Radical Health Rebel
Welcome to the Radical Health Rebel Podcast, where Leigh, a renowned Functional Medicine Practitioner, CHEK Practitioner, CHEK Faculty Instructor, Active Release Techniques® Therapist, Emotion Code Practitioner, author, and podcast host, takes you on a journey to achieve optimal health, wellness, and happiness. With his extensive training and years of clinical experience, Leigh provides a truly holistic approach to health that has proven effective even when other methods have failed.
Join us every week for insightful discussions and expert interviews focusing on chronic pain, gut health, and skin health. Leigh's diverse background and passion for holistic healing brings you valuable knowledge and practical tips from leading experts in the field. Whether you're struggling with persistent health issues or simply looking to enhance your well-being, the Radical Health Rebel Podcast is your go-to resource for achieving a vibrant and healthy life. Tune in and start your journey to radical health today!
Radical Health Rebel
129 - Preventing Chemotherapy-induced Diarrhoea with Jason Hawrelak & Erin O’Meara
In this episode, I’m joined by Erin O'Meara and Jason Hawrelak to discuss their groundbreaking study, "Preventing chemotherapy-induced diarrhea and microbiota imbalances with prebiotics and probiotics in breast cancer treatment: A case report."
We explore how strategic use of prebiotics and probiotics can support gut health during chemotherapy, reduce side effects like diarrhea, and maintain microbiota balance during breast cancer treatment. This insightful conversation highlights the power of gut health in cancer care and offers hope for a more holistic approach to managing treatment-related challenges.
If you or someone you know is navigating cancer treatment, or if you’re passionate about the potential of microbiota-based therapies, this episode is essential listening.
We discussed:
0:00
Microbiota-Based Therapies in Cancer Treatment
Microbiome Impact on Cancer Treatment
Impact of Chemotherapy on Gut Microbiome
Probiotics and Lactulose in Cancer Treatment
Diet and Lifestyle Impact in Medicine
Future Directions in Microbiome Medicine
Sharing Vital Cancer Information
You Can find Jason @:
https://www.probioticadvisor.com/
https://microbiomerestorationcenter.com/
https://www.facebook.com/probioticadvisor/
You can find Erin @:
https://www.functionalnutritionmn.com/
You can read their paper @:
https://www.tandfonline.com/doi/epdf/10.1080/29933935.2024.2379475?needAccess=true
Don't forget to leave a Rating for the podcast!
You can find Leigh @:
Leigh's website - https://www.bodychek.co.uk/
Leigh's books - https://www.bodychek.co.uk/books/
StickAbility - https://stickabilitycourse.com/
Eliminate Adult Acne Programme - https://eliminateadultacne.com/
Substack - https://substack.com/@radicalhealthrebel
YouTube Channel - https://www.youtube.com/@radicalhealthrebelpodcast
Rumble Channel - https://rumble.com/user/RadicalHealthRebel
the amount of research that's grown in cancer and a bunch of other areas. It's just huge and that it's really going to be a key component, should be and will be a key component of how we address Alzheimer's disease, obesity, type 2 diabetes, cancer all these different things we're seeing all around us in Western nations all have a microbiome driver.
Speaker 2:Welcome to the Radical Health Rebel podcast. I'm your host, lee Brandon. This work started for me several decades ago when I started to see the impact I could make on people, helping them to identify the root cause of their health problems that no doctor could figure out, including serious back, knee, shoulder and neck injuries, acne and eczema issues, severe gut health problems, even helping couples get pregnant after several IVF treatments had failed, and it really moves me to be able to help people in this way, and that is why I do what I do and why we have this show. In this episode, I'm joined by Erin O'Meara and Jason Horolick to discuss their groundbreaking study titled Preventing Chemotherapy-Induced Diarrhea and Microbiota Imbalances with Prebiotics and Probiotics in Breast Cancer Treatment.
Speaker 2:We explore how strategic use of prebiotics and probiotics can support gut health during chemotherapy, reduce side effects like diarrhea, and maintain microbiota balance during breast cancer treatment. Like diarrhea and maintain microbiota balance during breast cancer treatment. This insightful conversation highlights the power of gut health in cancer care and offers hope for a more holistic approach to managing treatment-related challenges. If you or someone you know is navigating cancer treatment, or if you're passionate about the potential microbiota-based therapies, this episode is essential. Listening about the potential microbiota-based therapies. This episode is essential. Listening Jason Horvath and Erin O'Meara welcome to the Radical Health Rebel podcast.
Speaker 2:Thanks for coming on the show.
Speaker 1:Thank you, it's a pleasure being here.
Speaker 2:Now, it is a first for the Radical Health Rebel podcast, because it's the first time I've had two guests to interview at the same time. So I'm quite excited about that. And not only do I have two guests, but two guests on completely different sides of the planet, which is also exciting One in Australia, one in the US, one in hot weather, one in cold weather. So it's great that we've been able to manage a time that's convenient for all of us to be able to have this discussion today To kick things off. Could we perhaps I'll get each of you one manage a time that's convenient for all of us to be able to have this discussion today to kick things off? Could we perhaps um, I'll get each of you, one at a time to share a little bit about your background, kind of including your educational and professional background, and also what your current position is at the moment. So should we go ladies first?
Speaker 3:so, erin, if you want to just give us a little bit of background about you.
Speaker 4:Absolutely yeah, I am a nutritionist in Minneapolis, minnesota, private practice, and I have a master's in nutrition and functional medicine from University of Western States, where Jason was my GI imbalances professor and where I got turned on to this way of practicing.
Speaker 2:And yeah, Awesome, that's great. And, jason, quick intro from you.
Speaker 1:Yeah, I'm a naturopathic physician and educator and microbiome researcher. Naturopathic physician and um educator and microbiome researcher. I started by delving into the microbiome research about essentially 25 years ago now and I started monitors, the thesis or the literature review from honors thesis around dysbiosis and ibs and actively in the, the um, juggling the, the clinical practice and research and education. Really, since that, that time, and that's more up to the passion, absolute passion is the gut, microbiome and gut health. Yeah, so it's yeah, and these days I'm a clinician, I work at the Microbiome Restoration Center, which is my sort of educational institute, and I still work at the University of Western States as well, cause I really enjoy having that interaction with, with and educating professionals. This is one of my other passions too that goes hand in hand with microbiome.
