Grace Liu transcript

Written by Christopher Kelly

March 19, 2015

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and today I'm really excited to be joined by Dr. Grace Liu. Hi, Grace.

Grace:    Hi, Christopher. Thank you so much for having me on.

Christopher:    Oh, it's a privilege and a pleasure. And I'm really excited because there's so many things, this is going to be one of those interviews where I'm going to have to try really hard not just to turn into a great big spaghetti bowl mess of things.

    I should start by introducing you. You're a Doctor of Pharmacy, is that right, but now a Functional Medicine Practitioner.

Grace:    That's right, yeah. I went to Pharmacy school and then did a clinical route where you do a one-year Pharmacy practice residency. So I got a lot of experience just working in clinics, seeing how clinical pharmacists do their job. It's a lot of working directly with patients, even doing diabetic foot checks and talking to patients about their insulin and trying to match their carb intake with their insulin dose -- things that are more hands-on. That was very cool for me.

Christopher:    And then I was first introduced to you, I don't know how it took this long, but I was there for your presentation at AHS last summer which was really fascinating and I'll link to that in the notes for this.

    But more recently, we've been talking and I was really interested in the fact that you seem to be the first person that I've met that could make some really specific recommendations based on the taxonomy of the human gut microbiome. What I mean by this is you can take a list of the bacteria or the microbes that are in someone's gut and then using the knowledge that you've acquired from research, gives that person some meaningful feedback on that data. I don't think there's anyone else that -- who else do you know that can do that?

Grace:    I don't think there's anyone like me right now. I've tried to connect with people who are on the same page and have done like similar research or actually even conducted research. Like I've reached out to a lot of gut researchers so I've been very lucky like I could chat with many of them and a lot are following me on Twitter actually. We get into a little semi-deep thoughts -- as deep as you can get on Twitter -- but it's really kind of interesting. I learned a lot from them and they're knee deep in all the research.

    I think like specialists and medical care, they see something but they're such a specialist they may not see the big picture. And I don't blame them. As a clinical pharmacist, we took each organ as its own little disease state, it's like life, right? Everything's connected. I think you learn the hard way that everything's connected. One thing happens and then it's like snowball effect on everything else. Or good things happen and then snowball good effects on everything else.

    So everything, like a lot of my Functional Medicine mentors, I've been so lucky to meet some really great teachers and they've been pushing systems biology forever for just like half dozen years I've been in this. It's really coming down to that because there are so many factors and they all touched upon each other. Just like in life, like our acquaintances and friends and everything.

    And I've been really lucky just to be able to read certain research and a lot of things just make a gut sense -- you know we have that gut feeling, that gut sense. I mean as an athlete, you go with your gut a lot because it synthesizes all the data out there in a split second in reptilian wizard brain, faster than any computer can assimilate all that. I think we have to rely more on the gut and the research really shows that. I used to promote a lot of drugs -- "Oh, if someone had this effect, we want this drug." You tie in every drug for every symptom of the disease. You have gout. We'll give you a uric acid reducer and tell you to go on a low-uric acid diet. It doesn't get to the root problem though.

    So what's the root problem? Well, you don't have soil bacteria, you don't have Acetobacter to break down all the oxalates coming in from all your greens and vegetables. It's abnormal to cut back all your oxalates, they're in all our vegetables which are high-fiber and good for our gut. But if there's disruption and we have all these high oxalates or if we have high yeast, as we know, there's high oxalates.

Christopher:    So what I did was do the American Gut Project. This is a fecal sample test that you can do at home and you send the sample into the lab and the lab would do their work. And then they provide you with this taxonomy so that's the list of microbes that are present in the sample. At first it wasn't clear to me that this was useful and that was partly because I wasn't looking at the full taxonomy. I was just looking at the PDF diagram, that scatterplot, I'm like "I'm not really sure what to make of this" but I suppose it's nice that you made some nice contribution to science."

[0:05:11]

    But if you look carefully inside, there is actually a button you can download this full list of microbes that are present. And so the thing that I thought was immediately interesting when I started talking to you about what was there in my taxonomy was you mentioned something that you called a keystone species. So can you start by explaining what exactly a keystone species is?

Grace:    I think the way gut researchers look at them is that they are single species or even maybe a family even or genus that have such an influence on many other species of the gut that their role is very integral. And if the loss, species is gone then it can affect others and if there's too many even, it can affect others.

    So one example are starch -- humans eat starch, we cook starch. If we don't have ruminococcus bromii which studies even show healthy controls 20 years ago, 25% of them did not have the species. When they were given cooked starch or raw starch, they couldn't break it down and then this impacted certain metabolism metrics.

    So keystone species also are very important for immunoprotection. One that a lot of people love to write about is called Faecalibacterium prausnitzii. It's a huge butyrate producer. Butyrate is an anti-inflammatory saturate fat that is a fermentation product from our gut microbiota and this species to eat a lot of pectins and other vegetable-sourced fibers. Not starch really but pectins and oligosaccharides and it's a keystone for inflammation. So when people are depleted of it, there are more inflammatory diseases. When scientists give it as a probiotic, then these diseases disappear. So that's kind of a short idea of what a keystone species is.

Christopher:    Okay. And then how much of this do you think… I almost get like confused about what's cause and effects. Like are you really seeing the bacteria have some effect on the person or are you seeing the healthy person just have these bacteria? Which way around does it go?

Grace:    I'm not sure and I think the researchers are still trying to figure it all out but they have these wonderful studies in animals and sometimes in humans. And sometimes causality seems to occur when there's introduction of a probiotic strain whether it's killed or alive.

    You're a practitioner, you're aware of how beneficial a lot of our probiotics are. Probiotic research is a huge realm of the pop med and many of them show a lot of benefit beyond placebo effects. And from the drug standpoint, I've been considering bugs over drugs and they're really effective. They really can modify disease or even reverse the root problem which is maybe a depletion of a species -- it can replenish it. Or it can modify the inflammatory milieu to make it healthier so that homeostasis can be more easily achieved.

