[00:00:00] Kara: Sick of the fatigue and fog? Fed up with the unpredictable flares? Hangry from the super restrictive diets?
Hello, and welcome to the Crunchy Allergist Podcast, A podcast empowering those who like me, appreciate both a naturally minded and scientifically grounded approach to health and healing.
Hi, I'm your host, Dr. Kara Wada, quadruple board certified pediatric and adult allergy immunology and lifestyle medicine, physician Sjogren's patient and life coach. My recipe for success combines, the anti-inflammatory lifestyle, trusting therapeutic relationships, modern medicine, and mindset to harness our body's ability to heal.
Now although I might be a physician, I'm not your physician and this podcast is for educational purposes only.
Welcome back everyone to this week's episode of the Crunchy Allergist Podcast. I am absolutely thrilled to have Dr. B with us. Dr. Will Bulsiewicz, who is an award-winning gastroenterologist. He is internationally recognized for gut health and his expertise in gut health. And he has two New York Times bestselling books, the Fiber Fuel and the Fiber Fueled Cookbook, which is so much more than a cookbook.
He also sits on scientific advisory boards. He has written dozens of academic articles that are published in peer reviewed scientific journals. He's giving presentations all over the world and has presented to Congress and the USDA. He's taught over 10,000 students how to heal and optimize their gut health.
And he not only, talks the talk, but he walks the walk as he lives in Charleston, South Carolina, with his wife and his children. And he is very active on Instagram @guthealthMD, which is a super fun account to follow.
Dr. Will thank you so much for joining me. I know we've been trying to connect and I had sick kid one day. And so I very much appreciate your time and joining us on the Crunchy Allergies Podcast.
[00:02:07] Dr. Will Bulsiewicz: It's my pleasure. Thank you, Kara, for having me. I'm excited to be here.
[00:02:10] Kara: Awesome. I always love to invite our guests to share their story. How did you end up as Dr. B, the Gut Health Expert?
[00:02:19] Dr. Will Bulsiewicz: Yeah, it's interesting, to be completely honest with you, this was not any sort of vision or plan that I had. And I feel like being a a medical doctor, we tend to be planners. We have a plan. We think we know what's gonna happen and we expect that it's going to happen. And then, sometimes things just don't work out that way.
And I've had so many moments in my life where, like something that's happening to me that I don't have control over. Sometimes I think it's the worst thing to ever happen to me. And it turns out to be a massive blessing in disguise.
You just can't see it in the moment and you say, "why am I being cursed?"
Then you get five years later and you go," I'm so glad I was blessed. Thank you for that."
So if I went back 10 years ago. I was in my GI fellowship and I'm a guest enterologist. I was actually on a grant from the NIH and I was studying both epidemiology and gastroenterology at the same time at the university of North Carolina.
So I did an extra year of training for my fellowship. It was four years instead of three. I was in a bad place, just like personally. Professionally, my career was taking off. Everything was falling into place for me in a way, far more powerful than I expected of myself, to be honest with you.
But I was miserable. I was having a health crisis. Not something that showed up out of nowhere but instead something that was brewing over the course of years from my late twenties into my early thirties. I would argue really, truly the go nonstop lifestyle of being a pre-med and then a med and then a resident and then a GI fellow. It caught up to me.
I considered myself to be a hard worker. I'm still a hard worker. But when I was not working, I was basically eating junk food or drinking alcohol and I was not exercising. I got into my early thirties and I'm 50 pounds overweight. I have high blood pressure, high cholesterol. I'm super anxious. I'm depressed. I'm not exaggerating.
When I say that, like I was in a place I was at was I wanted to weigh on a couch with a blanket in a dark room, and I just wanted people to leave me alone. That's where I was at. I knew that I needed to fix these issues.
I was board certified as an internal medicine resident. I was the chief medical resident, Northwestern in Chicago. Yet this excellent training that I've received, I didn't have solutions for myself. I actually think it was a quite powerful thing because many of us as medical doctors, we have a great education. We have hospital based training.
In my case, I also had research experience in training and all of that is great. But if you can't relate to your patient, it just only goes so far. Being in the position that your patients are, where you're a bit desperate and you just want some help. You just wanna feel better and you're struggling to get there.
I actually think that was an empowering thing for me. And what really changed my life was I met the person who's now my wife, and it was actually 10 years ago that we met. And look, she never once at any point in the 10 years that I've been with my wife, she's never once said to me, this is what you need to be, or this is what you need to eat.
She has always led by example. When we were on our first date, we were at a restaurant in Carrboro or North Carolina, that's known for their pork. So that's what I was eating, but I look across and she ordered something that wasn't really even truly on the menu. She said to the waiter, "Can you take these sides, like black eye peas and collards and mashed potatoes and some grilled veggies and just put it on a plate and make it look nice."
It was eye opening because she looked amazing and she was, from what I could tell, in control of her health. She was raving about how delicious her food was. And we ended the date. I had not had any alcohol and yet I was hungover and I needed to go home and go to bed. She was like," why don't we just keep hanging out?"
I'm like, I really want to and so this was not some sort of massive life changing moment, but instead it was a seed. That seed matured and it grew in my mind into something that convinced me that one day I should try not going to Hardee's for dinner and instead go home and make a smoothie.
