So what you're saying is if I could get my hands on the fecal samples of the
Olympic athletes that I expect my children to be,
I should not inject that into them in my kitchen at home.
Okay. Listen, take that with a kind of salt.
My question is, do you eat the shit or is it a suppository?
Cause I was like, they do both.
She encapsulated it.
So technically we ate it.
Yeah.
I mean, if we're being serious here.
But in the clinical, it's generally via colonoscopy.
Yeah, I think that would probably have more of a draw for me.
Yeah. If you're going to go down the pathway.
Hello and welcome to the 40s Formula,
your go-to place for insightful discussions on navigating your 40s
and thriving in this transformative decade.
We're your hosts, Amanda and Jasmine,
two women that are passionate about exploring the challenges
and adventures that come with turning 40 and what lies ahead.
Dr. Elizabeth Biggs is a medical doctor and co-founder of Akisi Wellness,
a Singapore based gut health company.
While she notes that Western medicine is predominantly the science
of ill health, Elizabeth has always been interested in promoting good health
through a holistic approach to diet and lifestyle.
With her co-founder, Victoria, they created a health and wellness brand
designed to improve their family's immune and digestive systems
using a food as medicine approach.
Because Elizabeth and Victoria are both working moms,
they made sure that Akisi products can quickly and easily be incorporated
into the daily family routine, supplying prebiotic and probiotic powder
supplements and drinks that can be taken on the go.
As a clinical nutrition coach, I spend a ton of time discussing
gut health with my clients, right?
And I think there's kind of a confusion and a lack of scientific
discussion around the topic.
Everyone kind of throws their hat in the ring of what they heard or what they read.
And that's why I am so happy to welcome to the podcast Dr. Elizabeth Biggs.
Thank you so much for being here today.
Thank you for inviting me on the podcast.
And first things first, you are a mom of four, OK?
And a medical doctor.
And you've now devoted your entire life's work to helping people find wellness
in a way that's distinctly different from the conventional Western medical model.
So can you tell us a little bit about your journey to get there?
OK, so my background is medicine.
I did all my training in Ireland.
So I definitely come from that conventional Western model of medicine.
And if you think about that for a second, it's very much a pathology driven
viewpoint.
So we are taught all about disease and pathology and how to fix it.
So it's I've now sort of embraced a kind of a different perspective
and coming from more of a sustaining that sort of health
span lifespan.
And I think gut health for me is sort of central to that piece.
I don't know if I planned on making that journey, but it's just one of those things
that's evolved over time.
And I think now there's really quite a lot of interest in that sort of
holistic functional medicine space where you really are looking
at individuals as a whole and you're trying to look at them from a multi
systems perspective rather than just waiting for the system,
the organ to be broken and then trying to fix it in a sort of a retrograde
kind of action.
And I think now it's that idea of looking at the way
modern medicine is designed so much in that sort of silo
kind of perspective that you have specialties and you absolutely need that
specialist knowledge.
You need the specialist practice experience over decades to be able to deliver
an evidence based driven medical model, which is exactly what it is.
But I think now there's an opportunity to use different kind of approaches.
And I suppose for me and my journey, I've I've sort of come to it.
I've lived in different parts of the world, gone through having children.
And I think your perspective sometimes changes.
So I've been able to incorporate a little bit of that
traditional medical background and then apply it to setting up a business
in the gut health space with my co-founder, Victoria McKellar,
and kind of taking it from there.
And I think, you know, in the gut health space, right, there's a lot of terms
that I think need to be the foundational understanding of what gut health is,
terms like what actually is the gut, you know, what organs and systems are involved
and what is the gut brain axis and what's the difference between prebiotic,
probiotic, postbiotic.
Can you give us a little bit of a primer in gut health?
Yeah, OK. So gut health is a bit of a generalistic term.
There's no really good definition, I don't think, that defines it.
If you think about when I did medicine, gut health wasn't a term.
And even the microbiome microbiota stuff wasn't actually
talked about.
We used to sort of tell patients, you know, there is gut flora.
That was the word that we used back then.
There was an awareness that there were microbes in the large colon,
but that was really the limit.
And because of developments in gene sequencing and the technologies
that have moved forward, the gut microbiome microbiota space has really
kind of exploded onto the mainstream, really over the last, I'd say,
sort of two decades.
So in terms of when people talk about gut health, what they're really
referring to is this a complex kind of microbiota.
So that is just a collection of all the bacteria, the fungi
and yeasts and viruses that basically inhabit you.
They live on you, inside you.
We talk about different...
The microbiota is the name given to the actual bacteria and fungi,
whereas the microbiome is the genetic material that sits there.
So if you think about, I think people find this a little bit confronting
when they start to imagine that they have all these microbes
living on them and in them.
