Podcast 35 - Gut Microbiome (Part 3 of 3)


Chad Edwards: This is Dr. Chad Edwards and you are listening to Podcast number 32 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions, then we are the clinic for you. We offer Tulsa prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to help you get back on track to optimal health. Call our clinic at 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org to schedule your appointment today.

Male: Welcome to Against the Grain podcast, with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready, because we are about to go Against the Grain.

Marshal Morris: Hello, hello. This is the super tall Marshal Morris here with doctor Chad Edwards, who believes that 80% of medical recommendations are crap, technically speaking here and he is the author of Revolutionize Your Health with Customized Supplements and he served in the US Army for 23 years as both an enlisted soldier and as an officer as a physician Tulsa prolotherapy.

He graduated medical school from Oklahoma State University and he’s the founder of revolutionhealth.org and then Against the Grain podcast doctor Chad Edwards, thank you so much for joining us today.

Chad: This is the pinnacle of the three part series that we’ve been talking about and I’m so excited to finalize this and talk about why I want to do this whole series to begin with.

Morris: Okay, so let’s get into it. What is the hot topic for us today?

Chad: Yes so we’re going to talk about the gut microbiome, specifically as it relates to the kind of food that we eat how that impacts it and how the gut microbiome is contributing to obesity, insulin resistance, metabolic syndrome and diabetes.

Morris: Okay so you’re going to help me out for my third grade mind here. What is the gut microbiome?

Chad: So the gut microbiome is a constellation or a whole eco culture of bacteria that live in our gut and as many people have said, you have more bacteria in your gut than you have cells in your entire body.

Morris: Should I be worried about that?

Chad: No, it’s a good thing.

Morris: Okay, so it’s good bacteria.

Chad: Yes in fact its essential bacteria. You have to have this and we– in functional medicine we know that the gut microbiome influences things like auto immune disease. Things like that. There are a lot of disease processes that can be tied back to the gut microbiome and what you have in there. So we’re going to talk about that as it relates to cardio metabolic disease Tulsa prolotherapy.

Morris: Okay, cool. So let’s get into it and for people that might not know including myself, what type of bacteria, where does these bacteria come from, is it naturally created? Tell me– give me a little bit of background on it.

Chad: So, we’re going to answer that question throughout the podcast because that’s some of what we’re going to discuss. But basically it’s determined in large part by the food that we eat and our exposures and our experiences throughout our life. So that’s the short answer to your question.

Morris: The short answer.

Chad: Yes. So we’ll just get right into this. This was a paper that was published in the journal Nature in 2013 and the title of it was Dietary Intervention Impact on Gut Microbial Gene Richness. What they saw was the composition of gut microbiota can determine the efficacy or how effective or how efficient the energy harvest from food can be.

So in other words, we eat something, it’s got a number of calories, we know about that and we’re trying to extract the energy from that food for our body. The composition of the gut microbiota, those bacteria, what kind of bacteria, how much the balance impacts how efficiently we get that nutrition or that nutrient energy from our food. Dietary changes, so you know shifting the way we eat changes the gut microbiome because of the shift in that stuff. And high gene diversity which means– the way they do a lot of your studies they’re looking at these bacteria and they’re doing genetic testing to see what kind of bacteria this is in the gut microbiome.

High gene diversity of these microbiomes, of this microbiota is associated with leanness. So the more diverse, the thinner. It’s what they were showing. Diets high in processed foods are linked to lower microbe diversity. So processed foods changes the gut microbiome and there’s more obesity associated with that. So this is one study showing that the highly processed foods change the gut microbiome which increases risk of obesity independent of the number or the type of calories that you’re eating Tulsa prolotherapy.

Morris: Okay so one, a lot of people they understand the fact that, okay, processed foods, less nutrients and they understand that part of it. But what you’re saying is that the uptake of energy is directly related to processed foods because they contribute to this type of bacteria that is responsible for taking the energy from the food. I’m I understanding that correctly?

