Okay.

Dr. Will Bulsiewicz 1:08:17 ... that actually does the thing. And it turns out that curcumin is what we call a polyphenol. So polyphenols, as we sit here and we look at this beautiful array of all these colors, every single one of these foods contains polyphenols that define the color and that impact the gut. Like, the onion here would have quercetin, and many people have heard of quercetin as being beneficial for longevity. Same would be true for the garlic. So there's different polyphenols for different-colored foods, and 95% of them require our gut microbes in order to be activated. So with turmeric, you just need to be careful with supplements, because if you overdo it, if you take too much, that could create an issue, though.

Steven Bartlett 1:09:07 Here in front of me, I have a...

Steven Bartlett 1:09:10 I guess a... I guess this is a perfect gut day. Have you seen this?

Dr. Will Bulsiewicz 1:09:14 Yeah.

Steven Bartlett 1:09:15 I wanted you to explain to me, step by step, how to have a perfect gut day. And this.

Dr. Will Bulsiewicz 1:09:23 All right. So I'm going to, I'm going to define for people the way that I would approach the perfect 24-hour rhythm. We have an innate circadian rhythm. Circadian rhythm basically means that our body functions on a 24-hour clock. Why? Because we evolved with the sun. The sun goes up, and it comes down, and that is one of the most powerful things that defines everything that exists, both for us as humans and in our entire environment, right? So everything around us also evolved with the sun and is connected to it. Around 50% of our genes are turned off or on at specific times of day based upon our circadian rhythm. More than 50% of our microbes rise and fall during the course of our day to meet the moment. Our body thrives on consistency. So what I wanna talk about is how do we create a consistent daily routine that can optimize our microbiome? And I'm gonna take you through all the different, all the different steps. Let's imagine that the sun comes up and it's 7:00 in the morning.

Steven Bartlett 1:10:33 Yeah.

Dr. Will Bulsiewicz 1:10:33 All right? And you naturally wake up, and you are consistent about it. You're off to a great start. Consistency with the time that you wake up is a fantastic way to start your day. And what I want you to do in the first five minutes of your day is I want you to initially just focus on, um, waking up and thinking about your day and how you're going to approach it. Because starting at 7:05, you're gonna wake up your microbes. You're gonna wake up your body with hydration. So we're gonna opt for water, and in a perfect world, I would love to add a prebiotic fiber supplement to that water. So, like, our company is called 38 Terra. You could add that there, or you can add an alternative. This is the hydration, the water turns on your gut, turns on your brain, turns on your kidneys.

Steven Bartlett 1:11:32 So not coffee straight away.

Dr. Will Bulsiewicz 1:11:34 No. So pause the coffee, start with hydration, and we're waking up your gut with the water and also with the prebiotic fiber. That's gonna feed those microbes in your gut, okay? So that's at 7:05. And let's pretend that takes you 10 minutes, and so now it's 7:15. And we're going to basically flip the switch to tell your body, "It's time to go, that we're starting a new day." And this is actually the most powerful moment. So if there's only one thing that everyone takes away, I want it to be this, 'cause I'm giving you the two most powerful levers in terms of activating your circadian rhythm. Number one, sunlight, or at a minimum, bright light exposure. So what happens is that light passes through our m- our eye and hits the retina in the back of the eye, enters into... The body detects this, and it enters into the optic nerve. And right at the very first spot where you could collect information from both your left eye and your right eye sits this part of your brain called the suprachiasmatic nucleus, the SCN. And the SCN is the orchestrator, that is the master clock of your circadian rhythm. So, like, I would think about it like school. So when we were kids and we went to school, we might have all been wearing a watch, and that watch gives us a general idea of where we are in our day. All your organs, all your tissues, more than half your microbes, they have their watch. They have a feel for where they are in the day. But it's the alarm that goes off between classes that ultimately is what matters the most. That's the central clock.

Steven Bartlett 1:13:20 Mm-hmm.

Dr. Will Bulsiewicz 1:13:21 That's your SCN. Your SCN is basically managing all of that. And there's an entire cascade of things that follows from when you tell the SCN today started. So that light exposure is what basically activates the SCN to release cortisol through a, through a series of events, it releases cortisol. All right. Cortisol is the morning hormone. It is... It, uh, it allows us to get activated, it makes protein and, and, uh, energy available to our cells, it makes us focused, it actually suppresses our immune system. In that moment, you want more cortisol, and by getting morning light exposure, you can bump it by 50%.

Steven Bartlett 1:14:07 Hmm.