But it's a co-evolved system.
It's an evolutionary evolved system over millennia.
And if you think about human existence has always coexisted with microbes
and they're absolutely essential for a lot of processes
that's part of nutrition and digestion, but goes beyond that as well.
So if we take a step back and think about the size of it.
So you're talking about microbes of sort of 100 trillion organisms.
If you put it together, it's about a kilo in weight.
We predominantly talk about the microbiota that inhabits
the gastrointestinal tract, GI tract, because that's really the most
studied at the moment.
But there are microbiota that inhabit your ears, your lungs,
the genitor urinary tract.
So there's other areas of research looking at what those microbes
are doing in those other places.
If we talk about gut health, we predominantly focus on the GI tract,
which everyone knows goes mouth to anus.
But most of the volume of those microbes
inhabits the large colon.
So that's the end part of the GI tract.
And that's really because it's more easily studied.
So the microbes that inhabit the small intestine are really the workhorse
is where the digestion and the absorption of nutrients is happening.
But it is much easier to study the microbes in the large bowel,
because that's really where you get stool samples.
That is showing you which microbes are growing in your large bowel, so to speak.
In terms of the space where we are, so that's really the microbiome,
where it is, what it's doing.
Gut health is really around the concept of how that GI tract is functioning,
what sort of state of health it's in.
And if you think about what those microbes are doing,
because the question is really why are we talking about it?
Why is it important?
And essentially, they are part of your digestion system of absorbing nutrients.
They synthesize vitamins that you need.
They produce important metabolites, which we can expand on later.
But some of these metabolites are called short chain fatty acids.
They're crucial to the health of the large bowel.
They actually are molecules that feed the cells that line your large bowel.
And the microbes also have enzymes which actually activate enzymes.
And a good example of that is estrogen becomes activated at the level of the gut wall as well.
They synthesize neurotrans precursors to neurotransmitters.
So I think once all these points had been sort of elucidated from some research,
people started talking about the health of the gut
and then its impacts beyond the gut system itself.
So it's gone beyond just the symptoms of say an irritable bowel syndrome or IBS type symptoms
to sort of look at what sort of impact is happening at the level of the brain and other systems.
And would you say that is the sort of the gut brain axis that everyone talks about?
Yeah, so a lot of you say gut brain axis or brain gut axis.
No one quite knows which one's more important than the other.
The brain influences the gut.
Everyone's had a personal experience of that,
getting nerves or butterflies, needing to go to the toilet more often.
That's just that anxious energy transmitting into the gut wall.
So the brain can control gut transit time.
It can control mucus production.
And this is all not under your conscious control.
So we call that through the autonomic nervous system.
The vagus nerve is the nerve that innervates into the gut lining wall.
The gut then translates information back up to the brain through neurotransmitters and chemicals
that signal all sorts of feelings, so feelings of satiety.
And so you have this incredible sort of two-way bilateral communication system.
And if you think really about the terminology around irritable bowel syndrome,
so a lot of people think about gut health and they think,
oh, I think that's just the IBS and maybe bloating.
So IBS-type symptoms, irritable bowel syndrome symptoms, can be gas, bloating, pain,
constipation, diarrhoea, or any kind of combination of those systems.
And it used to be very much a bit of a catch-all bucket.
So people would traditionally go to their local doctor, be referred onto a gastroenterologist.
And it's important that real pathological diagnoses were excluded.
So things like Crohn's disease and ulcerative colitis, which are diagnosed by specialists
and have a criteria set for diagnosis.
So if you have symptoms and you've excluded any red flag indicators of pathology,
then sometimes you were put into this bucket of an IBS and it was a little bit of a functional bowel disorder,
so to speak, because there's no, wasn't an identified cause for some of those symptoms.
But I think now there's more attention on IBS as a brain-gut disturbance or a gut-brain disturbance
rather than just a catch-all bucket for all the things that couldn't be put into another diagnostic space.
So would you say then that people who have, let's say,
issues with their, I guess, mind or feelings or sort of personality type disorders,
they could potentially be something that's caused through the gut?
Yeah, and there's definitely research to demonstrate associative change, like connection.
So we have to be very careful around cause and effect.
So these aren't necessarily causal relationships, but they are definitely associated.
So I think that's where you start reading a lot of literature between autism and gut disturbance.
You have a sort of a, what would you call it, like a predisposition,
say in a Parkinson's diagnosis that you have a constipation type picture.
And so there's people now, there's an association there with the bowel being affected.
So I think people are now looking at some of these brain conditions or psychological diagnosis
and how the gut is interconnected to them.
And I think understanding that we don't know the directionality.
Correct.
And again, we can't establish causation.
Yes.
