If you are looking to heal your gut to improve your health, this is the blog for you! This is the second blog post with Dr. Will Bulsiewicz, you can read the first one here where he talked a lot about the benefits of fibre! Read on to learn about the growth strategy, what food intolerances are, tools to address constipation, the impact of fibre on the immune system and a client story that shows us the power of holistic healing!

Who Is Dr. Will B?

I come from a background of traditional medical training. I'm a gastroenterologist and have worked many years doing that. But going back 10 years ago, I was in my early 30s and had my own health issues. I was 50lbs/20kilos overweight and had high blood pressure, high cholesterol, anxiety, low self esteem, and low energy. The irony was that I had great training from some of America's best hospitals, yet the pills and procedures I was taught were not the solutions I needed for myself in a time of need. Ultimately what I discovered was that the diet that I had been raised on, the food that I loved, was the source of my problems. And that discovery transformed my life. I was able to overcome these health issues and go back to feeling young, alive and vibrant, and thriving.

It was so radical that it forced me to look at healthcare in a new way and see that it's missing an important part. We can prevent many conditions through diet and lifestyle. It set me off on a mission to try to understand that better. I would consume nutrition research at night before work and then bring it to my patients the next day. Because:

- I would be treating patients who had IBS and I helped them overcome their food intolerance

- Or they had acid reflux and help them through their proton pump inhibitors in the trash

- Or I put someone's UC into remission

These are powerful transformations for people because they desperately wanted help. This led to a series of things and accelerated how my life changed. In 2016, I started an instagram account and in 2018 I did a podcast with my friend Simon Hill and it went viral. This created an opportunity for me to write a book. “Fiber Fueled” made the New York Times best sellers list and it has sold 200,000 copies. It's been fun but it's been overwhelming because throughout all of this I've been a full-time doctor. My purpose is to use my education experience and talents to help and empower people. I recently left my medical practice which wasn't an easy choice but I am restructuring my professional life so I have time with my family. So I am taking advantage of the opportunities to write books and courses, and get my message out on a larger scale.

The Fibre Paradox

We need to have honest conversations around digestive health issues because each person has a unique gut microbiome. Even if you had an identical twin, you would only share 35% of the same microbes. What works for me doesn’t necessarily work for others, the journey is not the same for everyone. I wrote the book “Fiber Fueled” from a place of passion and enthusiasm. I wanted to show people the connection between this new science of the gut and the dietary choices that we make. In the USA, we are deficient in fibre which is causing some of our health issues. So I want to help empower people with the right facts to improve their health.

In doing that, some people come to me and say “I want to eat the way you are describing but I don't think that it’s possible.” The reason they say this is that they suffer from symptoms when they eat this way. They are trying to eat these fibre-rich foods, which I say are good for us, and it makes them miserable. The fiber paradox is that this food that heals, nourishes, and supports a healthy gut microbiome (plants, fruits, nuts, seeds, and legumes) are the foods that a person with digestive health issues needs the most. But these are the foods that make them the most miserable. It's a matter of being upfront and honest about that because I don't want people to think eating fibre is easy.

Following our instincts and what our body is telling us is very important. But there are times when an intuitive approach can misguide us and get us into trouble. This is one of those examples. I completely understand when a person eats a food that causes digestive distress, it would make sense to just reject the food. To say “I can't eat that so I might as well stop.” The problem is, it’s ignoring the resilience that you have as a part of your gut microbiome. You may struggle with that amount of that food today but your gut:

Can be healed

Can be made stronger

Can be fortified

You can restore function

You can enhance function

And it’s capable of taking these foods that you feel are your enemy and turning them into your friend. An important part of this message is don’t allow those foods to be your enemy, because your memories will drag you down. But instead, let’s take those foods and have me guide you through the process in “The Fiber Fueled Cookbook” and take those enemies and turn them into your friend.

Once we go through the healing process, then foods that you maybe couldn’t tolerate in the past you might be able to after the healing has been addressed -Kriben Govender

What is Food Intolerance?

Food intolerance is when you have undesirable symptoms when you consume a food in normal quantities. It's not that you went way overboard on certain food because if any of us drank a gallon of milk, we are all going to have diarrhea. But if you have a single glass and it causes bloating or cramps then it's an intolerance. About 70% of the world has an intolerance to lactose (the sugar in dairy products). Food intolerances, generally speaking, are the manifestation of symptoms as a result of sloppy digestion. Meaning that your body is struggling to break down and process the food. Which isn’t the immune system. If it were the immune system then it would be a different food allergy.