    Or what a lot of times is that the gut barrier is disrupted and a lot of these gut species, their job is very singular -- it's just to improve gut barrier protection that is so important for humans. We have this [0:08:43] [Indiscernible] upper gut. It's meant to digest and enzymatically break all the food down and eat it all up and absorb it. But to absorb it there's only a single cell layer so it gets disrupted very easily. It's not like our skin, the integrity of our outer layer, we have multiple levels of skin. And as you know, if you abrade it, it hurts like a mother and to fix a wound it takes weeks.

    And just like our gut, that single layer, if we break it, it can take months not just weeks but months to heal as you know from dysbiosis or SIBO, because we're dealing with this load. There's a hundred trillion bacteria there not including also the yeast and to fix the integrity of a gut barrier, you have to do what's kind of aligned with what our gut barrier is used to.

Christopher:    Right. So we've been getting great results using the protocols it seems like most of the emphasis is on the killing part. So we do some sort of diagnostic test and we find something that everybody's pretty much in agreement is a pathogen and then we use some sort of killing phase and then probiotics to rebuild.

    But is that the only approach? Do you think there could be something more intelligent available?

[0:10:06]

Grace:    I think there's so many good ways to get to better health. We're so lucky now to have Am Gut, American Gut, uBiome, Genova Diagnostics as well as Great Plains and all the others, CDSA, Comprehensive Diagnostic Stool Analysis because we can just see what's going on now. I mean a lot of people may feel better… just like suddenly prior to a disease, people feel fine but we know things are going on. They're making antibodies, there's great information in the gut -- these all precede disease.

    And they have great examples now. They can track people early on from birth and up and they see who gets disease and who gets no disease and it's all tracked in the gut and all these precursors happen way, way early. So I do believe that's a simple approach and in part functionized in others, four steps -- restore, repopulate, fix everything along those lines.

    But I think a lot of those aren't really ancestral so I kind of have a different approach and it might be faster for some people, it may not be for others. But for some people it works really tremendously faster.

    And one is kind of more aligned with our ancestral path which is to provide some soil probiotics. And I know you're a big fan of soil probiotics as well. Yeah, Prescript Assist made by Magnetic Clay, it's a wonderful product. But there are many others also out there that I love. And then the species keystone sort of probiotic is of course the bifido. I'm kind of divided about the lacto cause some strains cause fat gain some not so much and so it depends on the person what's going on with them.

Christopher:    Right. We see a lot of that on the organics profile. People with the overgrowth of the d-lactate forming species, I've seen some evidence that it causes brain fog as a neurotoxin. So I wonder about that and like people, have they been pounding all these probiotics is trying to do something that's not really working and…

Grace:    I think it's one of those stories our bacteria in our gut they're commensal but then when the environment shifts they lose their bodies before they're packing heat and ammo and if their bodies are around they feel more defensive. So they go into this defensive stage, they're just trying to defend their territory. But this is a common biological story if you look at the literatures called commensal switching. So at one point they're happy, benign, that's because the community's intact. And then suddenly it's the Gaza Strip and they're like fighting for their families and all their offspring. And then they turn on their defense mechanisms which are inflammatory, very inflammatory.

    And you know a lot of these lactobacillus -- well, maybe not lactobacillus but some certain probiotics but in certain strains the lactobacillus which already uses probiotics. It cause fat gain and weight gain in animals and so they do allow these animals not to use antibiotics in Europe but they put in the weight just as an antibiotic would and then use that in their way. So yeah; we have to be careful about lactobacillus and where the lactates coming from.

Christopher:    Right. And so do you think it's possible to crowd out certain things that can be, say, like Giardia by like encouraging or making a better environment for other species of bacteria? Do you think that's possible or do you think you're almost going to have to do some sort of killing phase if you have?

Grace:    No. No I think there's many stories now that we get to have the privilege of hearing about where people don't actually take these strong antibiotics that would normally be used for Giardia like metronidazole or other ones. Because they're so strong, not only do they wipe out Giardia but then they wipe out half of your gut. And that's lovely, then how do you recover from that? Fecal transplant next or you know what?

    So there are plenty of stories and I love the story about Giardia because all of our good gut flora -- bifidobacterium, good lactose, for sure, saccharomyces boulardii and a lot of soil probiotics that we find in fermented foods, lactobacillus plantarum also has great anti-pathogenic benefits. If we feed this well, they do their job and can squeeze out little things like Giardia. People get exposed to vibrio cholerae in clinical trials and they don't all get vibrio cholera. There's a lot of protections. Not because they have the antibodies against it but they have plenty of bifido [0:14:31] [Indiscernible]. That's what studies show. If they have plenty of these keystone species, they don't come down with the disease.

    And why is that? Because actually a lot of these species produce anti-Giardia toxins, they can crowd out these really nasty kinds of bugs because through evolution they figured it out and they want to protect the host so that their infrastructure and home doesn't get brought down by just a couple [0:14:58] [Indiscernible] viral species.

[0:15:00]

    So evolution-wise, things are set this way and I think evolution-wise, our ancestors ate a lot of something called oligosaccharides. So it's [0:15:11] [Indiscernible] in milk just like your baby gets tons of oligosaccharides every day and doesn't keel over from staph infection but in our diet we get plenty of oligosaccharides. It's in a lot of non-starchy roots, it's in bananas, it's in whole beans and whole grains -- we get plenty of these oligosaccharides. And also dairy -- if you're a fan of dairy -- you can find a lot of oligosaccharides in dairy. And these are really beneficial for us plus they feed some wonderful species in our upper gut which protect this really sensitive vulnerable area which is one single cell layer thick in terms of the barrier, the fortress. It's only one cell layer and how do you protect that? It's actually by a lot of vinegar.

