Prebiotics, Probiotics, And Gut Testing With Dr. Jason Hawrelak
In this episode I speak with Dr. Hawrelak about: Important stool testing markers such as: pH, calprotectin, butyrate, akkermansia, and fecalibacterium. The use of prebiotics and probiotics, and whether we should use single or multi strain. Probiotics for SIBO. Transit time testing. Why we might react to probiotics.
#105 Your Microbiome & Gut Dysbiosis with Jason Hawrelak
We're so excited to be bringing you today's episode of the SuperFeast podcast; Mason sits down for a chat with the super knowledgable Dr. Jason Hawrelak and delves into the microbiome, gut dysbiosis, disease and, pre-and probiotics. Microbiome health is quite a ubiquitous topic these days and with good reason. Your microbiome is essentially a portal to longevity, and if you want to invest in your future, then it's wise to invest in the health of your gut ecosystem. Dr. Jason Hawrelak is a naturopath (over 21 years of clinical experience) and educator with a passion for gastrointestinal health, the GIT microbiota, pre-and probiotics, and a wealth of knowledge in his field. This episode is full of essential goodness on the gut/vaginal/breast milk microbiome and the importance of the gut ecosystem to all other disease states prevalent in the western world. Dr. Hawrelak touches on the exciting advancements, tools and, technologies that allow us to shift the imbalances in our microbiome, as long as we are willing to make the necessary changes. Make sure you tune in for this one! Mason and Dr. Jason discuss: What your microbiome says about your health. Bacterial DNA testing. Stool analysis. Chronic Western diseases and the dysbiotic gut. Probiotics and prebiotics for better health and immunity. Which foods have the best sources of prebiotics? What Dr. Hawrelak recommends for a healthier gut ecosystem. Leaky gut and emulsifiers. Why a diverse diet is essential for a healthy microbiome. Microbiome modification. Depression, anxiety, Alzheimer's, and gut dysbiosis. Optimising the gut ecosystem pre-conception and during pregnancy. The Vaginal microbiome and causes of dysbiosis. The breast milk microbiome. The link between the gut and breast milk microbiota. Who is Dr. Jason Hawrelak? Dr. Jason Hawrelak is a researcher, educator, and naturopath with over 21 years’ clinical experience. He did his PhD examining the capacity of probiotics, prebiotics, and herbal medicines to modify the gastrointestinal tract microbiota and teaches widely, both in Australia and internationally, on these topics. He has published extensively (including 20 textbook chapters) in this field. Dr. Hawrelak is on the Medical Nutrition Council of the American Society for Nutrition and is a Fellow of both the American College of Nutrition and the Naturopaths and Herbalists Association of Australia. He is currently the Senior Lecturer in Complementary and Alternative Medicines at the University of Tasmania’s School of Medicine (Hobart, Tasmania), where he coordinates the Evidence-based Complementary Medicine programmes. He also teaches natural approaches to Gastroenterology within the University of Western States Master of Science in Human Nutrition and Functional Medicine program (Portland, Oregon). Additionally, Dr. Hawrelak is Chief Research Officer at ProbioticAdvisor.com, a searchable database that enables easy, evidence-based prescribing of probiotic products and online resources for clinicians and health-conscious members of the public to learn more about the human microbiome and how they can positively influence these ecosystems. Resources: ProbioticAdvisor.com Probiotic Advisor Courses Probiotic Advisor Facebook Q: How Can I Support The SuperFeast Podcast? A: Tell all your friends and family and share online! We’d also love it if you could subscribe and review this podcast on iTunes. Or check us out on Stitcher, CastBox, iHeart RADIO:)! Plus we're on Spotify! Check Out The Transcript Here: 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. For more details go to: https://www.superfeast.com.au/blogs/superblog/jason-hawrelak-podcast
SUMMER SERIES: Dr Jason Hawrelak on the Microbiome, Gastrointestinal Disorders, the Role of Pre- and Probiotics
Unstress with Dr Ron Ehrlich
Our relationship with bacteria is changing. Well, our knowledge and understanding are anyway. It's been an adversarial relationship for over a hundred years and with the advent of antibiotics and antimicrobials, along with products that promise to make our surfaces and bodies 99.9 per cent antimicrobial and clean. But we are learning that most microbes are actually our friends and we need to learn more about them and how to look after them. Dr Jason Hawrelak joins me to chat about the microbiome, gastrointestinal diversity and the role of pre-and probiotics. You can also watch this episode at www.DrRonEhrlich.com. ----- TIME TO TAKE CONTROL OF YOUR HEALTH? Join our online health workshops. ----- CONNECT WITH ME You can ask questions via social media using my Instagram or Facebook or YouTube page.
HHHK 308: The Role of the Microbiota in Depression & Anxiety with Dr Jason Hawrelak
Health, Happiness & Human Kind
In today’s episode, we are joined by Jason Hawrelak, Naturopath, researcher and educator with special interests in the gastrointestinal microbiota, irritable bowel syndrome and the clinical applications of pre- and probiotics. Today we explore the incredibly fascinating topic of mental health and the microbiome. You will learn why we need to rethink the serotonin deficiency hypothesis of mental health, the role of a dysbiotic microbiome, yet the fact that there is not one distinct pattern observed in depressed individuals at this point in time, the impact of endotoxins, inflammation, key microbes including Alistipes and so much more. This conversation will change the way you view mental health and the research offers incredible hope for the management, and potentially treatment, of two extremely prevalent conditions experienced today. Show Notes: Head to https://www.stephlowe.com/podcasts/308 for show notes, episode transcripts and more.
