Strengthen Your Microbiome

Dr. Will Bulsiewicz • Episode 96

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The microbiome is a super organism ecosystem that is arguably the center of human health.

We rely on microbes to keep us healthy… and when they fail, we fail. Making peace with your microbiome is one of the biggest steps you can take to improve your health and wellbeing.

When you take care of your gut, just about everything else in your body is impacted…from your immune system to your moods to your brain and heart health.

To help strengthen your microbome and improve your gut bacteria, Dr. Will Bulsiewicz joined the podcast for his second appearance! 🎉

To heighten your gut intelligence and maximize your health, this NEW episode is a must watch (or listen).

Dr. B is a genius in helping teach what’s going on in the gut. He has a new book, The Fiber Fueled Cookbook, that will put you on a healing path to restore function to your gut.  It is a step by step program to support your journey to better digestive function.  Whether you have gut issues or want some outrageously good tasting recipes, it is all there.

Dr. B is not your ordinary doctor.  He’s an award-winning gastroenterologist and an internationally recognized gut health expert. His New York Times best-selling book, Fiber Fueled is changing lives. It’s a must-read for optimizing your microbiome and learning which foods help create a vibrant and healthy microbiome.

Dr. B is a rockstar. When he talks, I listen.

If you missed our first discussion, you can watch or listen here. It’s all about identifying weaknesses in the  gut, what habits lead to a poor microbiome, the role of pre & probiotics, and some really valuable information you can learn from your bowel movements.

Understanding your gut is a gateway to revealing what’s happening in your body. Let’s get started!

To LISTEN, Just Click Play!


Dr. Will Bulsiewicz: [5:44] Kathy Smith, it’s such an honor to be here with you today. I feel like that was a mic-drop moment by you right there because you basically just summarized the basics of gut health. Now, I’m ready to go beyond that, and let’s get into some details.

Kathy Smith: Yeah. That’s the thing. I wanted to make sure that we didn’t just repeat our last… That’s why I gave you that intro, that we didn’t want to repeat everything that we did in the last episode. I really want people to go back and listen to that. But, for the people that just didn’t listen and need a quick 90-second recap, why is microbiome the be-all-end-all to health?

Dr. Will Bulsiewicz: This is transformative science. This is the breakthrough that is occurring right now as we speak, and going to be one of the biggest stories – if not the biggest story – when it comes to human health during our lifetime. The reason why is because we didn’t have the ability to study them 15 years ago. Breakthroughs in laboratory technology, computers that finally caught up and were capable of handling the amount of information that exists – dare I say it – in our poop. In using this information, we then became capable of seeing the big picture, which is that, holy cow, these microbes that live inside of us (38 trillion of them), they are as alive as you and I are. As you mentioned, Kathy, they’re connected to our digestion, to our immune system, our metabolism, our hormones, our mood, our brain health, our genetic expression. Basically, when you think about everything that’s important for human health, I kind of just rattled it off. Yet, here they are. These microbes that are not human – not even a part of our body – kind of pulling the levers and making the decisions in terms of what ultimately happens with our body.

So, I see it as a moment of empowerment because we didn’t really understand or know anything about these guys until very recently. Now, the science is allowing us to take and shape them and allow them to be what we want them to be. [7:45] They’re not stuck. We’re not sort of born with this. We get to make this what we want it to be, and that’s a beautiful thing.

Kathy Smith: So, it morphs, it changes. What I’m really fascinated with when it comes to gut health, what I want to talk about today is this idea of how much control we have over it. I mean, how much we can change and shift it. It starts with little things, and then it’s these habits that we develop. One of the habits is this idea of fiber. The reason I wanted to jump right in with the fiber is because I feel like it’s so… We underestimate how important it is. We think it’s, okay, fiber is something we take so that we can eliminate properly. It’s taken me months and years to really understand fiber is so much more than that. So, I want to jump into the fiber talk.

Dr. Will Bulsiewicz: Well, I think, you know, it starts with this: that we have an inherent bias towards viewing fiber as the orange drink that our grandmother used to stir so that she could have a bowel movement. There’s this misunderstanding that fiber goes in the mouth and just kind of sweeps through, and then comes out the other end in the exact same form that it went in. That’s not actually true.

