Your Microbiome & Gut Dysbiosis with Jason Hawrelak (EP#105)

Mason: (00:00)

Hey, Jason.

 

Jason Hawrelak: (00:01)

Hey, Mason. How are you going?

 

Mason: (00:03)

Very, very good. It's been great meeting you. I feel like we've talked about your work and you so much on this podcast. It's just so great to tune in. We're really grateful. Everyone loves Dan Sipple, one of your students here on the podcast, and we're really grateful for him opening us up to your work. It's been nice for me to see, because I knew him when I was just at the markets coming up myself before he was a naturopath, so we've had chats for me not in the practitioner realm, kind of going in and out of health circles, him kind of more from a practitioner angle. We've had conversations about all the different types of diets and everything. It's been nice to see him land in one element of his practise here in what we're going to talk today and microbiome and this kind of analysis. It's kind of been, as we were talking about a little bit beforehand, it's nice to not just be hoping that your diet is as good as you think it is.

 

Jason Hawrelak: (01:09)

Yeah. Well, I think we're lucky now that we can more easily assess at least the impact of the diet on the microbiome. That is accessible now, and listen, it wasn't very well accessible 10, 15, 20 years ago. I've been a clinician for 21 years, and the stool tests we had access to 20 years ago gave us a very tiny snapshot of the ecosystem. We know the average person might have 160 species present, and the old stool analysis would tell you four of those and engaged your health on what those four populations were like, which never felt quite right. I think we skip forward in time, we're like, "No, that was not close to it." I know it's the best we had at the time and we're always working with the best tools we have, and again, you skip forward 20 years from now we'll have amazing tools and quick turnaround time for stool tests, et cetera, but I think now we just have that capacity to really see the individual nuanced effect of dietary factors, lifestyle factors, on the microbiome.

 

Mason: (02:13)

Was it like all those years ago, even when you had the four populations you were able to test, did you have the instinct that, all right, well, the gut for you is the foundation? Were you just like, "This is the best we've got and this is what I'm going to have to work with," because this is the foundation of your practise and your treatment?

 

Jason Hawrelak: (02:30)

Yeah. I'm lucky that I did my naturopathy training, I think it started in 1996, and sort of my final fourth year was 1999, and then I moved on to doing my honours degree looking at the gut microbiota or dysbiosis of the ecosystem in irritable bowel syndrome and how we could alter that with prebiotics, probiotics, and herbs. So I went from being a student to when I recently graduated new practitioner seeing patients, but at the same time I was reading research studies that were talking about how to analyse the gut ecosystem, and I could see then that the tools that we had access to were very limited even to the gold standard then.

 

Jason Hawrelak: (03:06)

The gold standard then could find 50, 60 different species in the gut, but it was immensely expensive and not practical in the real world. You had to get stool samples from people and freeze them at minus 40 degrees under a nitrogen atmosphere within moments of them being voided, and then culture that in the lab which is a painstaking, costly experience. So yeah, they can do that in research settings, but it just wasn't possible in clinical reality, so we were stuck with the lactobacilli, E. coli, tetracocci, and bifidobacteria. I think those are the four things they could tell us about, which we know that most of those are tiny players in the healthy gut, but it was what we had access to.

 

Jason Hawrelak: (03:48)

There were some other function markers on those tests, the old comprehensive digestive stool analysis that could help us fill in some of those gaps around short-chain fatty acid production, some of the fat suggestive markers. That would help get us get a feel for someone's gut functionality and gut health, but the ecosystem component was just so tiny, and really, researchers knew it was a tiny amount. Even with what we could do with that recurring gold standard of culturing was what we knew was a tiny amount of what was actually there. There was hints of that.

 

Jason Hawrelak: (04:20)

You look back at that research and you could have people on a mostly meat diet and a vegan diet and you'd look at their ecosystem via culturing and it was no different. It just didn't make sense. It's like, "How the hell could that diet and this diet create the same ecosystem, or changing the diet make no difference to the ecosystem?" That's really the state we were at in the '80s and '90s, is that the technology we were using was just so insensitive we couldn't see these things.

 

Jason Hawrelak: (04:49)

But there was one study that was using a raw food vegan diet to treat rheumatoid arthritis, I think in the early 2000s, that shared a dramatic improvement in rheumatoid arthritis, huge, but the culturing showed no difference in the ecosystem. But they used a different technique which never really caught on and really wasn't great, but it was looking at fatty acid profiles and the cell membrane of cells from memory, and they showed it was dramatically different. And they said, "Something is changing in the gut. We can see it, but this technology [inaudible 00:05:23] is too insensitive. We can't work out what's going on. We really need to develop new techniques. We need to start moving into DNA," and that's where we shifted in the early 2000s is that shift using bacterial DNA as a way of looking at what's there.

 

Jason Hawrelak: (05:37)

That's why everyone is talking about microbiomes now and we weren't so much 20 years ago is because technology has advanced that we can see. We can see the impact of diet. We can see the impact of medications. We can see the impact of environmental chemicals, et cetera, on the ecosystem that we just couldn't see before.

 

Mason: (05:53)

Where do you think we're at in terms of the... We just opened a can of worms with this DNA testing model in terms of just how deep we're going to be able to go with diagnosis and treatment protocols. Are we just scratching the surface, or do you think it's pretty flushed out at this point?