If a person has a dairy food allergy then if you do one drop of milk on their tongue that could be enough to make them react to vs someone who is lactose intolerant, there is an amount that that person can tolerate. If you have lactose intolerance, one drop of milk isn’t going to give you diarrhea. It's just a question of how much will it be. If an 8-ounce glass is giving you diarrhea then what is the amount you can tolerate? Because that number does exist.

The best way to empower yourself is to isolate the specific food that is causing you trouble. And it's just as important to know how much you can tolerate. Unfortunately, there is no reliable test to allow us to shortcut that information. We have to go to the tried and true approach, which is temporarily removing the food from our diet to see how we feel, then bringing it back in, and evaluating whether we have a food intolerance.

Different Types of Food Intolerances

FODMAPs: This is a complex way of saying the sugars, or chains of sugars, that exist in your food. It could be:

-The fructose in fruits

-The lactose in dairy

-The fructans in garlic and onions

-Wheat or whole grains

-The galactans that are in legumes

And what's interesting about FODMAPs is that it’s easy to say “oh they cause gas and bloating, they aren't good” but almost everything I just described to you is a prebiotic. It has been proven in studies that it feeds and nourishes our gut microbes and makes them more healthy. So we don't want to throw the baby out with the bath water. Because we all have gut microbes that are starving for fiber and prebiotics, and when we remove these foods from our diet we are digging ourselves into a deeper hole. We want to heal these food intolerances so we can include these foods because they are good for our gut

Histamine intolerance: This is a bit different. Histamine is a signaling molecule that is a normal part of our body. It’s a part of being healthy and serves good biological functions when it’s balanced. But when it falls out of balance we can manifest symptoms. The number one symptom of histamine intolerance is gas and bloating. Because when we have histamine intolerance, we are struggling to process the histamine that is in our diet. So that means that there is an excess of histamine in the body and we might get:

-Sinus issues

-Sore throat

-Rapid heart rate

-Light headed

-A rash or flushing of the skin

These are all different potential manifestations of histamine intolerance. The topic is nuanced and can be complicated but the solution is very simple. If we could just give patients 2 weeks’ worth of low histamine recipes and then tell us if they feel better, then we have just done the appropriate test for histamine intolerance. And that's what's happening in my new book. Handing patients a list of recipes and eating from something that is designed to evaluate what is going on in their gut.

How Prevalent is Histamine Intolerance?

There is not a blood test for histamine intolerance. The way you determine if a person has it, is by putting them on a low histamine diet. There is no diagnostic tool in the clinic which means this will be underdiagnosed. We don’t know how prevalent this is because of the diagnostic limitations. But that’s not to say that it isn't real and that people aren’t suffering with these problems. It tells us it is real, people are suffering, but we are struggling to use the tools that are available to us at this moment to identify who they are.

This is why I have 26 low histamine recipes in my book. You aren’t going to hurt yourself doing the low histamine diet for 2 weeks. And then what if you find that your symptoms are radically improved? How powerful is that? I wouldn't put my reputation on the line with histamine intolerance if I didn't wholeheartedly believe in it. There are 90 references just to make sure that it's very clear that it's scientifically based.

Growth Strategies

In the book, I bring forward my approach to food intolerance called the GROWTH strategy. Which is an acronym and if you follow through the letters one by one it will teach you the steps you need to take to heal your gut. I was excited to come up with this because in “Fiber Fueled”, I talked a lot about the growth mindset. Because having a growth mindset is something that I want to impart on my community. A growth mindset was first described by Carol Dweck, it’s this idea that we don’t worry about winning or losing but we focus on the process. We celebrate that we’re challenging ourselves, and there’s growth that comes from those things, even when we fall flat on our faces. And in this case, GROWTH is my acronym:

G: Genesis

R: Restrict

O: Observe

W: Work it back in

T: Train your gut

H: Holistic Healing

And I will be breaking down each piece throughout the rest of this blog.

G: Genesis. As a medical doctor, the very first step has to be a root cause understanding of the genesis of your symptoms. If we know the root cause, then we are empowered to make great choices in how we attack the problem and make it better. And if we don't properly understand the root of the problem, then we are in the position where we are just swinging stuff against the wall and hoping something will stick. And maybe it will, but that’s called luck, that's not being smart. We want to make sure that the first thing we do is evaluate for things that can explain and identify the root of the issue. And many times what I’ve discovered is that if you do this properly, you may come across something that once you fix it, their food intolerances go away entirely.