Dr. Will Bulsiewicz 1:14:08 So we're off to a good start. The second lever that we can pull with our outdoor time is exercise. You don't need to do like a full-scale workout. I'm not talking about the most vigorous exercise of your day, I'm talking about light exercise. But if you just move your body, right? Which during the summertime, what you would do is like you might go outside and you might have a ruck fest, and you take a walk, right? When the weather is good. And when it's January (laughs) and the weather isn't so hot, you might actually have a light box. The light box allows you to stay inside, you just gotta make sure it's 10,000 lux is what you're looking for. So the light box is the substitute for the sun. And then you could do any form of exercise. You could do squats, you could do lunges, pushups, whatever it may be. You could do jumping jacks.

Steven Bartlett 1:15:01 Mm-hmm.

Dr. Will Bulsiewicz 1:15:02 You could do yoga, right? So during this period of time, if you get light exposure and you exercise, the exercise can add another 25 to 50%. This is a compounding effect that's going to give you the ultimate morning cortisol peak, and, um, this is essential to propel your day because by getting this, you will be more focused, you will be able to do more from a cognitive perspective, like your endurance will be enhanced. Um, you also will, uh, sleep better tonight, and you will, you will f- notice this on day one, I promise you. So, all right, so... And you're gonna do that for about 20 minutes. So from 7:15 until 7:35, you're gonna be doing your light and exercise, okay? Ideally outdoor light whenever possible. If you wear glasses, by the way, take off your glasses. You don't have to look directly at the sun. At 7:35, we're gonna basically come back in, and this is a time for us to now have our coffee, and also quiet time. So like to me, we don't have enough time in our day... The day is so fast-paced, right? We need to be intentional about creating opportunities to like activate our parasympathetic nervous system.

Steven Bartlett 1:16:23 Which is?

Dr. Will Bulsiewicz 1:16:24 So there's two sides to our autonomic nervous system. Autonomic is just like you haven't... Like you, you can't totally control it, it's just going. One side is sympathetic. Sympathetic is the part that gets you going fast, like this is your accelerator, all right? And the other side is your parasympathetic, which is your break. It's your rest and recovery. So now that you've done your outdoor time and your exercise, you come in and we wanna give you 10 minutes of just like quiet, low-key sympathetic time. So that could be meditation, breath work, could be reading your Bible, could be journaling, right? Whatever it is that works for you. So you do that with your coffee for 10 minutes, and that brings us to 7:45. And now you have breakfast, right? So... And breakfast, um, is the perfect opportunity to take your supplements.

Steven Bartlett 1:17:22 Okay, so what breakfast, what supplements?

Dr. Will Bulsiewicz 1:17:24 Okay, so your breakfast and-

Steven Bartlett 1:17:25 What is my breakfast strategy? Am I going for a lot of food? Do I need to have breakfast? Why do I need to have breakfast?

Dr. Will Bulsiewicz 1:17:30 You should have breakfast. You should definitely have breakfast. Yeah. So, um, your metabolism changes during the course of the day. Your strongest metabolism is first thing in the morning. And so what that means is that you could literally eat the exact same food at 7:45 or at 3:00 in the afternoon, and when you eat it at 7:45, you will get better blood sugar control, you will get better blood fat control. So those are... Tho- those are manifestations of our metabolism, and when they're under control, that's actually really good for our body.

Steven Bartlett 1:18:09 Hmm.

Dr. Will Bulsiewicz 1:18:11 So whenever possible, we want to shift our food towards earlier in the day.

Steven Bartlett 1:18:16 And what kind of foods?

Dr. Will Bulsiewicz 1:18:18 I would argue that we go high fiber and moderate protein.

Steven Bartlett 1:18:22 No sugar?

Dr. Will Bulsiewicz 1:18:23 No sugar. Yeah.

Steven Bartlett 1:18:24 No sugar?

Dr. Will Bulsiewicz 1:18:24 Or low sh- low sugar, right?

Steven Bartlett 1:18:26 Low or no sugar.

Dr. Will Bulsiewicz 1:18:27 R- refined carbohydrates should get left out as much as possible.

Steven Bartlett 1:18:31 What's a refined carbohydrate? Give me an example.

Dr. Will Bulsiewicz 1:18:33 Flour or sugar.

Steven Bartlett 1:18:35 Okay, so no...

Dr. Will Bulsiewicz 1:18:36 No baked goods.

Steven Bartlett 1:18:37 No eggs Benedict?

Dr. Will Bulsiewicz 1:18:39 Uh, so the exception from my perspective would be if you're going... If you wanted to have avocado toast, then a sourdough croissant.