Speaker 2:Yeah, absolutely. And for those that perhaps haven't heard, jason has previously done an episode with myself a while back talking about small intestinal bacteria overgrowth, which has been the second most downloaded episode out of 120 odd. So it was a very popular episode, so I'm sure this is going to be just as uh popular. And one.
Speaker 2:One of the reasons I'm quite interested to speak to both of you we're going to come on to talk about your research paper in a moment is because you know, like, know, like you, jason, I'm very interested in the gut and the gut microbiome. But interestingly, I've had a number of women become clients of mine after already having treatment for breast cancer, which is quite interesting. So I guess you know the reason why I've asked you to come on the show is really to share the results of the study that you guys did together on a treatment modality aimed at treating the gut microbiome and how it can potentially minimize or eliminate the side effects of cancer treatments on women receiving treatment for breast cancer. But I guess, before we get into the nitty gritty of the paper, I guess what I would really like to know is what prompted you guys to do the study.
Speaker 4:I reckon you're best at this one, that, um, let's see well, um, full disclosure.
Speaker 4:I am um, I am the patient and author um of this paper so, yeah, so I was um regularly testing my microbiome and working on on um a dysbiotic gut um for a few years prior to breast cancer treatment, which makes one wonder a little bit about you know, was it a contributor? And I had worked with some clients who had been through breast cancer treatment and had seen probiotics very specific probiotics work really well for the quote-unquote diarrhea drugs. So when I was diagnosed in December of 2021, I knew I had to get together a plan and I didn't know right away that I would need chemotherapy, but I knew that I would have surgery and radiation, so I knew I needed to support my microbiome and not slide backwards in my gut health.
Speaker 1:I had come so far because you had the history of irritable bowel syndrome too.
Speaker 2:I did, yes, I did yep years and years so so you, you mentioned um, I think the wording you used was diarrhea drugs. Do you want to be more more specific what you mean by that? For the list?
Speaker 4:yeah, I had. I had a client that called it that. She said that oh my god, I'm going on back on the diarrhea drug and she was a stage four, you know metastatic breast cancer 10 years years, 10 to 15 years, um, she lived with that Um but she and she didn't, she didn't want to do the testing, so we didn't test back there and it was kind of early on in my getting into into gut um, gut health and specifically the microbiome, so we didn't test. And I think too that kind of also shows the capacity of women going through this. It's incredibly intense and so people's capacity for, you know, taking another test or seeing another practitioner can be kind of low you know.
Speaker 4:But she said I just need help and I know you talk about probiotics and particular probiotics and what can we do? And and so then she had really good results from that and told her surgical oncologist at the university of Minnesota and he adopted, you know, those two probiotics and yeah, so that kind of started it all right there.
Speaker 2:So just to clarify, when you're talking about diarrhea drugs, you're talking about chemotherapy, right? Yeah, yeah, yeah, so obviously you were the person in the study, as you said, but what was the motivation to actually make that a study?
Speaker 4:Yeah. So I had taken a workshop years before on case reports. So that's always been on my radar and when something kind of interesting or even, dare I say, miraculous happens, I think about writing a case report. So in my own case you would do a follow-up. I had four rounds of chemotherapy and after each round later you would go in and see a nurse and she would go ticking boxes down a huge list of symptoms and she would stare at her computer and say you know, list all these things. And you'd say yes, no, yes, no. And we get to diarrhea. And I'd say no, and she did. Every single one of them would turn away from the computer and look at me and say no, everyone has diarrhea on these drugs. And then I would say, well, do you want to know what I'm doing?
Speaker 4:And conventional people in conventional medicine sometimes are interested, but usually not interested in what I'm doing, but anyway. So that then, is working closely with Patricia Kaufman, our co-author on the paper, on other things. We get together and discuss cases and things like that regularly. She's in California and we mentor regularly under Jason, and so it just kind of came together. That gosh, we should really write this up because I, especially when I was able to yeah, just able to avoid diarrhea or any backsliding on IBS, yeah.
Speaker 2:Yeah, so again we'll probably come on to it. But obviously, as you were saying, you had a history of IBS and you know what I got from the paper is oftentimes people receive the treatment, ie chemotherapy, and then it's bad enough, they're dealing with cancer, they're dealing with chemotherapy, and now I've also got diarrhea to deal with as well, which you know has all kinds of issues in its in its own right. So I'm guessing from what you've said is the major motivation was we need to get this information out there. More people need to know this information. Would that be right?
Speaker 4:absolutely. I think we could help many, many people and outside of breast cancer as well yeah, absolutely, absolutely okay.
Speaker 2:So just to kind of overview again for the audience. So the study was you, so you were 57 years old at the time. You don't look 57 now actually. So well done, you must be doing something right, it's my microbiome so you, as you said, you're're receiving chemotherapy for breast cancer. Can you, or either of you, explain to the audience what are the common side effects that you discuss in the paper from the chemotherapy itself? Karen, I think you're probably best placed here.
Speaker 4:You think so?
Speaker 1:Okay, well, you experienced it and you would have delved into the potential.
Speaker 4:Yeah, Well, all kinds of functional GI symptoms, but the main one is diarrhea and that's what's expected, and bloating, and certainly in the day or so following an infusion I would have mild to moderate GI upset. One of the drugs I took in the first infusion was an antibiotic, a tumor antibiotic. You know what I mean. It's the adreomycin. They call it the red devil, and so that's really expected to give you diarrhea?
Speaker 4:Yeah, so diarrhea, gas, bloating but the diarrhea can really lead to some really significant problems and I've met women that have dealt with this. They end up in the hospital because they're dehydrated, their electrolytes are out, or they end up in the hospital because they're dehydrated, their electrolytes are out. It just makes it not possible to tolerate the chemotherapy and sometimes the chemotherapy has to be stopped.
Speaker 1:Yeah, I think those are great points there, because I think sometimes you go, oh, diarrhea, it's like pruning once or twice more frequently per day. It's like it can be far more intense yeah, cause significant disability and and treatment and cessation of treatment essentially, which is, you know, not what we're wanting in that situation at all, and their you know quality of life will go down when they're already dealing with a bunch of other things. And and I think there's also that you know, some people do get longer lasting gut symptoms that persist afterwards. So, yeah, you get acute diarrhea episode that you know might be manageable at the time when you're juggling a bunch of other things, but certainly not ideal. But then you might get stuck with, you know, a dysfunctional gut for for months afterwards too.