Food Intolerance Side Effects

One of those is constipation. Constipation, to me, is the number one cause of gas and bloating. It's poorly understood because a lot of people have been inappropriately taught that constipation is only “when you never poop”. Constipation is the manifestation of symptoms that you don't want because you are inadequately evacuating your colon. For example, one of the most common things I saw in my clinic was people pooping every day but not completely emptying. They didn’t feel like they went all the way and pooped 30 minutes later. That person could poop every day, still be constipated, and manifest:

-Gas bloating or discomfort

-Nausea

-Loss of appetite

- Fatigue and brain fog.

If you figure out if someone is constipated you need to get them into a rhythm. Our body thrives off of rhythm. For example, if you take an Olympic athlete and you throw them into an abnormal heart rhythm, you could make it so that the athlete can't even walk up a flight of stairs. And the same is true with the gut. Stop start, stop start, is not rhythm, rhythm is effortless. Bowel movements were meant to be enjoyable so when a person is struggling or it's not coming then they are out of rhythm. Restoring rhythm not only fixes these issues but I've found that people who are constipated get bloated with everything. And when you fix the constipation issue the bloating goes away…

Bloating and gas: if you are having issues where you aren’t completely evacuating, then I feel like it is in your best interest to get into a rhythm. Some people think they have SIBO and go on an antibiotic. But I am cautious to take a person who has dysbiosis, which is what SIBO is (an unbalanced damaged gut), and then go after this with an antibiotic. I have found that most of the time people don’t get better. They might feel better at first but then there's a relapse. I don't think in the long term we are making people better with antibiotics. I would encourage people with SIBO to approach this in the way that I described in the book. Then slowly increase your fiber intake to help rebalance the gut microbe.

Basic Tools to Address Constipation

With constipation, we don’t want a rollercoaster. We want something that allows us to stay in the rhythm and keep things moving through. You can think of this as a log that's floating down the river. You have to make sure there's enough water there to float the log down the river so it can't get stuck on the rocks. We want a bowel movement that's a torpedo but it's soft and formed. Part of how we can accomplish that can be fiber, BUT I want to warn people that if you have moderate conspiration, cranking up the fiber can make you feel worse. I like to add magnetism first. And it comes in a lot of forms. For example, magnesium glycinate is great for headaches, mood, and sleep, but not great for constipation. The 3 forms that I like for constipation are:

Magnesium oxide

Magnesium citrate

Magnesium sulfate

And I would encourage people to do this under the care of a healthcare provider. They can check your magnesium levels before you start. I have found that most of us are low in magnesium at baseline. And then when we supplement, I will start someone at 500mg at bedtime. I choose bedtime because it helps you sleep better AND because we are priming the pumps to have a great morning bowel movement. So take 500mg at bedtime and give it at least a couple of days to see how you feel. If you aren’t quite there and you need more, you can go up in 250mg increments from 750-1000. If you go to 1000mg or more, you need to go to a doctor and check your magnesium levels to make sure they aren’t too high. Most people are good under 1000mg and once you are on the supplement it's usually right where it needs to be.

The Other Steps to the Growth Strategy

R.O.W: Restrict, Observe, Work it back in. When we are trying to isolate a food intolerance, this is the approach we take. It's a temporary restriction, but by:

Withholding the food
Seeing how we feel
Bringing it back on the menu
Again seeing how we feel

And going off on off on, allows us to create the shifts and current where we can evaluate:

Is this one of your problems? Do you have an intolerance to this food? And no matter what the answer is, whether yes or no, you are empowering yourself with valuable and reliable information.
How much? In this process of restrict, observe, and working it back in, we figure out how much your threshold is. And once again, this is empowering information. It's not “I'm intolerant to dairy, it's I'm intolerant to milk and this is the amount I'm okay with and this is the amount that gives me trouble.”

Once you have this information you can move on to the next step:

T: Train your gut. Your gut is a muscle and it can be trained, made stronger, and fortified. But when you struggle with food intolerances we have to acknowledge this is indicative of a damaged gut. People don't get food intolerances when their gut is in a good place. The engine needs to be tuned up.

I would make an analogy to playing a sport that you love. Imagine that you twist your knee and in your recovery, I’m going to give you 2 choices. I want you to tell me what you're most comfortable with:

No pain in your knee but it requires you to stop walking. And as you stop walking, your muscles above the knee and below the knee will be weaker. You will be sedentary so it will affect your metabolism which means that there will be health issues that will show up pretty soon. This could lead to diabetes and heart disease because you aren’t moving anymore but you don't have any pain!
I get you hooked up with a great physical therapist. They are supportive and encouraging. They will work you through a process where you will progressively challenge your knee. With each challenge, your knee will get stronger and you will get to a point where the function is restored. As you are going through this you may experience some pain. But when you are on the other side not only is the pain is gone but you’re fully functional again.