That being said, I think that within the circle that we run in with nutrition and wellness people,
there's still this like, okay, it doesn't matter what the directionality is.
I want to optimize both ends.
So I want to be really strong mentally and also really strong physically.
Correct.
So then obviously the next step is to turn to supplementation.
So then, okay, how do I maximize my gut health?
I'm going to take prebiotics, I'm going to take probiotics, I'm going to take postbiotics.
Symbiotics.
Yeah.
Hey Amanda, do you know of a really easy way to give your kids some good gut bacteria?
I do indeed.
I'm giving my family Akizzi Wellness Elderberry Boost.
They come in these little sachets.
You just rip them open, pour it right in your mouth.
That sounds like fun.
And I bet I could add that to their smoothies and some Greek yogurt too.
And what I love about Akizzi is that you can take it any time of day.
And there's a product for all ages, even my 12 week old little guy.
Akizzi believe that food is medicine, so you know the products are clean and have no gums and fillers.
They also take a science forward approach and include pre, post, probiotics, as well as polyphenols.
And the best thing is you can get 15% off full price items with free delivery when you use code 40s at checkout
for any purchases in Singapore from their website akizziwellness.com.
And don't forget to check out their new Akizzi Berry and Akizzi Tropical Flavors too.
Now back to the chat.
What's your take on what's really necessary to maximize gut health?
Or is there even such a pattern?
Like, is there something that we can do in that end?
Definitely.
So I think even if you're maximizing your gut health, you're actually also maximizing your brain health.
All right. Two for one.
So in terms of gut health, it's really about diet.
Diet is the single most powerful force you can use.
We've all inherited our genes, which we can't do anything about.
So the human genome you're fixed with, your microbial genome pattern can change and that changes with what you eat.
So the first thing you can do is look at your diet and it's really about plants and fiber.
Microbes feed off fiber.
And essentially, it's like looking at your diet and working out how do I maximize plants in my diet?
It really needs to be three quarters of your plate.
It needs to be varied and diverse.
It needs to be colorful.
You can make it fun.
And obviously, the fermented foods are key.
If you can make your own fermented foods, that's ideal.
If you can do your own fermented drinks, any of your kombucha keffirs, they can be milk-based or water-based keffirs.
There's a lot of foods in that food group.
If you don't have time and we're all rushed, then you look to supplements.
So we've created supplements for busy families.
And in the ideal world, people can ferment themselves.
They don't have the time and they don't necessarily have the know-how.
Even though it's a relatively straightforward process, I make some great sauerkraut at home.
My kids tell me it smells and they won't eat it.
So they possibly benefit more from having a supplement.
I've made great water kefir that's exploded on the roof.
You've got to get it right.
You need to know what you're doing.
So in terms of maximizing gut health, you can use, as you said, prebiotics, probiotics, postbiotics.
We've created some products that include all three.
So if we go to basics, prebiotics are essentially the food that microbes eat.
There are definitions, a sort of a substrate that's selectively utilized by host microorganism
and confers a health benefit on the host.
That's the classic definition.
But for most people, prebiotics are essentially a food for your gut bugs.
And that includes a subset of prebiotic fibers.
They're essentially what the chemical name are oligosaccharides.
That's a medium to long chain sugar molecule, essentially.
You can supplement with those.
And ones that you may see on the side of a container are fructooligosaccharide or FOS,
galactooligosaccharide or GOS.
Inulin is another one.
You can also get prebiotic fibers from your food.
So anything from garlic, chicory root, artichoke, you've got the lovely green banana starch.
So there are lots of examples of prebiotic fiber in your diet.
Probiotics you can get from supplementation, but you're also getting live bacterial species
if you're ingesting fermented foods.
If you think about how to choose probiotics, essentially you can use a really simple classification.
So group one generally have the common species that you'll have seen.
So lacto species and bifido species.
So they're both bacteria and that you can get a combination of those.
The second group normally includes a beneficial yeast.
And the most common one for that is the Saccharomyces cerevisiae.
And the third group are what we call soil-based probiotics or spore formers.
An example of that is a bacillus coagulans.
You might see that in a kombucha style drink.
So that's a broad classification of probiotics.
In terms of a postbiotic, it's a really new area.
So postbiotics can include either the probiotic that's been inactivated or it can include
the bacterial species and the metabolites that it makes, or it can include the probiotic
and its little, let's say cell components or cell wall or protein molecules that are
associated with it.
So it's a little bit of a bucketing group.
But it's a new area and I think it's really showing where we're heading in terms of the
space.
The other thing that's worth thinking about are what we call polyphenols.
So polyphenols is essentially plant-based nutrients.
So they are described, there's a complex group of them.
There's something in the order of 5,000, 6,000.