The smoothie, by the way, was a perfect fit. I needed something convenient and easy. I'm not a gourmet chef. Despite what you may think you read on the internet, so... Anyway I felt so good drinking this 36 ounce smoothie that I wanted to feel that way again. So I went back and I did it again and then again, and then I would look for new changes that I could make in my life.
Over the course of years, I changed my diet and it completely transformed my life. I lost 50 pounds. I got back to my high school weight. Blood pressure pills went into the trash, fixed my cholesterol issue. Started feeling confident and young and vibrant again.
This didn't lead me to writing books, instead, this motivated me to want to explore this in my medical practice. I spent years learning in collaboration with my patients. I think people see this medicine as the doctor tells the patient what to do.
I think of it more as this is a collaborative relationship. So I was working with them and I would, basically read at night and learn. I was shocked at how much research existed that we had not been taught in medical school or our medical education. I would bring it into the clinic the next day and things started to snowball.
Next thing I'm seeing patients having these transformations. And just to kinda accelerate from there, once this started happening, from my perspective, it's like people like, we're not talking about this, but we should be talking about this. Yeah. It's completely evidence based and it's completely transformative for a lot of people.
If this opportunity exists, let's not be pill and procedure dependent. I'm not saying that those things are implicitly bad. What I am saying is let's not be so dependent on those things that we lose sight of these opportunities that we have to change people's lives through food, through exercise.
I felt compelled to share this story beyond the walls of my clinic. That was 2016. I started my social media account. It was extremely humble. No one really cared for a very long time, it's very true. No one really cared for a very long time, but I did have a breakthrough in 2018.
I had a podcast that went viral. It was with my friend Simon hill from the Proof. And that led me to a book deal. That was late 2018. I wrote the book all of 2019, basically, at five in the morning at Starbucks before I would go to work. And book came out in May of 2020 and was a great success, which led me to the opportunity to write a second book , which just came out a few weeks ago.
And that's the Fiber Fueled Cookbook. It's my new book and here we are.
[00:09:59] Kara: Yes. Thank you so much for sharing that. I have to say, I know we haven't really talked much before, but I had a similar experience with. I ended up being diagnosed with Sjogren's a few years ago and really saw dramatic benefits from lifestyle changes.
I think sometimes it's so easy to get our heads wrapped up, especially growing up in the generation we grew up in, and like this diet culture of on again, off again. But these small changes add up over time and really can make a huge difference. I'm just amazed at seeing how much, and you probably too, but like over the last couple years, how much we are seeing emerging in the medical evidence as well with kind of the role of the microbiome in every aspect, it seems like of our health.
[00:10:49] Dr. Will Bulsiewicz: I think we're just getting started. The laboratory techniques were absent prior to roughly 2006. It took us a lot of time just to understand what we were even looking at. We're finally starting to get into the phase of attempting to manipulate. That is very exciting, cuz I think that's when we started to step into this is more than just, "Hey, what do we see?" This is now, "Hey, how can we use this to help us?"
[00:11:17] Kara: I'm anxious and like ready to be there, especially with in the clinic. I see so many folks certainly with concern for food allergy that turned out to be intolerances. So that's a pretty good portion of my clinical experience, but I also see a lot of folks with eosinophil esophagitis, and all of these other conditions that we really didn't see.
We didn't really know about them until maybe 30 years ago. We've just seen them increase along with celiac, along with all of these different things. And so to be able to know better what we're seeing and also then help these folks have a much better quality of life, I think is pretty good incentive to keep on chugging away.
[00:12:02] Dr. Will Bulsiewicz: Yeah. I also think that, people interpret in their own way this rising incidence of these allergic and autoimmune diseases. People have different ways that they interpret that. Some people will say this is like a testing thing. I don't believe that's actually true.
The reason why I say that is that many people who have eosinophil esophagitis, so for the listeners at home, what we're referring to as an allergic disease. Allergy means that your immune system is reacting to some foreign thing. Something foreign to your body. Could be pollen if you have seasonal allergies. Could be pet dander if it's a pet allergy. In this case, it's food.
The immune cells, which are called eosinophils, they show up in the esophagus. This is more than just eosinophils showing up in the esophagus. This causes people to have difficulty with swallowing and it can get severe to the point that I've had some patients that they almost ignore.
They get tight to the point that they can't swallow hardly anything other than their own saliva. So it's almost like when we're talking about cancer, and people will say, "is it just a detection bias?" I'm like, no. Because it's cancer and one point it will make itself very clear that it's there.
To me the same is very much true with eosinophil esophagitis, which is that if you have eosinophil esophagitis and it's untreated, at some point, it comes to a tipping point where it becomes very clear that it's there.
I think these conditions are rapidly on the rise and also very much tied to industrial society or the Western world where if you track these in third world countries, as they become first world countries, that they increase substantially in a very short period of time, 10, 20, 30 years.
[00:13:42] Kara: Yeah. It's it's amazing. Even looking and talking with different patients. I'm in a college towns and there's a fair bit of like international presence. Folks coming from all over. You'll see sometimes first or second generation families. You can see sometimes then the progression or the development of this across just one generation, which is really humbling.
These changes are moving much faster than like our genetics would anticipate seeing. That's where we're talking about this idea that it is our modern way of living that in all likelihood is really strongly implicated in this increase.
Yeah, totally.
So as we're thinking about trying to make some of these these switches to a more fiber fueled lifestyle, do you have any tips for someone who's just getting started?