Speaker 1:Um, and that's certainly something we wanted to prevent as well that's where I think this approach of trying to protect the microbiome from harm and and help encourage the beneficial microbes to regrow after these sort of very you know dysbiotic inducing medications is is a key strategy there yeah yeah, so.
Speaker 2:So from what you're saying, you know chemo causes these gastrointestinal issues. How, how does the? How does the chemo actually disrupt the microbiome? Do we know what the mechanism is? Is that understood?
Speaker 1:Well, I mean, I think we know each agent will be a little bit different in this regard, but in general what we see is an overgrowth of more pathogenic bacteria, particularly proteobacteria, and a reduction of beneficial bacteria, and that would include butyrate-producing species, bifidobacteria and overall diversity.
Speaker 1:So you'd see it essentially having an antibiotic-like effect in terms of this microbiome and selectively for killing good bacteria and increasing levels of bad bacteria, which is not uncommon with antibiotic use as well, for that matter. Yeah, so that's kind of. The impact on the microbiome is that, and then we will see an increase in inflammation. That occur because some of the proteobacteria we know tend to have very pro-inflammatory endotoxin in their cell wall, which will increase gut inflammation, and at the same time we're taking away sort of the protected anti-inflammatory endotoxin in their cell wall, which will increase gut inflammation, and at the same time we're taking away sort of the protective anti-inflammatory species like bifidobacteria or those that make butyrate, which essentially will impact the killing of the gut cells to heal, because that's the other thing too is that chemotherapy kills fast-growing cells, and some of the fastest-growing cells in the body are obviously cancer cells. But beyond that it's.
Speaker 1:It's got cells and immune cells, and those are the areas that tend to be more, more impacted by chemotherapy. Um, and at the same time they're killing. It's killing the bacteria whose job it is to heal the damaged gut, because I think we sometimes forget this how vital the microbiome and particularly b-rate producing bacteria are for healthy colonocytes. We know that 70% of the energy needs of colonocytes are met from bacterial byproducts, short-haven acids and beetroot may. Essentially, it's a bacteria that are feeding and nurturing those colon cells. And if we're smashing down those bacteria, at the same time killing those cells, that's where we get these sort of side effects. So we're really trying to create an intervention that would limit both those things of going okay well, can we speed up the healing of of the gut itself and can we, you know, protect the mic, the protective species in the microbiome, and help regenerate them more quickly after the, you know, chemotherapy sort of insult?
Speaker 2:yeah, I mean, you know. I'm sure a lot of people believe that you know all health, or you could say, all disease starts in the gut, right? So the last thing you want I'm in that camp for sure, absolutely um.
Speaker 2:But you know, when you think again, you've got cancer. You've got cancer, you've got chemotherapy. The last thing you want is your gut not performing at its best because, as you say, that's what's going to help you heal at the end of the day. So if you can negate any of the negative aspects of the treatment, that's only got to be a positive thing, right.
Speaker 1:Yeah, and it is interesting looking at the broader you know microbiome and and and cancer field and I think this area is truly starting to boom now and I think this will bring the microbiome on the radar of of current clinicians who don't, where it's not and I think it's god you have to get your head in the sand for it not to be the case but but truly there's still people out there who don't think microbiome.
Speaker 1:I think it matters, um don't think there's any. It's too too early to do anything about it yet. Um, so just we'll ignore it for 20 years until enough research builds up. But I think some of the research around how you know the microbiota it's been is like a driver of cancer development, how the composition actually can modulate treatment efficacy. And this is very clear in maybe not so much research yet in in some of the breast cancer, but in um melanoma, like skin cancer, it's immensely clear from the research that the composition of your microbiome at baseline when you start treatment can dictate whether you respond or not to immunotherapy approaches. Like you can get zero efficacy if you've got like a bacteroides-dominated ecosystem versus 67% efficacy if you've got a fecalibacterium-dominated ecosystem.
Speaker 1:It's like dramatic difference, you know in outcomes and I think that research is going to spread beyond, just like the skin cancer area, to looking at you know it's already there in the colorectal cancer area too but to move towards breast cancer too. We're like okay, this microbiota composition impacts how you respond to these agents that we're using, and our focus here was really on twofold was to protect the microbiome from harm and protect against getting side effects that would typically be the case and restore these afterwards. But there's even a focus on how we can reduce chances of cancer recurrence by by altering the microbiome too, because there's a certain, you know, bacterial species that um seem to play key, key roles in in in cancer progression that were that were really delving into in greater detail in the last sort of 10 years.
Speaker 2:Yeah, I mean that sounds like music to my ears that you know that's being looked at as an approach, you know, for treating cancer. Again, if you think all disease starts in the gut, why would you not start there with the treatment protocol? And also, if you compare the potential side effects of you know what might be called conventional treatment versus that kind of treatment, which I mean, the side effects are normally positive anyway, if there are any right. So that makes that makes a lot of sense to me. So let's fingers crossed that that research is allowed to happen, because I know there's some vested interests that might not want that to happen. So yeah, fingers crossed that does continue. So we've mentioned so people go on chemotherapy. It has a antibiotic-like effect. It causes issues like diarrhea. What are some of the standard treatments for things like diarrhea? When someone with breast cancer has diarrhea because of their chemotherapy, what treatments are normally given and what are the knock-on effects of those treatments?
Speaker 2:When 35-year-old Amanda first scheduled to see me, she'd been suffering for 19 years from severe IBS, diarrhea and faecal incontinence, along with abdominal pain and bloating. Her condition had not only made life uncomfortable for Amanda, but very inconvenient, as she had to walk two hours to work every day along a route that had public toilets and she'd never been on holiday as an adult. Because of her condition, the only advice that several doctors and specialists had given Amanda was to take Imodium, and when she first saw me she was taking five Imodium a day and wasn't getting any better. To help Amanda, I ran tests to find out what foods were right for her metabolic type, to see which foods she was sensitive to and to assess her gut. Microbiome Tests showed that Amanda had several food sensitivities and a parasite infection.
Speaker 2:Over the coming weeks I coached Amanda to eat right of her type and to replace the food she was sensitive to and a protocol to deal with her parasite infection. And after three months Amanda was IBS free and she also reported her skin was much improved and she had lost weight. And she booked a holiday for her and her husband to New York, as they'd never been on a proper honeymoon because of her IBS. And if you're suffering like Amanda was and you want to get to the root cause of your problem, you can arrange a consultation with me at wwwbodycheckcouk and if we're a good fit, I could help you achieve the same kind of results as Amanda. Now back to the podcast. You achieve the same kind of results as amanda now back to the podcast.