The issue is that we humans – as big and as strong and as complicated as we are – were not born with the enzymes to break down fiber. So, if we lived in a completely sterile world – which, by the way, if we lived in a completely sterile world, we actually wouldn’t be healthy at all. But if we did, and we had no microbiome, we wouldn’t be able to process our fiber. But guess what? These microbes, they have digestive enzymes. Like, far beyond the capacity that we have as humans. They have the digestive enzymes; they have the ability to break down, process, and digest our fiber. When they do that, there are a couple of things that take places that are borderline magical, from my perspective. It stops being fiber. It becomes food for the microbes, which is why we call it prebiotic. The microbes – which are alive [10:00] inside of us – they get to eat. They grow stronger. They become more capable of doing their job. One of the things that they immediately do is they take what is fiber, and they transform it. On the other side – after the microbes are done doing their work – they reward us with what are called short-chain fatty acids. These short-chain fatty acids are the most anti-inflammatory, most healing molecule, that I have discovered in all of my reading over the past 20 years of being a doctor. These are the most anti-inflammatory things that I’ve ever come across.

We get them by consuming fiber. This is a very important point because 97% of Americans are not even getting the minimal or recommended amount of fiber in their diet, and we have to change that. So, this is, to me, our most prevalent, most important nutritional deficiency, and it’s not getting the attention that some of the other things do.

Kathy Smith: So, just for the record, how much fiber are you recommending for people on a daily basis? How many grams?

Dr. Will Bulsiewicz: So, I will give you the number, Kathy, but then I want to give a caveat after that.

So, the recommendation, generally speaking, for women is 25 grams of fiber per day. By the way, the average woman in the US is getting about 15 grams of fiber. The average recommendation for a man is about 38 grams of fiber per day, and the average man is getting right now about 18 grams of fiber. So, both genders, we’re not hitting the mark. We’re not where we need to be. We both have some work to do.

But I think also, Kathy, this goes beyond grams of fiber. Let’s not slip into the trap of thinking that we can just take a fiber supplement and start cranking up grams of fiber by taking a supplement. This is much more than that. This is about the food that we eat. This is about the quality of our diet.

One of the things that I think is very important to acknowledge is that variety is critically important. So, I would encourage people, rather than [12:00] counting grams of fiber, count the number of plants in your diet. Do this at every meal. When you do this, when you count the number of plants in your meal, you will inherently move towards a more variety-based, diversity-based diet that enhances the gut microbiome and that supports your body with more fiber, and you will accomplish your goals. If you are eating more plants by doing this, trust me. You will get this number that I’m getting to, but I want you to go beyond this number, and I want you to improve your diet. So, this is more than just counting grams of fiber.

Kathy Smith: No, I totally agree. Since the last time we were together, you threw out that number of 30 different varieties of plants throughout the week – more if you can. So, now it’s become a game for me. We’ve gamified it. It is amazing when you start to think about all the varieties of plants out there. The colors, the textures. Every week with my blog, I’m really encouraging people. Every week, find something else you haven’t eaten before. I’ve done that over the past eight months (or whatever it’s been since we talked last time). It’s been a huge game-changer in my digestive tract. So, I’m loving that.

Before I forget about this – and I’m getting off course for a bit here – but in your book, you talk about this idea of gut and Covid. I think it was in Gut Magazine that came out in January. I think it’s important just to throw things like this out because people, again, forget about the immunity system of our gut. Especially in times like this, or whenever, with viruses going all around. So, can you talk a little bit and maybe mention that research study?

Dr. Will Bulsiewicz: [14:00] It’s very interesting. There have been a series of studies… Let me lead with this. No one study proves anything.

Kathy Smith: Right, right. Totally.