 

Jason Hawrelak: (06:11)

That would depend who you ask and their knowledge of the field. And as someone that's spent 21 years researching this area now I'm pretty comfortable navigating through it, but if you find someone that's just come across the microbiome in the last two years and never heard of it before and then they started reading stuff, they're like, "Whoa." They're looking at it at a different viewpoint, and they might feel that it's insufficient knowledge to make dietary changes or recommendations based on the level of science that there currently is. And I think that yes, science is evolving, yes, we're learning more all the time, but we still know a fair bit. Listen, there's still species in the gut we have no idea what they do. Some of them haven't been named yet. So yes, we know a certain amount and there's a lot more we don't know than what we do know, but as someone that's been in the field to watch it change over that 20 years and being able to work with patients and putting into practise recommendations that change that and see the benefits, I'm pretty confident in that area.

 

Jason Hawrelak: (07:09)

I just look forward to, essentially, probably two things with testing. Perhaps seeing a bit more functionality looking at the genetics, the microbes that are there, but two, just quicker turnaround. At the moment you might be looking at four to six weeks if you're lucky to see what's going... When you sample it, send it off to a lab and get a result back. What I would love is when you can do this on a semi daily basis where you can look at it and even a couple days later you can go, "Okay, what's it like?" You can give a course of antibiotics and then get a result of how disturbed that ecosystem is two days later, not six weeks later, because what are you going to do six weeks later? It's too late to individualise treatment for that patient based on what it was like. You'll still get it to work, but you know what I mean. You can't see the acute damage caused by an event whether that's dietary or medication induced.

 

Mason: (08:01)

That's something I was really thinking about. I haven't really been comfortable doing any tests with naturopaths whether they're mates or not, other than doing heavy metal analysis, looking at long term longevity marks especially, until this came along and it was a really easy, sensible test for me to go forward with. It was based on markers that weren't swinging or weren't volatile. It was something I knew I could invest in long term, and if there was something chronic there, because in my mind it's a long term kind of plan test, and I was looking at all the chronic issues and yeah, it really makes sense in those kinds of treatments settings.

 

Mason: (08:46)

But then I'm looking at just how powerful this could be with acute bacterial and fungal, parasite, viral infections, so on and so forth, that kind of gets me a little bit excited. If I was a practitioner, or we have a huge community and we're able to expose them to awesome practitioners like yourself, it makes me very excited thinking about that kind of progression where again, not taking swings in the dark. You're actually seeing immediately what's happening with the impact of a herbal protocol or an antibiotic protocol. That's really exciting. I've never seen such a potential of like... I'm optimistic, but it would be interesting to hear your two cents on where we are with this information being integrated into the modern medical system. That feels like that's a sensible bridge. That doesn't feel like pie in the sky, like that would be too much to ask. So two questions, the acute, and then that integration. Do you see this being adopted at any point?

 

Jason Hawrelak: (09:56)

Listen, it's happening slowly. And again, back to 20 years when I first started digging into it, there were naturopaths, nutritionists, integrative GPs talking about gut health, dysbiosis, leaky gut, as core contributors to chronic disease, but it was not discussed in the wider medical community. The mainstream media wasn't talking about these issues, but fast forward 15, 20 years, people talking about gut microbiome, people talking about dysbiosis, people talking about leaky gut, so I think that those concepts have reached out to the broader community definitely heaps more in that time period, and I think there's a lot more clinicians aware of it at least to some degree and peripheral degree.

 

Jason Hawrelak: (10:35)

I still don't think that they're core aspects of typical medical training, for example. I think there's probably some discussion now in some medical courses around microbiome, what it is, why it's a little bit important, but just nutrition might take up eight hours of lectures in their five years of clinical study. They do more than that, but you've gone there for five years. The microbiome might take two hours of that, and this is really such a pivotal thing.

 

Jason Hawrelak: (11:03)

What I find fascinating is the microbiome sceptics who say, "I was really sceptical and then I started reading, and now I'm a convert," because they've actually looked into it and spent the time, and I think that sort of proves that there's so much evidence that's built up over time that is enough to get some of these more sceptical people excited if they take the time to look at it. So there's still people that haven't and who are naturally sceptical of anything that feels faddy to them, which for some people this does. For some of us that have been here for 20 years it doesn't feel remotely like a fad. This has been fascinating to watch the growth of that.

 

Jason Hawrelak: (11:39)

There used to be a handful of research teams around the world looking at microbiota health. Now there are thousands, and the number of papers published every year is just huge, not even just on probiotics or prebiotics but just the importance of gut ecosystem health to all these other disease states and how dysbiosis causes or contributes to all these different disease states. I think that's absolutely fascinating, making these broader connections which allow us as clinicians far more tools to treat the cause, other than going, "Okay, I can give you St. John's wort or saffron to treat your depression." Certainly better than giving an SSRI pharmaceutical, for sure. Side effect profile much better. Long-term use not an issue. However, it's still not necessarily getting to the cause, and if that cause is increased permeability and a dysbiotic gut ecosystem, which it often is, it's good to know that we can test for those things and go, "Okay, what's your imbalance like?"

 

Jason Hawrelak: (12:35)

I think that's the other aspect too, is that everyone's ecosystem is so unique, that there are certain patterns we can see associated with disease states, but that doesn't always mean that this individual patient with that disease label is going to fit that pattern that's been found in that research, and that's what I love testing for, going, "Okay, do you? Maybe you do. Great. Maybe you don't, and then all right, we know exactly where it's at. How can we individualise tweaks, make some changes to your diet with prebiotics, probiotics, supplements, to actually get that ecosystem into a healthier state?" Which, to me, probably brings the point of how do you define a healthier state, and to me there's a few things.

 

Jason Hawrelak: (13:13)

One is diversity. You want it to be diverse just like you want the rainforest and coral reef to be diverse. You don't want a forest to be 80% one tree species and then 100 species make up 20%, because it's going to look like a plantation not like a forest. You want it to be a wide number of species present, so species rich and a nice spread, and then you want high levels of beneficial bacteria, low levels of pathobionts and pathogens. Pathobionts are species that are fine in normal amounts, could even be quite helpful, but when they get too high they cause harm, so we want to keep them down to low levels, and that's how we define that and how do we achieve that balance. And I think once you look at their ecosystem, we can generally work out, if you know what you're doing, how to actually change that.