Speaker 4:Yeah, um, the only thing I was offered was um anti-diarrheal medicine. Um, uh, and that has the side effects of um slowing down motility and with that could could come a rise in um proteobacteria and more dysbiosis. Um, yeah, so that was the only thing that was offered and I knew I didn't want to take that because it felt like a band-aid that wasn't getting that.
Speaker 1:You know, yeah, really, it wasn't supporting me, it was yeah yeah, yeah, I guess not fixing the underlying dysbiotic changes or gut damage that's caused the diarrhea is just stopping.
Speaker 2:You know, the diarrhea yeah, yeah yeah, and the other thing I guess you know again, if someone's got cancer, the last thing you want to do is stop toxins being released through through the colon, right? Because obviously, if you're holding on to more stuff and now you're becoming constipated, your body's going to be holding on to toxins, which you know, I would imagine. I'm no oncologist, but I would imagine that would not be a favorable thing for someone that has cancer or has just been treated for cancer. Right for sure.
Speaker 1:Yeah, yeah, yeah, that's right. I think if it actually did have the end result of not pooing at all and really really slowing down the gut, which is obviously from a symptomatic okay, you don't have diarrhea now, that's an improvement. But if it stops things from moving at all, you will be reabsorbing, you know bacterial toxins that are released and potentially, you know, um, you know argue environment toxins too that your body's trying to get rid of through that way, and and even your hormones might be altered by that process too, because we know the longer fecal matter sits in the colon, the more it sort of interacts with bacteria and the more sort of you know, um, you argue talk toxins are produced and or released in that, in that process, just because of uh, you know greater chance of being bacterial enzymes like beta glucuronidase to to play a role in that, for example, or you know, get a chance for endotoxins to be absorbed, which, again, as you noted, neither which is particularly going to be helpful overall for that person's health yeah, yeah.
Speaker 2:One thing I think would be quite useful for the audience is if you could perhaps give an overview of how you actually did the study, if you could just break it down now. Obviously we know we now know. I didn't know, but I now know the participant was you, erin, but if you could just break down almost like a timeline of kind of what you did and what was found, sure.
Speaker 4:Okay, well, let's see. So we realized partway into my chemotherapy that maybe, um, you want to go back and say what? What did we do? You know, and luckily I I keep good notes about you know and test my microbiome regularly. So we had that data right, um. And so then I guess we just you know we started to dive into the literature to well, we knew, we knew as clinicians and researchers, that when we chose the, the different remedies that they took, um, you know that they had the evidence behind them to um, to support what we were trying to do, um, but but we went and compiled all that together and wrote it up.
Speaker 2:So if I could just take you back. So I'm just thinking back to when I read the paper.
Speaker 4:The first thing was you did a series of tests at the beginning.
Speaker 2:There were three tests over time. Yeah, and can you explain what you did in between each?
Speaker 4:test and kind of what the results were of each test. Yeah, yeah, okay, yeah. So I had a baseline test that I took in april of 2021, diagnosed again in december, so a little bit before um, before heading into treatment surgeries that I started with um and what were the results? You want to know? Like, uh, butyrate producers were at like 35, so a good, a good number um proteobacteria so, so for the, so for the audience, let's just say that's good bacteria right.
Speaker 4:Yeah, the short-chain fatty acid producers, the butyrate producers, were at a good level and my pathogenic bacteria was well within a healthy range. Bifidobacteria was below, kind of like where we like to see it at that point, and I can tell you kind of how that went over time. Diversity was pretty good. Okay, I've had a lot of antibiotics in my lifetime, so my diversity is something that I'm always trying to work on, you know, and I'm only able to work with what I've, and I'm only only able to work with what I've got Right. Um, but we really wanted to support, yeah. So then, kind of timeline diagnosed, uh, lumpectomy surgery, another surgery to get good margins, a surgery to place the port margins, a surgery to place the port, the chemotherapy port. And then we retested before I started chemotherapy, but after those surgeries, so what was the time gap between those?
Speaker 4:That was almost a year and this is a limitation of the study. Right, like I, it would be really great if we had started it just before surgery and maybe done one between each surgery and and and not just surgery, but the stress of a cancer diagnosis. It's huge. And stress, we know, is a huge, um yeah, factor in gut health, right, yeah.
Speaker 1:Yeah, and I think the reality of trying to implant more. You know when you're dealing with. You just got that diagnosis and you're like fast-tracking.
Speaker 1:Exactly At this time in hindsight, sure, but in the real time, you know, it's just like we're lucky that we just had one that was, you know, not too far apart. You hadn't really changed your diet or lifestyle, so we would expect the micro-hormone to stay pretty similar up until the point where you got the diagnostic label placed. And then that's where things are going to change. I agree like geez, that's one of the most stressful things you can ever be. Yeah, here is given the C word diagnosis. That inevitably will have impacts, let alone the surgeries and the underwater exposure during surgery too.
Speaker 4:Yeah for sure. So in March of 2022, just before chemo I tested again and those butyrate-producing bacteria had cut about half, less than half and proteobacteria had about doubled and bifidobacteria, interestingly, went way up. But I I believe that that's because of the lap, the bifidogenic, um uh, effects of yeah, effects of prebi, the prebiotics from your family Prebiotics.
Speaker 2:Okay. So when did you start taking anything like prebiotics and probiotics? At what point?
Speaker 4:Yeah. So even in April of 2021 and before diagnosis, I was probably taking a maintenance kind of a dose of some pre and probiotics, probably phgg and um. Yeah, maybe lgg or something like that for probiotic, um, but then in in january we're like, oh gosh, you know, let's kick up the lactulose and because of my iBS in the past, lactulose was a really hard one to to ramp up for me. Um, but I I pushed through it and it's had really, really good effects on shifting my entire ecosystem Um, but then also in quite a bit and um. So that was interesting. No-transcript. The butyrate producers really ended about the same place that they had started.
Speaker 4:And proteobacteria had yeah, which is great, and proteobacteria was lower than my baseline and bifidobacteria was up, not as high up as when I had first started the lactulose, but higher than baseline. And diversity did not quite make it to baseline but did bounce up again from march to august and I did the testing about. I should have looked at this, I could look at the timeline. Um, I want to say it was about four to six weeks.