[00:14:37] Dr. Will Bulsiewicz: Of course. Yeah, I do.
[00:14:38] Kara: Yeah.
[00:14:39] Dr. Will Bulsiewicz: So when we talk about the gut microbiome in general, we're talking about this invisible community of microorganisms that frankly we ignored and dismissed because we didn't have the appropriate testing available to us until 2006, as I mentioned earlier. There's 38 trillion of them living inside of our colon. All right. 38 trillion.
This is an insane number. If we were to take the number of stars in the sky, in our galaxy, it would be 380 galaxies full of stars living inside of your colon. Literally right now. They're as alive as you and I are.
They have unique skill sets. They have personalities. They have certain friends or cohorts that they hang out with. They have different dietary preferences and they are there with a purpose. They're not just something where like they're aimlessly there. They're not there to take from us like a parasite, but instead they're actually integrated into our physiology.
You find that they're intertwined with digestion, our immune system, our metabolism, our hormones, our mood, our brain health, our energy levels. So the first two of those, digestion and the immune system, those are very relevant because that the digestion is my career and the immune system is your career. That's what we do.
We find the microbiome is at the intersection of both of these things. So as a quick example of like how they're intertwined, digestion and immune system. When we consume our food, that food ultimately will come into contact with these microbes, but a very large part of most of the food that we consume is going to be digested within our small intestine before it ever gets to the colon.
So these microbes, they need something that can actually survive digestion in the small intestine and reliably make its way all the way down to them. 20 feet further down the intestine. And as it turns out, their preferred food is dietary fiber. Fiber is a part of all plants. So whether you eat the plant or you don't eat the plant, every single plant, and then the entire planet has fiber as a part of it.
Fiber is a carbohydrate and we, as wonderful as we are as humans, we lack the enzymes to break down fiber. And there was this old myth that fiber, because we lack the enzymes, it just goes out the other end. This is, sweeping through, cleaning up the walls.
[00:17:14] Kara: That's what I learned in med school. It was just cleaning things up.
[00:17:18] Dr. Will Bulsiewicz: Exactly. And then it turns into a bowel movement. And that's it. The story is so much more exciting than that. That sort of sweeping thing, it's partially true for some types of fiber, but there's these other types of fiber that we call prebiotic. Which means they're food for these microbes.
The prebiotic fiber arrives into the colon intact. Because again, we don't have the enzymes to touch it. These microbes, they have the enzymes. In fact, there's estimates that they may have 60,000 of these unique enzymes, allowing them to break down and process fiber and they work as teams. If you had a microscope and you zoomed in on the colon, you would see this fiber enters into the colon and here come these microbes and they get to work. Working as teams to break it down.
Ultimately the end result of this, is that there's two things that happens first. The microbes that are consuming this fiber and breaking it down, they actually grow stronger. This is their source of life. We are feeding them. The second thing that happens is, they release what are called short chain, fatty acids, and the most famous of which is butyrate.
The short chain, fatty acids, they are anti-inflammatory, they have effects literally throughout the entire body. There's a number of ways they affect your brain. They're very important and relevant to our immune system and they help to shape and manipulate the immune system to get it organized. To function the way that it's supposed to. Because the immune system, as very well, we don't want it to be too big. We don't want it to be too small. We want it to be just right. Targeted, precise, efficient, without overreacting,
[00:19:13] Kara: The goldilocks of our body.
[00:19:15] Dr. Will Bulsiewicz: Yeah. So the short chain, fatty acids help to condition the immune system in order to be the way that you and I are describing it. So at the end of the day, for a healthy digestion for a healthy immune system and metabolism and hormones and mood and brain health, we want these short chain fatty acids. And the way that we get them is quite simply by consuming dietary fiber.
The problem we have is, 95% of Americans are not even getting the minimal recommended amount. When I say not getting it, like we're way deficient.
The average woman is getting about 16 and a half grams of fiber. The recommended amount is 25. The average man is getting about 18 grams of fiber and the recommended amount is 38. We're way low. So I'm not here to claim that this is the only thing that's relevant to our digestive system or our microbiome or our immune system. I'm not here to claim that the absence of fiber in our diet is like single-handedly responsible for allergic diseases and autoimmune diseases. But I do think it's one of the factors.
[00:20:28] Kara: There's a new study that I haven't even gotten my hands on yet, but was just discussed at the European allergy conference this past week. It showed that about 50% of food allergy may have some role in the microbiome in this realm, in preventing food allergy, I should say. So there, there is more data coming.
[00:20:52] Dr. Will Bulsiewicz: When it comes to supporting and nurturing this gut microbiome, there's a lot that we could talk about. I've written two books to deep dive into these topics. But if I were to simplify into, what are the core principles, at least from a nutritional perspective, here's what I would say:
Number one, we need to address the fiber gap. That's not complicated. The answer is not actually Metamucil. Nothing against Metamucil, but the answer is quite simply, we need to eat more plants. The average American, only 10% of their calories comes from plants. It needs to be more than that.
The second thing is that I mentioned earlier, these microbes they're varied. They're unique. They have different dietary preferences, much like you and I, Kara, we don't eat the exact same diet.
[00:21:40] Kara: No, I do like the recipes and the fiber field books. So there's that.