If you think about that beautiful variety of colorful fruit and vegetables in front
of you, all the plants essentially make these polyphenol chemicals as a form of defense.
So a plant makes those in response to UV light, in response to drought, in response to its
own pathogens.
We then ingest those chemicals.
They are extensively metabolized by your gut microbes.
So polyphenols, by their definition, I know there's a lot of words, are acting as a prebiotic.
They're feeding your gut microbes.
So the more varied and the more colorful plants that you can include are packed with these
important polyphenol molecules.
And I think if you think about them, you have to actually eat fruit and veggies three meals
a day each day because a lot of these plant chemicals, they're broken down extensively,
metabolized and used.
So you can't sort of store them up, so to speak, which lends itself to that, you know,
eat your, originally they eat your five fruit and vegetables a day.
You've moved much further on to, you know, see if you can get your 30 different plant
points a week or 30 different plants.
But essentially it's packed with these polyphenols.
People might have heard the word sort of antioxidants and really that's what people thought these
plant chemicals had powerful antioxidants in them.
There's also other examples of them, like all those great anthocyanins that are in all
the red berry group.
You've got curcumin that sits in the turmeric family.
So people have heard of this.
Oh, I love the turmeric in my cooking.
That's right, yeah.
So people have heard of these fabulous plant inputs, but that's really what they are.
And we've sort of worked hard to include a lot of those plant ingredients in our fermented
drinks so that we're covering both the probiotic part of it, but we're also including those
important probiotic inputs and polyphenols to feed your gut microbes.
Yeah.
And what you mentioned about eating the rainbow, right?
I know that, you know, one of the gut health conclusions that I've come to, and we're going
to talk about the hack your health documentary a bit later, but one of the conclusions they
came to as well was that, you know, there was so much early focus on how many, you know,
what was the amount of probiotic in your supplement, right?
Like how many billion CFU, but now it's like, what is the diversity of the bacteria in your
gut?
Right.
And I think, you know, eating the rainbow speaks to that, right?
It's not about how many cups of broccoli can you have, let's say, versus having broccoli
every single day and every single day.
That's the one vegetable I eat, right?
It's more about what does the diversity look like in your gut.
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I am.
You are.
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Now back to the chat.
And to that end, how can we determine whether a probiotic supplement is a good one?
Is it the number of CFU?
Is it the strain is patented?
How do we vet our probiotics?
So good advice to start with is if you want to move away from what we call the arms race
of the CFU, you can look up any probiotic supplement.
Ideally, you want a minimum CFU of 1 billion and people you'll see anything from 1 billion
right up to sort of 800 billion, it can vary.
But the most important thing is the diversity of species in there.
And if you look at the back of any supplement, it'll tell you which species and you can sometimes
get inputs of the individual species and you can get strain level information.
Most, I can speak to our probiotics, we include like an overage.
That just means we put more probiotics in it to ensure that this fat CFU is still at
that level at the end of shelf life.
So we call that overage where you input more into it.
There's different, various of refrigeration and shelf stable that they're not necessarily
a lot of people want to go for fridge, but you can have shelf stable as well.
But I think the most of the key thing is diversity of species.
And really to think about those groupings, as I said, if you want to try probiotics,
it's great to also rotate them is another thing I would say, because you're actually
introducing different species as well.
And if you think about it in those three classes, so try trial a lactobifido combination.
And maybe if that doesn't work for you, look for one that has that saccharomyces, that
beneficial yeast.
I know as soon as you say yeast, everyone kind of freaks out and thinks of like, I don't
know, thrush.
Yeah, candy.
Yeah.
But this is a beneficial yeast.
And then all try the third group, which is that spore forming.
So you can sort of trial them in that sequence is another way of doing it.
And most advice would be, you know, you can be a responder and a non responder.
So try a probiotic for three months and then decide yourself, did I get improvement in
what I what's important to me in my metrics?
Am I treating an IBS type picture?
Would I like to go on prebiotics to really just maximize my gut health?
Am I considering doing some gut health testing?
So it really is individualized, I think, to why you're taking it and how it fits into
your life and whether you enjoy it.
So I think the other thing with liquid probiotics is they're meant to be fun and they're meant
to really replace a less healthy option.
So if you think of a busy household, you're really trying to have an alternative to say
a juice, a soda, a sugary milk.
So you're trying to introduce something that is also enjoyable to drink.
And that is that that's a unique space.
And that's where I think we're really happy to be in that space.
Talking about sort of diversity of species.
I have recently read about acromantia and its link with possible obesity and whether,
you know, people who don't have enough of this type of species in their gut microbiome
are more prone to having obesity or metabolic disorder.
Is there anything relevant or real?