Speaker 2:I I guess you you know, had you not have been using the, the prebiotics, you would probably have expected much worse results from from the final stool test right. Um, I don't know. I mean, I've never seen, I've never seen a stool test from someone that's just had chemotherapy. Have you guys seen that before?
Speaker 1:We cover some of the literature in the paper itself. But you tend to have decreases in bifidobacteria, diversity, b-ray-producing microbes and, at the same time, blooms of proteobacteria. So some of those things were expected, but I do think that we it was definitely blunted, because the increase in proteobacteria that might sound like a lot it's actually was relatively small speaking compared to what you would often often see. Yeah, yeah, and that's where I think lashless has got this amazing capacity to um, reduce overgrowth of proteobacteria and prevent overgrowth, particularly through its capacity of acidifying the colon, and there's nothing, no agent we're aware of, that can acidify the colon to the same degree as lactulose, and I think that is really how it works so well at preventing and reducing overgrowth of proteobacteria.
Speaker 1:And for those of you who are listening, with the proteobacteria phylum, it's a broad phylum, which means there's lots of different microbes in there, but you'd be familiar with the ones that are problematic are in the enterobacteraceae grouping and that's like E coli, escherichia, klebsiella, haemophilus, citrobacter, cliveira, enterobacter are common ones, that kind of bloom in that situation and their endotoxin is just, you know, they're growing in those cell walls immensely pro-inflammatory. Many of them also produce colibactin, an actual genotoxic agent that can cause gut damage too. They are definitely core contributors to that kind of the symptoms we see after chemotherapy because they're sort of pro-inflammatory gut damaging potential.
Speaker 2:Yeah, so you're saying lactulose is really useful in that situation. Lactulose is prescription only, isn't it in the US?
Speaker 4:It is. And in going to conventional medicine practitioners and saying I want lactulose to avoid diarrhea might be a little counterintuitive, right, because they think of it as this age-old remedy for constipation. But I have a lovely primary care doc who's an integrative medicine practitioner and she's prescribed it for me.
Speaker 1:Yeah, it's interesting because I think it's often prescribed for the treatment of hepatic encephalopathy and stage-liberal disease and conventional medicine too, and they're like, why would you want that substance? But I never really quite clicked that. The reason it worked is it reduces levels of toxic bacteria in the colon and prevents the release of brain inflammatory compounds. That's how it works for hepatic encephalopathy. So it's like it's always worked for these gut things. But it's just never really clued that this was. That's why people are taking it for, um, yeah, and the dose is.
Speaker 1:Dose is very different. You know we're trying to treat constipation. It's like 30, 40 milliliters in one hit, whereas the prebiotic dose is, like you know, the minimum pre-optics of one teaspoon. So five milliliters, so far less than that. Um, and you know, and people are often surprised to know that lactose was was once added to formula, ancient formula. You know it was the first sort of prebiotic added to formula back in the 1960s I think it was, and it prevented or it encouraged a more normal sort of microbiome in those babies compared to normal formula. Um, because it, because it's kind of got us a drug kind of feel about in the us, because the way it's classified, whereas I think every other country in the world is not a prescription drug and you can buy it at any sort of drugstore, chemist pharmacy, but it is often in the laxative section.
Speaker 1:So it does require a bit of an explainer of why. Before my shop starts selling ASA, I would have to tell my patients to go to the chemist pharmacy to buy it and you have to get the laxative section but ignore all the separate laxatives. You know this is dose you take, etc. And take a lot of explanation to get their head around why. Because they're kind of as was sometimes using an off label. Because the main reason it's promoted in most countries is not as a prebiotic but as a laxative agent and it's very effective as such, as an osmotic laxative, in larger doses, um, but in the smaller doses you just have that really amazing capacity of encouraging bifidobacteria specifically, but also important gut microbes like fecalibacteria and prosnitzii, um. You know, for most of our key b-rate producing microbe will go up with with lactose ingestion, um.
Speaker 1:And you have those reductions in those more problematic species like the proteobacteria mentioned before, but also bacteroides as well, and bacteroides is one of those genus we consider to be a pathobiont that large amounts are problematic. Small amounts are quite okay, but we know that there's bacteroides fragilis that one specific species in that genus that does seem to have, I would argue, pro-cancer type impacts too, and so it's production of bacteroidetes for just toxin, which is clearly tied in with colorectal cancer and other cancers too. It's really even Alzheimer's disease too. It's a really problematic toxin. So lactulose does have that capacity of decreasing bacteroides populations too, which is an added bonus yeah, interesting.
Speaker 2:So we've spoken a bit about prebiotics. I don't think we've spoken too much about probiotics yet, have we? Do you want to explain what you used in terms of probiotics?
Speaker 4:um sure, um. So we um very carefully chose specific uh probiotic strains to support my gut through chemotherapy. Um, um, so, lactobacillus rhamnosus, lgg or gg, I guess um, and would you like to know, like, why we chose that? I guess that's? Um, yeah, I'm supposed to help increase epithelial cell synthesis and to help with gut healing, um increase back uh diversity and to um keep those pathogenic bugs down. And then we also use Saccharomyces boulardii and a particular strain that Jason can probably rattle off, but I don't have on the tip of my tongue. Anyway, that one.
Speaker 1:CNCMI 745.
Speaker 4:And that one is known to increase antibiotic-associated diarrhea. Keep pathogenic bacteria down again to keep inflammation down and to also increase the activity of the brush border enzymes.
Speaker 1:That one's also pretty cool because its capacity, as it traverses through the gut it releases these things called polyamines which speed up gut healing and gut regeneration, so that's an added bonus. But it also breaks down bacterial toxins, even endotoxin too. It secretes its own alkaline phosphatase which breaks down LPS endotoxin too. It's a pretty phenomenal microbe actually, um yeah, and very well indicated for, you know, well researched antibiotic associated diarrhea where we have, you know, meta-analysis level data showing it protects against the development of symptoms and protects the microbiome and helps to regenerate more quickly after that kind of insult.
Speaker 1:There's less research in in chemo diarrhea with probiotics at all actually to date, um, so we're kind of had to extrapolate some of the stuff from the. The probiotics have the best evidence in antibiotic associated diarrhea. We assume we're going to work similarly with chemo because the the overall impact on the microbiome is pretty similar and you know, arguably you get more more gut damage obviously with chemo than you do with with hematocrit and virus yeah so is it understood?