30. How Your Gut Bacteria Influences Your Biology with Dr. Jason Hawrelak
Boost Your Biology with Lucas Aoun
In this episode, Lucas invites an internationally renowned expert on gut health, Dr. Jason Hawrelak. They discuss how certain diets influence the microbiome, the effects of antibiotics, and other factors on overall gut health in IBS and IBD. This episode is cutting edge, and full incredibly useful resources, so get your notepad out! Relevant links:Lucas’ Health Webinars: https://www.ergogenic.health/masterclasses Jason’s Website: https://www.probioticadvisor.com/ Show notes: www.nofilter.media/boostyourbiology
Ep. 72 Interview Dr. Jason Hawrelak: The Last Microbiome Episode You Will Ever Need
Dr Jason Hawrelak is a naturopath, herbalist, and nutritionist with 20 years of clinical experience. He is one of the leading experts in the treatment of gastrointestinal conditions with natural medicines. He has a passion for gastrointestinal health, the gastrointestinal microbiota, and probiotics.Jason did his Honours (First Class) and PhD in the gastrointestinal microbiota, irritable bowel syndrome, and the clinical applications of pre/probiotics. He has written extensively in Australian and International textbooks and journals.He consults with patients from all over the world who come to him for his expertise and experience.Jason believes in the importance of ‘food as medicine’ and an individualised approach to care. He uses a range of skills and healing modalities. These include dietary guidance, herbal medicine, nutritional supplementation, and lifestyle counselling.Notes:Dr. Hawrelak’s Website: https://www.probioticadvisor.com/Gould’s Natural Medicine Clinic: https://www.gouldsnaturalmedicine.com.au/Bacteria List: https://imgur.com/a/8xPeja4Homepage: www.quaxpodcast.comMusic by Jenny Jahlee from Live at KBOO
Gut Parasites with Dr Jason Hawrelak: Rational Wellness Podcast 169
Rational Wellness Podcast
Dr. Jason Hawrelak speaks about Parasites with Dr. Ben Weitz. [If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/] Podcast Highlights 6:49 Gut parasites used to be considered a more common cause of gut infections 20 years ago, whereas in the last 5 or 10 years in Functional Medicine circles we have come to focus more on conditions like Small Intestinal Bacterial Overgrowth, H. pylori, dysbiosis and fungal overgrowth. What should make us suspect that a patient with digestive symptoms might have a parasite? The symptoms do overlap with symptoms from conditions like IBS, SIBO, functional dyspepsia, and inflammatory bowel disease. We have to distinguish between parasites like Giardia and Entamoeba Histolytica that clearly cause serious gut infections from more debatable ones like Blastocystis Hominis and Dientomoeba Fragilis. You might get some history like they have recently travelled overseas and then got a case of traveler’s diarrhea. We have to do some testing to see what is causing the symptoms and not just stool testing for parasites. If you find Giardia, you can be fairly confident that this is responsible for that patient’s symptoms. But if it is Blastocystis Hominis or Dientomoeba Fragilis we can’t make that assumption, because of the prevalence of these microbes in healthy populations. Dr. Hawrelak recommends doing a suite of tests to determine what causes these symptoms including not only a PCR stool test but a microbiome analysis stool test, fecal calprotectin or lactoferrin for inflammatory bowel diseases, a fecal occult blood, and SIBO breath testing. 12:00 If you have a patient who has digestive symptoms like gas, bloating, diarrhea or constipation, and they have a positive SIBO breath test and they also have a protozoan organism like Blastocystis and/or Dientomoeba that shows up on a stool test, you should treat the SIBO. Such protozoans are extremely common and are generally irrelevant to that person’s symptoms. 15-20 years ago SIBO wasn’t that well known and we used to treat such patients for Blastocystis and we would get some results but it would generally not resolve completely. He talked about one patient who he treated for Blastocystis and got somewhat better and then 12 months later was diagnosed with fructose intolerance and went on a low fructose diet and all her symptoms completely resolved and Dr. Hawrelak was upset that he missed that diagnosis. 15:15 It is interesting to consider whether there could be SIPO or Small Intestinal Protozoan Overgrowth as a cause of IBS. We should probably think of certain protozoans like Blastocystis and Dientomoeba as commensal, as a normal part of a healthy gut. In fact, Dr. Hawrelak noted that he personally has elevated levels of Blastocystis Hominis on a stool test and no gut symptoms. Perhaps we’ll be taking protozoan probiotic supplements one day. On the other hand, taking certain antibiotics like Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms, it tends to awaken the pathogenic potential of Blastocystis and increases its capacity to actually cause gut damage and to interact negatively with precancerous cells and become much more virulent. 20:54 There are 17 different subtypes of Blastocystis Hominis but only 9 have been found in humans and the rest in other animals, like chickens, pigs, cows, etc.. For humans the most common subtypes are 1, 2, 3, and 4, esp. 1 and 3. There is no consistency in the data around which of these subtypes may be more pathological than the others. Dr. Hawrelak wants to emphasize that when he has a patient who shows elevated Blastocystis or Dientomoeba he used to think that these were primary parasites that needed to be killed to help his patients feel better and now he generally regards these as a normal part of the microbiome in healthy patients. There have been a lot of good studies done in western Europe that have found that 7 out of 10 healthy kids have Dientomoeba in their guts and kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy. 25:33 In rare cases where he has a patient with significant GI symptoms and who has elevated Blastocystis and no other findings on gut testing, Dr. Hawrelak will treat the protozoan. Blastocystis Hominis flourishes in an alkaline environment, so he will have patients eat more fiber, prebiotics, and a more plant based whole food diet. More fiber will lead to more production of short chain fatty acids like butyrate and acetate, which will lower the colonic pH. That in itself can lower Blastocystis levels. Dr. Hawrelak will use agents like pomegranate husks and garlic along with saccharomyces cerevisiae boulardii probiotic. 29:57Of the more clearly pathological parasites, Giardia is the one that Dr. Hawrelak sees most commonly, though less common than when he was practicing in a more rural area of Australia. He said that Giardia will often resolve without the need for specific treatment, but when it is required, he will use raw garlic and have patients press a couple of cloves into capsules or a glass of water and consume it twice per day. One study in Eqypt showed 100% erradication in only 3 days with raw garlic. He will also use pomegranate husk and plantago major ribwort. Dr. Hawrelak used to use berberine containing herbs like coptis, but he is concerned that berberine may have a damaging effect on the microbiome since it reduces bifidobacteria levels. He will also give saccharomyces cerevisiae boulardii again as a probiotic, since it has been shown to help erradicate Giardia. The Giardia is an amazing protozoal organism that forms a cyst and when you get one or two of them in the gut, they can cover the entire small bowel with the Giardia trophozote and they can damage the intestinal villi so necessary for absorbing nutrients from our food and damage the brush border and affect the brush border enzymes that are necessary to absorb foods like fructose and lactose. Saccharomyces boulardii are wonderful for helping to regrow those villi and the brush border and you might do that during, then for at least six to 12 weeks afterwards to speed up healing. 36:18 When treating worms, especially bigger worms like pinworms, it may be necessary to treat for 10 days, wait 10 days and then treat again for 10 days since eggs laid by the worms will not germinate until the antibiotics or antimicrobials are stopped. But this approach is not necessary with Giardia, which has a short treatment period and does not require using some of the stronger antimicrobial herbs. For pinworms, Dr. Hawrelak used to use various herbs, including megadoses of wormwood and pomegranate husks and mix some garlic and peppermint essential oil with Vaseline and inserting it around or up the anus. Now he tends to use the prescription anti-parasitic taken once and then again in 10 days and that turns out to be both effective and cost effective and less labor intensive, esp. if it occurs in an entire family. 