Chad: Yes but it’s not a specific bacterium, it’s looking at the landscape. It’s just looking across and what’s the health of this gut microbiome and how diverse is the population of the bacteria – the probiotics, so to speak. How diverse is that population and what’s the health of that organism across the board and that’s impacted by highly processed foods and that then impacts our obesity.

Morris: Okay, cool.

Chad: Another study. This one was — where was this one? I don’t have that. It’s either bit of the short notes. But this was — it was a symposium review from, it looks like the Journal of Physiology. The Core Gut Microbiome, Energy Balance and Obesity is the title of this one. They looked at — they did an RNA analysis of the gut microbiome and they saw lean — and they looked at lean and obese twins. Mono and dizygotic twins, 154 patients and they saw that the gut microbiota was highly variable between individuals.

So one, it changes a lot from person to person. But family members have more similar microbiota. There’s less change. There’s little difference between mono and dizygotic twins and early environment — we’ll talk a little bit more about his in a minute, is the key determinant of adult gut microbiota and another study will really drive this point home toward the end. But there is an identifiable core microbiome composed of genes encoding various signaling and metabolic pathways and again that kind of goes back to that energy extracting because these pathways are how we get the nutrients and how we get the energy out of these things and obesity was associated with changes in the microbiota, reduced bacterial diversity in metabolic pathways involved in nutrient harvest.

So when we start changing this stuff, there’s a higher risk of obesity. And again independent of the type or the quantity of calories. We’re merely looking at the gut microbiota. We start changing this stuff, we’re seeing multiple studies showing an increased obesity, increase in the shifts in these microbiota. Another study from Plos Pne, P-L-O-S One from July of 2013, microbial re-programming inhibits western diet associated obesity. So what they did is they looked at — they did a western fast food diet and we know that that’s associated with obesity and we know that the immune system plays a critical role in this whole process.

So what they did is they gave two groups of patients, one a healthy diet and one a western diet, fast food diet. Then they had another set that was, you know the western diet and the healthy diet but they gave them oral lactobacillus reuteri. So it’s a specific bacterium and that giving that bacterium alone was sufficient to change the pro inflammatory immune cell profile and prevent abdominal fat pathology. So we talked about that omental fat in the first and second parts of this series and giving these bacteria was able to prevent that abdominal fat and prevent weight gain regardless of their fast food intake.

Morris: So just taking this specific bacteria orally was enough to drive down the production of this omental fat.

Chad: In this case, in this study it is completely offset the western diet. But those protective effects were contingent upon inducing interleukin 10 and if you go back and listen to part one and part two, we talk about — just touched on interleukin 10 as an anti-inflammatory chemical Tulsa prolotherapy.

If you look at this I wish I had this graph that I could– I mean I got the graph but I wish I could show it over the podcast. But when you look at the control group and the control group with L Reuteri and the fast food group and the fast food with L Reuteri the serum interleukin 10 levels were dramatically higher and again this is anti-inflammatory in the group that got L Reuteri, independent of whether it was fast food or the control group. So L Reuteri was anti-inflammatory in this case when it showed a reduced obesity and those kinds of things.

Another study published in England Journal of Medicine, major publication. This was from September 18th 2014. The title of the study was Ectopic Fat and Insulin Resistance Dyslipidemia and Cardiometabolic Syndrome. So we’ve been talking about that in the last couple of podcasts. And what they saw intracellular fat accumulation reduced beta-oxidation. And beta-oxidation is what we’re breaking down those fatty acids as in the source of energy. And if you’re trying to lose weight that’s key that’s what you want to do but the intracellular fat if you had more intracellular fat then you couldn’t have as much beta-oxidation that made weight loss more difficult.

Another study showed, the title this one was Artificial Sweeteners and this one is really interesting. Artificial sweeteners induce glucose intolerance by altering the gut microbiota so if you look specifically about how the gut microbiome changes glucose intolerance. So what they did was they had a little bit a background that non-caloric artificial sweeteners abbreviated NAS are among the most widely used food additives in the world. Diet Coke, Diet Pepsi, Diet this diet that all of those kinds of things.