 

Mason: (14:01)

That's what I like as well. I think it's been four months since I had my analysis done and it was super interesting. We did it as a family, and there's a couple of things I'm going to try and fit... As I normally do when I'm in conversations that excite me, I'm going to try to fit too much in at one time, but whatever.

 

Jason Hawrelak: (14:19)

I hear you.

 

Mason: (14:23)

The biggest thing we've talked a lot about, you brought up fads. Most people think this is maybe going to be a fad and then they realise it's not a fad once they start doing a bit of research.

 

Jason Hawrelak: (14:33)

Yeah. That's right.

 

Mason: (14:36)

And in the health world it's been one of those things that's been bandied around for so long like, "You've got to work on your microbiome. How do you do that?" And in the beginning it's like we're just going off kind of body ecology, not to say that these were bad movements, but it's like, "Oh, just cut some sugars, more vegetables, a bit of diversity," and everyone is like, "Oh okay, cool." And then it's like, "All right, but this is going on now. I'm a bit anxious." Skin issues, it's like, "All right, we're going to have to look at the gut," and it became one of those things where everyone is like, "Oh my god. I'm sick of being told it's the gut," and I felt like that was warranted to an extent when you're busy and you don't have anything measurable to know when you are healthy within your gut. Not just go on the raw food vegan diet as you were saying and get some really good lessening of symptoms but then not knowing what's going on long-term and then all of a sudden cracks start showing potentially if it's an extreme diet.

 

Mason: (15:34)

And then being able to finally, for someone who's busy... I think I always think of a mom I knew. She's my prototype when I started my business. I was telling her to go and harvest her own turkey tail in Lane Cove National Park and she's like, "Hey, mate, I've got four kids," and two of her kids were autistic and she works full time, and she's just like, "I don't have bloody time. Give me my mushroom powder." I was like, "All right, I can see the relevance of this business." All of a sudden the, "Well, how is your gut? How does your gut look?" And you're like, "I think it's healthy." Now, bang. You can go and actually, as you said, get an individual approach of what's going on within the diversity and actually start getting a definition of what is healthy. Okay, cool. We can start to kind of actually look at that rather than going, "Trust me."

 

Mason: (16:22)

We talk about a lot of extreme diets here. I'm an extremist, that's why I kind of have a sore spot for talking about them. I throw myself at them and then talk smack at extreme diets, but me and Dan quite often talk how interesting it would be if everyone would present their microbiome profile after they've been on a diet for-

 

Jason Hawrelak: (16:45)

Yeah. That would be fascinating. I agree. For me, sometimes the people who are doing really extreme ones like carnivore diets, I think you can't really assess the impact of that without looking at microbiome, and I think it's skipping a giant component of the potential negative consequences if you're not looking at that, the short and long-term. That's a good example.

 

Mason: (17:12)

Or at least integrate it as a piece of the puzzle. When I was extreme, if someone asked me to test my microbiome I'd be scared because I would have felt like I was about to get called out and possibly I'm going to get shown something that I don't want to see. I get it. I'm empathetic towards folks who are like, "Cool, let's just look at ATP markers," or whatever it is. Metabolic markers or muscle mass or some hormonal... Cherry pick. At least this being slid in there, but it's just nice that's available now instead of four to six weeks. But even then, that's fine if you've got a long-term intention, right?

 

Jason Hawrelak: (17:55)

Yeah, and then the price I think has come down too. Again, if you skip back to early 2000s the best tests we could do was $800 per test and that looked at 12 species of bacteria instead of four. It was like a big step up and used a bit of DNA marker for that, so it's like, "Yes, okay. Evolve with technology, but $800 per patient is like... How often do you do that? How often is that justified? Is it justified at all?" As much as I'd like to see what's going on even in that limited realm, it's like, "That's a lot of money," whereas now, there's a few different types of DNA-based techniques and some of the 16S technique ones are around the 100 US dollar mark per test, and sometimes you get them on special where they can be 50 bucks or something like that, so it means you can really do frequent testing.

 

Jason Hawrelak: (18:52)

To me, that was a game changer when the 16S test came online. It was like, "Oh, gosh. Now we can look at testing these things for $100 a pop and it means we can do repeated tests." Now it's like, "Let's give you stuff for two months and we test, another two months, we test, and you can see dramatic changes from that and see whether your protocols are working or not." And I think obviously this objective is are they feeling better and their disease is getting better. That's the most important thing, for sure. You've got that regardless, but you see that objective change.

 

Mason: (19:26)

[crosstalk 00:19:26] You forget that the symptoms have alleviated to be able to see it.

 

Jason Hawrelak: (19:30)

That's a very good point. It's true, because people, sometimes they're getting better on the slow trajectory and then you look back going... This is where it's nice if you have measures or ways. You could ask them their energy out of 10, and when they first came to see you it's two out of 10. Now it's like seven and they've already forgotten that it used to be two out of 10 because it's taken four months to get there and they just kind of get used to that new normal. But I do think having an objective diet is fantastic and to really gauge treatment effectiveness, because people are unique and their ecosystems are unique, and whilst I'm using research like clinical trial evidence to guide my decision making around what prebiotics to use and what dose et cetera, as well as my clinical experience, it's like someone may... Most people respond as you expect them to and some people respond a bit differently to that, and that's where having that feedback makes a big difference.