Dr. Will Bulsiewicz: At the end of the day, what’s important is to be looking at the breadth of the work, and to be interpreting sort of the bigger picture that – in a perfect world – shows multiple studies of multiple different varieties all pointing in the same direction. That’s what we ultimately want. So, we want the pre-clinical data. We want the clinical data. We want the randomized controlled studies, the epidemiology studies all kind of saying the same thing. Then, when we have that, we can have great confidence that we know what we’re talking about.

That’s kind of, actually, what we’re seeing when it comes to the relationship between the gut and Covid, and the response to Covid. So, if we go back to the early days of the pandemic – like, March, April, May of 2020 – what we were seeing was that there were some people who were getting very, very sick, and there was a very, very large proportion of people who were not getting sick or minimally getting sick.

So, what separates these groups of people? What makes one person who’s 40 years old crash and burn into the intensive care unit and require a breathing tube to survive versus the person who’s like, “Yeah, I can’t believe I had Covid. It was the sniffles. It was nothing”? What separates this?

What we have discovered is that it probably boils down to these microbes that live inside of us. You’re referring, Kathy, to a paper that came out in January of last year in the journal Gut, which is one of the top two gastroenterology journals in the world. It’s more of a European journal, but it’s one of the top two. Basically, what they showed in this study is that there was a difference between the people who had symptomatic Covid severe enough to land them in the hospital and the people who did not. What they showed in the paper is that as the severity progressed, the changes [16:00] that were taking place in the gut microbiome became even more pronounced, even more clear.

So, what were those changes? What they discovered was that there was a disturbance in the microbiome, where there was a loss of the anti-inflammatory healthy microbes. These are actually the microbes that help us to process our fiber. These are the same microbes I was talking a moment about short-chain fatty acids – the most anti-inflammatory molecule. This is what they produce. We had less of those types of microbes, and more of the inflammatory microbes (the ones that actually want to push inflammation to get our body up into a tizzy). That’s what we were seeing taking place in the setting of Covid.

So, it started to sort of connect the dots because there was, Kathy, some pre-clinical research that was already available in the early days of the pandemic before we ever even knew what Covid-19 was. There was pre-clinical research where they would basically take animals – like, take a mouse – and feed it fiber, and look at its response to a respiratory virus. They would see that the mice that were being fed fiber would survive at a far higher rate in terms of respiratory viruses. When they tracked this and got into the details of what was happening inside the body of these mice, it came back to the gut. The gut microbes were interacting with the fiber in the diet, producing short-chain fatty acids, and then the short-chain fatty acids were shaping the immune system in the fight against these respiratory viruses. Not Covid-19, but respiratory viruses.

So, we could kind of see the writing on the wall. I actually wrote an editorial that I submitted to the New York Times – and they declined it for reasons that I understand – back in May of 2020. Like, it was very early in the game. So, that’s why they were not quite ready to accept this. But I wrote an editorial that basically said like, “I think that a plant-based diet is going to end up being the solution.”

[18:00] So, we saw this Gut article that you’re referring to, Kathy, come out in January of 2021. Then, guess what? In the summer of 2021, new research comes out that shows that people who are consuming a plant-based diet are less likely to not only be diagnosed with Covid but also less likely to have moderate to severe Covid-19. So, the whole thing starts coming into focus where it’s like, now we have the pre-clinical studies showing us the effective fiber on the respiratory viruses. We have the Covid-19 study that shows us that the microbiome is missing the short-chain fatty acid producers in people that have severe Covid. Now, finally, the last piece: human research showing us that if you were fueling your gut microbiome with fiber, you are less likely to have moderate to severe Covid-19.

One last thing. So, that picture is now complete. There is one more part. This is not just what happens to you acutely when you have Covid-19 and potentially could get sick. This is also what happens after the fact. One of the biggest concerns in healthcare today is long-Covid. Covid that lingers for months, potentially a year, after you’ve basically cleared the virus, but you still have symptoms and you’re suffering. What’s the difference there?

Guess what? Yet again, new research just came out in the last few weeks showing us that Covid-19 that lingers – long-Covid – is associated with changes in the gut microbiome. Once again, it’s the exact same changes: a loss of the anti-inflammatory, short-chain fatty acid-producing microbes in the gut microbiome.