[00:21:45] Dr. Will Bulsiewicz: I appreciate that.
I embrace our individuality. I want you to enjoy the food that you eat. I'm not trying to convince you to eat my way and I'm gonna eat the way that I eat, cuz I love it. These microbes are like that too. So what we've discovered, one of the things that we've found that has actually now been shown in multiple studies is that a varied, diverse diet becomes very important to feeding these microbes.
It was first most powerfully shown in the American gut project, which is actually an international study. More than 11,000 people who've submitted their microbiome specimen along with diet and lifestyle information. What they found in that study is that the people with the healthiest guts were the ones eating at least 30 varieties of plants per week.
We need more fiber, but it needs to come from a wide variety of plant sources.
The last thing that I would add, this is getting into something that was published about a year ago and I'm quite excited about, is not only do we need to be varied in terms of, we need to eat plants and we need to eat a variety of plants, but let's not lose sight of the fermented foods either.
Fermented foods are unique because they have a very high number of probiotics, meaning living, living micro robes, bacteria, and yeasts that are good for us. They have unique forms of fiber. In many cases, they have special access to phytochemicals or vitamins. Things that are good for us. It was a theory up until a year ago that they must be good for us.
But now I think that we're beyond the level of this being a theory because published in the Journal Cell, which is one of the top four journals out there. Justin Sonenberg and Christopher Gardner from Stanford university, found in an interventional trial that adding daily consumption of fermented food increases the diversity within the microbiome and reduces measures of inflammation. More plants in variety and don't forget the fermented foods. That's my cliff notes version of gut health right there.
[00:23:50] Kara: I love it. It's interesting because we think and look at other cultures kind of tradition and those foods come up time and time again. Like my husband's family is Japanese American, and they have a whole host of fermented foods that my mother-in-law will set out. That we're working on getting our palate a little more accustomed to but it's cool to see the science and the tradition coming together and really give. I don't know, the nerd in me just really loves seeing the data.
[00:24:20] Dr. Will Bulsiewicz: I'm a completely data and science driven person. It frustrates me when people lead with the narrative or the story, but I understand that's a very human thing. Like we hear stories and we feel more emotionally attached to them than we do to data.
But that being said, what excites me is when the data starts to align with the story. I've been watching this show recently. Hope you don't mind?
[00:24:44] Kara: No, please. Okay. Which one?
[00:24:46] Dr. Will Bulsiewicz: So it's on Netflix. It's called Alone. And the premise of the show is rather simple. 10 people who like have, experiencing the outdoors. They agree to basically be released into the wilds in Canada, by themselves.
[00:25:05] Kara: Oh geez.
[00:25:06] Dr. Will Bulsiewicz: With almost no supplies. Like they're allowed to bring 10 items, which sounds like a lot. Oh, that's generous.
[00:25:13] Kara: A hatchet.
[00:25:15] Dr. Will Bulsiewicz: Yeah. You get a hatchet and you get, maybe some fishing line, that's two. If you wanna sleep in bag, that's three. Very quickly 10 are gone.
Okay. Here's my point. These people, they have no access to fermented. I'm sorry. They have no access to ultra processed food, right? They can't eat that. They're forced to basically be either a super efficient hunter. And by the way, these people that are selected to do this they're, I'm not a hunter. My dad was.
[00:25:44] Kara: Yeah.
[00:25:45] Dr. Will Bulsiewicz: These people are, they're all hunters, right? So like they're used to hunting. And yet when they get put into this environment, they're not good enough at hunting to actually make enough calories from hunting alone. So what you see is that they have to forage and they're eating everything.
They're pulling onions out of the dirt. They're eating berries. This is how they get their sustenance. It's it makes you think about the Hadza in Tanzania. This is a tribe of people. They still exist, although they are diminishing in numbers. And, I don't know if we'll still be talking about their existence in 20 years, because basically they're entering into society. But the Hadza, they are modern day hunters and gatherers and they forage and they hunt and most of their calories come from the foraging and they eat ons of varieties of plants because they have to eat whatever is available to them.
Meanwhile, here we are, and we have the benefit of our supermarket. That we can hop in our car and cruise down to, or we can Instacart it. And have delivered to our home, a diet where in the average American it's 60% ultra processed foods that did not exist even a hundred years ago.
30% of our calories come from animal products. Again, like these hunters, even the Hadza or these skilled hunters that are released into the wild, they can't sustain 30% of their calories from animal products. They're not good enough at hunting. Only 10% of our calories come from plants, which used to make up the majority of our calories. And so it just shows you how much life has changed. In a short period of time.
Because we would describe these things as luxuries that we have living in, civilized society. And yet these luxuries there are downsides to these changes that take place.
[00:27:37] Kara: Absolutely. I think that's a really poignant thing to make note of and thinking about, there is a big push and I think a lot of I don't know, little chatter between the paleo camp or the ancestral living camp and then the whole food plant based camp. But when you really look at what we see in the diets of modern hunter gatherers, that it really is overwhelmingly a reliance on the plant-based foods and the animal-based products really are the condiment.
[00:28:12] Dr. Will Bulsiewicz: That's the way I feel. For what it's worth, if you took the average American's diet and you eliminated the ultra processed foods and you replaced them with plant
[00:28:21] Kara: That would be huge. Yeah.