 

Jason Hawrelak: (20:21)

I would say I've been working more with autistic kids the last couple of years, and their ecosystems are particularly changeable and flexible and exaggerated responses, so it's been a fascinating learning working with this population. If we weren't doing pre-imposed testing you'd have bloody no idea what's going on, but where you can have a species go from 0.06% of an ecosystem and then four weeks later be 80%. It's just changes that are unheard of in a neurotypical population, but in this population it happens, and it's important that you know that as a clinician and important that you know how to adjust dosages and [inaudible 00:21:03] and things, again, which comes from testing and having the access to these tests at a more affordable price than before.

 

Jason Hawrelak: (21:10)

Some of the other molecular tests or DNA-based test we use are a bit more expensive like shotgun metagenomic sequencing which is more around the $300, $400 mark, so that's another notch up, and again, I've got to consider whether the additional data I get is worth the added cost or whether getting three tests for the same price of the inferior 16S tests would be a better option for this patient.

 

Mason: (21:40)

Lots of questions about that part of the population responding, but I feel like I'm going to open up... That's going to be a big conversation in terms of what's going on there if I go there.

 

Jason Hawrelak: (21:49)

Yeah, it could be.

 

Mason: (21:55)

Straight away, you've brought up depression, and everyone is now at this point of... I'm sure 20 years ago when you talked about a gut-brain connection it's not like today where everyone is just bandying that out there, talking about that access, which is amazing, the gut-brain microbiota. So naturally, I can see your work is with acute and chronic gastrointestinal conditions, but then it just seems like you wouldn't have ever been able to not work in mental health at the same time.

 

Jason Hawrelak: (22:29)

No, and because of that full on link, I see patients with chronic fatigue and patients with depression, anxiety, kids on the spectrum, some of which would have gut symptoms or obvious gut dysfunction and others do not, and we're just looking at how does their gut health or their microbiome composition affect their disease symptoms and how can we then modify it afterwards? So I think that microbiome composition, it's huge for all of those different things that we've just mentioned and more, and really, I don't see it that far in the future where doing a microbiome assessment will be standard because you look at that growing list of diseases associated with dysbiosis, it is growing.

 

Jason Hawrelak: (23:16)

On a monthly basis a new study find a new link between a new disease and dysbiosis, so I don't think it's too far away when this will be part of your annual general checkup. I'd like to see it more common than that, but there'll be awareness around this with all these new disease states and awareness of, "Okay, well, maybe if this practitioner doesn't know how to modify it they can refer to somebody who does," and to people who specialise in microbiome modification to work alongside people who might be prescribing the pharmaceutical that that person might need or the people who are prescribing herbs and nutrients as a way of dealing with that condition.

 

Mason: (23:52)

That's a comforting thought, thinking about that being a part of the regular checkup.

 

Jason Hawrelak: (23:57)

I'd like to think so. I think Western medicine can be slow, cautious, and there's some benefits to caution, but I think sometimes it means things move very slowly. And even, I think of the impact of, to talk about a different ecosystem, but vaginal dysbiosis. This is an area that I'm passionate about because it's just an area that I think doesn't get the attention it deserves, and there's women who are suffering health consequences from having a dysbiotic vaginal ecosystem that no one talks about and no health professionals know about at all. People talk about the gut now, but there's the vaginal ecosystem too and there's a range of increased health risks for women who have a dysbiotic ecosystem, from cervical cancer to a range of STIs, sexually transmitted infections, as well as just symptoms in that area.

 

Jason Hawrelak: (24:54)

I look forward to when that's just part of people's checkup. We look at that and go, "Okay, how is that ecosystem health going? How do we improve that?" We know that vaginal dysbiosis is linked to infertility and poor birth outcomes as well, so to me it's a no brainer that this should be part of a discussion and should be part of a consideration of someone's state of health, but it's just not there in conventional medicine. I don't know how many studies need to be published before it does get there, but I'm hopeful on the other hand that in five or ten years time, which is a long ways away for a lot of people, that some of these cautions will be around this and that care will be far more broad in its scope and some of these areas of dysbiotic ecosystems will be addressed, because I mean the gut was kind of the tip of the iceberg. There's stuff about skin ecosystems that we know so little about, and how do we even modify that? We know so little about it. We know how to kill things, put antibiotics on there, put an antifungal on there, but how do we make the ecosystem on my cheek healthier?

 

Mason: (25:56)

Yeah. Far out.

 

Jason Hawrelak: (25:57)

Nobody even researches that yet. That will change and we're just starting to do that with the gut over the last 20 years, how do we make that ecosystem healthier, but I think there's other broader systems that we are way behind on too.

 

Mason: (26:10)

Yeah. And as we keep saying, it's not just stabbing in the dark. It's nice to have a part of your health protocol or your strategy or your lifestyle or whatever it is, something that you can show, "Actually, how can I increase the diversity in my oral cavity and my skin?" And just talking about UTIs and thrush, I mean that's... What do you get? You get antibiotics or you go and take some cranberry. That's kind of all there is in the awareness around that at the moment, but I think where that's going to start. It's always in preconception. That's where the doors get opened for a lot of the population that do things.

 

Mason: (26:53)

So I think there, just looking at the vaginal cavity and going, "This is going to have a direct link to your gut microbiota," and then, "Okay, cool, so let's..." So now it's nice for me when I have friends who are trying to conceive and we talk. There's a lot of conversation like the Daoistterminology around that, but we always say you've got to make sure you have a nice, healthy gut because that's going to be handed over.

 

Jason Hawrelak: (27:18)

That's right.

 

Mason: (27:19)

All that's in our testing. It was interesting watching at the time our three year old. We were just going, "Yeah, you can see there's the direct... This is what you've given Aiya," which thankfully is pretty good. Just could use some more biodiversity.