Acromantia is definitely the next poster child probiotic coming on.
And yes, and that research has again got some associative links to it.
I think in terms of acromantia, you can actually feed your resident amount of acromantia by
using elagitanins, which are actually polyphenols, but pomegranate is has been touted as a great
input for feeding that acromantia.
I need to get some more pomegranate in.
And also that the staffer on obesity also looks at some of those ratios of different
phyla of bacteria.
And so you've got different sort of patterns that you can look at from a gut health testing.
Obesity is also, it's definitely kind of progressing and it's quite an expensive probiotic also
to work with at the moment.
I've just bought some and I'm like, oh my god, I can't believe it.
Has fastidious kind of growing requirements, which makes it kind of quite an expensive
and difficult probiotic to grow and to keep stable.
But that space is really evolving.
I think that is definitely worth watching.
Now you mentioned earlier about having products that are accessible to families, right?
That fit easily into family routines and making sure that you can provide gut health supplementation
that's accessible.
Now I am a mom of little littles.
My little little ones are four, two and brand new.
And I love the idea of giving them probiotics, but I'm wondering why.
What would be my motivation?
And is it immune system?
Is it gut health?
It's one of these things when other moms ask me about it, I was like, I'm not actually
quite sure why I give them probiotics.
Can you help me?
So I think if you go back to the journey and if I had my time again with my kids, I would
love to change a few things.
So if you think about the microbiome in utero, so ideally for a woman, you really need to
be optimized in terms of your microbiome preconception.
Not dissimilar to really being optimized before pre-pregnancy.
And everyone's OFA now with folate to prevent ureotube defects.
So I think women are very cognizant of the fact that they need to really consider their
nutrition and nutrient status preconception.
Essentially at the moment, the understanding is that in utero, that it's a sterile space.
I would challenge that.
At the moment, it's very difficult to consider an amniocentesis to look at the microbiome
of an unborn is just not really feasible.
So at the moment, the working hypothesis is essentially a sterile environment, but Bob
inherits essentially the blueprint of that microbiome from mom.
So then we have the journey of pregnancy and the exposures of that.
So that includes everything from antibiotics during pregnancy to environmental exposures.
At birth, we have a bifurcation.
Is it a vaginal or is it a C-section?
And I've had four C-section children.
So I completely understand there are decisions for both and there are medical indications
for both.
But once you go down the C-section path, you don't have that natural vaginal delivery.
You don't have that seeding experience.
You generally on C-sections in most places are given antibiotics at anesthetic induction.
So you have these knock-on effects and the first exposure are the surgical gloves of
your obstetrician.
So the pathway of that is altered from the moment.
That's not to say we should all feel bad if we've had a cesarean child.
It's just to be aware that the journey looks different.
Then you've got the breastfeeding formula bifurcation pathway.
So I was fortunate enough to be able to breastfeed my four children.
They didn't start off ideally, but I felt as though that was a very good.
And I feel if you can do either, both is brilliant.
A vaginal delivery and a breastfed child is ideal.
But if you can do one or either is also amazing.
So that first amount of colostrum and breast milk has, and I don't know if your listenership
is aware of that, one of the really important ingredients in breast milk is those human
milk oligosaccharides.
There is specifically a subgroup of oligosaccharides and they are essentially undigestible for
that.
That baby does not have the capacity to digest.
They are essentially digested by the baby's microbes.
And there's this incredible flourishing period where that feeds that microbiome picture and
it flourishes on those human milk oligosaccharides.
They're now synthetically made and included in a lot of formula.
So then you have the process of that first six months of essentially that's in most countries
it's milk fed.
And then you have a weaning phase where you get the introduction of those incredible fibres
and carbohydrates which you get another flourishing and you get another change in that blueprint.
So you have this incredible opportunity I think with young children in that zero to
three year period.
It's an incredible opportunity to really bolster that gut microbiome picture.
But it's also a risk period as well because every course of antibiotics, and my children
all received antibiotics in that first three year period, they had everything from skin
infections to ear infections.
And each time you do that you do either perturb or you cause an imbalance.
It's not to say antibiotics absolutely have their place and they are life saving.
That's an important point to get across.
But I think we're now in the phase of a lot of us discussing antibiotic resistance in
the community and really just questioning that the use, judicious use of antibiotics.
And if you can you really want to avoid those prophylactic courses.
So that's just a course that's given to you in the in case scenario.
And really to ask is it necessary, can I do something else?
Can I do watchful waiting?
And that's not to say when you have a sick baby that has a high temperature you need
to seek medical attention.
So I certainly don't want anyone to misinterpret what I'm saying but it is just in that broader
context of having kids in that period.
It is a great opportunity and it's also a risk period because that first three years
is their founding time to establish a very strong diverse microbiome.