41:02H. Pylori is another type of infection that has been famously shown to be the cause of gastric ulcers in a percentage of patients. What should Functional Medicine practitioners think about seeing an elevation of H. pylori show up on a stool test? Dr. Hawrelak said that if he had a patients with GI symptoms and H. Pylori showed up on a stool test, he would look to see if there are any virulence factors and then he would follow up with an antibody blood test and a breath test. If the antibodies and breath test were negative and a small amount of H. pylori showing on a PCR stool test, then its probably benign and not there in large enough amounts to cause any issues. If there are antibody levels and they have symptoms consistent with ulcers or gastritis, then it is important to treat H. pylori. We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer. But there is also concern about eradicating H. pylori, since if you wipe out this species, what other microbe might start growing there that might be more virulent. Also there are quite benign strains of H. Pylori that might even have some healthful effects for us over time. We should be especially concerned it we are considering using a triple or quadruple antibiotic cocktail that can cause permanent damage to the microbiome. On the other hand, we can use some common nutritional products that have very little risk of harm and that can be very effective, like a mixture of the following natural agents: cranberry juice, broccoli sprouts, Lactobacillis reuteri DSM17938 probiotic strain, green tea extract, turkey rhubarb, and pomegranate husks have about a 90-95% eradication rate. Dr. Harwelak noted that he rarely uses potent antimicrobial herbs like high dose berberine or eregano, clove, or thyme oil, since these can cause damage to the microbiome. Dr. Jason Hawrelak is a Naturopathic Doctor, a PhD, and a master herbalist. He has been in practice in Australia for more than 20 years. Dr. Hawrelak is one of the leading experts in the treatment of gastrointestinal conditions with natural medicines and he has written extensively in Australia and International textbooks and journals on digestive topics. He continues to see patients in person and remotely. Dr. Hawrelak has developed an incredible subscription based resource to keep track of all the research on probiotics, called ProbioticAdvisor. Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available. Podcast Transcript Dr. Weitz: Hey. This is Doctor Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts, and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness podcasters. Today, I’m very happy to be speaking with Doctor Jason Hawrelak all the way from Australia about parasites. Parasites is a topic in gut health that seems to have fallen out of favor among functional medicine practitioners who deal with patients with gastrointestinal symptoms in the last five or 10 years. The focus seems to have shifted towards focusing for patients who are negative for having Crohn’s and ulcerative colitis, the focus seems to be towards SIBO and IBS. Certain parasites are referred to as protozoans. Protozoans are actually single cell microorganisms and they include a large variety including amoeba, flagellates, ciliates, protozoans. Protozoans are common in fresh, brackish, or salt water. As well as in other moist environments including in an extreme environments like hot springs, hypersaline lakes. The protozoans can also form cysts to survive in dry environments in a dormant state. Some protozoans live in our guts without causing harm and may even provide some benefits while other protozoans may be a significant cause of disease such as [inaudible 00:01:54], malaria, giardiasis, et cetera. Protozoans are not infrequently found in the stool of patients when undergoing stool testing, especially some of the very sensitive molecular PCR tests. Parasites can take the form of worms or protozoans, of which, Blastocystis Hominis, dientamoeba fragilis, and Giardia are some of the more common parasites. Blastocystis Hominis is often considered by Functional Medicine practitioners to be a particularly difficult microorganism to eradicate and is often associated with a host of gastrointestinal symptoms including diarrhea and it’s also sometimes thought to be associated with Hashimoto’s hypothyroid disease. Some of these protozoans may not always be pathological as many of us think, as Doctor Hawrelak will explain today. One other topic I would like to ask Doctor Hawrelak about is H. Pylori infection, which at one time was considered an obvious problem when discovered on a stool panel, but is now understood to have a much more complex relationship with our gut. Doctor Jason Hawrelak is a naturopathic doctor. He’s a PhD, he’s a master herbalist, and he’s been in practice for more than 20 years in Australia. He’s one of the leading experts in the treatment of gastrointestinal conditions with natural medicines. He’s written extensively in Australia and international textbooks and journals on digestive topics. He both sees patients in person and remotely, he also teachers other healthcare practitioners. He’s currently coordinates and teaches the evidence based complimentary medicine program in the School of Medicine at the University of Tasmania. He’s the gastrointestinal imbalances lecturer in the master of science and human nutrition, and functional medicine program at the University of Western States in Portland, Oregon. Doctor Hawrelak started and runs an incredible resource to keep track of all the research on the latest probiotic strains called Probiotic Advisor, which I have used and is an extremely valuable resource. Doctor Hawrelak, thank you so much for joining me today. Dr. Hawrelak: You’re very welcome, Ben. Nice to speak to you again. It’s been a while. Dr. Weitz: Absolutely. Before we get started, I don’t know if you saw 60 minutes on Sunday, but I have bad news for you. You’ll have to close down your Probiotic Advisor because 60 minutes reported that there’s absolutely no benefit to any probiotic. Dr. Hawrelak: Great. What can I tell my patients for the last 20 years? I can say it was all placebo perhaps. I haven’t seen that actually. I should put it on my agenda as something to watch to see what the mainstream media is actually reporting there. I think that comes from really misunderstanding some of the nuances around probiotics. Rather than taking them to change the ecosystem or to repopulate, which I think is the more popular idea, with knowing that they actually have specific effects and actions when ingested which creates physiological change, so we can use it for helping to eradicate H. Pylori for example, for decreasing obesity, or for moderating mood. There’s a whole bunch of positive clinical trials that it’s I think pretty mind blowing to come to that viewpoint that probiotics don’t work for anything based on what data has been published for the last 30, 40 years, particularly the last 20 years. Dr. Weitz: Amazing amount of studies. Of course, that was one of their complaints. We’re not going to spend the whole time talking about 60 minutes, but that was one of their complaints that the probiotics that you ingest don’t actually find themselves to populate the gut. We know that. Dr. Hawrelak: That’s not surprising, that’s now why we should be taking them. At least, what the research has shown us is that if that’s why you’re doing it, you’re not really taking it for the right reasons because you’re not really going to achieve that with the current generation that we have. It’s pretty rare to have any sort of longterm colonization, but that’s not to say that won’t be something we generate with future probiotics if we start making probiotics from things like Akkermansia, [inaudible 00:06:24]. Novel species that might actually have that capacity to stick around for longer periods of time or if not permanently. Reality is that they have therapeutic effects when we take them, some of them do anyway if we select them well and make sure they’ve got the right traits and qualities. When we stop taking them, that will stop having that effect just like any pharmacological agent whether that be pharmaceutical or herbal medicine that they’ve got an action while you take it. You cease taking it, it stops having that action. Dr. Weitz: One of the reasons I really have been looking forward to this discussion is that I really wanted to dive into some information about parasites. When I first got into Functional Medicine 20, 30 years ago, it was a lot of talk about parasites. In the last five or 10 years, we’ve lost that focus, but I think it’s an important topic to talk about. When you’re consulting with a patient, are there any particular symptoms that come up during a consultation that will make you suspect this could be somebody who’s having a problem with parasites? Dr. Hawrelak: I mean, the challenge with most symptoms that we’d associate with gut parasites like Giardia, which is undoubtedly a cause of gut infections, gut damage, Entamoeba Histolytica for example that are in that camp, versus ones that are