 

Jason Hawrelak: (27:35)

That's the cool thing about testing. You can see those things which I think is fantastic too.

 

Mason: (27:41)

Well, I think I see that's where it's really going to. Again, like gastrointestinal microbiota during pregnancy and that handing over the encyclopaedic knowledge, just between that information that's getting handed over to a child and then through breastfeeding, I think this is going to... I'm really excited to be able to give my friends something that's data driven where they can start seeing exactly what they are now handing over to their child versus would have not been.

 

Jason Hawrelak: (28:14)

And by testing that during early pregnancy and working out, "Okay, what's the ecosystem like now?" Ideally before that if you're working with the preconception we can test and look then and then make changes, but how do we optimise the ecosystem during pregnancy so we can pass on the healthiest ecosystem possible? And I think that will be a core part of... I think it is in some people's circles already a core part of that prenatal care, but I think it will become even more so, because you've got that opportunity to... You've only got that one chance of passing on in some ways, one chance of passing on the healthiest ecosystem possible so you do your best. If you know that, you do your best to make it as healthy as possible, but to do that you need to know how healthy that is in the first place, how you can modify that, and then you can follow up and go, "Okay, how is it tracking over time?" And then to ensure the best introduction to the next generation, best seeding and reinoculation to the next generation.

 

Jason Hawrelak: (29:11)

And then we'd expect also that a healthier gut ecosystem will essentially result in a healthier breast milk ecosystem that will be passed on too, because there's certainly a link between the gut microbiota and the breast milk microbiota. The breast milk microbiota is far more complex than just the gut, but there's a sampling going on is what we feel, that bugs are being sampled from the gut, brought up to the breast tissue and fed to the next generation, alongside some amazing, unique prebiotic sugars to feed those microbes.

 

Mason: (29:48)

So cool.

 

Jason Hawrelak: (29:48)

Yeah. It's very cool.

 

Mason: (29:52)

Your mind starts going to fantasy land around this becoming subsidised and us looking at it as a population, because we're walking on eggshells and we've seen that the last year immunologically what's happening. All these symptoms being brought up, all these susceptibilities, seemingly healthy people all of a sudden going down to... That's with the flu or with any virus, but you mentioned data. I didn't want to throw this one out there, but I was just looking, there was a paper that was just starting to look at the diversity of the microbiome. Okay, this is obvious, but it's interesting seeing the papers come around specifically with the... I don't know which strain of COVID they're actually testing it on. Have you seen that data? Have you seen that starting to come out?

 

Jason Hawrelak: (30:43)

I've seen a little bit. I haven't focused too much because I suppose being in Australia, being in this little cocoon, that you're kind of outside the COVID sphere, so you don't actually have patients who are at high risk of getting it and asking questions around it, but I think from my understanding, and I am doing some research with a UK-based practitioner where we're actually treating long COVID patients by changing the microbiota and we're doing pre and follow up testing along the way and we're hoping to get it published to show the improvement in long COVID symptoms associated with microbiota optimization. I'm aware of some of the research around it, but not all the studies are coming out. I wouldn't be surprised if lack of diversity and high levels of pathogens and pathobionts and low levels of beneficial are core risk factors for more severe COVID, given that those are the same risk factors that we would see for most Western diseases that we're dealing with too for that matter.

 

Mason: (31:44)

I guess as you were saying the data is kind of catching up whereas someone would be looking at the data they'd be like, "Okay, maybe this could work," whereas after two decades of clinical practise you know that you're going to see an improvement. It's going to see immunological, a whole physical robustness and basic adaptability and ability to get back to homeo spaces and reduce inflammation, not stay chronically inflamed, is going to be improved. Hormonal functions are going to be improved if you have at least this foundation focused upon as a primary.

 

Mason: (32:20)

This is the first time I've gone, "Yes, here's a test that shows just how much we're walking on eggshells," especially in the Western world and especially on a standard Western diet. It's kind of really going, "All right, guys." I assume the data is going to catch up and be like, "Look at these disease states. Look at the microbiome. Look at the outcomes," and you can start to see various population overgrowths or deficiencies and start going, "Well, how about-"

 

Jason Hawrelak: (32:51)

And similar patterns throughout between a broad range of Western chronic diseases from Alzheimer's and depression [inaudible 00:32:59] I think the similarities between the gut dysbiosis that is showing up in research, which again, is often low diversity, low levels of beneficial species like bifidobacteria or akkermansia or butyrate producing species and high levels of pathobionts like proteobacteria. It's the by parts of some of those bacteria like proteobacteria specifically that are seen as drivers of brain inflammation, changes in neurochemistry, changes in neurotransmitters that occur with things like Alzheimer's as well as depression, anxiety, and I think it's just fantastic that we have the tools available to actually shift that and it's not that... Well, assuming you're willing to change your diet, it's not that challenging to actually make those sort of imbalances and shifts pretty substantial in people's gut ecosystems if they're willing.

 

Mason: (33:49)

We've discussed some of the basic recommendations on the podcast before, but I'm interested in hearing... Obviously, so if we're looking at some serious symptoms you'd want to be getting some testing and formulating I'd assume an individual diet plan, supplement herb plan. Are you most comfortable recommending that? Are there general recommendations at this point you're happy putting out there to take the population in a particular direction?

 

Jason Hawrelak: (34:22)

I think there's different recommendations too. I think the point with individual ecosystems is perhaps just tweaking those to suit this person, giving a little bit more of this, a little bit less of that, because that's what some of the individual nuances are. I think there are some general principles of helping it. How do you get a healthier gut ecosystem, well, that's getting more than seven hours sleep a night. We know that's important, and I didn't always see that. I try. I didn't always.