    So we have a lot of certain species like bifido and other ones like Akkermansia. They make a lot of acetic acid and this vinegar -- basically acetic acid is vinegar and if you've ever done house cleaning, vinegar cleans everything. Mold, pathogens, some good bacteria I think probably but a lot of these -- our good bacteria actually have defenses against probably some of these acetic acid. But acetic acid keeps everything sort of pathogen-free because pathogens don't like it. They tend to thrive in alkaline environments.

Christopher:    Oh, interesting. So this is I think a really important point -- so you've just found some mechanism, something that we can sort of pivot around and like try and crowd out the bad guys and encourage the growth of the good guys and it's the pH, the acidity--

Grace:    Oh, absolutely. Studies show if we just add pepsin and HLC Betaine to people like yeah, the pathogen go -- it particularly -- yeast absolutely do not like acidic areas.

Christopher:    Right, okay. And then so if I can just give a scenario that I see occasionally. So we've had lots of people that show overgrowths on an organics profile and then they do a kind of two-month killing phase. So it's quite long with oregano and some other botanical herbs, and these people always get better. But for say maybe 1 or 2 out of 100, they see a relapse that comes in the months that follow. And so the problem is they think "Oh, well, I just have to take more of the oregano" and I'm not sure that that's necessarily true.

    So what do you do to prevent the same thing -- I think the main thing that we do is with the diet and lifestyle coaching. So by the time that the person's been through this protocol, we spent an awful lot of time explaining what they need to do in order to stop this from happening again. But what do you do in terms of like the supplements, antimicrobials or probiotics to stop that from happening again?

Grace:    Well, as soon as they can, I try to encourage starches. So in the beginning obviously a lot of people can't tolerate starches; it just flares everything. We get into trouble because we have such a high modern high-carb diet, full of fructose, full of high fructose corn syrup, full of refined carbs.

    So the problem most people have -- I would say 99% -- it's not necessarily Giardia but we have this compromised gut because of our really sad, really, really F-upped high carb diet, so all the bad pep characters, they eat carbs -- they eat sugar and they eat carbs. And of course it's naturally really effective to go on a low-carb diet in the beginning but as soon as they are able to, if they can tolerate FODMAPs and starches later, start introducing it.

    So what I love is to do what you do exactly. I tend to aim for fecal transplant doses of probiotics if they can tolerate it. Obviously some people, one, half-a-pill of probiotic will keel them over. Their guts are so delicate orchids, they cannot tolerate life so you have to be very, very careful. But most people actually can do well and titrate up to these doses. And if possible, get as much diversity in as possible.

    The second we lose diversity, we're big shooting targets for disease -- that's what studies show over and over again. So part of the healing process is to introduce diversity as soon as someone can tolerate. But in the beginning, my goal is to get the bifido in and later a little bit of lacto and then… In the beginning if they tolerate soil probiotic -- [0:19:45] [Indiscernible] are taking it and they aren't having problems and it's not overgrowing. You want to verify that maybe on a test. And really it's not like -- I've never seen it really but then when you can, the soil probiotics are great.

[0:20:01]

    They are ancestral, they're a part of our past, maybe we are born -- our primitive ancestors even just 50, 100 years ago, we usually were being born and pooped out on dirt floors. Things weren't super clean. Immunity were colonized by bifido, bacteria-wise, and a lot of the soil-based bacilli like Bacillus subtilis, Bacillus coagulans, Bacillus [0:20:26] [Indiscernible] -- these were great members but they were there and they're part of our makeup. We don't need a ton of them but we do need them.

    So that's part of my clinical approach.

Christopher:    Okay. So it's helpful then to eat these microbes, I was kind of wondering. And then what types of carbohydrate, can you be specific about what sorts of carbohydrate people should be eating? What, like carrots or sweet potatoes or..?

Grace:    Yeah, the most non-starchy kind in the beginning. Usually inulin-containing ones are a problem because they're FODMAPs and if your microvilli are broken, all of our digestive enzymes that sit on the tip of the microvilli… So the microvilli is sort of like a little projection coming out of our intestines, so like a shag or a really great thick hotel towel, you get great surface area. You just dab it on you and you're completely dry. But a cheaper towel and you're still sopping wet. Because the greater surface area is how we absorb all our wonderful food and that's how the carnivorous part of our small intestines can absorb, suck up all our really great food. But if it's broken or disrupted or you have a lot of pathogens growing on it, it can't do its job.

    So once that fixes up and you get a lot of the good bacteria back in there, then you can introduce slowly certain foods. So in the beginning it's best not to push it. Whatever people can eat, like a little bit of spinach, a little bit of root vegetable -- carrots or daikon or rutabagas -- these kinds of vegetables are just wonderful and then gradually see what they can tolerate week after week. Later I tried to get people to consider sunchokes which are really rich in inulin. It's hard to get chicory root, I haven't been able to myself. But chicory root is really ideal as well.

    Most of our green vegetables have inulin and oligosaccharides in it so those are usually something people tolerate in small amounts and then gradually increase it up. But at some point, I even try to have people foods that aren't really considered Paleo or primal in that respect. Starchy roots like yams, a lot of yams, sweet potatoes, regular potatoes and heirloom potatoes -- just gradually see what can work out. In Asia I was lucky, I was able to eat a lot of different kinds like taro and all kinds of purple-colored potatoes and this was part of my healing. And I realized like probably for our ancestral past, this was really a key component of part of our diet.

    And in there there's a special fiber called resistant starch -- I'm sure you're aware of it -- and the cooked one is really fabulous. It comes out of the granule and there's this long fiber that grows into [0:23:11] [Indiscernible] and then as it cools, it crystallizes. It's actually this biophysical phenomenon. Scientists can even use resistant starch in this cooked form as an electrode. It communicates and has this connectivity of energy and its super powerful for our gut flora. Resistant starch 3 which is this cooked crystallized form of resistant starch which is so tight and compact, if produces more butyrate gram-for-gram compared to the many other kinds of fiber. And it's shaped like a DNA, its actually very contorted and tight and I think our flora just love that. It's a really tight gourmet kind of nutrient-dense food for them.