much more debatable like Blastocystis and Dientomoeba is that the symptoms overlap with irritable bowel syndrome in some degrees with inflammatory bowel disease, functional dyspepsia, post infectious IBS with SIBO. It’s a whole cluster. If someone presents with these symptoms, you really need to do testing to ascertain what’s going on. You might get some clues from history in that they’ve just traveled overseas. They went to developing nations and they got a case of traveler’s diarrhea. That to me is a red flag that there may well be something staying in their gut from that. That time of ingestion and that acute flair. Sometimes, your body will fight that off. Most of the time, it’s a bacterial agent anyway that causes traveler’s diarrhea, but we do get protozoa as part of components of or as contributors to that overall traveler’s diarrhea load. We might get that flag on the history, but we really need to do testing to ascertain what’s going on. For me, that wouldn’t mean just doing stool testing for parasites because I think we all get the potential of getting quite lost and missing what’s going on if that’s all that we do just because some microbes like Blastocystis and Dientomoeba are so common in healthy everyday people that if they’ve got some runny stool and some abdominal pain, you do one test, you do a stool test. It shows that, I think there’s a decent chance you’re going to miss what’s really causing that person’s issue in that instance. If it happens to be Giardia, fair enough, that’s a different scenario. If it’s Dientomoeba or Blastocystis, we can’t make that assumption that this is the cause of their symptoms because of the prevalence of these microbes in healthy populations. Essentially, to me it means we’ve got to do a suite of tests that if they present with that symptom picture that overlaps with so many other conditions, we actually have to test to rule out those conditions. That would be things like fecal Calprotectin or Lactoferrin for inflammatory bowel diseases, a fecal occult blood for example also looking for more pathological changes and damage to the small or large bowel. For me, it would mean SIBO breath testing would be a component of that. As well as doing a stool PCR looking for the presence of potential bacterial and protozoal parasites that may have been picked up from overseas. Dr. Weitz: What is your favorite stool test these days? Dr. Hawrelak: I would actually use a number in practice. I’m based in Australia, so we have the conventional pathology labs that do a stool based multiplex PCR that looks for the most common protozoal parasites, the most common bacterial causes of diarrhea. I might run that, but then also do a microbiome assessment as well that tells about the bacterial ecosystem, as well as doing breath testing. Then, the other tests looking for inflammatory markers. In the colon, that might indicate that it’s more likely to be inflammatory bowel disease. Even some of the more rare ones like lymphocytic colitis or collagenous colitis for example. Dr. Weitz: Which microbiome tests will you use? Dr. Hawrelak: Good question. These days, I’m using one of mostly between two different labs. One lab here in Australia called Microbiome that does metagenomic sequencing, which means we get very good detail and data from a species level perspective as well as from genus and higher up the hierarchy up to phylum. It also gives us the markers around levels of LPS production, levels of hydrogen sulfite gas production for example that I find can be clinically useful. Then, I’m also using Thrive as well particularly for my US patients where we get that nice snapshot of the bacterial components of the ecosystem. Dr. Weitz: Yes, you might check out this biome FX test that Microbiome Labs is promoting now that Kiran Krishnan helped fine tune. It looks pretty interesting. Dr. Hawrelak: I haven’t had a chance to look at that yet. Dr. Weitz: Yes, check that out. If you had a patient who came in your office and they’re having some of these symptoms like gas, bloating, maybe diarrhea or constipation, they had a positive SIBO breath test, and you also saw a parasite, which would you treat first? Dr. Hawrelak: For me if it showed up a very clear positive on SIBO breath testing and it had Blastocystis and/or Dientomoeba in the stool, I would treat the SIBO. I do this all the time. The presence of Blastocystis and Dientomoeba is generally completely irrelevant to that person’s symptoms. That’s something I’ve come to from 20 years of practice and reading more the recent literature around the prevalence of these parasites or in parasites. Protozoal and protozoal like organisms in people’s guts is extremely common. What I found is that most patients who present to me with, they go I’ve got a positive stool test for Blasto or Dientomoeba and they haven’t done a breath test yet, we’ll do a breath test for SIBO and it will actually show up positive. We treat the SIBO, their symptoms get better, they still have Blasto in their gut afterwards. That is so common. For me, it really showed clearly … I go back to how I treated patients 15, 20 years ago. If they showed up with a positive Blasto or Dientomoeba, I was like let’s try to kill this. Let’s focus in on that. Sometimes, you’d get symptomatic improvement for sure, but I think at least temporarily. I still think we were often inadvertently treating the SIBO in these patients, which was the cause of their symptoms because I wasn’t really aware of SIBO 15, 20 years ago. It wasn’t well known as a diagnostic label. Testing wasn’t really promoted, discussed, and talked about very much. I think I’ve seen that major shift in focus. I mean, one patient also illustrated to me very clearly that they came to see me. Classic symptoms of bloating, distention, some runnier stools. Positive stool test for Blastocystis. I just made the assumption that was the cause. I said let’s treat that. Yes, there was symptomatic improvement while they were taking the herbs. Then, I hadn’t seen them for a while. Then, she came back. I think it was probably 12 months later. She said, “I was actually diagnosed with fructose intolerance. I reduced my level fructose and all my symptoms went away.” I just really was like, how could I miss that? I really let this patient down by not doing a proper diagnostic workup. I got fixated on this thing and that wasn’t the cause of her symptoms, she still has Blastocystis in her gut, but no symptoms if she goes on a low fructose diet. That patient really taught me a major lesson that we can’t … We’re often guilty of this premature diagnostic closure. I try to be less guilty of that now than I was in the past where we wouldn’t do a proper suite of tests to really see what’s going on. We’d get really fixated on that one and actually miss it. I’ve had other patients that I’d subsequently diagnosed with celiac disease that were by other practitioners diagnosed with Blastocystis and not followed up. You think, what’s the consequence of that missed celiac disease because we got so fixated on that Blastocystis on a stool test? Huge. Dr. Weitz: Right. I want to go into some more detail on those two protozoans. I wonder if it’s possible that we have SIBO, which is bacterial overgrowth in the small intestine, I wonder if there’s a SIPO, if there could be a protozoan overgrowth in the small intestine that could be creating some of these problems. I asked Doctor Pimentel that when he was speaking at our meeting last month. He said, “We’re still going through all the samples. We’re going to look at that as a possibility.” Dr. Hawrelak: Yes, because I think really with the evolution of technology I’ve used in metagenomics, we can actually take samples and see things that exist that we didn’t know existed before. It is interesting. I think because we’ve changed that technology or evolved into using technology that is far more accurate in its capacity to tell us what’s there, we’re seeing now that we all have protozoal organisms in our gut. That’s totally normal for humans. If you go back 20 years ago, people weren’t thinking that. We were thinking if there’s a protozoal there, we must need to kill it because it shouldn’t be there. It’s like, no. We’re supposed to have fungi in our guts, we’re supposed to have bacteria, and we’re supposed to have protozoal. They live in this usually beautiful harmonious ecosystem where they’re all interacting in ways that ensure our state of health until we upset that balance in different ways. Dr. Weitz: Are you proposing that we should really think of protozoans in some cases as commensal? Dr. Hawrelak: Definitely. I think certainly in the camp with microbes like Blastocystis and Dientomoeba, I will generally put them into the commensal camp in vast majority of my patients. Personally, I had a stool test done just because I was testing a bunch of different labs. It turns out I’ve got Blastocystis and Dientomoeba in my gut and I’ve got no gut symptoms. Managed