 

Jason Hawrelak: (34:50)

Point two is moderate amount of exercise. So some of these things aren't mind-blowing, and we've associated with better health for a long time for other reasons too, but moderate amounts of exercise are good. Too much is not so good. Too little not good. Thirdly, probably stuff around diet would be having a greater diversity of plant food stuffs, eating whole unprocessed plant foods, so you're getting lots of fibre, a rainbow of colours. I usually suggest people aim for eating 40 plus different whole plant foods per week. It's not like this is a magic number, but it's an achievable number where people can actually eat 40 plus different food stuffs and that's enough to result in diversity improvements, because essentially in that situation you are not introducing new species into that ecosystem, but you are feeding up species that are there in teeny tiny amounts and allowing them to bloom into larger amounts, to sufficient numbers that they can actually contribute to your ecosystem health and your health. When they're at 0.001% of an ecosystem they're not doing much in terms of contributing much, but when you get them up ten or a hundredfold higher than that, all of a sudden they can.

 

Jason Hawrelak: (35:58)

That's one of the key things associated with health is a more diverse ecosystem, so I think the best way of doing that is feeding the widest number of beneficial microbes possible. I think the key thing there is diversity of diet, as I've said before. That you're having lots of fibres is important but also different shapes and sizes of that fibre, so you're eating 50 grammes of broccoli fibre a day. It's better than no fibre per day, but it's not the same as 50 grammes of fibre from a range of legumes, whole grains, vegetables, fruits, nuts and seeds. You're going to feed a far more diverse ecosystem with a diverseness of food stuffs.

 

Jason Hawrelak: (36:37)

Other things are avoiding processed foods, one because they're often fiberless and don't contain anything really healthy for you anyway, but two, sometimes they contain things like emulsifiers, like polysorbate 80 and carboxymethylcellulose which doesn't really sound like stuff you want to eat, and it's not, but they're things we know now that strip away your protective gut line and it's like, "Do we really want to do this? No, we don't." It needs awareness around that. When people are buying that big tub of home brand ice-cream at the shop, they're not looking at the ingredient so much. There's $2 for that tub. There's a reason why it's two dollars for that tub. It's because it's sugar, water, and heaps of emulsifiers to make that sugar and water and fats all combine together, and oil. Those emulsifiers we know strip away that protective gut lining, make your gut more leaky, and then allow bacterial byproducts to get into your system, and we don't want that.

 

Jason Hawrelak: (37:34)

And choosing organic as much as we can, because we know that certain food chemicals are unhealthy for our human cells but also cause disruptions to the good bacterial populations in our gut as well. And as mentioned before too, a rainbow of colour, because it's the polyphenols in foods like blueberries, eggplant skin, strawberries, raspberries, those colours are generally polyphenols. Not always, like red capsicum isn't polyphenols. It's carotenoids that make that one red, but the multicoloured foods. Most of the polyphenols, in fact probably 90% of the polyphenols are absorbed by gas and they feed the colonic ecosystem, the good guys in the colonic ecosystem, and their populations grow. But as a consequence of eating those polyphenols, they release a smaller compound which we then absorb and we get the health benefit of, and I think it's this great win-win situation that we eat it.

 

Jason Hawrelak: (38:28)

If not for the gut bacteria we would just be pooing it straight out and not getting any health benefit from it, but what we're doing is feeding species who then create an absorbable compound that helps us, plus their population grows, so it's a win-win situation. So we want to have as much colour in our diet as possible, so I always recommend things like red rice and black rice and black beans and adzuki beans to get the different colours. Lots of berries for example, and I think that's one of the other core things we can do.

 

Jason Hawrelak: (38:57)

Things that contain resistant starch, which is a type of starch which is indigestible to us but feeds our microbes, those things are found in legumes, whole grains, root vegetables, but often these things, you get higher amounts when they are less processed i.e. not ground into flour, and secondly when they're cooked a certain way or when they're already processed, so they're cooked and cooled. So if we bake our potatoes and eat them the next day or boil our red and black rice, but then eat it the next day. Some of that starch when it cools gets converted to another type of resistant starch which then feeds our microbes.

 

Jason Hawrelak: (39:40)

Then there are certain foods which contain higher amounts of what we call prebiotics, and prebiotics are the selective fertilisers of supplements, that we take them and we selectively feed the species that are healthy for us to have more of, and I think the key things of that prebiotics is that generally those compounds are indigestible so we can't break them down, and two, it's selective, and I can't reiterate the importance of that as how you define it, because that term prebiotic is thrown around all the time. "Oh, any fibres are prebiotic." It's like, "No."

 

Jason Hawrelak: (40:13)

Fibres are great, and they can feed a whole bunch of different things and that's not a bad thing, but prebiotics are very selective in that I can look at an ecosystem and go, "Okay, your akkermansia population is low. Your bifidobacteria population is low. I'm going to give you some foods or suggest you eat more foods that contain a type of prebiotic called inulin or fructooligosaccharides and that will increase those populations very specifically, and you can see the before and after." You eat those things as a supplement or in those foods, their populations go up very clear.

 

Jason Hawrelak: (40:43)

The research says that. My 20 years of experience says that too. It's not feeding a wide range of microbes. It's really feeding some very specific members of that ecosystem, and we're generally doing that alongside broader dietary principles like diversity and polyphenols that feed a wide diversity of microbes as well, and that way we get that increase in specific beneficial species as well as increased diversity overall.

 

Mason: (41:07)

Have you got any foods currently that are just like, maybe you've read a paper about it recently or a particularly unique pigment or something that you're kind of nerding out on or really enjoying?