Christopher:    So resistant starch, you're talking about the RS3 type here so it's starch that's being cooked and cooled and then it becomes less digestible by us but the bacteria love it.

Grace:    Yeah, exactly.

    But when you say resistant starch, I think a lot of people listening will start thinking of the potato starch. I know you laugh at that because -- I mean I've literally just kind of spun on a dime in these last couple of weeks which I think is something that you did a while back. So tell me what is the problem with potato starch?

Grace:    Initially I kept saying like "Oh, I really don't see people losing weight," "With the fiber they really should be losing weight, they should be improving metabolism, they should be doing this and that." It didn't do it. And now I kept waiting for research, I was digging and did not really find anything on why we tolerate and tons of people that didn't tolerate but just didn't make total sense to me. Because in the research, the researchers mixed up resistant starch, they talked about cooled along with the raw and they kept mixing but they're really vastly different -- totally different. And I think it's completely irresponsible that gut researchers don't differentiate the two.

[0:25:13]

    One is like a granule which a lot of our good bacteria can't even break or adhere to, and then the other is a long one which many of our bacteria can. And then as the cooked and cooled one, it's almost in a package with other fibers. Unless we buy isolated manufactured forms which I had problems with because it's kind of more ancestral. But our real food, whole foods, if there's RS3, this cooked-cooled resistant starch, it would always come in package with other things like oligosaccharides which are good for our immunity and good for babies, good for everything.

    And the raw starches, literally no humans eat raw starches daily. I mean, there are so many problems --

Christopher:    The moment you said that to me I'm like "Wait". Like when was the last time you ate -- yeah.

Grace:    Yeah! I'm not going to give [0:25:58] [Indiscernible] my baby. I would not let them chew on or even gnaw on it because you die instantly and we know that as Paleo people. So it's just retarded that… what's kind of creep me out but the studies seem to reconcile. But then when I looked at it again, they're all hamster studies, they're all rodents, so of course that's their food, they don't have the toxicity issues that we do because they evolved to somehow overcome that.

    But humans cannot. We cannot eat a lot of raw potatoes because it breaks down trypsin. We can't break down protein and then we end up with pancreatic cancer. There are numerous studies that show that, I only just see three but that happens. But we don't want to disrupt our pancreas and it has to shoot out a whole bunch more proteases -- these are enzymes that break down protein --because raw starches have these they're called trypsin inhibitors, TIs, and that's a protective way that livestock don't eat them all up. And then same with beans, same with maize and corn -- all our grains and beans, we have special ways of preparing them and processing them just so that we can eat them and have them edible and not kill our offspring and all our future offspring.

    So there's also something inherently creepy but somehow our minds are so strong, we can overcome a bunch of stuff. But now I look at gut profiles and I find that because we get into problems with starches. Even though people are low-cab when they took the resistant starch raw, they have all these huge weird growths of things that contributed to inflammation, joint pain, worst blood sugars, worst insulin and I can't explain that either. But then when you look at the profile it's because most of our gut does not eat raw starches. They are equipped and evolved to eat cooked as well as oligosaccharides that go along with the cooked starches like oligosaccharides.

    So a lot of our good species like Bifidobacterium longum, Akkermansia, Faecalibacterium prausnitzii, [0:27:56] [Indiscernible] -- a lot of these will actually be suppressed when someone is on even a small dose of resistant starch, even one tablespoon a day. And I found it's just really appalling because we know these issues are so good for us and you know modern life we see a reduction of these then disease ensues, even obesity, even diabetes, even many other conditions and autoimmune disease.

    So how can we help people even though they inherently feel better with sleep and other parameters but then we're basically debilitating the gut and chopping it off at its knees by cutting off these good gut flora?

Christopher:    Okay. So I can conclude that I can put the potato starch in the bin, that's kind of… at least I didn't spend much money on that one, right?

Grace:    We spend a bunch of money and I use this too all the time. They make great meatballs. Also I use it as face powder occasionally, I don't want to waste it. And it's not toxic on our skin -- well, maybe it's changing the flora in a bad way but I figure if I rolled around in dirt and some raw potatoes on the ground, it's probably the same.

Christopher:    So the next starch I wanted to talk to you about was UCAN SuperStarch. And for the people that don't know, I think they probably do know by now. So UCAN SuperStarch, I've been getting great results with. The reason I get great results is it's not a carbohydrate source that's as readily digestible as most. So when you consume a simple sugar you see a release of oxygen which then shuts down an enzyme, [0:29:26] [Indiscernible], and that slows down your fat burning which for endurance athletes is a disaster because you only have so much sugar on board and you have lots of fat.

    And so resistant starch, in a way, it allows you to have your cake and eat it. You can take your carbohydrate, keep insulin low. And the way it does this is it's a high molecular weight corn which I believe is heat-treated to make an extremely long glucose polymer. In fact I think it's like the longest glucose polymer ever. You kind of pointed out that this might be acting as some sort of resistant starch that may feed good or bad bacteria.

    So what are your thoughts on that? Should I be avoiding the SuperStarch too?

[0:30:10]

Grace:    Well, again, we get our guts into trouble because of sugars and starches and it probably depends on the composition of someone's small intestine. If someone has like a sugar or starch lever in the upper gut, it will feed on it just like someone reverting from low-carb diet to higher-carb diet and suddenly you see a lot of health problems.

    For some people it will cause dysbiosis if they didn't have it already. That's my experience with the potato starch. And I can see the same problem with UCAN SuperStarch a little bit because it's going --

Christopher:    Even though it's cooked?

Grace:    I just don't know enough. I mean it can't be much different than food except that its really high concentration. One tablespoon is a massive amount of this kind of fiber. Whereas in food really it's hard to exceed ten grams of RS3 in a serving of beans, let's say and then you still get these other oligosaccharides and they feed bifido which bifido would protect against many strains in the gut that would feed on sugar and these pathogenic strains that feed on certain starches in an ultrafast way.