So, if I have to make a prediction, Kathy, here is my prediction. I think we’re going to see a new study sometime this year that’s going to say that by eating a plant-based diet, you reduce the likelihood of having long-Covid because it’s the exact same pattern that we saw with moderate to severe Covid in the first place.

Kathy Smith: Okay. So, now we’re going to go [20:00] into there’s a doctor in the house, and I have to ask you questions because I have my athletic, Olympian daughter got Covid in December, and she has long-Covid maybe. Maybe. But, point being, I was just telling her about an hour ago I just finished your book. I said, “Okay, we have to talk about this.” I mean, she does eat plant-based, and maybe this will segue to the entire audience. She does have plant-based, not vegan, but plant-based. I think one of the things that we need to discuss is the difference between plant-based and this variety aspect. Also, close the loop for people on this. I get it because I’ve heard it over and over again. But fiber gives you this SCFA – short-chain fatty acids – but is it all vegetables give you that? Are there certain vegetables you’d say, “Okay, stock up on these vegetables because you’ll get more of these short-chain fatty acids?” Kind of close the loop there on that discussion as well as come back around to if you are in the long-Covid stage, is there anything they’re seeing except for the recommendation to eat more vegetables? Do we have to go off the charts? Because I guess with plant-based, I see people plant-based, but they might have lettuce, bell pepper on a salad, and some carrots. Then, you know, there could be some chips in the discussion with that. So, I think that not all plant-based is created equal. Maybe we should define that a little bit.

Dr. Will Bulsiewicz: I think this is such an important topic, and I’m very glad that you asked me to bring some clarity to this because I want people at home – who could very easily be confused about these terms – to understand this with clarity.

So, to me, veganism [22:00] is an ethical choice. That is the decision that you’re going to exclude animal products in their entirety from your diet because you are concerned about the environment or animal welfare. That is an ethical choice.

Now, what’s leftover is devoid of animal products but it could be many different things. That could include junk food. Right? Oreos are vegan. You could eat Oreos all day and it’s a vegan diet. That ain’t a healthy diet. Calling a vegan diet inherently healthy, that’s not necessarily true because there are many forms of a vegan diet. Again, the motivation for a vegan diet is not health. The motivation is that you have these beliefs – which I think are great – but it’s about the animals, it’s about the environment, and it’s a selfless choice.

But it’s okay to be selfish when you’re talking about your health. That’s okay. That’s where the plant-based diet comes in. A plant-based diet means that you are placing an emphasis on plants. That could come in many different varieties.

Now, let me just say something, Kathy. We like to apply terms to people’s diets. Right? We want to define it by, like, one word: keto, paleo, vegan, plant-based. We just want to apply one word, but yet we’re far more complicated than that. I find that exercise to be a little bit sort of unnecessary because, at the end of the day, I want every single person who’s listening to you and I right now, to find a diet that they love, that brings them joy, but also that makes them feel great and doesn’t require them to make compromises about their health. That’s where, to me, a plant-based diety comes in.

A plant-based diet is making the choice that you’re eating for your own health. They can come in many forms. If I say plant-exclusive, plant-exclusive basically is a vegan diet except, again, this is whole foods. [24:00] You’re not eating Oreos on a plant-exclusive diet. Plants predominant can be many forms. A paleo diet could be plant-predominant. But the point is that you’re making a decision: “Look, I want to eat more plants. 70%, 80%, 90%, whatever it may be.”

For me, it’s about the direction. It’s about the journey. This is not about, like defining who you are and whether it’s right or whether it’s wrong. That’s nonsense. Right? This is about where are you today, and what are the steps that we can take to get you moving in the right direction? That’s what I care about.

I can assure you if you think you have a bad diet, I was worse. All right? I was on a fast-food diet. I was less than 10% plants. So, it’s not…

Kathy Smith: You were a total wreck in your book! Med school, your weight, I mean.. That’s why to look at you now and to see you when you’re dancing… I love your energy and your joy. One of the things when I took your six-week gut health program… Are you still teaching it? Are you still offering that or not?