And of course we think that we can– for a long time a lot of people thought that they could drink those things with impunity. I would argue that– I can’t stand high-fructose corn syrup but sugar itself– I would rather have a Coke with sugar in it than any diet drink with that crap in it. It’s awful Tulsa prolotherapy.

Marshal: It’s better to just reduce the number of Cokes that you’re drinking than to more regularly drink Diet Coke all the time.

Chad: Yes and to be clear, I’m not in favor of either one of them.

Marshal: It’s one of those lesser of two evils.

Chad: Yes, exactly. I think you better off drinking Coke with sugar not high fructose corn syrup which is most of what we get in United States. But absolutely get rid of those non-caloric artificial sweeteners. And this study talks about one of the reasons why. So these non-caloric artificial sweeteners drive glucose intolerance through [unintelligible 00:13:06] and functional changes in the gut microbiota. I’m just going to read you the quotes from the study and this was published in Nature in 2014. “Metabolic changes are fully transferable from non-caloric artificial sweeteners. A treated mice to germ-free mice with fecal transplantation or from microbiota cultured with non-caloric artificial sweeteners demonstrated similar NAS-induced dysbiosis in humans with development of glucose intolerance”.

So what does that mean, they were able to demonstrate that when you give these mice non-caloric artificial sweeteners it changes the gut microbiota. When they took– when they did a fecal transplants, they took the poop from one mice transplanted in another one then you saw the same physiologic changes in that mice that was not exposed. So we know that bacterial imbalance made a difference and that bacterial imbalance was caused by non-caloric artificial sweeteners. Does that make sense?

Marshal: Yes, absolutely. It means that the artificial sweeteners, the same stuff that you find in Diet Coke, or we are talking about like sweetener packets not like actually sugar, same thing.

Chad: Right.

Marshal: Those are actually changing those type of bacteria that’s in the gut.

Chad: Yes.

Marshal: Okay.

Chad: And they were able to demonstrate that transferring the bacteria from your gut to someone else induced the exact same physiologic abnormalities. So we know that the gut microbiome plays an important role. This was very very interesting study to me and again I’m going to read what they said here, “Our results suggest that non-caloric artificial sweetener consumption in both mice and humans enhances the risk of glucose intolerance not being able to tolerate blood sugar. And these adverse metabolic effects are mediated by modulation of the composition and function of the gut microbiota.” So the bacteria is what cause this. Notably, several of the bacterial taxa, the type of bacteria, that changed following non-caloric artificial sweetener consumption were previously associated with Type 2 Diabetes in humans. So they’re showing a co-relation between the gut microbiome and Type 2 Diabetes, all being influenced by non-caloric artificial sweeteners.

Marshal: And that’s just one example, that’s just one example of something that’s contributing to the microbiota.

Chad: Absolutely. Again big chant I’m just going to be read it because they said it better than I can. “Artificial sweeteners were extensively introduced into our diet with an intention of reducing caloric intake and normalizing blood glucose levels without compromising human sweet-tooth. Together with other major shifts that occur in human nutrition this increase in non-caloric artificial sweetener consumption coincides with the dramatic increase in the obesity and diabetes epidemics”, it’s crazy. “Our findings suggest that non-caloric artificial sweeteners may have directly contributed to enhancing the exact epidemic that they themselves were intended to fight.”

Marshal: So they went out to solve one problem and either further created a problem, further extended the problem or created a new one.

Chad: That’s exactly right. That’s exactly right. And then there is again– I want to put these slides up in the show notes but from the Ne England Journal of Medicine in 2013 they show a– and this is a pretty dramatic effect when I did the presentation. So there is a map of United States and the first map is States, it’s shading in blue of States and then the next map is shading in red. The darker the shade, the higher the number of whatever it is they were looking at.

Then when you put them side-by-side the shades in red – we’re looking at obesity. The shades in blue – we’re looking at antibiotic usage. And the two correlate almost 100%, I mean it is shocking that got the exact same pattern.