    It really just all depends on the train on the small intestines, I think. If there's plenty of bifido… I have really a lot of leeway; people have all the keystone species that the gut scientists say should be there. They're found in healthy adults and centenarians and long-lived people, the people who live in these regions that have high longevity. If those species are there, then I don't think it probably matters as much because these strains do everything to prevent the pathogens that eat starches and sugars.

    So if they're not there, then what I see there is tipping. Maybe initially people don't feel anything wrong. Like for me, for weeks and weeks and weeks I didn't have almonds and then boom, it happened kind of suddenly. And for other people, it seems like it takes like a year for my observations or even over a year. If they're relatively healthy in the beginning, it just takes time to maybe later see a problem which is triggered often. I really look to studies like organic acids because we can kind of get an idea where someone's small intestines -- so it's wonderful that you do these tests because that really can give us some gauge.

    They're not perfect, like a lot of times I don't see anything wrong there yet, a person tells me they have all these problems. so it's not perfect all time but if we could see a lot of things leaking then it's just… that's why certain diets like a lower-carb diet during the transition of the first month or two during weeding and seeding the good flora in there and trying to nurture them to grow. It's good to avoid certain triggers because if you add like a FODMAP for some people… but after the good flora there, I don't know.

    I'd love to see more studies. I mean RS3 is a really good thing so if it is an RS3 and people eat plenty of oligosaccharides with it to balance it, I think food comes in a medley of different probiotics to feed our gut flora. If it comes in a balance, it's not a problem really. But if it's a super high dose and then we don't have those keystone healthy immune modulating species there I'm not sure because Akkermansia does not eat, bifido longum does not eat RS3 and they don't really seem to cross feed too well. They have to have the sort of oligosaccharide of diet. And honestly, some gut researchers they speculate we ate a ton of oligosaccharides and inulin-based food at some point in our past and even recently.

Christopher:    Okay. So I think the nice thing about the UCAN is you tend to need less of it as you go on. So in the beginning I was kind of really, really dependent on sugar for endurance activity which is not a very nice place to be. And so I was doing jellos like every 40 minutes.

    And then I made this switch to UCAN and UCAN keeps insulin lower and you become fat-adapted over time. Now I've got to the point where I don't really need to take it at all, like it's really just a performance enhancer. So if I'm going to do a short hard race then it would make sense to take the UCAN but it's not something that I would be supplementing with on a daily basis.

Grace:    Well, sure. Anything compared to sugar is probably better, that's what you're comparing it to, Christopher.

Christopher:    Something I constantly wrestle with is like am I doing this for health reasons or am I doing it for performance reasons and the two are quite often completely juxtaposed or just totally [0:35:07] [Indiscernible] is the word I'm looking for.

[0:35:09]

Grace:    I agree. I think it's really important for performance or even brain performance in any realm -- someone's looking at whether it's an executive or a mom who's juggling all these things in their family or a high performing athlete like you. I really promote that. So that's why I go to certain fibers that have been shown to improve fat burning. They don't produce weight gain.

    So RS3, if that's what UCAN is. I'm not sure what the studies are yet for isolated UCAN only products. But for sure, for potato starch, yeah, it seems to promote fatty organs, fat gain, fatty pancreas, higher insulin, higher blood sugars and some of these are even in healthy people, not disease people.

    So what other studies show for other fibers is not the case at all. So the probiotics I tend to go with now which I see a lot of great improvements with are all the ones that improve fat burning. And what they do is they stimulate selectively the Akkermansia, Bifido longum, and F. prausnitzii from the gut and these seem to be really…

    Just like the gut which you're saying, when the yeast numbers go up I see gut healing faster, the sealing of the gut, improvement of gut barriers, people's diseases seem to just improve overnight in 2 to 4 weeks and it's much faster than when I used to work with people a couple years ago, these results are much more faster. And then it also ties in with some of the soil probiotics because the soil probiotics also eat oligosaccharides.

Christopher:    So did you just say that you're using prebiotics there and then is that assuming they're not from food?

Grace:    Yeah. It's not forever. I stress try to go with food but healing it helps to have -- they're almost like botanicals in a way. Many of them have this botanical fact and pathogen purging effect which I really like, like [0:36:59] [Indiscernible]. It's kind of like mastic gum. In the Mediterranean, people would just chew on this resin for fun. It actually has huge anti-pathogen benefits. It lowers H. pylori for one and bites of mastic gum improves H. pylori ulcers and other ulcerations in the gut. But I like acacia gums, it's very similar and comes from Senegal. So in Africa people still utilize this resin off the trees.

    I'm from Asia, I'm Asian, but I don't know if my ancestors really use resins. It'd be interesting to delve into that. But we're Asians, we eat everything so I will be surprised if we were chewing resin off the trees besides eating goat ears and all kinds of raw food.

Christopher:    Okay, acacia. So what else have you got? What do you think about like psyllium husk or any of those kinds of things?

Grace:    I'm divided about psyllium. I mean I love psyllium. Personally I had the prevotella overgrowth so this is also a big problem for the standard American diet, we get overgrowth of prevotella. So I had to stop psyllium for a whole as much as I love it. But psyllium does -- I'm on it again and no problems -- but certain people won't do well with it. And if you have a broken mucosa barrier, it can scratch because it's so isolated and not… once you get more of the refined one maybe perhaps. I don't know. But there's some evidence, it may scratch.

    So I like to use it but I like to add it when people can tolerate FODMAPs. So psyllium is wonderful for Bifido longum and Akkermansia. Several studies show they just thrive with psyllium because of the arabinoxylans and the arabinoxylan-oligosaccharides that are developed after some breakdown of it. Whole grains have this as well.

    And it's very ancestral actually. Psyllium is related to this weed that grows all over the world that our ancestors probably cultivated and ate the seeds off because they're really tasty and yummy. And it's gummy so it's viscous so you get both like insoluble fibers as well as nice viscous soluble fiber. It feeds a lot of different flora in the gut and people usually do really, really well. But if someone has really severe dysbiosis, I would kind of avoid or if they have like prevotella overgrowth like I had, like I would kind of avoid it for the first 2 to 4 weeks.