to work 60 plus hours a week for the last 10, 15 years. No fatigue issues like the things that people see as symptomatic with these things, I don’t have. Here’s this one clear example of a case of a healthy person that has these microbes there, no symptoms whatsoever. You look at the literature, we find that’s actually fairly common with Blastocystis and Dientomoeba. They are extremely common in healthy people. The more recent research for the last few years have suggested particularly for microbes like Blastocystis that they actually play a pivotal role in keeping our ecosystem healthier verses the loss of our protozoal species that we’ve evolved with over millions of years some scientists and researchers are suggesting is having negative repercussions on our state of health that we see around us. Just like we’ve had that loss of bacterial diversity and loss of arguable fungal diversity that we are just finding out about now, but the repercussions of which I think we see all around us with the Western disease states that we see in practice all the time. Dr. Weitz: Yes. Maybe we’ll be taking protozoan supplements at some point. Dr. Hawrelak: It’s possible, I reckon. Yes. Dr. Weitz: Maybe, it’s a question of balance. Maybe, it’s a question of you’re supposed to have a certain amount, but maybe if the Blastocystis is too high, it’s not a question of it shouldn’t be there, but it shouldn’t be there at that level. Dr. Hawrelak: Yes. I mean, I do think there might be a part of that. Part of that is around environment. I always go back to that, the train is really immensely important for most organisms whether they can be infectious or not. The train is important and I’d dare say it’s similar with some of these microbes too that if we’re eating the right things and living the right lifestyle, then their presence is probably fairly irrelevant. You throw those things way out of balance and you throw other things in the gut out of balance, then maybe their populations or their behaviors change. I think that’s something we can see with microbes. There is some research around that with Blastocystis for example, research published very recently showing that exposure to Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms. Well when it doesn’t kill Blastocystis it seems to actually awaken it’s more pathogenic potential that was lying dormant beforehand, exposed to antibiotics, and it increases capacity to actually cause gut damage to interact negatively with precancerous cells and become much more virulent. I think that there is an argument around how we eat, what our lifestyles are like, and potential functionality and behavior of these organisms within our gut that can be different if we ate a completely different diet, different lifestyles, exposed to low levels of antibiotics in our food chain. Maybe we’re bringing up more of the pathogenic potential. Dr. Weitz: I was listening to an interview that Michael Ruscio did with Ilana Gurevich. She was talking about a study that found that species like Blasto and Dientomoeba fragilis, what they do is they change the microbiome enough to make the bacterial neighborhood more pathogenic and predisposed to negative changes either in the small or large bowels. Therefore, they’re maybe setting up things like SIBO. Dr. Hawrelak: Interesting. I haven’t seen any research around that. I’d be happy to be posted some so I can read it. There is certainly some data. There was one study done in 2019 in vitro data getting a subtype seven from a symptomatic isolate subtype seven Blastocystis and giving it to mice. Finding that in in vitro, that it was able to shift the ecosystem. Maybe that’s what she’s referring to. She might be referring to some other study that I’m unaware of. That was interesting in that it did seem to increase levels of more pro inflammatory bacteria like E coli and [inaudible 00:20:51] for example, and decrease levels of bifidobacteria. Dr. Weitz: We need to discuss the subtypes. There’s 17 different subtypes of Blastocystis, right? Dr. Hawrelak: There is and there’s nine that are found in humans. The rest are found in other animals. That said, it’s not like these are only exclusively found in humans. The ones we find in humans, we also find in chickens, primates, pigs, cows, horses, rhinoceroses, zebras, and any animal you can name generally has a Blastocystis that can be in its gut or a number of them. For humans, the most common subtypes are one, two, three, and four. Prominently, types one and three. Extremely common. Dr. Weitz: Is one of those subtypes more pathological potentially than the other? Dr. Hawrelak: Well, there’s been a lot of research trying to tease that out and I would say the research has been generally … has not shown any clarity around that at all. The only small pivot I’d say there is subtype seven is very rare in humans. It’s mostly found in animals, birds. Chickens particularly, they sometimes carry seven. That study that looked at those shifts in bacterial ecosystems was associated with symptomatic type seven isolates. If I had a patient and it did show up a subtype seven Blasto and all the other tests came up negative as in normal, then I might be inclined to go let’s see about eradicating this organism because it could likely be a cause of their symptoms in your case. I certainly don’t think the data is consistent enough because you’ll find one study that goes subtype three is more common with IBS patients. Another study will go subtype three was totally not and it’s subtype one. Another study will show subtype four. There’s no consistency around the findings. Dr. Weitz: Right. I just want to highlight the fact that what you’re discussing is that Blastocystis Hominis, which I still think a lot of functional medicine practitioners if they see that on a stool test are going to say you’ve got this parasite and this parasite is pathological. This is probably the cause of your symptoms. You’re saying that in a majority of cases, it’s probably not the cause of their symptoms and you may be missing another important underlying cause of their symptoms and you may be going up the wrong path focusing on eradicating the Blastocystis Hominis. Dr. Hawrelak: Yes, that is definitely my viewpoint for sure. Dr. Weitz: I just want to make sure that everybody understands that. Dr. Hawrelak: Fair enough, yes. It’s something that for me has evolved over 20 years of practice, of dealing with patients who present with gut symptoms and Blastocystis on stool test from what I used to do, to what the research is saying, and to what I do now and the results you actually see. I generally will see something else. When we do a suite of tests and make sure we don’t stop our diagnostic procedures so early, we’ll find something else that actually explains it. You treat that something else, their symptoms go away, Blastocystis or Dientomoeba are still there. There’s that component of it, but it’s also just the fact it’s so common. I mean, Dientomoeba in Western Europe where a lot of good studies have been done, it’s found in up to seven out of 10 healthy kids have got Dientomoeba in their guts. What’s normal, what’s not normal? Kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy. I still have practitioners here, integrated practitioners who wanted to use antibiotics or a suite of antibiotics to try to kill that Dientamoeba because it shows up on the stool test. Yet, the data tells us that it’s actually immensely common in kids. It’s more common in healthier guts and it’s unlikely to be a common cause of the gut symptoms when you look at the research in totality. Yes, if you’re going to be selective and not look at the broader literature, find a study going look we gave them antibiotics and the case study’s showing they improved, will quote that study rather than looking at the totality of data or looking at only one to date, randomized placebo controlled trial that looked at kids with chronic gut symptoms and had Dientamoeba present and that seemed to be the only … everything else had been essentially ruled out. They said they’ve got these kids with chronic gut pain, they’ve got Dientomoeba, let’s give them antibiotics or placebo. Let’s see the response. Do you know what the response was? Placebo was equally effective as antibiotics for reducing these kids’ symptoms. There was no difference between them. There was no correlation between eradication in Dientomoeba and any change in symptoms. I think the really good quality data is not suggesting that particularly things like Dientomoeba when we’re talking about now is a cause in symptoms in kids and that it is immensely common in health population. Dr. Weitz: In those rare cases when you have a patient with elevated levels of Blastocystis Hominis and you don’t find any other pathology, what natural treatments have you found to be the most effective? Dr. Hawrelak: It’s been years since I’ve found a patient like that, Ben. Dr. Weitz: Really? Okay. Dr. Hawrelak: I can tell you it’s actually really rare that I don’t find something else that’s going on. The biggest challenge can be teasing out the post infectious IBS from a case of Blastocystis induced infection, gut symptoms because you’ll have a similar picture where someone will travel overseas, they’ll get traveler’s diarrhea, their gut’s never well since. You do a stool test, only thing that shows up is Blastocystis. Now, that Blastocystis could have been present in their gut for the last 10 years, 20 years, or 30 years and not be remotely relevant to what’s going on because we know that post infectious IBS happens where two things once post infectious SIBO develops, that’s pretty common. Then, you have more the colonic inflammation that persists after the infection is gone. You might have traveler’s diarrhea caused by E Coli. It causes colonic inflammation and visceral hypersensitivity that persists for weeks, to months, to years after that infection. There’s no more infecting agent present, you just have this residual inflammation that impacts. Causes bloating, distension, may alter transit time a wee bit. Certainly, holds a sensation in the gut, so you feel a small amount of gas being produced. We know that’s common in literature. Yet if you do a stool test and you found Blasto in that case, you might go I want to kill the Blasto. That’s the cause, but it may not be because it may just be post infectious IBS. That’s I think the area that can be the most tricky to navigate because you’ll have normal tests come back. They may not have SIBO, but they can still have post infectious IBS and there’s no test for that. It’s based on history and their symptom pattern. Dr. Weitz: Not to kick a dead horse, but one more attempt. What if the stool test shows a really high level of Blasto? Does that raise any suspicions or not? Dr. Hawrelak: I think … Dr. Weitz: No. Dr. Hawrelak: It would depend on the overall path from the history side. It wouldn’t rely solely on that. Looking at their symptom picture, looking at their history. Let’s assume if there was someone, now it’s been years since I’ve had one of those patients that I think Blastocystis is the cause of their symptoms. Then, there are certainly some herbal preparations, et cetera, that I would use to try to help reduce levels, but you’re also focusing on trying to optimize the microbiome as well, heal up inflammation in the gut, and improve their overall vitality and health anyway. I think for me those are always the core aspects. What can I do to improve this person’s state of health? What can I do to make the ecosystem a more healthy environment that’s less conducive to bringing out the bad behavior in things like Blastocystis? We know that Blastocystis likes living at a more neutral or alkaline PH. It doesn’t like living in an acidic environment in the colon or levels can be certainly reduced that way. The focus is on having a lot more fiber, using prebiotics, eating predominantly plant based whole food diet as ways of actually shifting the ecosystem in the colon, so it’s actually one more healthy, but two there’s more production of short chain fatty acids like butyrate acetate for example that then will lower the PH. That in itself can be effective in decreasing levels of Blastocystis just by changing the environment. Then, I might compliment that with some herbs. These days because of my concerns of causing collateral damage to the colonic ecosystem, I try to avoid as much as I can when I can. I’ll use agents like pomegranate husks and garlic, which we know that can be effective against Blastocystis. The best data that we really have at this juncture of time is in vitro studies or animal studies for example. Mostly, in vitro. I do use that alongside saccharomyces cerevisiae boulardii, which we know has got the positive research for eradicating Blastocystis in the human trial alongside the other agents I talked about that they’re focusing on improving the ecosystem balance in the colon. That will generally one sometimes eradicate the Blastocystis, but two certainly improve their symptoms and importantly their overall state of health and well being. Dr. Weitz: Let’s go on to some of the more pathological parasites. Which ones do you see most commonly? Dr. Hawrelak: I would say Giardia would definitely be top of my list. I work in an inner city environment that is a colder climate, so I don’t see Giardia as often as I once did. My first number of years in practice, I was living in the subtropics where people drank creek water and rain water for most of their … it was rural and people were often bush walking, hiking and drinking the water from creeks, et cetera. Giardia was much more common back then, so I had a lot of chance to hone my practice on Giardia treatment over the years. Now, I tend to see it more in the odd returning traveler or I see the odd person who’s got a chronic infection of Giardia that they weren’t able to get rid of with their previous course of antibiotics. Dr. Weitz: What is some of your favorite natural agents for treating Giardia? Also, do you cycle your use of these? Dr. Hawrelak: Generally, there’s no need. My experience with Giardia is it’s immensely responsible to the right treatments and target treatment with natural medicines. I would use raw garlic ideally and if they’re very sensitive, we might use an allicin based product, but most of my patients have tolerated raw garlic. A couple cloves pressed into either little capsules or a little glass of water and swig it down a couple times a day. There’s one study out of Egypt that showed I think a hundred percent eradication rate by day three on having essentially blended raw garlic. Dr. Weitz: Wow, three days. Dr. Hawrelak: That’s impressive. A hundred percent reduction of symptoms or essentially elimination of symptoms by 36 hours into the treatment protocol. That’s very quick. Garlic’s definitely on my list. These days, I would be using pomegranate husk and usually plantain, plantago major ribwort, which is one of those herbs that grows as a weed almost everywhere in North America and here in Australia. It’s got some lovely potent anti-Giardia activity, but it actually has some healing anti-inflammatory effects on the gut as well. It doesn’t taste too bad and it doesn’t have that broad killing effect that I might get with something that was more berberine containing herbs. Years ago when I first started practicing, I used more berberine containing herbs and it’s certainly effective for Giardia, no doubt. I would be using coptis chinensis, which contains more berberine than goldenseal or other berberine containing herbs like Mahonia aquifolium or Berberis vulgaris a lot more. It’s undoubtedly effective, but I also know from research I did as part of my PhD that it reduces levels of bifidobacteria. It’s not such a big deal for 10 days, which is a usual treatment period for Giardia, but given I can get the same results without having to worry about any collateral damage to my bifidobacteria populations in patients if I use pomegranate husk, ribwort, and garlic, I’ll choose that. Then, I would give saccharomyces cerevisiae boulardii again as my probiotic of choice because there’s good data on that in Giardia both for helping to eradicate, but I think this is the important aspect too. A number of people have symptoms that persist long term post Giardia. It’s because Giardia, amazing little protozoal organism that when it exits from it’s little cyst, you often get one or two little guys that come out of that, but they can cover up every single little bit of your proximal small bowel, every little millimeter of space will be covered with Giardia trophozoite. They can actually cause a lot of damage as part of that. They can cause nutritional issues in the short term in that most things you eat are going to be malabsorbed because they’re just covering that entire area, they’re going to eat those foods, you don’t get much if any. They’ll also cause a fair bit of damage to the small bowel. This can sometimes mean that there’s a bunch of symptoms that persist even after eradications. You might kill off the Giardia with antibiotics or with herbal medicines in my case in probiotics and nutritional supplements, but they might still have some persistent diarrhea, persistent lactose intolerance, persistent fructose intolerance that comes from afterwards because when you flatten those villi and you damage the brush border, you don’t have lactates on those brush enzymes anymore. The fructose transporter is very much impacted by inflammation. If we inflame the small bowel, we really limit the capacity of that fructose transported to pull up the fructose and take it in. We can often get this secondary lactose and fructose intolerance. The saccharomyces boulardii is wonderful for helping to regrow those villi and the brush border. You might do that during, then for at least six to 12 weeks afterwards to speed up healing. Dr. Weitz: Interesting. The