This is why sometimes an intuitive approach can be the wrong approach for us. If the only thing that motivated us is the avoidance of pain then we would choose the first option. But there is more to healing a knee than the avoidance of pain. We have other goals we want to accomplish and the same is true with the gut. When you introduce these foods to an injured gut, they can give you pain. You can remove those foods permanently but your gut will grow weaker. And as a result of this, not only will you be less tolerant of these foods and find it more difficult to introduce them at a later date, you may find you have other gut health issues that pop up because it has become weaker.

But we can take these foods that cause you discomfort (not just tough it out) and challenge your gut with an appropriate amount of that food that doesn’t cause any symptoms. Then it grows stronger and we rechallenge you at a higher level next time. We keep repeating this process until you have fully restored function in your gut. And now you are consuming this food without restriction that you didn't think you could tolerate. That's training your gut. That's what I want people to do, start low, go slow, and rechallenge their gut.

H- Holistic healing. People need to realize that we are talking about a formulaic approach and H is the part to remind everyone that this is not just biochemistry, this is not just carbohydrates, proteins and fats contacting enzymes and then something happens. You are a complete person, you have a soul and spirit, you have people in your life, you have an environment in which you live and all of these different factors ultimately are imprinted in your gut microbiome and become a part of you. People that you spend time with, your sleep, your exercise, the environment in which you live, and even your emotional state. One of the things I've discovered is that there are people who do everything right and they don't understand why they still suffer.

We are going full circle on the growth strategy, you have to understand the root of the problem and if the root of the problem is that you have something unsettled emotionally like:

-Trauma (big or small)

-A breakup

-An unhealthy relationship with a parent or spouse

-A medical issue

And if it's unsettled, then what it does is it activates your sympathetic nervous system. Then there's something that happens psychologically that becomes out of your control. Your pituitary glands release hormones called CRH and this sets off a cascade of stress throughout the body. And ultimately if you zoom in on the gut you will see dysbiosis. And this is why many times, in times of stress, it manifests itself in our gut. But what happens if that stress is chronic, low grade, and 24 hours a day because something in your life is unsettled?

A Case Study About Stress

A patient of mine came in with uclutor colitis and had been suffering from chronic diarrhea. She's young and single and it’s disrupting her quality of life. I’m her GI doctor and I'm trying to do everything I can. And with complete humility, I'm failing. I was working on the diet, sleep, exercise, and right medication. This was going on for 2 years. One day recently she came into my clinic and I'm expecting that it was going to be frustrating and challenging for both of us but she looks different. She has a big smile on her face, she says her life has changed and she feels like herself again. I asked her what changed and she said “I realized that my job was holding me back. I would wake up every morning and fear having to go to work because when I got there my boss abused me and he would publicly embarrass me in front of my peers. And I finally got the gaul to walk away.” And she found a new job where they treat her with respect and all of a sudden this chronic, diarrhea causing, inflammatory medical condition that I could not fix, goes into remission and she gets back to having a normal life again. That's the power of holistic healing

Stress is such a big factor when it comes to gut health, we talked about this many times on this podcast but that just highlights it perfectly. You tried all these different scientifically based strategies and couldn't fix it but a simple thing like changing your job and getting yourself out of a stressful situation is the one step that needed to be addressed. -Kriben Govender

It’s easy for me to go bananas talking about nutrition because in my life it was nutrition that changed it. And most of us will at least acknowledge the sleep and the exercise but we’re far more complicated than that. People need to see these paths to healing so they can apply this to their own lives. I’m encouraging people, safely with the love and support of the people around them, to take a look in the mirror and ask the question, is there something holding me back? And if there is, with the right type of support including a health professional, you turn yourself towards it. You take on that challenge and you fix it. And it's amazing the healing that takes place after that.

The Importance of Fibre on The Immune System

We’ve seen how important fibre is during the pandemic. The data is continuing to emerge but we have quite powerful data already. Animal model studies were going back to 2018 where they would infect the mice with a respiratory virus (not Covid 19) and then put them on a high fibre or low-fibre diet. The scientists predicted that the mice would be sicker on a high-fibre diet because fibre is anti-inflammatory so it's going to reduce the immune system. But it had the opposite effect. The mice on the high fibre diet lived longer, they had improvements of lung function, and they recovered more quickly.

When they dug into this further, they found that fibre improves the gut microbiome. The gut microbiome releases short-chain fatty acids, and these acids have healing effects throughout the entire body. Including in the lungs where they help to shape the immune system. This means you get the right immune cells on the battlefield to get the virus taken care of and you simultaneously prevent the immune system from going nuclear. When a person lands in the ICU (with Covid 19 for example) and they require ventilator support to sustain their life, it's not a virus doing that. It's the result of the virus but it's ultimately the immune system overreacting. We call that a systemic inflammatory response. And that's the immune system going overboard.