    My other favorite prebiotic is glucomannan. Have you heard of that?

Christopher:    No.

Grace:    It comes from the konjac root which is related to some of the starches that probably a lot of European and Asian people kind of might have used. Like huge trees that have all these starchy roots. There is a starch but when glucomannan is isolated, it's this like clear viscousy gooey gummy kind of fiber which Asians seem to love, it's like this gooey thing. They make noodles out of it, they make these like blocks of gummy jello-like things. It has a jello kind of consistency and it's really yummy.

Christopher:    How do I buy it? I've never even heard of it.

Grace:    It's on [0:39:55] [Indiscernible] or vitacost.com. A lot of online places have it on Amazon. If they go to an Asian store they have it in the refrigerator, there's like tons of it. And it just soaks up the sauces. Whatever sauce you're using, it just soaks it all up.

[0:40:12]

    Mung bean noodles are very similar too and yam noodles that Korean dishes are made out of are very similar too. They're very high protein, lower carb, low GI. My blood sugar never even bumps when I eat these. And relatively they're almost like celery. It's like a negative calorie food.

Christopher:    I'm shocked actually by this conversation. Some of the people listening will know that our whole family is following a very low carb ketogenic diet. Even our daughter who's only 17 months doesn't show much of an interest for… And we don't want to restrict her in any way and we just like want to experiment and show her all sorts of things. She's just not that bothered by food that's kind of gooey like sweet potato because it's like kind of like a gel, paste sort thing. It seems to be consistency she doesn't really like.

    All of the things you've been talking about, the oligosaccharides and all these different fibers, these are all completely compatible with my ambitions to keep my blood sugar low and stay in ketosis. I'm quite surprised by this. I think you're going to tell me to eat sweet potatoes.

Grace:    No, not necessarily, even I'm pretty low-carb. My net carbs on most days is almost like 100 grams. Those are days I work out a lot because I bulk actually. I have some adrenal issues, I'm still kind of [0:41:37] [Indiscernible] sometimes. Not usually now but I can go kind of long distance and higher endurance now. But I try to not bulk.

    I think for the gut health and following the ancestral patterns, everyone just have look at their DNA and figure things out. Some people can, no problem tolerating more carbs and others just can't. My family and I, we can't do a lot of sugar, we can't do a lot of high-carb foods all day long every day so I love these non-starchy alternatives. We try to incorporate a lot of them. We do a lot of root vegetables, sunchokes, daikon, carrots, all kinds of parsnips. The Asian vegetables are great, there's like three different kinds of daikon you can choose from.

    And when we do a potato, we roast it. So we roast it on high and really literally there's not as many calories. Like if I'm doing glycolytic stuff, I'm starving after a couple of potatoes because there's no calories there. It's only for my gut flora, all the RS3 and I'm still starving. I could eat 4, 5 potatoes and it doesn't raise my blood sugars. Because the resistant starch when we roast it and it's cooled in the refrigerator overnight, it all complexes into this crystal and there's not much that our amylases can break down for carbs. It's a low-GI food, I think the GI is like 50 or below depending on the variety of the heirloom species.

Christopher:    Interesting.

    So I really wanted to talk to you about some of the other kind of oddball species that we see on some of the lab tests. I'm wondering, like say, Klebsiella for example, are they all evil or is it just like certain types or certain amounts? What do you think?

Grace:    It's so funny. We were watching Prison Break lately, my husband and I, we're like so addicted.

    If you have a society like there are sort of like the jail keepers and then regular people and then non-regular people like kind of prisoners. I think in a society there's always balance. If it's all like not-so-great characters, how's society going to function? How are people getting fed, how are people going to work, how are people going to maintain order and function?

    So I think that the gut is a lot like that. There are a couple of sentinels and they're keystone and they regulate a lot of peace and harmony and maybe that's how we best get energy as well as a host to them. We're really just scaffolds for 100 trillion bacteria and all of yeast, wild yeast and fungi. When there's a breaking point, I think at some point then the harmony is broken, then these the kind of savory characters, then they are really just more greedy, they're out opportunistically for their own to get as much food, simple carbs as they can or other carbs and they kind of trash the place. They don't upkeep or respect the integrity of the structure, the machinations going on that try and keep the host as happy and healthy as possible.

Christopher:    So Klebsiella will fall into that category then?

Grace:    I think we all need maybe… if some is there, it's not a problem. You know in a lot of gut profiles I really don't see it actually in the detectible range. So when I see it detectible, just as clinical trials are showing, it's only because the keystone guys are gone. Bifido longum is not there, Akkermansia is not there, Christensenella is not there, [0:45:16] [Indiscernible], all the Clostridia clusters like the group IV and the XIVa. They are all known to be really super immuno protective for human beings -- not hamsters, human beings -- and when they're not there that's when disease ensues.

[0:45:30]

Christopher:    What about the Clostridia species? Because sometimes I see that… so we run two types of tests and the first is a urine test and there's a metabolite on the urine test, organic acid shows overgrowth of the Clostridia species. And then we also run a traditional stool culture that looks for the toxins A and B that are produced by C. difficile and they not always concordant so sometimes you'll see one without the other.

    What do you make of it when you see the elevation of the Clostridia species on the organic acids test?

Grace:    There are a couple of markers -- I forgot which one is totally but like [0:46:11] [Indiscernible] as well as the HPHPA. There are several that go up when the Clostridia goes up whether it's good or bad. Most of the time it's only up when it's really bad, I believe.