villi are damaged by the parasite. Dr. Hawrelak: Yes, by the Giardia because they’ve got this little ventral disc that sucks onto it and actually causes tissue damage, inflammation. It’s a crazy little guy. Dr. Weitz: Do you have to have Giardia for a long time for that to happen? Dr. Hawrelak: One would say the longer you’ve got it, the more severe the level of inflammation would be. There’s a caveat there because we know that most people will throw off Giardia in three weeks with no treatment at all. I think from memory, it’s around 90 percent of people who get Giardia, you do nothing. In three weeks, it’ll be gone in 90 percent of people. It’s going to be an uncomfortable three weeks. There’ll be lots of diarrhea, lots of bloating, lots of nausea. I don’t recommend it, but we know that the immune system can generally deal with it, except for people that have IgA insufficiencies tend to be the biggest issue where they will have it … it’s impossible for them to throw off Giardia if they don’t produce enough secretory IGA in the gut. There’s some people that it tends to be a chronic infection. Even a week to two weeks is still enough to actually cause a degree of malabsorption. Depending on how severe the infection was and how much of the small bowel was covered will dictate how much of that post infectious symptomatology we have to deal with and post infectious damage we need to heal up to get patients’ function back to a good level and absorbing food again the way that they should be. Dr. Weitz: Interesting. Have you heard this concept that when trying to kill a parasite because parasites are laying eggs, that you want to use the antimicrobials for 10 days, then wait 10 days because supposedly in the presence of the antimicrobials, the eggs won’t germinate, they’ll wait until the antimicrobials are gone, then the eggs will germinate and you’ll have more Giardia or other parasite? Then, you’ll have a reinfection, so therefore there’s this thought that you treat for 10 days, you wait 10 days, and then you treat again for 10 days. Dr. Hawrelak: Yes. I mean, I certainly will do that with helminth, actual bigger worms, pinworms, et cetera. I will follow that approach. I don’t with Giardia and I haven’t seen any cases where that particular approach has been problematic in that instance. I think if we’re choosing agents that are not going to cause collateral damage to the ecosystem, then I got no qualms with that approach at all to err on the safety side. I’ve never seen it necessary with Giardia. That’s by far the most common one I would be treating in practice. Dr. Weitz: What’s your protocol for pinworms? Dr. Hawrelak: It’s a tricky one. I’ve tried lots of different things. To be honest these days, I actually recommend the pharmaceutical ones from the pharmacy because they work. Yes, I can give you herbs that taste absolutely ghastly, garlic [inaudible 00:37:55], and essential oil put in a little bit of Vaseline around the anus at night, you can do all that for weeks at a time and will get okay results, or I can give one little dose of that chocolate, 10 days later another dose of that thing, and they’re gone. It’s far less costly. You’re often treating a whole family. I’ve trialed and error-ed lots of different things. Maybe some people have got much better results with herbs than I ever had, but we’re using megadoses of wormwood and pomegranate husks which has got anti worming activity too. Listen, it’s certainly brought worms down. Oiling up a tiny a tiny clove of garlic that’s been peeled and inserting up the anus, that helps break the cycle of bit. Same way with putting some peppermint essential oil around, a little Vaseline around the anus. The worms come out to lay their eggs and are like I don’t like that oil, so they go back in and it’ll help break the cycle. It’s labor intensive. To do herbs for a family of four for a month, that whole process, is costly. I still don’t find the results as effective as just doing the pharmaceutical twice. In this case, I’m not worried about the collateral damage to the gut ecosystem because the data to date doesn’t suggest this much in the way of collateral damage because worms are actually more related to us than they are to bacteria. The agents that are targeting those worms actually have more capacity to cause us side effects than they do kill bacteria directly. I’m not so concerned and that’s my approach now, which is not so exciting as you got to use this fantastic herb, but I just didn’t find the result with the herbs as what I’ve got with the pharmaceutical. The cost differential didn’t make it worthwhile. Dr. Weitz: Speaking of worms, have you looked into helminth therapy, the therapeutic use of worms? A couple of worms that are used is the pig whipworm or the human hookworm. I’ve read some articles where they’re being used for allergies, autoimmune conditions, inflammatory gut disorders like Crohn’s and ulcerative colitis. Dr. Hawrelak: I’m not super familiar with the literature around that. I’m a little bit around the uses of [inaudible 00:40:05] for celiac disease. Dr. Weitz: Yes, that’s the hookworm. Dr. Hawrelak: That’s right. When I looked at the results, they were very underwhelming in terms of [inaudible 00:40:18]. It was like, okay. They gave them these worms, they had a bought of severe enteritis, and they got a lot of pain from the worms. Then, it slightly diminished the degree of inflammation caused by subsequent gluten exposure. To me, that was underwhelming. Okay. Yes, you made the gluten, you got less gut damage than if you didn’t, but it still didn’t completely stop the gut damage and it didn’t completely stop the pain from ingesting the gluten. Plus, you had the pain and discomfort from ingesting the hookworm in the first place. I thought the worm results were very underwhelming for celiac disease. That doesn’t mean that they might be more useful for inflammatory bowel disease and other conditions. I’m not so familiar with the literature there, not enough to make any judgment calls on their efficacy or not. Dr. Weitz: I like to ask you about one more topic about H. Pylori. H. Pylori is another infection in the gut. Often, occurs in the stomach. There’s a whole story everybody’s probably familiar with that it could be related to ulcers and we have that whole story about Doctor Marshal giving himself H. Pylori causing ulcers. Anyway, H. Pylori is another thing that comes up on stool tests a lot. We’ve learned more and more how H. Pylori’s an important part of the gut. It may not necessarily be pathological. What’s your take on H. Pylori? When is it pathological? How do we know? Dr. Hawrelak: That’s another great thread of questions. I think we’ll answer this question differently in five years’ time than what we can now. Dr. Weitz: I mean, we do have the virulence factors that give us an idea of whether we’re reacting or not. Dr. Hawrelak: That’s right, we’ve got some of them. I think that’s a step in the right direction. For me if I had H. Pylori show up on the stool test for example, I would look at the presence of the virulence factors. That’s the first thing I would do because that’s usually in that same test that might pick up the H. Pylori and tell me those things are present. I would always follow that up with doing a antibody test like a blood test or a breath test because for me I want to see, is the body reacting to that H. Pylori? Is it increasing antibodies to the H. Pylori? Is it high enough of a count that it’s actually showing up on a more conventional test rather than using these genetic markers? Those to me really tell me the data that I’m after as well as, do they have symptoms that coincide with gastritis, gastric ulcer or peptic ulcers? If they do, then I would go H. Pylori’s probably related to what’s going on there. If I have a patient where they have it negative, no antibodies in the blood, nothing on the breath test, and a small amount in the stool that showed up on a PCR based test that didn’t show any markers of virulence, then I wouldn’t worry about its presence at all because I would be thinking it’s probably benign, it’s probably there in tiny amounts, not enough to cause any issues. Conversely if it actually showed up with antibody levels, they’ve got symptoms that are consistent with peptic ulcers or gastritis, then I would generally treat H. Pylori in that case. For me, it’s always this balance. We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer. That is clear. There’s also some concerns about the eradication of that species. One, leaving an ecological vacuum and what will grow in there. What’s next if we take that species out? Some other microbe might start growing in there. That might be more virulent than that. Second point is there are quite benign strains of H. Pylori that might even have some healthful effects for us over time. It’s just we don’t necessarily have the technology yet and this is where I would say five or 10 years’ time