And I think it's just to think about the things that both impact it positively and negatively.
I had two c-sections and I did give the boys, so I've got twins which is why I had two
c-sections.
But I did give the boys the colostrum.
I tried breastfeeding my first baby.
It was very, very difficult and then ended up moving on to formula.
And now I sometimes I feel like I kick myself like I wish I tried harder or you know could
I have done anything differently.
And I wonder if I've screwed them up.
Sorry boys.
But we're then using probiotics in this situation sort of help aid their sort of microbiota.
And then is it also how important is it then to get in the prebiotics, the vegetables,
the fibers to ensure that obviously we're putting the microbes in there and then are
we helping them flourish by giving them that section because obviously it's really difficult
to get kids to eat their veggies.
Absolutely.
And I think that's where probiotics have really come in.
It's to supplement the fact that we have a really modern fast-paced lifestyle.
In the ideal world, yes we should all have vaginal deliveries and breastfeed and live
in a more rural setting that's exposed to the natural environment.
But we can't and realistically we supplement to offset all those exposures and toxins that
we're exposed to.
We can't you know we need to just try and maximize the system.
And when the probiotics have their place there's really good evidence for them in infant constipation
and colic.
They're actually part of certain medical protocols for premature babies to avoid a medical condition
that's called necrotizing enterocolitis or NEC.
And some hospitals include a probiotic protocol for that specifically because you've got a
preemie baby born with an immature GI tract and it just cannot tolerate formula or breast
at the earlier stage than when it should.
Other things that are in the older category though are travelers' diarrhea, antibiotic
associated diarrhea and we'll get on to sort of that C. diff picture maybe in a little
while.
But so I think there's really good evidence that in those early years you do look to supplement
the probiotics to really enhance digestion but also to support that immune system because
that three-year development of microbiome is really where that young immune system is
learning.
It's designating friend from foe.
Those microbes are teaching the immune system how to react to either pathogens or friendly
kind of inputs because essentially it lines the gut wall and it's the first exposure
to the outside environment to the body.
What about when a kid has had antibiotics for whatever reason they needed to have the
antibiotics?
Can they take probiotics with the antibiotics?
Should they wait until after the antibiotic course is finished?
When would be the optimal time to start to rebuild that gut microbiome?
Yeah and there's different research on that.
Most people would argue that you could take probiotics at the same time but just space
it from the antibiotic dose.
Some antibiotics give you quite bad GI side effects.
So anyone who's been on a flat gel or metronidazole course will know you get quite bad nausea
and diarrhea.
So sometimes you can use probiotics to increase the tolerance to the antibiotic course.
The most important thing about antibiotics is to actually finish the course.
Partial use of courses is really part of this picture of emerging antibiotic resistance.
So just if you commit fully, finish the course, use probiotics, offset them four to five hours
outside the other dosing and continue them on afterward after you finish the course.
Yeah, that's exactly what my husband says is if you're going to go for antibiotics,
just finish it.
And if you're going for antibiotics just to shorten kind of the duration of your symptoms,
it's not worth it.
No.
It's not worth it.
You know, just go for it to the end.
Well, speaking of going for it to the end, right, this new Netflix documentary is kind
of all the hot rage and it's called Hack Your Health.
It's all about the gut, right?
And it's kind of cutesy to be honest.
You have seen it.
Yeah, I have seen it and I love the people they interviewed.
Julia Enders.
She is very cool.
Love her.
She's very cute as well.
My kids saw it.
They loved it too.
They were in an apple while they were watching it.
Get me that fatter.
But, you know, they kind of bring it.
Obviously for them, they're looking at everything through the lens of gut, right?
So gut health is the root of chronic illness.
Gut health is the root of skin disease.
Gut health is related to infertility.
I mean, they go for everything.
Do you believe that it's that fundamental and that far reaching?
Are we ready to make those statements yet?
And if not, what's your takeaways from that documentary?
I love the documentary.
I think it's a great way to really introduce gut health, particularly if you're at the
start of your journey.
I think they interviewed fabulous people in the space, particularly people like Rob Knight,
John Cron, they know this space.
In terms of the links, I think a lot of the research links are still really associative.
I run a gut health company, so I would love to say it actually impacts absolutely everything.
I think that's still coming.
I would argue there's absolutely really good evidence for gut brain health and there's
great gut skin health.
I can't speak to some of the other topics.
There's a huge amount of research.
The base premise in medicine is do no harm.
So most clinicians who recommend probiotic usage would say they're relatively cost effective,
they do no harm, and they're worth a trial.
So if you take that premise, then I think it is worth supplementing and trying them.
In terms of the doco, I loved how they included the little felting.