Speaker 2:what mechanism is used, if you like, for one of the better phrase, by using probiotics, how that helps to prevent diarrhea is the mechanism understood? Hey there, rebels, I have got something very special to share with you today. Did you know that every month, I release an exclusive no Punches Pulled episode? These are conversations you won't hear anywhere else, with incredible, sometimes controversial, guests who expose hidden truths, challenge corruption and bring you to actionable steps to take charge of your health. In a world where censorship and restrictions are on the rise, these subscriber only episodes go deep and, for the price of a single takeaway coffee each month, you can become a paid subscriber to access this extra content, the kind of content certain authorities would rather you didn't hear.
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Speaker 1:I mean, I suppose there's a few ways in which it could occur. I mean, I think reductions of over-reversed pathogens would be one of those. I think decreasing gut inflammation would be one of those as well, and potentially, as I mentioned, before breaking down bacterial toxins that might be involved, you can look at clostridial OEDs, difficile diarrhea, which is what we typically see after antibiotics Really more broad-acting antibiotics like clindamycin, for example and it's the toxins from the C diff that are particularly problematic. And if you take the right saccharomyces it breaks down those toxins and stops them from causing gut damage, inflammation. Yeah, so there's a, there's a few ways there, and potentially, through their distribution of short-chain fatty acids and um, encouraging, um, an environment more conducive to the growth of beneficial microbes who then produce their their short-chain fatty acids, which which again help regulate motility too yeah, awesome, um, awesome Lee.
Speaker 2:excuse me just a second.
Speaker 4:There were four other. There were four other probiotic strains we also used and we used those just right around the infusion time and chose, chose those for yeah, for their chemotherapy induced diarrhea, lowering capacity and then also bloating and diversity and again keeping pathogenic bacteria low.
Speaker 2:Yeah. So if I was to summarize the paper so you can check my homework to make sure I've understood everything, so, and again, this is to summarize for the audience as well, just to again make sure I've got it right, but make sure the audience understand. So, basically, when women have breast cancer, they go for chemotherapy. It has an antibiotic effect on the gut microbiome that leads to a lowering of the good bacteria, that allows overgrowth of the more pathogenic bacteria that creates the diarrhea and, by using prebiotics like phdg and lactulose and supplementing with specific strains of probiotics, that almost negates the effects of the chemotherapy and helps to in this case, in this study, prevent diarrhea. Yes, would that be correct and something that you mentioned? You mentioned it in the paper and you've mentioned one of these already today. But what limitations were there in the study and what further research would you like to see performed in this field, or indeed like to perform yourself?
Speaker 4:Do you want to take that, Jason, or Okay, let me just take me a second to refresh.
Speaker 2:Well, you can both take a turn each.
Speaker 1:Okay, I mean, I think you know again in hindsight, like if we had kind of come up with it beforehand, okay, well, this is the case study and they didn't have all the stress and everything else going on. You might go cable it to more frequent stool sampling at different time points to gauge the impacts in more smaller time windows. That's something that I think would be interesting to do. I think you could argue about using a test that using shotgun metadopic sequencing to to go deeper into, like a species level changes, where we we chose a inexpensive, easy to come by 16 S RNA testing, um, because the cost points is is low, yeah, um, and we see the accurate level at the at the genus level. You know, accurate data, chance level, not so much of the species level but genus level is, yeah, it's very accurate and we and we get, you know, good, good picture of diversity from from that that tool too, yeah, yeah yeah, I guess you know money being no object, I would guess that it would would be.
Speaker 2:I mean, you don't wish that anyone gets breast cancer, but for the study I guess a larger number would be useful, I guess, and even having a placebo control group as well would be quite good to compare the two. But that makes sense, yeah.
Speaker 1:Yeah, I totally hear that and that and I think whether I mean there's ethics around using placebos in certain conditions, and I would argue that this would be one of them. I mean so other people would argue differently, but yeah you know where, you have something that can you know um reduce harm, reduce side effects um that is placebo ethical in that situation.
Speaker 1:Yeah, you know, yeah, I mean obviously the best data that we accept as evidence comes from, you know, placebo-controlled studies.
Speaker 1:But I do think there are times where we don't think that placebos are ethical, and so I think the next step would be doing like a larger case series of the same sort of protocol and then you can kind of go from there in terms of you know how much evidence.
Speaker 1:I think the next step would be doing like a larger case series of the same sort of protocol and then you can kind of go from there in terms of you know how much evidence is enough evidence, what sort of study designs are acceptable for, for making clinical decisions on like those. Those are broad, broader questions. But if you had, like you know, 30, 40, 50 women do the same protocol, all getting great results, then I think, okay, many clinicians will be satisfied with that, particularly for me, when there's no risk of harm from interventions or the risk of harm is so minuscule that the quality evidence required showing efficacy to me can be less. Yeah, so you've got a novel agent that's never been ingested by humans before. I have no idea what the side effect profiles are like. You know, I want really good evidence that it's both safe and efficacious.
Speaker 1:Yeah, Whereas when we're like eat a Mediterranean diet. Take these prebiotics that we know are immensely safe. That I think that for me, like a lower standard of evidence is required for efficacy for me to implement on my patients, because there's just not much risk, yeah, whereas I think when the risk level goes up, you want much higher levels of evidence of efficacy, yeah that makes sense.
Speaker 2:I hadn't thought of the ethical point of view, but yeah, I completely agree with that.
Speaker 4:Yeah, there was. Another limitation, I guess, is that the confounding factors right, there was a lot going on here. I took a lot of different prebiotics. I took a lot of different probiotics. I was eating a good Mediterranean diet. I was putting myself to exercise through most of it. When you're really hit hard with chemo, that's pretty difficult, but even walking can help with how you feel and probably motility and things like that. And I was getting a whole bunch of integrative therapies too. I was getting shiatsu and acupuncture, and so there were all these different lifestyle things too that you know, in nutrition, research can be difficult because there's just so many different yeah, confounding factors.