Dr. Will Bulsiewicz: It’s coming this summer.

Kathy Smith: Yeah, okay. So, I recommend anybody. We’ll talk about it in the liner notes, but I went through Dr. B’s six-week program. Is it six or eight? Whatever it is, it’s a program. It was remarkable. What I loved about it is all of these concepts – which can get overwhelming when you get them all at once. What I like is bite-sized, every week you’re learning a little something. You get together at the beginning of the week for a group chat with everybody, and you learn so much from other people’s questions and your responses, obviously. But the big thing is you start a session off with a song and a dance and just getting that energy up.

So, you have this energy around gut health. I love that you’re not… You’re accepting. You’re accepting of where people are [26:00] at because it is this journey.

One of the things I want… I know we don’t have tons of time. I want to switch over in a second to this idea of people who do have problems going to a plant-based diet because of food intolerances or food sensitivities, that sort of thing. They eat too much fiber and they go, “Oh, I thought this was going to make me feel better, but I’m actually feeling worse.” So, and how you could actually train your gut to, you know, shift that into a more fiber-friendly mode. But, is there anything else you wanted to wrap up on the long-Covid, the short-chain fatty acids, or anything there? Do you think we’ve closed that loop? Was there anything else because I kind of interrupted you?

Dr. Will Bulsiewicz: Well, no, that’s okay. I think that, at the end of the day, what we really want is to… We aren’t in a place where we have shortcuts on how to manage long-Covid to make it good for everyone. I wish we were. I think that at the end of the day, what you want is to build your shield and let that day start today. Don’t wait until you have Covid to start figuring this out. Work on your health, and moving your health in the right direction. Again, I’m all about progress over perfection. So, every step in the right direction we should celebrate. That’s what I’m about.

Kathy Smith: Brava. Especially on my website, that’s my motto: progress not perfection. Especially with food and exercise. Let’s switch over to all the people… Again, so many questions when we reached out to our Facebook group on what they want to hear about or talk about. I know you talk a lot about it in your course. It’s this idea that when you do have intolerances – it’s gluten or lactose or these other food sensitivities – and also just eating more fiber. Some people start to eat fiber, and they just feel like they’re going to explode. So, do you want to go down a little bit of how do you transition to a more fiber-based diet?

Dr. Will Bulsiewicz: I am more than happy to. So, you know, my general [28:00] philosophy when it comes to the gut and introducing new foods – whatever that food may be – is that you have to train your gut. So, whatever it is that you have been eating, that’s what your gut is designed for. Just like exercise, just like going into the gym, you want to build up strength. You have a starting point, and that starting point may be a position of weakness. There may be foods that you quite simply struggle with, just like going to the gym on January 1st and you haven’t been working out. Guess what? You might get sick if you run too hard. Right? So, the point is that we want to introduce and implement this dietary change progressively, slowly over time. You start low with a new food. You go slow as you ramp it up. This allows your body an opportunity – your gut – to adapt to what you’re doing, to grow stronger, to become fortified. You’re building strength in the same way you would build muscle in the gym.

Kathy, to go just a little beyond this, my new book coming out May 17th The Fiber Fuels Cookbook is far more than a cookbook. It’s actually a protocol – a methodology – for people who are suffering with food intolerances. What I consider to be my biggest contribution from this book is something called the GROWTH strategy – G-R-O-W-T-H. So, I just want to run through this real quick to tell people what they are. It’s a preview, and I’m more than happy to come back any time with you, my friend, and we can continue the conversation about this.

GROWTH is sort of my philosophy when it comes to your diet. I want you to have abundance, not restriction. But GROWTH – in this case – is an acronym. It’s our approach to food intolerances. It breaks down like this. G stands for Genesis. What is the genesis of your symptoms? If I see a patient in the clinic, the first question in my mind is, “What am I treating?” That should be the first question for [30:00] you. What are we treating? We have to know that if we really want to get it better.