In January of 2021, in the top gastroenterology journal in Europe called “Gut”, there was a paper that showed that when a person has Covid 19:

- There's a change to their gut microbiome

- There's an increase in inflammatory microbiota

- More importantly, there is a loss of the anti-inflammatory short chain fatty acid microbes

And as you racket up the intensity of Covid 19, the deficiency of these microbes becomes more pronounced. Those with the most severe disease have the biggest deficiencies in their microbiome.

There was a study of health care providers in 6 different countries looking at what diet they are eating and what their health outcome was when they contracted Covid 19 (this is predating the availability of a vaccine). What they discovered was:

- People who were eating a plant-based diet had a 73% reduction in their likelihood of having moderate to severe Covid 19

- People who were eating a pescetarian diet (plant based plus seafood or fish) had a 59% reduction in moderate to severe Covid 19

- And people who were on a low carb diet were 4x more likely than the people on the plant-based diet to get moderate to serve Covid 19

I'm not here with the intent of bashing a low-carb diet, there are ways in which it can be a great diet. But fibre is a carb and for the majority of us if we are cutting carbs we are cutting fiber. In the real world when people go low carb they are going low fiber. That is part of what we were seeing in this study was that it was a side effect of not eating fibre. But getting sick and landing in the hospital is not the only bad thing that can happen with Covid 19. People can develop long Covid, where the symptoms will persist for months. And the question has been what is going on and how can we protect ourselves? There was a study that showed if you looked at the gut microbiome of people with long covid, you’d see a loss of the short-chain fatty acids in the microbiome. And we don't have a study that says fibre is good to prevent long covid but I'm here to make a prediction that we will have that study next year. I expect that we will have a study where they will say “to reduce the risk of long covid you can reduce it by having a fiber-rich diet.”

Fermentation Nation Rising Synopsis

I think that one of the big messages in the gut health space is that fermented food is supposed to be a part of our diet. This was something that we observed among cultures around the world. If you look at every major culture and what their most celebrated foods are, it's usually a fermented food and an acquired taste. And part of that was by necessity because we didn't have sterilization or refrigeration.

But these microbes are everywhere. All living creatures on this planet have a microbiome, are part of the microbiome, or both. These microbes have always been there and they are powerful. Fermentation is setting up an ecosystem on your kitchen counter. You're allowing the right microbiomes to rise, flourish, and use their unique skills to transform your food. And nature is screaming at us, please do this. It’s so easy. If you want to make sauerkraut, all you have to do is chop up cabbage and submerge it in a brine. All the microbes you need to produce sauerkraut are already on the leaves of the cabbage, nature couldn't make it any easier. And all bread, unless it's unleveled, is all created with the help of baker's yeast. It’s so easy to create sourdough (you can use this kit here!) The grain is begging you to make bread.

There's a group of microbiome researchers at Stanford, Justin Sonnenburg, PhD and Erica Sonnenburg, PhD and Christopher Gardener who is a large-scale clinical nutrition expert. They did a study where they had people introduce fermented foods for 10 weeks. They had people introduce consistent consumption of fermented foods (a few bites) on a daily basis and in just 10 weeks they saw an improvement of their gut microbiome. There was increased diversity and inflammatory markers were reduced.

I like to say that fibre is important and the backbone of health is eating a diverse diet of plants. But don’t lose sight of the fermented foods, we have to make sure they are in there! Get the book here. This is a “choose your own adventure” toolkit for health! We should all care about good gut health even if you are healthy…you don’t want to wait until the bomb goes off. This is meant to empower people to find what works with them on an individual basis.

One Thing That You Can Do For Your Gut Health

One thing I would recommend is giving someone that you live with, a big hug. When we kiss, we share 100 million microbes and a recent study came out that found that people that live together share more microbes than they share with their own siblings. They discovered that it wasn't a food-related thing. And one of the most exciting and fascinating things is that they looked at the quality of your relationship with your spouse and the people who were optimistic and still very happy were sharing the most microbes together. But the people who were struggling in their relationships weren't sharing as much! So give a big hug and remember that gut health is not just about food but it's about feeling loved and supported and vice versa.

There is a lot that you can do to improve your health. You can add fermented foods into your diet, go on an elimination diet to get rid of your symptoms, add fibre into your diet slowly, and even eliminate low-grade stress. Make sure to share this with a friend that could benefit from this information.