Speaker 1:Yeah, and then how do you control for that do you go? Hey, well, you go, eat a standard western diet while going on this so we can take that evolutionary diet as an equation? No, of course not, because that, we know, will cause harm and worse than outcomes from chemo and worse than outcomes for cancer and just overall health perspectives. So some of those things are like we want all patients to do anyway eat a, you know, a probably plant-based Mediterranean diet, eating the rainbow of colors, variety of foods, because that's the best, arguably, diet for numerous factors, you know, metabolic health and, um, even cancer risk too, I would say. And and cognitive health, um, but also but microbiome health too. So I think you're right.
Speaker 1:So that was one of the things of this paper took so long to actually get through peer review. They kept sending more and more peer reviewers because they just couldn't understand. You didn't do one thing, you did multiple things. What the hell? And people are not just one agent. It was just mind-blowing to me that people could do this, cause I think they're really stuck in that model of you, don't? The only thing you change is one thing.
Speaker 1:Nothing else changes. Just give this one thing and you see, for us it was not about it. I was trying to get the best outcome for this person and that requires really, as a clinician, you do multiple things. You know we're doing the diet, we're doing exercise, you're doing stuff to help manage stress, your movement, and it's like a bunch of different things to get the best outcome for this person. So you can't say that, okay, the outcome we had was due to, specifically, pre and probiotics.
Speaker 1:Sure, you know it's due to the entirety of things, but I think we know that from the microbiome perspective, we would argue that the key interventions there were the pre and probiotics, and it was just really important to get that information out there so that other patients don't have to suffer the diarrhea drug and get the gut in months of IBS-like symptoms afterwards if they can be prevented. And that was a good first step, because that's the lovely thing about case reports is they get that information out there, they stimulate thinking, stimulate researchers, stimulate researchers, stimulate clinicians to go ah, okay, I can implement these things, stuff we chose for, stuff that were commercially available. It's like stuff that everyone can access. That's, I think the strength of our study, too, is we didn't use this full-on novel probiotics or novel prebiotics or novel testing that no one can access. It's like every patient can access all these things we use here and achieve at least microbiome support and protective qualities of those agents.
Speaker 2:Yeah, I guess the other thing that I'm thinking as well is that what might be really useful as well is to have some long-term follow-up as well, because you know, as we know, sadly there is a lot of um recurrence of cancer. And you know, if let's say, I don't I don't know what the figures are, but let's say, on average someone might go six years cancer free and after six years on average the same cancer or another kind of cancer comes back, but if continuing these protocols 5, 10, 15, 20 years and there's no reoccurrence, it's like, well, okay, now we're onto something right?
Speaker 2:so I think maybe that kind of long-term follow-up would be actually in talking to a surgical oncologist who's interested in doing both intervention and long-term studies julie, a 47 year old who works in computer sales, came to see me complaining of lifelong irritable bowel syndrome, which included severe abdominal pain and bloating, loose and very frequent stalls, along with hot flushes, menstrual brain fog and low energy which affected her work performance. After taking a comprehensive history, plus running some labs, I discovered that Julie had a parasite infection which may have been causing the loose stalls, a methane producing bacterial overgrowth that was almost certainly causing the abdominal bloating and pain, a leaky gut, low levels of digestive enzymes, as well as eating too many high oxalate foods on her vegetarian diet. So Julie reduced the high oxalate foods from her diet. Plus she took a broad spectrum antimicrobial supplement to help with the parasites and the bacteria in her gut. Supplement to help with the parasites and the bacteria in her gut, probiotics to increase her good bacteria and help repair her gut lining. She also took prebiotics to help feed the commensal bacteria, digestive enzymes to improve her digestion and herbs to help clear the toxic lipopolysaccharides from her system produced by the overgrowth of gram-negative bacteria.
Speaker 2:At the end of the program, julie reported that her health had never been better. In her own words, the improvement is staggering. The abdominal pain and bloating was gone, her stools were back to normal, her energy was up, she no longer had brain fog or hot flashes, and her immune system had improved, as she no longer suffered from frequent bugs and colds. If you're suffering like julie was and you want to get to the root cause of your problem, you can arrange a consultation with me at bodycheckcouk. That's b-o-d-y-c-h-e-k, and if we're a good fit, I could help you achieve the same kind of results as julie. Now back to the podcast.
Speaker 1:Yeah, that's fantastic. Yeah, and I love it when there's a conventional physician who's curious and sees the benefits and actually is happy to chat about it, because my observation with many clinicians in the conventional world is a lack of curiosity. Yeah right, oh, you didn't get diarrhea, okay, and they don't care what you did, have no interest in like finding out what you're doing differently than the 95 people who are getting diarrhea, you know. So when you have someone who actually is like whoa, my god, that's like different, what are you doing and and using to look at the research on it? Because it's not these things that have studies on them. They're not like made up things. You know the research is there, just people are generally ignorant of them because they haven't spent time to look at it, you know, as yet. So it's, it's.
Speaker 4:I always find it so heartbreaking to find those curious clinicians are like who want to go learn more and this particular doc is also interested in not just crossing our fingers and hoping that it doesn't reoccur, right, she's she's interested in how could this affect your outcomes?
Speaker 2:yeah, yeah, that's, that's good to hear. I mean, I'm sure both you guys have found the same experience as me. You know, after many years, and you know you work with a client and they've, or a patient and they've been seeing a doctor about a certain condition. The doctor hasn't really helped them. They work with you for, you know, a few months they've solved their problem and they go back to the doctor and the doctor said, oh, what do you mean? What do you mean you've got rid of that? It's impossible. And they say, well, I changed my diet and I did it in this, that. And the doctor normally says, no, that wouldn't have done it right.
Speaker 1:Yeah, yeah, there's certainly occasions like that, or at best they might.
Speaker 2:They might say, well, just keep doing what you were doing, yeah, rather than asking more questions. And I guess, to be fair, most doctors haven't got time to even ask, okay, so what?
Speaker 1:was you actually doing? No, no, fair point. I think they spend the average of seven minutes with people and it's just like point. I think they spend the average of seven minutes, yeah, with people. It's just like what, how, how he can't even cover lifestyle, can cover diet. You know what can he cover in seven minutes? Besides, yeah, you know pharmacological interventions. That's yeah, and which is a major problem absolutely, and I think I was extremely lucky.
Speaker 4:Um, this is a hub of, you know, progressive practitioners and the system that I was working in, which was the public health system, many, many really curious, fabulous doctors, open-minded enough to maybe not curious enough to go the next you know what to do or whatever, but at least open-minded enough to you know, oversee and allow me to do these things along the way, Although I think they all sort of saw me coming and were like, oh no, here she comes again. What? What study is she bringing, and what kind of, what kind of remedy does she want to go on, yeah, yeah, yeah.