    So Clostridia, it's a main character in our lower gut, in the colon, and has a big, big job. The clusters they produce a lot of butyrate but when they talk about Clostridium they talk about cluster I which the first name is Clostridium when you look at the species and the genus, and these seem to be a little more pathogenic. And they tend to love sugars as well as actually starches, starches and raw starches, they're very primordial. They appear to be able to eat these raw starches really well. And I've seen a couple of elevations actually after potato starch which kind of alarm me because many of them are toxin berry [Phonetic] and many of the strains I see that pop up actually are the toxin berry ones. So this is another reason why I kind of put up alert because that's not normal. If you're getting good fibers, it shouldn't do that.

    So like you mentioned, the C. difficile toxin, that's probably the [0:47:23] 4-cresol. Cresol is associated with a lot of colorectal cancer as well as inflammation to the gut related to IBD, IBS. So usually these tie in with people's symptoms when it comes to dysbiosis or even failure to sleep well completely or other little markers here and there. Because it just means that probably the gut brain and the gut barrier are not completely 100% optimal.

    So I think it doesn't hurt to try to address this especially if the urine organic acid test shows that there is a disruption in the barrier -- high yeast overgrowth, high bacteria overgrowth. It really would benefit the person to get some treatment and to alleviate this because this is a precursor to further disease later whether it's cancer, heart disease, diabetic problems, autoimmune. All these are actually preventable and many of these signs show up years, even a decade or two prior to the full-on manifestation of disease.

Christopher:    It's very difficult to get people to understand that, to feel the pain point early enough. So people are always waiting so the disease stay or something really bad has happened before they take action on it. I'm not [0:48:41] [Crosstalk] human nature --

Grace:    I know. You can't bring rock bottom to someone. I don't call myself an athlete but I look at certain things and I don't… I look at numbers, as an athlete you probably feel it. You can tell, a slight shift affects numbers for you, seconds, whether you trophy or podium up or not. But other people, life, it's not… you know.

Christopher:    As an athlete I don't even think that you even need to go that far, right. So I'll know within 35 seconds of starting the rides whether or not this is going to be a good day. It's unusual for me now to feel like muscular, soreness but you just know that your nervous system is not ready to go for another hard workout and so that's the thing that I would only notice if I was because of the training. If I wasn't doing that then yeah, I'm sure I would bumble through a lot of days not feeling that great and not really paying a lot of attention to it.

    But I wanted to ask you finally before I get too far off-track, about the automation of this whole process. So clearly you have a ton of information that is at the moment stuck in your head and you can use it to make a diagnosis when you see this taxonomy of microbes that's living in someone's gut. Now when am I going to be able to -- and I've not done uBiome yet so maybe they're already doing this but when am I going to be able to just like send in a sample and have somebody spit back a report at me saying "You need to take this supplement, eat more of this food, stop doing this…" How far away from that are we, do you think?

[0:50:30]

Grace:    I really have to hand it to like Genova Diagnostics, Great Plains, and all of these great, great companies that have come before uBiome. They have actually really great treatment protocols. I've worked for a lot of people and now it's just being fine-tuned. I'm sure I'm not the only one doing this. I'd love to teach more people and educate the general person on how important the gut microbiota is and how we can't mistreat it and to really respect it.

    But I don't know. For now, I'm working on some projects but a lot of it's already being done by really great companies. And just by applying a little bit of Integrated Medicine and Functional Medicine, we get similar results. I'm more impatient, I just want faster results for people and my family and myself, so I think it's getting there. I think we still have a long ways to go. I don't even want to say this is a diagnosis, this is really nothing. This is like tea leaf reading to me or whatever you want to call it.

    But I do think once we combine more information, the gases, the other metabolites, we know how much butyrate, propionate, acetate, a lot of people maybe because these are volatile, we can just analyze a lot of things as you know for SIBO. We can pick up already certain gases like methane and hydrogen but we are just at the tip of the iceberg, I believe. We have so much further to go. Studies really show people who display cancer masses, they already produce different organic acids and volatile ones that dogs can pick up. You're in ketosis, you have some fruity smell, dogs can pick up certain ketones on their owner if it's a type I on insulin if they go into DKA, Diabetic ketoacidosis, to the point where when they skip insulin or they have high blood sugars, the animal have some training to pick up these volatile gases, organic acids.

    And I think we'll get to that point where we can tie in what's living in and on us -- in our mouth, in our bladders, in every organ -- and tie it into what's going on to optimize health if people are interested in that. I find it's just extremely interesting and fascinating as well as it helps me just to be a better practitioner because we can speed a couple of things up sometimes. We haven't seen the yeast half of it, I'm sure you're aware too -- yeast, the parasites Giardia and other protozoa -- even the [0:53:09] [Indiscernible] and Lyme disease. We're so far away from even touching that and that's probably again, 80%, 90% of our health that a lot of people can't even recognize definitely not mainstream but mainly it's only Integrated Functional practitioners like yourself that are aware of it. But we're kind of still far away.

Christopher:    Okay. So what have you got for us then? So if you've got something to come out, you've got a book or...? How can we learn more?

Grace:    Yeah, I got a book coming out. It will come out in a couple of months called Gut Rich: How to get out of the rut of your gut [Phonetic]. It will be like more of a practical guide, how to shift your hundred trillion friends for fat-burning and leanness and longevity. It will have a lot of like I've been synthesizing for the last year and a lot of research that's come out that's applicable for people.

    Yeah. I hope to really work on things… you're probably a fan of [0:53:59] [Indiscernible], Christopher?

Christopher:    To be honest, I've had limited use of that. It's kind of confusing and quite stressful like when you start putting it through Prometheus and then you don't really know what it means in your life, right? I think it's like looking at the previous form of a racehorse, like what does that really tell you about the result? Well, it tells you something but it's not everything, right?

Grace:    Yeah, I know. It's not everything at all, right. It's not everything at all. It just gives like a neat little other dimension I think. Again, like the gut, it's just another dimension. Again, we're missing a lot like 89% of the other side of the picture.