 

Jason Hawrelak: (41:20)

Probably, because I'm a bit of a permaculture gardener guy too.

 

Mason: (41:24)

That helps the microbiome.

 

Jason Hawrelak: (41:25)

Ceylon hill gooseberries.

 

Mason: (41:26)

Are you into gooseberries? Yeah. Yum.

 

Jason Hawrelak: (41:29)

The ceylon hill ones, they're these little purple ones that are really high in anthocyanins which are the same compounds in blueberries. They don't grow well down here, sadly, but they grow well up in North New South Wales. They've got beautiful flowers too. They kind of look a little bit like a pink tibouchina. The leaf is a bit tibouchina-like. They're probably some sort of cousin of the melastoma species that also are native to Southeast Queensland or northern New South Wales, but they're more bountiful fruits. Those fruits have been used for centuries in traditional Chinese medicine and Ayurvedic medicine. In fact, the fruit was said to be made by Krishna himself to give to... I can't remember which five brothers it was, but I think when you've got so much historical lore around the fruit, tells you that it's important if it's made by Krishna. It's important food. But it's also very high in polyphenols as well, so that's excited me recently.

 

Mason: (42:21)

I've got a mate who's a permaculturist. I'm going to have to go talk to her. I'm sure she's got some. I'm sure if anyone's going to be like, "Yeah. Yip. Got a couple of trees over there or bushes over there." She'll have the hook up. I guess jaboticaba I think for me at the moment and Brazilian cherries. I guess that's kind of where I'm leaning towards. So are there any herbs or supplements that you are kind of taking or seeing that you're getting most of your clients to take? IS there any kind of just fleshing out what maybe you think they're not going to be able to get in abundance just in an organic diet by getting from the food markets, or are you generally happy with that?

 

Jason Hawrelak: (43:04)

I use lots of prebiotic supplements in practise, and initially, as ways of targeting those species that are deficient in the gut and bringing them up quickly. Yes, eating some more of those foods will help bring that more slowly, but we're often wanting to change things quickly. So I personally don't necessarily take prebiotic supplements so often, although sometimes I do because I like that they taste good. My treat is having a teaspoon of fructooligosaccharides, but I rely mostly on diet. But I'm not unwell and when I'm treating people that have things going on that they need a boost quickly, these things work quickly that a month, two months, you can have a thousandfold increase in bacterial populations from adjusting prebiotic supplements. So for me, they're a core part of my practise and that would be probably three main prebiotics. There's inulin or fructooligosaccharides, oligofructose enriched inulin or inulin-type fructans are all names for compounds in that area. Then there's galactooligosacchardies.

 

Mason: (44:06)

Mm-hmm (affirmative). I like that.

 

Jason Hawrelak: (44:07)

Yeah, which we find naturally in legumes and beets as well, but primarily just amounts on legumes and tiny amounts elsewhere, and then thirdly is lactulose. Now, lactulose isn't found naturally in foods. It is found in tiny amounts of ultra heat-treated milk because lactose when it's boiled converts over to lactulose. Lactose is milk sugar, so I don't suggest people drink UHT milk, but you can find it in there. You essentially bought it in the liquid form from the chemist of all places in the laxative section, because lactulose in large doses, because it's indigestible and it reaches the colon intact and large amounts too much for your bacteria to eat, it draws water to it and you get softer bowel movements that go with it. But in small doses like we use as a prebiotic it just feeds the beneficial bacteria and their populations can expand as I said, hundred, thousandfold in many cases. And things like lactulose is fantastic for lowering levels of things like proteobacteria, species that have really pro-inflammatory endotoxin or lipopolysaccharide into the gut as they live and die. Lactulose is a very effective tool at bringing that population down very quickly.

 

Mason: (45:25)

I thought you were about to say it's in yakult.

 

Jason Hawrelak: (45:32)

Maybe there's a tiny amount because they probably had heat treated milk in there, but I wouldn't recommend it for source of lactulose.

 

Mason: (45:38)

I'm like, "Oh, that's what that crap is." No. You know what I started doing after having my session and just talking about this, the importance of all these pigments, and then just making that natural connection to a diet that was based more on foraging wild foods and just seeing that if you can... For me, I'm starting to really merge these two worlds because after my raw foods days I kind of sat, I guess for lack of a better word, more of that Weston Price ancestral world, but missing the capacity to get biodiversity because I'm not out there foraging, and so I wasn't letting any of those insoluble fibres... I wasn't doing really grains. No lentils, no real beans or anything like that. It was just bad in my mind, and so now I've started really resolving that and merging those two worlds and feeling really fantastic for it.

 

Mason: (46:38)

After that session I was like, "Wow, I've really let go of those wild fruit pigments," and started getting back onto making this big mix of my Kakadu plum, my Davidson plum, really [inaudible 00:46:54] finger lime, native peppers and mixing that up, just getting freeze dried Australian native fruits and just sour, tart, and just...

 

Jason Hawrelak: (47:03)

I love that.

 

Mason: (47:04)

Because we were talking about these other supplements with all the red pigments, it's got beet, and I got one and it was just sweetened with stevia and xylitol. I just couldn't handle it. But then made up that mix, I think, from just Australian Superfood Co is where I bought it from. That made a world of difference for me as well. I'm looking forward to getting that test done.

 

Jason Hawrelak: (47:25)

Yeah. And I think traditionally we would have always eaten things that didn't taste sweet. We'd harvest whatever fruits were growing around that were edible, and certainly some of the Australian ones are not known for their great taste.

 

Mason: (47:39)

Really?