Marshal: Just briefly just because I want to make sure that selfishly I understand and maybe somebody else wants to understand this as well but we hear the consumption of antibiotics a lot. So specifically how does that work and why is that correlated, why is that significant?

Chad: Well so what we’re talking about is the gut microbiome and how changing the gut microbiome the bacteria in our gut impacts obesity, impacts blood glucose regulation. Antibiotics kill bacteria. Not all antibiotics kill all bacteria but certain types, affects certain bacteria and the more bacteria– the more antibiotics you’re exposed to the more likely it is that you’re going to disrupt the gut microbiota and alter that. So when you alter that it changes your risk of obesity and this is looking at just correlation. This is not a causation study but it’s very interesting that high usage of antibiotics correlated, as far as population correlated with high levels of obesity.

Chad: It’s very interesting.

Marshal: Sure. We’re going to take a quick break here and then when we come back we’ll talk a little bit more on what we could do to further help or assist the body to create the correct microbiota and to diversify it.

Chad: You got it.

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Marshal: All right we are back with Dr. Chad Edwards and we’re talking about the microbiome here in the body and how that is really the pinnacle of these three part series of what we’ve been talking about. Dr. Edwards let’s get back into it.

Chad: Yes. So again looking at the exposures and when early in the podcasts we talked about exposures early in life affected adult gut microbiome population. So what are some of those exposures? Normal delivery, when you’re born, we pass through the birth canal, we’re exposed to a number of bacteria in that process and that’s normal. When you have a C-section, you’re not exposed to the same level of bacteria, and some of the studies show a direct correlation between those two. Digging into that a little bit, one of the things from 1990 to 2012, we saw C-sections go from 22.7% of live births up to 32.8%, so a 10% increase in C-sections. When you look across the globe, some countries have high levels of C-sections for a number of reasons, there’s several studies and graphs that we’re looking at here that show primary and repeat C-section delivery rates among low risk women by age, and it’s increased overtime without question.

Then this one is a study called Mom Knows Best, the universality of maternal microbial transmission. Another one, a case-control investigation of prenatal risk factors for childhood. Insulin dependent diabetes type one, diabetes in Northern Ireland and Scotland, this one is really interesting. They looked at 258 insulin dependent diabetics, type one diabetics from Northern Ireland and 271 from Scotland. They did five matched controls for each diabetic child. The risk of having type one diabetes if you had a C-section was 66% in Northern Ireland and 70% in Scotland. 70% of those that got C-sections— oh, I’m sorry it is a risk increase. So it almost doubled the risk of having type one diabetes. Interesting. So strong correlation between having a C-section and developing type one diabetes. From what we talked about previously, type one diabetes is an autoimmune disorder, so the gut microbiota or the exposures– we’re inferring, we don’t know this, but when you look at the associations, the gut microbiota changes a lot of stuff.

There’s a paper, this was from 1994, but Why are C-section Deliveries Linked to Childhood Type One Diabetes? This is really interesting. Early life factors have been shown to be associated with increased type one diabetes risk and perhaps involved in the development in the immune system. It was a meta analysis of 20 studies worldwide that reported C-sections independent of maternal weight gain, all kinds of things, and there was a 20% increased risk in type one diabetes if you had a C-section.

Marshal: That’s crazy.

Chad: So that multiple studies, multiple places worldwide, and this was from January 2012. Very interesting stuff. We know that there’s immune regulation genes and we know that those are—or we strongly suspect that they are tied with the first microbe exposure, that delivery method, C-section versus normal vaginal delivery. And that can modify your immune responses and genetic predisposition to multiple different autoimmune diseases and things like that. Children born by C-section lack the benefit of protective vaginal bacteria. The initial microbiota to which a neonate is exposed and which may be related to the type of delivery is important in the development of child’s immune system and in modulating in response to external agents later in life, and that was from the Journal of Diabetes in 2012. In summary of all these stuff, we know that metabolic syndrome is a major problem, we know that its incidence is increasing, more and more people have this problem, a quarter of the world’s population deal with this stuff, and we know that hormones dictate our metabolism. We know that the gut microbiota alters inflammation in hormones, we know that the gut microbiota is affected by gut health and nutrition, we know that inflammation alters hormones and metabolism. There’s just a lot of really interesting things about metabolic syndrome and how does that come about? And specifically for this podcast, that the gut microbiome, there’s a strong correlation with this stuff.