    But hopefully we'll get like reports that are meaningful like you're saying. Like if someone has like Clostridium and a lot of it, this is what I see. They have a lot of [0:54:46] [Indiscernible]. They have a lot of even Clostridium botulinum. What the hell do you do? There are great botanicals, [0:54:54] [Indsicernible], get the bifido on, Bifido longum will squeeze all of them out, get some [0:55:00] [Indsicernible], feed this really well.

[0:55:05]

    So you're part of the computer world and my favorite analogy is if your computer ends up with a virus or a malware, how do you get rid of it?

Christopher:    Of course, you've got to do something pretty proactive to instruct it.

Grace:    You have to weed a little bit and extract and then you reinstall perhaps if you have to, the whole software, operating system, depending on how bad the damage is. Because things are so bad now, we've gone to that point where fecal transplant is how we reinstall.

Christopher:    I was wondering what you were thinking about that because you know I'm taking part in this study so I was like trying to wrap up that but this is too [0:55:43] [Indiscernible]. I'm taking part of this study and there are several different arms. And the arm I'm taking part in, I'm collecting a sample every week and then I'm going to do the potato starch so we've already discussed this. It's probably a terrible idea but so I'm doing that part.

    And then I'm going to drink this solution called GoLYTELY which is basically just going to induce diarrhea and totally clean out. And my thought was that I don't think it's really going to change that much because of the mucosal lining. So I think most of the bacteria, there's going to be enough left over in the mucosal lining that's probably not going to go anywhere.

    But what do you think is going to happen? Do you think it really is just going to nuke everything in my gut or do you think something --?

Grace:    Oh, no. no, you're right. The biofilms are pretty sturdy, that's how they protect us. Plus you have your… actually the gallbladder probably get seeded but for sure the caecum or appendix -- if you have an appendix -- those are sort of the libraries, the back-up drive. They should come and reinstall pretty well.

    But just anecdotally I heard, sometimes things happen with that flushing out. It's pretty intense. But I think if someone's relatively healthy and probiotics might make a deal too, [0:56:57] [Indiscernible] the installation stages out. I don't think it would be like a huge problem or adverse effect or anything. I think that's quite cool that you're doing all these guinea pig studies. Personally I haven't have the guts to do it, it is a lot of work, but I can't wait to hear what your results are.

Christopher:    Yeah. I'm worried it's going to be an awfully long time before I see any data but I think it's still important. I've actually recorded another podcast on this if you look back in the back catalogue you see I --

Grace:    Yeah, that's so awesome. You actually have a chance to --

Christopher:    Well, I should mention it here so that people will know. But that's great. Thank you very much for answering that. This has been wonderful.

    So you're going to be presenting at Paleo FX, is that right? What do you talk about Paleo FX?

Grace:    How to shift your gut, microbiota and your hundred trillion friends for leanness and fat-burning.

Christopher:    Ooh, that sounds exciting, I really want to go. We've been sort of wrestling with this but there's also a bike race I really want to attend so I'm not sure whether I'll be there or not. I think probably not.

    And then also, I've just been listening to the Gut Guardian podcast. I've literally been doing them back-to-back going back to the back catalogue, you're not on that many. There are only about 15 I want to say maybe so there's time for you to like listen to them all and they're all fantastic and you go into much more detail than we have here.

Grace:    Yeah. That's kind of become my secondary [0:58:21] [Indiscernible]. I haven't had as much time to do the blog as much as I'd like. And then we have a couple uBiome posts up at the parent site. Because a lot of people are so into uBiome -- I love them -- I love Am Gut too, they're both great. They give us such wonderful tools to look at the gut. So look out for those. We're going to be shifting a couple of guts and see what happens and it will all be on the uBiome.

Christopher:    Excellent, that sounds great. It's not expensive either. Like so a lot of the tests that we run, they're quite expensive like nearly $400 for most of them. But the uBiome, you can find out this taxonomy, this list of things that are in your gut for $89. Although I think we've probably made it clear that we don't know everything there is to know about what that data means, I think it's really useful to have that as a baseline and then see how that changes. Cost you $89, not much money.

Grace:    No, it's not. And I think Am Gut's only $99 I believe. I think they're all really, really great though. Genova if you get down to it, Genova is only $99 if you have the right insurance as long as it's not an HMO type of insurance or Aetna or Humana. But I think they're great, great value to you because you get to see all the acetic acid, propionate and other [0:59:30] [Indiscernible] acids that show up in the gut, in the stools. And they do a little bit of a pathogen report on there. It's not as intensive as some other testing.

    That's the problem with uBiome and Am Gut. You don't get the pathogens.

Christopher:    Right. So I think that's the same problem with the clinical study that I'm taking part in. Actually it's not clinical study, it's just a study, is they're not looking at any of those things at all.

Grace:    No. As you know yeast is such a problem. We get into this high-carb cycle from the standard American diet, high sugars, high carbs and antibiotics. The second you take a couple of rounds of antibiotics you got yeast overgrowth. Some people they're more susceptible to it, certain genetic predisposition can allow that like [1:00:18] [Indiscernible] or other ones, or [1:00:19] [Indiscernible], just more vulnerable to this yeast that were overgrowth of antibiotics but others are not because they do not have this genetic predispositions.

[1:00:30]

    Therefore it's more important to even have these gut guardians, these keystone species, I think, and to feed them really well. Feed them the oligosaccharides and the inulin-based root vegetables. That's why I tie in information from all over because they're all important. They make up the person. It's not just one thing but many, many factors.

Christopher:    Wow, yeah, thank you. a lot to think about there and I'd love to have you back on to talk about… just like I've got this big unlisted bullet points here and I've really only scratched the surface off it.

Grace:    Oh, it's so fun. Thank you so much, Christopher. I love chatting.

Christopher:    Excellent. Well, thank you very much. I'll link to as many things as I can remember in the show notes to help people find some of the stuff that we've been talking about. But yeah, thank you so much for your time. It's much appreciated and I'll talk to you soon.

Grace:    Great. Thank you, Christopher. Take care.

Christopher:    Cheers.

[1:01:08]    End of Audio

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