Yeah, that's what my kids loved.
Although the FMT side of it, so I think it was really good that they introduced fecal
microbial transplants.
I would hold that space more, that is very much in the clinical space still.
So the indications at the moment for FMT is for C. diff.
In a hospital setting that's resistant, I don't think people should look at the documentary
and think that doing FMT yourself at home is a good idea.
It is not a good idea at all.
That was a breathtaking segment.
The main issue I have with that documentary, and I think FMT should be kept in the space
where it currently is, which is under very strict clinical research.
And the reason for that is that no one actually knows what the ideal microbiome is for you
as an individual.
So I think that space is still really being explored.
And I think gastroenterologists in that space are still really heavily in the research side
of it and are really looking at it specifically in the C. diff. space.
I might be wrong, but that's my understanding of FMT and that's for the moment where it's
at.
My understanding is if I could get my hands on the fecal samples of the Olympic athletes
that I expect my children to be, I should not inject that into them in my kitchen at
home.
Correct.
Maybe just hang on that.
Take that with a penisul.
So my question is, do you eat the shit or is it a suppository?
Because I was like...
They do both.
She encapsulated it.
So technically, we ate it.
Yeah.
I mean, if we're being serious here.
But in the clinical, it's generally via colonoscopy.
I think that would probably have more of a draw for me.
Yeah.
If you're going to go down the pathway and if we've established the perfect one for you.
Yeah.
Well, again, outside of eating poop, right?
So outside of the very extreme methods here, I have so many friends, right, who think they're
just going to pop open a kombucha.
They're going to take a packet of probiotics, a sachet of this and boom, instant magical
gut health, right?
But I'm getting the sense from you that there's a lot of work to be done food-wise before
the supplementation even makes a difference.
What are your non-negotiables for someone who's seeking better gut health?
Okay.
Well, I think I have to use the triumvirate.
I mean, it's a sleep diet exercise.
So for gut health, it's diet first and foremost, and it's highly malleable.
You can change your meals.
And the thing with fiber is just ideally you need like 30 grams of fiber a day.
And that's hard if you're looking at the back of a packet.
So instead of looking at backs of packet, which ideally you shouldn't be, should be
eating whole foods, is three quarters of your plate needs to be plants and they need to
be different each time.
So you can look at that straight up and look at diet.
And as you increase fiber, you should actually increase it slowly.
Because if you go from eating your fast food kind of standard American, say diet or whatever,
and then the next day you ingest, you know, 40 grams of fiber, your gut might be a little
bit upset with you that you've gone from sort of zero to hero.
So the food that you're eating is the most powerful choice you can make.
This is great quote by a physician in the 1970s.
I think he was Irish.
And he said something like, you know, America is a constipated nation.
That's not the quote I thought you were going to pull, but I like it as an American.
Yeah.
And he looked in the 70s, I think, at fiber intake, you know, at parts of Africa and Uganda.
And they have seven times the amount of fiber that we're sort of currently ingesting.
But they also have a genetic and lifestyle.
They're eating a huge amount of starch and tubers, and that's their local geographical
diet.
But it's just to say that variation of fiber intake is huge.
Exercise is great for your gut, a natural circadian rhythm, the gut actually does need
a rest.
And if you build in a 12-12, if you want to do intermittent fasting, the time that you're
fasting, your gut is regenerating, the mucus layer is regenerating itself.
It does absolutely need that gut rest.
And in terms of sleep, I mean, I don't need to, I think most people understand the impacts
of sleep on any system you're talking about.
So unless you're really nailing down those three, everything else is really just the
top part of it.
You need to focus on those three things as core.
And I think from a female perspective as well, is gut health influences brain health.
And if there's one thing to sort of get across is women are really good, I think, at understanding
currently risks of breast cancer, but brain health and dementia risk is substantial.
And I think if you're eating to support your gut, you're actually supporting your brain
as well.
When it comes to eating fibrous foods, does it matter how it's prepared?
And I'll give you an example.
So yesterday I made this dish called sorgh, which was full of loads of different greens.
I chucked in some broccoli, some cabbage, some chai sims, some spinach and ginger and
onions and garlic.
So basically a lot of stuff.
But then I blended everything.
And then I'm thinking, is this blending breaking down that fiber that should have been done
in the gut or will I still be able to get the fiber out of it?
I mean, you know, I was, I don't know if I'm overthinking it or whatever.
Yeah.
So I think the goal is get the fiber in.
If you have a fussy child, then smoothies and blending is a really good way of doing
that.
If that's the only way in the ideal world, you really want to slow down that level of
absorption.
And the issue with liquefying is that you're getting faster absorption higher up in the
small intestine and you're not having that mechanical digestion process that starts obviously
with enzymes in the mouth and really ramps up with the stomach and then into the small
intestine.