[00:28:22] Dr. Will Bulsiewicz: By itself would be absolutely huge. And I would feel really good about that. I still think that there would be room for improvement, but even just that, without even compromising on the animal product side of things I think would be step in the right direct.
[00:28:35] Kara: Yeah. Do you, I know we were talking a little bit beforehand, what I really appreciate about the fiber field cookbook in particular folks. So first of all, it's so much more than just a cookbook. You really do a great job of walking the reader through kind of all of these concepts of gut health, but in a pun intended, a very digestible manner in where I've really been recommending it.
A lot to my patients is having this step by step plan to help people figure out what foods they may be, having trouble digesting. And helping them understand a little better than I'm able to in a 30 minute office visit, how and what, and why all that's going on. One of the things though that I mentioned beforehand, and we have this a pretty robust body of work, looking at food maps, FOD maps tomato, tomato which are these fermentable sugars that in many folks with irritable bowel syndrome will have trouble digesting them and will result in symptoms. But one of the other aspects that you bring up in the book is something I increasingly see patients deal with in the office called histamine intolerance.
But this is something that some of my mentors and those who have been in the field of allergy for a long time are resistant to hearing about or thinking about, I love to hear your take and how you've incorporated in your practice.
[00:30:09] Dr. Will Bulsiewicz: Yeah. So let's first, let's separate out the acceptance of medical doctors on new ideas.
[00:30:18] Kara: Yeah.
[00:30:19] Dr. Will Bulsiewicz: Let's separate that out for a moment and first talk about histamine intolerance and what is being discussed in the medical literature on this topic, which is not something that I invented. If it were something that I invented, I wouldn't write a book about it because I believe in allowing the evidence to lead and guide. This chapter in my book has 90 references that anyone is free to read.
You don't have to buy my book by the way. I make it as easy as you can possibly have it, which
[00:30:47] Kara: On your site . Yeah.
[00:30:49] Dr. Will Bulsiewicz: It's on my website and I've even included the links. If you want these 90 references, you don't even have to buy my book, just click the button. I can't make it any easier for you. Histamine intolerance, it's a real challenge.
It's a real challenge to the structure of how we do things. But the problem that exists, Kara, is that there's a lot that we don't know. Much of what we do know, we know because we created a test that allows us to measure something. In the absence of a test, there will always be skepticism. If you go back, if we hopped in the Devian and we go back to 2005 and I raised the term gut health, people like myself included would laugh. How can you take that seriously?
[00:31:38] Kara: Or even thinking about the story of H. pylori, and the discovery of that, which was, during our medical education, the big.
[00:31:46] Dr. Will Bulsiewicz: So yeah, the, for the people who are listening at home, the story of H. pylori is quite fascinating and it's worth checking out in more detail than we're gonna probably cover in the next minute here.
But the person who discovered H. pylori, by the way, but H. pylori is bacterial. It takes up residents in the lining of the stomach. It's one of the few bacteria that has the capacity to actually insert itself into the stomach and exist in this place where there's so much stomach acid and H. pylori has actually been shown to be a carcinogen.
So like particularly in east Asia, H. pylori is associated with the development of stomach cancer. Anyway there's a lot that we could talk about with H. pylori. I diagnose H. pylori as a gastro. I've treated hundreds of patients for H. pylori. But back in the day, like we're talking about the early eighties, there was intense and tremendous skepticism to the point that the doctor who was bringing forward, the idea of H. pylori was effectively called a quack by his peers.
And as I recall the story, he, in order to prove that H. pylori is real. He ingested it himself and gave himself a stomach ulcer, cuz by the way, H. pylori is one of the top two causes of stomach ulcers. It's not just a stomach cancer thing. It's also stomach ulcers. H. pylori and ibuprofen or non-steroidal anti-inflammatory drugs are the top two causes of stomach ulcers.
So anyway, this doctor gave himself H. pylori. Gave himself a stomach ulcer in order to prove that this was real. And subsequently went on to receive the highest honor that literally exists on our planet from an academic perspective, which is a Nobel prize. The Nobel prize is like the culmination of the journey.
If you were to insert yourself into this story 10 years before that you would discover that this person was basically being dismissed and, in many cases told that they're crazy. There are many aspects of what we take care of in medicine that we don't have complete information and we're working on it and we're trying to do better.
But there are people who still have these issues and we're trying to create solutions for them. The gut microbiome, again, like we didn't have a test prior to 2006, but within my field irritable bowel syndrome is the number one diagnosis that gastroenterologists take care of. It's the number one diagnosis and it was actually my mentor Dr. Osman at the university of North Carolina who developed the criteria for us to diagnose irritable bowel syndrome. Which is based upon subjective symptoms like what the patient says happens, not based upon some sort of blood test or poop test or cat scan.
I'm quite certain that there was skepticism of irritable bowel syndrome. And it took a 40 years. We still don't have a test. We still haven't developed any sort of confirmatory way. Yet this is the number one thing that gastroenterologists take care of in their clinic.
We have to acknowledge, and with humility, acknowledge that there are limitations to what we know. There are going to be things, patterns that exist in patients that we may not have the capacity yet to identify with our testing technology. Yet they're there and they're real. That doesn't reduce the experience of the patient.
It also is meaningful to a person when they have something that is negatively affecting their quality of life and you can provide them with relief. When we talk about an intervention or something one of the things that comes to mind is, look, if it's potentially dangerous, then we need to be conscious of these potential risks, right?