where we know a good chunk of virulence factors now, but we’re still discovering new things. We might discover more, we might be able to get down to strain subtype. [inaudible 00:44:30], look at the genes of this specific strain. Beyond that, and yes. There’s a greater risk of it being a problem, let’s get rid of it. For me if I’m using natural agents that don’t have the capacity to cause widespread damage to the colon ecosystem, I’m not that worried. If I’m going let’s eat some broccoli sprouts for two weeks, have some cranberry concentrate, and take this herb, et cetera, that can be in my experience very effective at getting rid of H. Pylori. I’m not worried about treatment so much. If there’s patients taking triple or quadruple antibiotic cocktail, then we’re talking about big life … essentially, it’s life altering in the respect that colonic ecosystem that will inadvertently be smashed by that antibiotic cocktail will be permanently changed. It will never go back to the way it was before. When we’re talking about those bigger interventions, then I think we need to consider much more about the risk/benefit ratio that are different when we’re looking at using natural medicines to treat the H. Pylori. That the risk is far less, so it’s quite a different way of considering it. Dr. Weitz: The natural agents you would use would be mastic gum and maybe something else? Dr. Hawrelak: I would usually use a combination of things. You look at the data about natural medicine, there’ll be ones today showing a 16 percent eradication with cranberry juice. 16 percent, not fantastic, but it’s better than none. There’s one study that used the Lactobacillis reuteri DSM17938 strain. I think it had over 50 percent eradication rate just with that single strain. You combine that and I might combine broccoli sprouts, which I think at a 78 percent eradication rate from memory. You’re going let’s add a few of these things together and nigellis sativa, so black seed again had over 60 percent eradication rate on its own. You’re doing a few of those things together. Then, I might use some herbs like green tea, rhubarb, pomegranate husks for example, turkey rhubarb, and in my experience we follow a protocol that’s for most of my patients around six weeks. It’s around a 90 percent eradication rate, which is really I would argue better than what we’re getting with antibiotics these days. At the first time they started using antibiotic cocktails like triple therapy, they were looking at 90, 95 percent eradication rate. Now, some of the recent studies are like 50, 60, 40 percent eradication rate because of antibiotic resistance. I’ve been impressed at how well a combination of herbal agents and natural supplements work versus using them just on their own, much more [inaudible 00:47:14] to get the occasional time just getting one of those things to work for a patient. My experience has been again through a fair bit of trial and error with patients, it actually makes more sense and I get the best results with doing a much more intense protocol for a six week stint. Then, do follow up testing, and go, yes. It’s gone. Generally, that combination of things works well. You get synergy between those agents. Dr. Weitz: You think natural agents like oregano, berberine, and maybe some of these other antimicrobials could potentially have negative effects on the microbiome. Dr. Hawrelak: I would say from both of some of the in vitro research I did as part of my PhD and from clinical work with patients doing pre and post testing, yes. That berberine I think clearly can diminish overall diversity of an ecosystem and reduce levels of bifidobacteria specifically. Some of those species may be fine with it. I’ve even seen one patient who managed to essentially result in the extinction of bifidobacteria population from taking high dose berberine for longer periods of times, so I’ve got some caution around that. Again, some plant essential oils, so oregano essential oil, thyme essential oil, clove essential oil that are potent antibacterial agents. They totally are, anti protozoal, and anti fungal agents. They’ve got a wide set of actions, but I do think they have come collateral damaging effects in the gut too. I think there can be times and places for more potent agents. I try to follow that, the naturopathic therapeutic order where we use the agents that are less likely to cause harm first. Then, we move along that order to those that have greater capacity of causing harm if the other ones don’t do the job. I’ll rarely use berberine when I’m treating Giardia these days, I’ll rarely use berberine or oregano essential oil for treating SIBO these days because I think there are other herbs that are effective that don’t have the collateral damaging effect that those herbs have. Dr. Weitz: That’s interesting because I haven’t seen that sort of negative effect on a microbiome from berberine. I also treat diabetics. We very regularly use a pretty decent dosage of berberine on a regular basis. I have seen no increased gut problems coming from that. Dr. Hawrelak: I wouldn’t say [inaudible 00:49:36]. Obviously, it’s got issues. Although, sometimes longer term I think that can manifest. In terms of populations of bifidobacteria, I would suggest if you haven’t yet, using the test that uses either [inaudible 00:49:48] looking at proportions of bifidobacteria or metagenomic sequencing for bifidobacteria pre and post, you might get a slightly different picture with that rather than some of the previous tests that use two plus four ways of measuring things, which are far less clear what’s going on. You may see that. Dr. Weitz: We’ve been using the GI map with quantitative PCR. Dr. Hawrelak: Okay. Dr. Weitz: Good. Excellent. Thank you for sharing some fascinating information with us. Dr. Hawrelak: You’re very welcome. I’m glad I could come back and chat to you, Ben. It was good. Dr. Weitz: Good. I’m glad we could make this happen across the world even in the midst of the coronavirus pandemic. How can listeners and viewers get ahold of you and find out about some of your … I know you have a number of courses that are available? Dr. Hawrelak: Yes, we’ve got one on Dientomoeba and Blastocystis because I’m trying to get that information out there about that. That change in conception that research has actually made manifest. Also, ones on Giardia too as it turns out. The microbiome, probably more broadly lactose intolerance, fructose intolerance, we’ve got a few different lecture out there on the Probiotic Advisor site. My passion is really around the gut microbiome, probiotics, and prebiotics. I’ve been in this area for 20 years when I first started my honors and my PhD research, so I love this area and I love being a clinician still so you get a chance to actually work with patients and see what works. Sometimes, what works in research doesn’t always manifest in clinical change in any beneficial way or it just doesn’t work in reality. It’s been nice to go, what does? What doesn’t? Over years of working with patients too. Dr. Weitz: What’s the website for the Probiotic Advisor? That’s where they can find new courses, right? Dr. Hawrelak: Yes. Www.ProbioticAdvisor.com. Then, we’ve got a teachable courses page too. I think we’ve got 12 or 13 courses up there now around microbiome and gut health more broadly. Dr. Weitz: Great. Thank you so much. Dr. Hawrelak: You’re welcome, Ben. Nice chatting again. Dr. Weitz: Nice chatting with you too. I’ll talk to you soon.
Episode #35 : How to consume enough probiotics with Dr. Jason Hawrelak
The Nutrition Expedition Podcast
In this episode Mateo and Lachie speak to Dr. Jason Hawrelak on the importance of pre and probiotics and how the impact the body. They also discuss topics surrounding the impact of gut health and how it can impact someones mental health. Find Dr. Hawrelak : https://www.probioticadvisor.com/ https://www.gouldsnaturalmedicine.com.au/ Find us: Instagram: @TheNutritionExpedition Email: NutritionExpeditionPodcast@gmail.com
Dr. Hawrelak is a researcher, educator, naturopath, and nutritionist with over two decades of clinical experience. He practices at Gould’s Natural Medicine, an over 130 years old natural medicine apothecary and clinic in Hobart, Tasmania. Today's topic is so fascinating to many of our practitioners that are in the field of gastroenterology because we are talking about gut parasites, and Dr Hawrelak just recently released a course about blastocystis and Dientamoeba fragilis.
Dr. Hawrelak is a researcher, educator, naturopath, and nutritionist with over two decades of clinical experience. He practices at Gould’s Natural Medicine, an over 130 years old natural medicine apothecary and clinic in Hobart, Tasmania. Today's topic is so fascinating to many of our practitioners that are in the field of gastroenterology because we are talking about gut parasites, and Dr Hawrelak just recently released a course about blastocystis and Dientamoeba fragilis.