 

Jason Hawrelak: (47:40)

From a traditional Western perspective of just being sweet, you get things like Davidson's plums which is pretty tart, but those colour pigments are absolutely outstanding. Dragon fruit, that one is sweet. The fluorescent pinky red, that's so rich in polyphenols. And we know that those pigments in dragon fruit can feed akkermansia quite well, which is a species that we generally want more of and many Westerns have a deficient population of.

 

Mason: (48:09)

Mm-hmm (affirmative). Yip. More biodiversity. That's going to help. That's true superannuation is go hunt here in the garden. It helps you grow.

 

Jason Hawrelak: (48:18)

Listen, the more you looK at chronic Western diseases that people are dying of in their old age, and slowly dying of too, I should add, the best thing we need to protect against those things is ensure you're looking after your microbes and your gut population now, and that will slow down and prevent that whole process, because Alzheimer's is very much a dysbiotic gut ecosystem and a lot of those chronic Western diseases are really being linked in to dysbiotic ecosystems. We know that Western diet has risk factors for those things and there's probably a number of mechanisms by which it does so, but certainly microbiome modification in a negative way in terms of those diets inducing dysbiosis, which then results in increased inflammatory tone and then that causes a whole range of negative sequelae is key.

 

Mason: (49:10)

Before I let you go, and I think I'm definitely going to have to come back on the podcast and maybe get into some... I can just dive down lots of rabbit holes. I'd really love to talk more about women's health and pregnancy and going into some specific protocols and so much other stuff. Curious in terms of the pigment, have you heard of the blue pigment and have any data on what that's feeding? The phycocyanin that's in the... Have you ever heard of it? That's in the blue green algaes and like...

 

Jason Hawrelak: (49:41)

No. I haven't looked. So some other people may have and there may be research that's looked at that at least in animal or vitro models, maybe even beyond that, but no, I'm not familiar with that research if it has been done.

 

Mason: (49:52)

Just wanted to throw that out there. That's a pigment I haven't been getting lately, is the true blue.

 

Jason Hawrelak: (50:00)

No. Well, true blue is hard. You do find true blue in the... I was going to say clitoris pea. Clitoria ternatea, the butterfly pea. That gives you that beautiful blue. Probably it's a different compound than what you find in that blue green algae, but it is one of the few natural food stuffs that contains such an amazing blue compound.

 

Mason: (50:26)

It's such a vibrant blue as well. Learning that no, actually blueberries aren't blue.

 

Jason Hawrelak: (50:33)

Not compared to that, no. They're like a purpley grey actually compared to that. I remember when I was in Thailand and had the butterfly pea tea for the first time. This is 15 years ago or 16 years ago. I was just amazed because the water was blue and then they gave me some lime juice to put on it and it turned purple. I'm like, "What the hell is this stuff?" It was incredible. It was just very hard to find back then. I remember searching high and low to find a supplier and there was nobody selling it back 15 years, whereas thankfully that's become more available. That grows beautifully up in your area too. You could just have a fence covered with blue butterfly pea.

 

Mason: (51:11)

I hadn't thought of that. Get that growing along the fence. That's a really good idea. Thank you for that. I'll take that gift. I'll let you get on with your day. Thanks so much. Really, really appreciate you coming on. Looking forward to jumping on again. I assume there's going to be a lot of people who want to... You've got so many other podcasts and talks and you've got so many resources on your website. Best place for people to go down the rabbit hole with your work or check out your clinic?

 

Jason Hawrelak: (51:48)

Yeah, so Probiotic Advisor is my broader website and there I've got a database. It's mostly designed for clinicians to teach them about evidence-based use of probiotics and trying to match the best probiotic on the marketplace to whatever you're trying to treat, but then I've got a range of courses as well. Most of my stuff is geared for training practitioners, but there's stuff there for health conscious people who are pretty health literate to gain from as well, courses around treatment of a range of gut conditions and functional testing in terms of what gut tests are the best, what leaky gut tests are the best, things like that. There's a world of information around that, and there's links to a range of my podcasts I think on that site too, so you can click and learn more on a range of different topics.

 

Jason Hawrelak: (52:35)

It's been an amazing journey to be in this field for 21 years and to see the growth of microbiome science in that time and I'm just glad that I chose that topic to do research because it's not often that you spend 20 years doing something and you're just as passionate now as what you were 20 years ago. I'm lucky that that's the case within this area.

 

Mason: (52:58)

Yeah. That's huge. I think because you're not having to pad how effective or how fast it's moving. It's actually been effective more and more and more. That's rewarding in itself. The reward is built into that path that you happened to choose. That's nice. I'm very happy that worked out for you.

 

Jason Hawrelak: (53:23)

Yeah, me too.

 

Mason: (53:23)

I'm just really stoked for... We've kind of always known this, but for the more literal needing data and science part of the population, it's really exciting to see that this is something which like the ecosystem that we can see on the earth is something worth preserving and reseeding and building and nourishing, so it's just really exciting for everyone.

 

Jason Hawrelak: (53:48)

It is, and for me that's a key passion, is that idea of custodianship and that we are gifted our microbes from our previous generation and we've got to give them on to the next generation, and what we do to that ecosystem in the intervening time determines what we pass on and how important that is that just like where we should be caring for custodians of the outer ecosystem and trying to keep it as healthy as possible to pass onto our kids, it's important that we do the same thing for our inner ecosystem as well.

 

Mason: (54:19)

Beautiful. Mate, thank you so much for coming on today. Have an awesome one down there in sunny Hobart.

 

Jason Hawrelak: (54:27)

Not sunny today. It's cloudy and 14, but it will return sunny again another day and two, so I'll enjoy it then.

 

Mason: (54:35)

Awesome. Thanks so much, mate.

 

Jason Hawrelak: (54:37)

Yeah. You're welcome, Mason.