What are the downsides of this thing that we're gonna do? We have to think about the risks. But if there's almost no risk and there's potential tremendous benefit, why would we not do that?
So when it comes to histamine intolerance, here's the problem. Here's the way of the land. The problem is that there is no blood test or poop test or cat scans to diagnose histamine intolerance. If you want to know if a person has this, you have to actually put them on a low histamine diet. We know, I'm quite sure that all allergists would agree that there's histamine toxicity. Histamine toxicity, also known as Scombroid Poisoning, is when people eat food that has way too much histamine and they get sick and it's a form of food poisoning.
So everyone agrees that's there, but could it be something that's more chronic and low grade? If you take a person who is suffering with these symptoms, by the way, for the listeners at home, let me name some of the symptoms.
So classically, this would include digestive symptoms, bloating and gas is the most common of the symptoms, but it would also include things like cramping, abdominal pain, discomfort, nausea heartburn, or acid reflux, diarrhea, constipation. Okay.
But it could also be things outside of the digestive system. So it could be headache, or migraines or runny nose, allergy, seasonal allergy type issues, sinus issues, chronic sinusitis could be a sore throat change in voice, dry cough could be cardiovascular or heart related issues. So rapid heartbeat, irregular heartbeat, lightheadedness, skin issues could be rash, hives, flushing of the skin. And then there's these non-descript symptoms that doctors tend to dismiss, cuz we don't know what to do about it, but the patient is suffering and they're just, they just want to be heard. And that includes things like, fatigue or insomnia.
[00:37:40] Kara: Brain fog.
[00:37:40] Dr. Will Bulsiewicz: Things like this. Okay. So if you have two of these symptoms, It doesn't mean that you have histamine intolerance and nor would I say that histamine intolerance is the most likely diagnosis for the majority of people. But if you are someone who has turned over a lot of stones and have worked with your doctor and you haven't really come to any sort of solution, and yet you continue to have these issues, you eat a meal, it causes bloating and a runny nose and a headache or hives.
Okay, there's something going on there, you don't deserve those symptoms. And you do deserve a solution. If you go on a low histamine diet and you do this for two weeks and it completely transforms your life, I frankly don't care what other doctors say because at the end of the day, this is not a high risk proposition.
I could see the argument of placebo effect, except is the placebo effect making a person's headache and runny nose and hives go away. I don't know about that, but the point at the end of the day is that if it makes people feel better then we are taking a step in the right direction.
Ultimately, my goal with people who do this, you implement the low histamine diet. You do it for a brief period of time. You identify whether or not this helps you and makes you feel better. If it does help you and make makes you feel better, you don't stick on this diet. You don't stay in a restrictive dietary pattern. You take steps, which I describe in the book to open your diet back up. That's a process that you work through and it doesn't happen instantaneously, but ultimately you get back to a place where you are eating a wide variety of foods without those restrictive patterns. It just takes time to get there.
So I'd be curious what you think about all that, Kara?
[00:39:36] Kara: This is what I see and talk with patients about every day in, and I think part of it, I'll sometimes share with them kind of my experience, cuz I went full blown, autoimmune protocol at one point, cuz I was so desperate for relief.
I had actually developed an acute hepatitis and it was pretty scary. I ended up in this, like this restrictive mindset of fearing food. So that's the other part that I so appreciate is really this you're through your writing, through your work, through everything.
It's always with this thought of getting the diet to be the most diverse diet possible because that's what the science says is most helpful. So from my personal experiences, but also seeing through all of my patients not all, but a good portion. It is easy to get into this restrictive mode.
And then we have other tools out there, which I know we feel similarly about like food sensitivity testing, which just gets people all sorts of confused and takes money outta their wallets. Without any meaningful information being gathered from it.
[00:40:41] Dr. Will Bulsiewicz: I feel like these are such complex issues because if the problem exists within the gut microbiome, the issue that we have there is that to date, we have not demonstrated the ability to do quite simply a microbiome test that is adequately reliable to tell us the existence of a problem.
So for example dogs can actually smell colon cancer. Dogs have the ability. It's more than 95%. It's either 97 or 99% accuracy, dogs can actually smell whether or not a person has colon cancer. All right. But we don't have a poop test yet. That's that accurate for colon cancer, which is why we have to keep doing colonoscopies.
But I do believe that at some point we will get there. The issue is that the microbiome is so complicated in dynamically changing and evolving that it may not just be one pattern. There may be multiple different types of patterns that can exist in different types of people. So I think that, if this problem with food intolerances and food allergies initiates in the microbiome, which it is my suspicion that it does, if it initiates in that place, we may 20 years from now be talking about a test that allows us to know exactly what to do with, you know, "oh, your microbiome says, eat this. Not that."
I don't believe that we're actually there when it comes to food allergies and food intolerances. And I should mention that I'm the us medical director for a company called ZOE and we're a personalized nutrition company. And it's a bit of a different thing, cuz we're not telling you what to eat based upon food intolerances or food allergies, we provide personalized nutrition recommendations based upon the effect that it has on your metabolism, which is a little bit of a different thing.
[00:42:28] Kara: But maybe the first step towards, some of the science that will get us there.