ROW – I put them together – they’re like a package. They’re like in a dance together all at once. ROW: Restrict, Observe, Work it back in. If you want to know what foods are causing trouble for you, a blood test, a poop test, a breath test is not going to answer this question for you. Science has not gotten there yet. What will answer this question for you is if you restrict the food, you observe how you feel, and then you work it back in and you see exactly how you feel. This will tell you, “Okay, gosh, I am having trouble with these gluten-containing foods,” or, “I am having trouble with dairy,” or whatever it may be. It will help you to isolate and identify where the problems exist. When you do that, you’re empowering yourself with knowledge.

Once you get to that place, it’s time to T: Train your gut. It’s like what you and I were just talking about. Low and slow is the tempo. You introduce these foods slowly, you give your body a chance to adapt. Over time, you’ll be able to grow, get stronger, and become capable of processing foods that you didn’t think you were capable of doing.

The last thing is a simple reminder. H stands for Holistic health. Let’s not lose sight of what’s happening with you and your body. You are not just a bunch of digestive enzymes. Right? You are not just ab unch of microbes. I can’t just do a poop test. Like, you are a whole person. You are more complicated. It’s a beautiful thing. So, let’s not lose sight of the fact that your mood, your emotions, your relationships, whether or not you got sleep last night, your exercise patterns, your movement – all of these different factors they all ultimately have an effect on your ability to digest your food and your relationship with your food is very important, too.

So, GROWTH strategy: Genesis, Restrict, Observe, [32:00] Work it back in, Train your gut, Holistic health. That’s actually what the Fiber Fuels Cookbook is going to be all about. Yes, it will also have 125 recipes, but the recipes are actually part of the protocol.

Kathy Smith: That sweet potato boat that opens up your book is awesome, which I can’t wait to make it. I’ve gone through and made a couple of the recipes already. It’s unbelievable.

But the 1-2-3: restrict, observe, work it back in is such a great approach. It seems like it allows you to find out where your threshold is for a lot of these foods. A lot of times, as you mentioned in the book, you don’t have to eliminate a food completely, but you might have to find out where your threshold is for. Do I have that accurate?

Dr. Will Bulsiewicz: You do. It’s an important point because food intolerances ultimately are about thresholds. So, there is a certain amount that you are capable of tolerating. I mean, let’s take a person who has lactose intolerance, right, and they can’t consume dairy. I can put a drop of milk on their tongue. They’re not going to have diarrhea from that. Right? But the question is what is the threshold? It may be far less than a glass of milk for that individual person.

So, what I’m talking about here is your unique body – your unique biology. Like, I can’t create a one-size-fits-all diet. That’s not possible. You are too unique for me to do that. But what I can do is I can empower you with the methods, the approach that will allow you to discover what works for your personal body, and to personalize. That’s what I’m trying to do with this book.

Kathy Smith: Well, I read it cover to cover, looked at all of the recipes, and started making a few of them.

The one last thing I want to touch upon because I don’t understand as well, and I think maybe it could be insight to our listeners, which is this histamine intolerance. Can you explain what is [34:00] histamine, and what foods trigger histamine responses, and what we should be looking for?

Dr. Will Bulsiewicz: Yeah. So, I think that this is going to be a game-changer for a lot of people. There is a challenge that exists in healthcare when it comes to this specific diagnosis. It’s not that the diagnosis doesn’t exist or it’s made up. It’s completely real, and there are people who are listening to me right now who, like, this may change their life. But the challenge is that in order to discover whether or not you have histamine intolerance, you need a proper dietary approach, and your doctor doesn’t have the ability to do that.

So, what is histamine? Histamine is a part of our body. It’s a signaling molecule which is involved in very important parts of human health, like we can’t vilify it and call it horrible because when we’re healthy, histamine is in there. But it’s like anything in excess is problematic. There are people who suffer with histamine intolerance, which in many cases, starts in the gut and is the result of a damaged, injured gut. As a result of this, when they eat certain foods, examples of this include fermented foods. So, like not just sauerkraut, but that would include alcohol or vinegar, yogurt. When they consume fermented foods, they may get a reaction that causes them to have any of a number of many symptoms throughout their entire body. The most common symptom is bloating. So, if you have a chronic bloating issue, you should be listening up right now. The most common symptom is bloating, but it can include, like, literally a runny nose. You ever get a runny nose after a meal? It could be a headache after a meal, like a migraine headache. Could be diarrhea, constipation, changes in your bowel habits, could be a rash, hives, could be that you get a rapid heart rate. There are many different possibilities that are the result of histamine because we have histamine receptors [36:00] throughout our entire body.