Steven Bartlett 1:18:47 (laughs)

Dr. Will Bulsiewicz 1:18:47 Prefer not.

Steven Bartlett 1:18:48 (laughs)

Dr. Will Bulsiewicz 1:18:49 They are delicious-

Steven Bartlett 1:18:50 (laughs)

Dr. Will Bulsiewicz 1:18:50 ... but no, I prefer not because ultimately what we want is we want, we want high fiber and moderate protein. And by doing that combination, it's maximum satiation, so you're gonna feel full. You're giving your body what it needs from a protein perspective, and you're simultaneously giving your gut what it needs from a fiber perspective.

Steven Bartlett 1:19:10 Oats?

Dr. Will Bulsiewicz 1:19:12 So, I mean, you could do oats, um... Uh, uh, for the reasons that we were discussing glyphosate earlier, the oats should be organic, and if you were to do them, do them as minimally processed. So like I don't really love instant oats.

Steven Bartlett 1:19:25 What about for kids?... i- if

Steven Bartlett 1:19:27 I'm, you know, giving my kids a breakfast, should I be thinking about anything in particular? 'Cause you know a lot of, a lot of parents, um... I've talked about this quite a few times before, but when I was younger I'd, I'd get a lot of orange juice, and I didn't realize that orange juice was just like sugar water.

Dr. Will Bulsiewicz 1:19:40 Yeah.

Steven Bartlett 1:19:41 Is there anything that parents should be thinking about when they're giving kids their breakfasts?

Dr. Will Bulsiewicz 1:19:45 Of course. Um, and I think that the most important thing is that you need to model for your kids what a healthy breakfast looks like.

Steven Bartlett 1:19:52 By having it yourself.

Dr. Will Bulsiewicz 1:19:53 Right? By eating it yourself.

Steven Bartlett 1:19:54 Mm-hmm.

Dr. Will Bulsiewicz 1:19:55 Because if you don't do that, then they're... you can't expect them to. So, um, healthy breakfasts. My kids... I have four kids. So my kids love avocado toast. They love avocado toast. Um, you could absolutely do yogurt with berries, right? You could do berries and nuts. There's a lot of different choices in that regard. So overnight oats, chia pudding, like these are different choices that you could do, for sure.

Steven Bartlett 1:20:19 On this point of kids, before we carry on with our perfect morning and day routine, are there decisions that you make as a parent to give your kids certain things that will have a lasting impact on their immune and

Steven Bartlett 1:20:32 gut function?

Dr. Will Bulsiewicz 1:20:33 100%. Yes. And the... I think it opens up a discussion about where the connection between our gut and immune system starts. It starts before birth. The first three years are critical. So let me unpack that just a little bit. Steve, they have studies where they look at mom's microbiome during pregnancy. All right? So like mom poops, they analyze her poop, and they're able to basically identify patterns that are associated with the kid developing allergic diseases later on.

Steven Bartlett 1:21:15 Oh, okay.

Dr. Will Bulsiewicz 1:21:15 They also have studies where moms who increase their fiber intake during pregnancy reduce the likelihood of their kids developing allergic diseases later on as well.

Steven Bartlett 1:21:27 What about kids taking antibiotics? Does that have a... when you're forming your gut microbiomes at a young age, does that have a consequential impact?

Dr. Will Bulsiewicz 1:21:34 100%. Antibiotics, uh, bottle feeding, and birth by cesarean section... and by the way, all of my kids were born by C-section. It's not what we wanted, but it's what happened. But those three things are associated with an impact on the microbiome and the immune system. And if you look downstream over the course of the first five years, increased risk of allergic diseases, increased risk of autoimmune diseases, increased risk of metabolic diseases.

Steven Bartlett 1:22:04 Because in a C-section it... the baby didn't pass through...

Dr. Will Bulsiewicz 1:22:08 The birth canal.

Steven Bartlett 1:22:08 ... the birth canal, and the birth canal would have given the baby some of the mother's microbiome.

Dr. Will Bulsiewicz 1:22:12 Yes. So...

Steven Bartlett 1:22:13 And then breastfeeding does the same, it gives the baby microbiome.

Dr. Will Bulsiewicz 1:22:16 Breastfeeding gives them access to mom's skin microbiome-

Steven Bartlett 1:22:19 Oh, okay.