So I would argue if that's the only way that your child adolescent will eat vegetables,
then do that.
Ideally, we want them eating whole, you know, whole vegetables on their plate, visually
being stimulated, having all that color.
Because the process starts really with vision.
And it's actually more appealing.
I find when you do smoothies and liquefies, it's not anywhere near as appealing.
It's also that combination.
You've got to really try and nail down that protein carbohydrate fat combo as well.
Because that obviously, that's a really big determinant of the absorption rates as well.
And fiber, you can talk a lot about fiber.
And it sounds really boring, but it's really important from a gut health perspective.
And we just aren't eating enough of it because as soon as you're eating processed foods,
high fat foods, you're actually not eating enough fiber in general.
And it's actually has a really filling component to it, which we often sort of don't think
about.
We all sort of think about protein and fat as filling us up.
But the fiber component of your carbs is and that's really that push to use whole grains
and to not process them and use them as nature intended them and use more of those ancient
grains ones that people can't pronounce and you know, like freaker and keemwe.
All these things if I, you know, in my, if you've got an old generation, they've never
heard of them.
They're like, what is this?
Yeah.
Well, you've given us a ton of food for thought, no pun intended for today.
But I would love to know kind of a summary point of your forties formula, right?
So this can, I mean, you can, you've already mentioned a few great things, right?
Between sleep and diet and all this.
But if you were giving women kind of one summary piece of advice for how they can live better,
think better, move better, feel better in their forties, what would that look like for
you?
Eat lots of fiber, make sure it's diverse.
Make sure you have as much diverse fiber as you have diverse friends.
So make sure you have friends that have differing views to you that support you but challenge
you at the same time.
And yeah, kind of use those in combination and really try and maximize that opportunity
to support your gut health.
I love it.
Eat the rainbow, befriend the rainbow.
Great tips from Dr. Elizabeth Biggs today being on our program.
Thank you so much for coming in.
Thank you both for having me.
This is Paul, our editor.
He's a 25 year old unmarried Singaporean guy listening to the ramblings of 12 older women
on everything from menopause to weightlifting to sex.
So Paul, what's your thoughts on today's conversation?
Hey, what's up, Paul here again.
You know, today's topic on gut health, I think it's something that I personally don't
know much about, you know, maybe besides drinking like Yakult when I was growing up, which is
basically like a yogurt drink that's readily available here in Singapore.
You know, and I also didn't know that I guess prebiotic and probiotics can be shelf stable
because I've always thought like they are something that you have to refrigerate, which
is pretty cool.
Pun intended.
I'm just kidding.
Yeah, you know, like the whole concept of introducing different species and looking
to probiotics to enhance digestion and support the immune system.
Also I like the part where he talks about eating shit, you know, being a thing for probiotics
to generally fire colonoscopy, which is, well, I guess similar to transplanting shit up your
ass, I guess.
All right.
Anyway, I'll catch you in the next one.
Thank you for sharing.
See ya.
Guys, you know how much we love coffee.
And if you want to share some love, you know, you can get us one.
Just visit buymeacoffee.com slash the forties formula.
Cheers.
Had a great review from user one two four nine zero three nine seven eight four on episode
five with Dr. Cheryl.
Just listen to the one about burnout.
I really think everything she talks about also applies to men.
Really interesting.
So far, loving all the podcasts and have shared with many friends.
Thanks for sharing our episodes.
And definitely this is not just for women.
Men can take in exactly what we're saying and apply it to their life too.
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Bye.
So I do feel a little bit of Stephanie Esteem.
Yeah, similar vibe.
But Gabrielle Lyons like all tatted up and like, yeah, a little rougher.
Yeah.
You know, she reminds me of who's that makeup lady?
Do you know who I'm thinking of?
Tell me something.
Something Von something.
Oh, Kat Von D.
I feel like she's got a Kat Von D.
Yeah, she definitely is.
She's the Kat Von D of medicine.
Yeah, she sounds kind of cool.
Yeah, she's that's exactly is exactly that.
She's I mean, she's really she does not mince words.
Yeah.
Okay.
She's basically like if you're not strength training, you're trash.
I don't disagree.
Okay.
I don't disagree.
I like it.
She's just putting her money where it matters.
Yeah, that's very much.
Yeah.
And she can much like Peter T.
It's like it's like she definitely has the credentials and research to back up.
So she's like, she's like, she's like, she's like, she's like, she's like, she's like,
she's like, she's like, she's like, she's like, she's like, she's like, she's like, she's
like, she's like, she's like, she's like, she's like, she's like, she's like, she's
like, she's like, she's like, she's like, she's like, she's like.