So when you look at the traditional approach to metabolic syndrome, the goals are– we manage all of these risk factor, we manage all the criteria that puts you in metabolic syndrome, so one of those is blood pressure. We manage hypertension, we manage your LDL cholesterol with statins. We want to optimize the HDL and we usually do that with lifestyle and niacin. We’re going to optimize triglycerides and we do that with omega 3s and most physicians that I saw traditionally would use lovaza, will give medications like fibrates, and we manage the blood sugar with medications and then we do some lifestyle stuff with lifestyle or with nutrition exercise. I want to do one little word with statins, with statins, we’re trying to manage cholesterol. The interesting thing is that this may be going against what we’re trying to do to begin with.

There was a Finnish study from Finland, found a 50% increase in type two diabetes in people who took statins. If you took statins, 50% increase. There was a decreased insulin sensitivity of 25% in patients that took statins, and increased insulin secretion of 12% in that study. At New England, Journal of Medicine study showed a 27% increase in diabetes in people taking rosuvastatin, one of the statins. The problem with metabolic syndrome is insulin, glucose, those kinds of things, yet we see– and one of the medications that we’re giving to try and help this or manage this is a statin which has been shown to increase the risk of diabetes. What in the world are we doing? This is crap.

Marshal: Sure. 80% of medical recommendations are crap.

Chad: And this is one of them.

Marshal: And this is one of them.

Chad: So how should we address metabolic syndrome? Aggressively with the healthy trinity. So whole food nutrition, eliminate processed foods, exercise, reduce stress, improve rest, probiotics and prebiotics, and this is the kind of food and we’ll talk—we’ll have this podcast specifically about this. Whey, NRP, protein supplements can impact the gut microbiota. Nutritional supplements is needed and medications only when needed to help optimize health.

Marshal: So kind of bringing this full circle, and you mentioned this at the beginning of the second part of this series. But a lot of medical clinics, they will address the disease and not focus on the overall health of the patient. And so with functional medicine and revolution health, the approach is to address the overall health. And at that point, you address the underlying root of the issue, and that’s what we’re talking about here.

Chad: Exactly. No one has metabolic syndrome because they’ve got a deficiency of their blood pressure medicine. Why do we think that that’s going to fix this problem? It’s not. Fix the underlying problem.

Marshal: Fix the underlying problem. And so what would you recommend for listeners that are hearing this and saying, “Hey. I get it. I’ve gone on, seen these studies. Who do I talk to about this because my doctor is not very receptive of this?” Where did he go?

Chad: Yes. Look for a functional medicine physician. You can Google “functional medicine, integrative medicine”, look for a physician that will listen to you and thinks this way. And then ultimately, this comes down to lifestyle, lifestyle, lifestyle. Get rid of the crap from your diet, get rid of artificial sweeteners, get rid of junk foods, eat unprocessed whole foods. If you can get it from Farmers’ Market, it’s best way to go or generally, whole foods, those kinds of things. Get away from that processed, refined foods. We know that that’s impacting your physiology.

Marshal: That concludes this three part series. Doctor Edwards, I really appreciate you kind of diving into this, “peeling back the onion” maybe, multiple layers here going into insulin, and in cardio metabolic syndrome, the gut microbiome. It’s kind of cool to see how that’s all related in the body and how you can address some of these issues with just some pretty basic lifestyle changes.

Chad: Yes, exactly.

Marshal: Thank you so much.

Chad: Thanks.

Male: Thanks for listening to this week’s podcast with Doctor Chad Edwards. Tune in next week where we’ll be going against the grain.