[00:42:35] Dr. Will Bulsiewicz: I think that the methodology that we're applying. For the people who are listening to us effectively what we do with Zoe. So Zoe is a company it started in 2017, but we actually didn't go public with any sort of product until we had done clinical trials for three years.
We published those clinical trials in nature medicine in June of 2020 to demonstrate that we could reliably do what we set out to do and the story, the method is what ultimately I think will be transferable to other ideas. The way that we approach this is we collect from a large group of people, their microbiome, they enter into an app what they're eating, and then we have the specific measures that we're trying to improve.
So for us, those are your blood glucose. People wear a continuous glucose monitor and your blood lipids. People do a blood lipid test. By having microbiome information and what you eat on, we're well over 20,000, I don't know if we're at 30,000, but we're darn close. That many people.
Knowing the outcomes of the glucose and the blood lipids. We can put all this information into a supercomputer and it runs these complex machine learning algorithms where ultimately what happens is the supercomputer can identify patterns that are unique to the individual.
So rather than saying, "okay, in a population, the average response to an avocado is this," instead of saying that, it'll say, "Kara, based upon your microbiome and your specific data, we know given all of this information that we have, this is what we expect your response to an avocado to be."
We've demonstrated the ability to predict those responses reliably in terms of blood sugar and blood lipid. So the future of this is to apply this sort of general concept and what you're gonna flip out. You're gonna keep the microbiome. You're gonna keep the food log that, you enter into the app, what you're eating, that's your data collection part, and what you're gonna, what you're gonna change is you're gonna change out what the outcome measure is.
Once you can do that and start identifying," oh, the outcome measure is, for example inflammation or which by the way, would be a big debate just to figure out what we would use for that."
[00:44:58] Kara: Yes.
[00:44:59] Dr. Will Bulsiewicz: But, or it could be, your subjective response to food and how you feel so that ultimately will allow us to move towards emerging, beyond metabolic outcomes and start looking at other things like the immune system or digestion or hormone levels or things like that.
[00:45:17] Kara: Super cool. It only makes sense that you would need those different pieces of the puzzle to be able to explain it, not just an IgG level, right?
[00:45:31] Dr. Will Bulsiewicz: Yeah. So what we do is if you think about, if we stop thinking about this in biological terms for a moment, and we think about this in purely mathematical terms. We were to create a formula that explains, for example, whatever the outcome measure might be, perhaps it's an IgG level.
Okay. And we're gonna create a formula. This already exists. We have predictive models where, an odds ratio is really just a part of the formula. And that odds ratio is telling you, like how likely something, how much something changes based upon the presence or absence of something.
So if we think about predictive models, we could build a pie. And that pie is gonna have different size slices based upon what are the things that are relevant to ultimately determining this number. And we've done this actually we did this with the nature medicine paper that came out in June of 2020, where we took a look at what is predictive for example of blood glucose?
And the answer to that question is that the top three things in terms of determining what your blood sugar is literally right now, Kara, is gonna be what you're eating. What is the context in which you're eating it? So have you been fasting and what time of day is it? And did you get a good night's rest last night? And did you just exercise?
And then the third thing is your genetics, but the microbiome is not that far behind the microbiome turns out to be more important to determine your blood sugar than your age or your gender, which are like two major things that we look at in every single research study.
And then with blood lipids, it's even more fascinating because it turns out that genetics plays almost no role,
[00:47:19] Kara: but we blame it so much on our, oh, I have bad cholesterol because of my mom or my dad, or whomever
[00:47:25] Dr. Will Bulsiewicz: More likely what it is it's not the gene, but instead it's the microbiome proves to be a super powerful thing in terms of predicting your blood lipid response to food.
And so it's just so interesting to ponder that we're now moving into a place where we're gonna have the ability to understand with more clarity, what goes into predicting these different outcomes or these different measures of human health. By the way, I guess while we're on the topic, I hope you don't mind me bringing this up blood sugar. It drives me a little crazy. This trend towards like only eating based upon your blood sugar.
[00:48:04] Kara: Oh yeah. No, that's just too complicated. And I don't know, I'm a busy working mom. Like I don't have time for that personally.
[00:48:14] Dr. Will Bulsiewicz: So what a lot of people are doing for those that haven't heard, is they're wearing a continuous group glucose monitor and they're checking their blood sugar after every meal. Then they're making decisions on what they're going to eat or not eat based upon what their blood sugar does.
The problem is like your blood sugar is going to go up after a meal, no matter what is the amount that it goes up, actually a problem for your body, if you start depriving yourself of healthy food, like fruit, because you go, oh fruit raises my blood sugar.
That's problematic because your health is so much more than just this one measure of your blood sugar. And it's just, I think it's a dangerous level of scientific reductionism to go towards one outcome measure as the entire body of human.
[00:48:56] Kara: And as we know that overall eating that diversity in all of those plants is really where kinda the magic happens.
[00:49:05] Dr. Will Bulsiewicz: Yep, exactly.
[00:49:09] Kara: So I wanna be mindful of your time. Do you have any last kind of parting words, tips, things that you like wanna make sure that you share with the Crunchy Allergist Crew?
[00:49:26] Dr. Will Bulsiewicz: First of all, I love that you're the Crunchy Allergist Crew. Hello everyone. I think that there's there's one aspect that we haven't dug into. We've been talking a lot about food. I'm guilty of overemphasizing food, our health and the health of our microbiome is much more than just what we put into our mouth. It is affected by whether or not we get sleep good, restful sleep.