Speaker 1:That's the well-read.
Speaker 4:But they were fabulous really.
Speaker 2:Yeah, yeah, no, that's good, that's good. And you know, as I said earlier, you're looking fantastic, Erin. So you know, whatever you've been doing is obviously doing something you know.
Speaker 4:I bounced back really nicely and I attribute that to what I did to support that as well.
Speaker 2:Yeah. So you know, the reason I asked you guys on is because I think this is really important information to share and you know, I'm going to invite, you know, anyone who ever got to the end of this interview. I'm going to put a link to the study in the show notes and I just want people to share not only this episode but also potentially share the paper as well with people that are perhaps going through that experience, because it might be really useful information and, like we've kind of alluded to, not only might it create a better experience if you're going through that modality of treatment, but it may well I mean again, we don't know yet because, as we say, there's no long-term information on this but it might well create a much better long-term outcome as well. So I think it's really important if people could could share this information.
Speaker 2:Yes, agreed, absolutely agreed so this is my kind of normal, normal kind of signature question and it's interesting I'm gonna have to ask two people, but but it's fine. Um erin, what's what's next for you?
Speaker 4:what's next for me? The beginnings of thinking about an intervention study and actually now listening to Jason thinking, yeah, it might make sense to do a case study series first, and I'm working on building my practice back up after going through cancer. My cancer journey got extended a little bit because of a medical mistake that was made, so I'm just finished now and, yeah, so I'm hoping to help a lot more people you know, prevent cancer, get cancer treatment and and mop up after cancer treatment if they haven't got the information while they were going through it.
Speaker 1:Yeah, I mean your, your skill set and knowledge in this area. Now it just means you're so well placed to help so many women going through a similar hurry, and we know it, it's a frequent diagnosis. Yeah, there's so many women that benefit from what you've been through and that's sometimes the silver lining in horrible of diagnostic events the horrible disease events that occur when we we as clinicians work through them is that it means we're better placed to help others going through similar situations yeah, for sure.
Speaker 2:And what's next for you, joseph?
Speaker 1:I'm still focusing. These are focusing a lot on training clinicians, you know, through the Microbiome Restoration Center, and I'm really passionate about creating what we might call microbiome-literate clinicians, you know, or microbiome analysts, like really lifting the standard there, because I think we can't ignore the microbiome anymore and most people listening to this podcast will know this already. But the amount of research that's grown in cancer and a bunch of other areas, it's just huge.
Speaker 1:And that is really going to be a key component. It should be and will be a key component of how we address Alzheimer's disease, obesity, type 2 diabetes, cancer all these different things we're seeing all around us in western nations all have a microbiome driver, and it's really important that clinicians are really substantially upskilled in this area and that's kind of my passion is trying to upskill them so they're going to be a better place to move into this new world, because I think conventional medicine can no longer ignore the microbiome and no longer ignore its role in cancer for, for example, that to me is one of the more areas that I know will drive acceptance of microbiome medicine and conventional medicine is because the difference in outcomes we get with cancer treatments, that is going to be one of those big leverage agents there.
Speaker 1:But you know, so, yeah, so that's my current main focus and passion, as well as well seeing patients too, because you know yeah, I've been doing this for nearly 25 years now, so you bring a lot of experience to the to the table and helping people that um have had a hard time getting help with with others today and certainly with that that microbiome focus yeah, yeah, I mean, it's interesting.
Speaker 2:You know you are one of the kind of the leaders in education when it comes to the microbiome, someone like myself. I'm a clinician, I've got a real passion for learning more about the gut microbiome, but it seems like it's moving so fast the a piece of jelly to the wall, you know, because you think you've got information and then there's new information comes out, which is a good thing.
Speaker 1:You know it's a good thing, yeah but but you'd be spot on, like, like these days they're like maybe 30 000 papers published a year talking about microbiome. Now when I started 25 years ago it was 100 per year. I could read every single paper on the microbiome that was published in my early parts of my journey and that's like it's impossible now. But I think there are themes that run through and once you understand those themes about like proteobacteria, bda produces mifedacty, like there's certain things that you see common commonalities between all the different disease states you often see the same bloody dysbiotic state, you know, and it's like the western diet causes this. Um, exposure to, to, you know, pesticides cause the same sort of dysbiotic state. Like it's. It's interesting, the more you get into, the more commonalities you actually see between disease states from a microbiome perspective yeah, interesting.
Speaker 2:So, erin, where can? Where can people find you online? How can people get in contact with you?
Speaker 4:yeah at um functional nutrition, mn from minnesota.
Speaker 2:Um and yeah, awesome good, that would be a great place to email me online with patients too correct I do, I work online with patients and um yeah cool and I'll make sure your details are in the show notes. And jason, oh great. And jason, where can people find you?
Speaker 1:yeah, the, the microbiome restoration center, is sort of my teaching hub. Um, then I've got the horolact gut microbiome clinic, where myself and a few hand chosen physician, um naturopaths and nutritionists start work, work with patients in the one-on-one capacity, and then the probiotic advisor, which is my, like you know, probiotic evidence-based database as well. There's probably three areas to find me awesome, awesome.
Speaker 2:Erin and jason, thank you so much. I've I've really enjoyed, uh, having you on the show. It's been great having two guests at one time, I feel I feel like I'm different, isn't it? I feel like I've been a juggler for the last hour but it's been fun.
Speaker 2:But, yeah, thanks for coming on, thanks for sharing your information from your paper and, as I say, I think it's potentially really important information for people to share because, you know, sadly, there is a lot of cancer around these days. I mean there was pre-2021, but it seems like that's gone up a hell of a lot more since 2021, sadly. So, you know, this is really vital information. So, again, I'm just going to ask anyone if you've got to this stage of the episode, please do make sure that you share it with relevant people that are going to really benefit from this great information.
Speaker 4:Thank you, lee, it's really been a pleasure to be here.
Speaker 2:Yes, thanks, my pleasure, my pleasure. So that's all from Erin, jason and me for this week, but don't forget to join me same time, same place next week on the Radical Health Rebel podcast. Thanks for tuning in, remember to give the show a rating and a review, and I'll see you next time.