So, how do we approach this complex issue? There is no blood test. This is why it’s very hard for doctors. What you need is you need to reduce your histamine intake for about two weeks and see how you feel. Now, if you do this if you reduce your histamine intake for two weeks and you notice, “Gosh, I feel awesome!” we’re on to something!

Kathy Smith: Yeah.

Dr. Will Bulsiewicz: We are now empowered, and we can work toward making this better because you are not stuck living this way. We can heal this, and that’s what the book is about.

Real quick, most plant-based foods are not high in histamine. Most are not. But there are some that are, and so that’s part of what we play upon in the book, and the recipes are designed to be low-histamine when you get to this protocol. So, spinach, eggplant, tomatoes, and – I hate to admit it – but avocados.

Kathy Smith: I was going to say avocado! When I read avocado, I thought, “No! Don’t take my avocado!”

Dr. Will Bulsiewicz: It breaks my heart. Yeah. It breaks my heart. But what you do is it doesn’t mean that you eliminate these foods for the rest of your life. I’m never about that. What it means is that you do your two-week low-histamine protocol, which is provided by the book. You see how you feel. Right? Restrict, observe, work it back in. Then, we’re going to go through a process of getting these foods back on the menu. It just may take some time in terms of healing.

Kathy Smith: Okay. So, why do you think your poop should be your fifth vital sign? Is that what you said in the book, that we should be looking at that as maybe our fifth vital sign?

Dr. Will Bulsiewicz: This is so important. You know, it’s like the stigma around poop is standing in the way of us having an honest conversation about how important this actually is. Right? So, it’s like, poop jokes that are… I have a five-year-old son. Like, this is all day long. This is what he wants to talk about, right?

So, that stands in the way of us being able to have [38:00] like a real, frank conversation about human health. Your gut microbiome is so important. You said it off the top in the lead, Kathy. Connect them, too: digestion, immune system, metabolism, our hormones, our mood, our brain health. Like, it all comes back to this one place. What is the single most clear indicator of the health of our gut microbiome that we can take without doing blood testing or poop testing or stuff like that? Like, what can we collect information on literally at home, for free? You can look at your bowel movement.

Kathy Smith: Every day! I mean, that’s…

Dr. Will Bulsiewicz: Every day!

Kathy Smith: I mean, it’s just an indicator for me. Like, what…? How was my eating yesterday? How are my stress levels? How much caffeine did I have? How much water did I drink? I mean, it all is kind of reflected right there, and I can make adjustments day by day – which is what I love about it.

Dr. Will Bulsiewicz: It’s 100% true. So, you know, what do we want to look for? Well, there is a number of different things. As a gastroenterologist, this is not just the frequency, but how often you go is something that I would look at if I were seeing you in the clinic. Also, you want to look at the form, the shape.

So, there’s something called the Bristol Stool Scale, which is in the book.

Kathy Smith: We talked about it on the last episode, which I… Four. I think four is what you’re shooting for. But, one of the questions that came in was, “Floaters or sinkers?” Is there something you need to talk about? Is one better than the other? Is there something…?

Dr. Will Bulsiewicz: Well, yeah, so, I think, with that, it’s actually a question of intrigue that many people have. Like, “My poop is floating. What does that mean?” It may mean nothing, but we have to look at the bigger picture. So, are there other associated symptoms that may indicate a bigger problem? Like, are you seeing fat or oil in the toilet water? Because that may indicate that you have a malabsorption issue. Are you having diarrhea and loose stool on a chronic basis?

So, if you have a change in your bowel movements in addition to the stool floating, [40:00] or if there is another change in the color or something like that, those would be potential reasons to talk to your doctor about what’s going on. [40:06]