Sleep that is in alignment with the way that our circadian rhythm works. Is affected by exercise. But it's also affected by our mood and how we feel.
This is part of the brain gut access and the there's ways in which your gut can affect your brain. I mentioned much earlier in the show that short chain fatty acids are produced in the gut yet they will travel to the brain and have an effect there.
On the flip side, there are things produced by the brain that will travel through the blood and actually have an effect on your gut. An example of this is CRH, corticotropin releasing hormone, and what I'm describing here in simple terms is you have a scenario where you're a little stressed out.
So like you're gonna go give a speech publicly, and that makes people nervous. Okay. When you feel nervous, where do you feel it? You feel it in your tummy? Maybe it's just a little bit of queasiness or butterflies, but then maybe it turns into a small ball of discomfort and that small ball of discomfort grows into a big ball of discomfort.
That is your brain-gut access actually demonstrating itself to you. It's the downstream effect of when you feel stressed, your brain releases this hormone and there is a consequence. The hormone is there for a reason. We evolve to have it for a reason, but if you follow it downstream, ultimately what happens is it does compromise your gut and it does cause temporary injury to the gut.
So the problem that exists is that for some people, their stress is continuous. It's not just like an acute, "Hey, I'm gonna go give a speech." It's more " Hey, this is my day in and day out life" and it can be something that you may be conscious of like "I'm in a bad relationship," or "I have someone that I'm taking care of", or "I don't like my job," or it could be something that you're not conscious of.
There's something that was traumatizing to you and it was years ago and you feel like you've dealt with it and pushed it away. You really don't have an interest in revisiting that, but what if it's still weighing on you and causing unrest. So these are examples of how, the way that we feel can negatively impact our gut microbiome.
The reason that I like to bring this up is that I feel like my best moments as a doctor have not been when I've told people to eat more fiber. Yeah. I feel like that's my platform because on a public health level, I feel like that's where I see the most opportunity, but I feel like my best moments as a doctor have been with the person that has failed with other doctors, and they're doing everything right.
They're eating plants in variety and exercising and sleeping and doing yoga and they're not getting better. And you discover that there's something in their life that's holding them back and you help them to address that. And all of a sudden they're better. That to me is what medicine is really truly about when you can transform a person's life, not through pills or procedures, not that they're wrong, but instead through helping people to understand that there are connections in their body that they didn't think were relevant and they're there.
[00:53:21] Kara: Yeah. It's the ultimate role of that therapeutic relationship that we're entrusted to have.
[00:53:30] Dr. Will Bulsiewicz: And that's, to me, so powerful. ,
[00:53:33] Kara: That's my favorite thing to work through and talk about with the trainees that come through too and help them not lose sight of it when they are in the midst call and all of those things.
[00:53:46] Dr. Will Bulsiewicz: I think it's hard. The system demands a lot of us and this is part of the issue. This is part of the reason why doctors, not just with histamine intolerance, but more globally are very reluctant to acknowledge that diet has any meaningful influence. Part of it is that we have not been trained on it.
So it requires additional effort to learn it. Part of it is that it's frankly, an inconvenient truth because we are not given the time that we need to really work through something like that with our patients. We want to but we're not given the time to do that and that creates problems.
[00:54:20] Kara: Or to even think about it in our own lives, right? It's one of those ultimate things where, you know, for our family it really took this huge health crisis to have the wake up call that we were living in survival mode all the time, getting takeout, all those things and really reentering ourselves on what our family's priorities were.
[00:54:46] Dr. Will Bulsiewicz: Obviously I can relate to that, given my story in the beginning the number one cause of death among cardiologists is heart disease. It just it goes to show you that we clearly have room to improve, I think in terms of our approaches and prevention.
[00:54:59] Kara: Yeah. And physician wellness too, which is whole another talk on that another day.
Thank you so much, Dr. B. I really appreciate your time, your energy, all of your expertise. I really, the fiber field cookbook is where it's at. It is a great resource and you can pick it up wherever you buy books. And then check out the gut health MD on Instagram. And then remind me your website, the plantfedgut.com. Is that right?
[00:55:28] Dr. Will Bulsiewicz: That's correct. My website is the plantfedgut.com. I have an email list that people really seem to enjoy when there's new research that comes out. I like to send an email to my list because it allows me to really unpack stuff in a way that's quite challenging to do on social media.
[00:55:45] Kara: I need to make sure I have that white listed. Cause I hate how email sometimes will shift things over. Thank you so much.
Okay, friend. I hope you enjoyed this episode and we'll catch you next week. If you like today's show, I would love for you to download my free 5 Foods You Don't Need to Fear. Hop over to www.crunchyallergist.com or the link in our show notes.
And if you're ready to join me in re-imagining what life with auto-immunity and allergies can look like, it's time for you to step into AIRsquared, where Jen and I give you all the tools, training and support you need to help you realize your goals while redefining your anti-inflammatory lifestyle.
In AIRsquared, you'll get weekly life and nutrition coaching. So you are never lost or stuck in confusion. Whether you're new to an anti-inflammatory lifestyle or ready to take things to the next level. This is a premiere coaching. Teaching program for the busy professional who is looking to ditch diet culture, and learn how to become their own best friend. Visit www.crunchyallergist.com to learn more.