Dr. Will Bulsiewicz 1:22:20 ... but also breast milk contains these things called HMOs, human milk oligosaccharides. It's quite fascinating to consider this. W- w- we evolved where mom's breast milk contains these things, human milk oligosaccharides. There's over 200 varieties. They have no nutritional value to the child directly. So why do we, why do we have them? Because they're prebiotic. So these human milk oligosaccharides in breast milk were basically designed to feed the developing baby microbiome.

Steven Bartlett 1:22:52 Okay.

Dr. Will Bulsiewicz 1:22:52 So... And this is part of why we get into some challenges where when you replace it with, with a bottle, the formula, you might put fiber in there, but it's like a mono-fiber. It's not the same as the 200-plus varieties of human milk oligosaccharides. So there was a study that was done out of Finland where they looked at, uh, uh, roughly 1,100 kids, and they tracked them for five years. And during this time, five years, they got a microbiome specimen, poop specimen, from the kid at 3 months and 12 months of age. And they looked at... Okay, so some of these kids develop allergic diseases. So eczema, food allergies, asthma, um, rhinitis, allergic rhinitis. All right? Those are the classic allergic diseases. And what they found is, okay, there were certain factors that predicted who was gonna develop allergic diseases by the age of five. Number one, exposure to antibiotics in the first year of life. Number two, being bottle-fed. All right. Then they looked at the microbiome at 12 months. So... And just to be clear, these kids, they, they had not developed the allergic disease yet. That comes later. But they looked at the microbiome at 12 months, and they could tell who was going to develop the allergic diseases later on because there was a specific pattern. What was missing were the bacteria that produce short-chain fatty acids.

Steven Bartlett 1:24:35 And the short-chain fatty acids are that chemical we talked about earlier on that-

Dr. Will Bulsiewicz 1:24:39 That you get from fiber.

Steven Bartlett 1:24:40 ... which produces those three things?

Dr. Will Bulsiewicz 1:24:41 Yes.

Steven Bartlett 1:24:42 Butyrate et cetera.

Dr. Will Bulsiewicz 1:24:43 Butyrate, acetate, and propionate.

Steven Bartlett 1:24:45 Okay.

Dr. Will Bulsiewicz 1:24:45 And, and in, in fact, when they checked the poop for butyrate levels, the butyrate levels were low. So in essence, what they discovered in this study that was quite fascinating is that you can look at the microbiome and predict who will later on go on to develop these conf- the confused immune system with these allergic diseases.

Steven Bartlett 1:25:07 So going back to our daily

Steven Bartlett 1:25:09 routine-

Dr. Will Bulsiewicz 1:25:10 Yep.

Steven Bartlett 1:25:11 ... where are we up to?

Dr. Will Bulsiewicz 1:25:12 So yeah, so we're at 7:45, and you... so you want your high-fiber, moderate-protein, as little shar- sugar as possible breakfast. And this is the perfect time to take your morning supplements because the morning supplements, the ones that I recommend that are evidenced-based, are vitamin D, omega-3s, and turmeric.

Steven Bartlett 1:25:32 That's for inflammation?

Dr. Will Bulsiewicz 1:25:34 So these are for inflammation.

Steven Bartlett 1:25:35 Okay.

Dr. Will Bulsiewicz 1:25:36 Yeah. So now, I also believe that we should test whenever possible. There's a test for vitamin D, there's a test for omega-3s. If you have enough, you don't need to take the supplement. But if you're deficient, that's where supplements play a, an important role. So I believe that the supplements should be taken consistently in a circadian fashion. So that means that we take our morning supplements at the same time every day.

Steven Bartlett 1:26:02 Why?

Dr. Will Bulsiewicz 1:26:03 Because basically everything about our microbes and our body and the way that it works thrives on consistency, so supplements would be the same.

Steven Bartlett 1:26:12 Okay.

Dr. Will Bulsiewicz 1:26:13 And when we do this, s- so it's been 7:45, we've had our breakfast, we've taken our morning supplement stack, and now it's been an hour since we woke up and it's time for a fantastic bowel movement, and that is the manifestation of all of the work that you've done because when you get your morning light exposure, that helps to contribute to that bowel movement. When you exercise, that contributes to that bowel movement. When you drink your coffee, that contributes to that bowel movement. All these different things ultimately lead to this, to this place where you're having that good, healthy bowel movement and that's indicative of a gut that's in rhythm and doing well. So that's your morning. Now you're gonna go to work and I wanna circle back to roughly the lunchtime hour. So y- it gets to be lunchtime, and 12 noon, and basically I would advocate for people to have lunch with another person, like the way that you and I are sitting here at this table right now. So because we don't do that enough. Like way too much, we're on our phone like this and eating at the same time that we're flipping