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Dr. Paul Mason – ‘From fibre to the microbiome: low carb gut health’

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Okay. Thanks for having me here again. In this talk, I'll take you on a tour of bowel health and a low-carb diet. At the end of it, I hope I can convince you of a few things. First, fiber is not necessary for a healthy diet. Secondly, There are some foods low in carbohydrates that usually cause bloating and other symptoms, And we can define it, And improving bowel symptoms in a low-carb diet, Finally, I want to make it clear that now it is simply, There is not enough evidence that changing intestinal bacteria may cause weight loss. So let's start with the fibers. This is known as the carbohydrate portion of plant foods, Which we cannot digest And remember, fiber comes only from plant foods.

It can be divided into two types: We have soluble fibers and these can be fermented by bacteria in the colon, This produces gases and something called short chain fatty acids, Then we have insoluble fiber Which has greater resistance to cracking by bacteria in the intestine This is the type that increases stool volume. There are many benefits suggested by eating fiber. This includes preventing bowel cancer, preventing bowel obstruction, Help hemorrhoids, reduce blood sugar, And for sure, treat constipation. In fact, it is now a familiar wisdom Fiber is an essential component of a healthy diet. So.. Understandably, many of my patients are concerned about the potential effects of removal Cereals and breads with a high carbohydrate content from their diet. In the Australian diet, these foods make up 45% of the fiber that an average Australian individual consumes.

And when we look at the next government tip, They think fiber is the best treatment available for constipation and nothing to surpass it. But this opinion does not carry scientific scrutiny. Now, regarding a widely agreed claim you will believe that there is conclusive evidence to support it. Except that there is no. I couldn't find a single randomized controlled trial that explicitly looked into symptoms of constipation. Sure, there are experiences with size and transfer rate and other such things. But when we look at the symptoms of constipation, There is no research there. So, I'd like to show you the best experience I've ever had, This was the case study. In this study, 63 patients with constipation volunteered, These patients were compared a high-fiber diet and a low-fiber diet. It also included a fiber-free system that requires a full pause About all kinds of vegetables, grains, fruits, whole grains and rice.

This graphic here shows the rates of study participants before conducting the study They suffer from the symptoms shown on the right side. So you can see Before the study, everyone had constipation, They opened their intestine with pressure, and a number of them felt bloated, Bleeding, pain. And when the study participants followed a high-fiber diet, We can see that the number of symptoms and suffering increased. Especially bloating. And then we have the low-fiber system, What you see here is that people in the low-fiber diet actually showed a modest decrease in symptoms. So, the question is what happened, For those, The majority in the study followed a fiber-free diet This is not an error. I didn't forget to add something on that side. Now, not a single patient in the fiber-free system has any symptoms.

This is really amazing, These results were of high statistical significance. so far. It was not because of a random opportunity. Just out of concern, Each person in the diet group is free of fiber, He ended up getting one bowel activity per day. How do you compare this to a high fiber group? One bowel activity, at a rate of 6.83 days. Do you still think that fiber is good for constipation? Therefore, in order to understand why fiber reduces constipation, it gives such striking results Let's take a look at the diagnostic criteria that we use as doctors for diagnosing constipation, And you'll notice that each of these criteria relates to easy passage of stool Across the anal sphincter, which really makes sense. Now fiber, especially insoluble fiber The type you find in wheat bran has long been declared to have the ability to increase stool, To make it bigger, But when you think about this logically, Did he really make something bigger is the solution, When you try to pass it through a small hole? Filling the rectum with feces makes it really difficult to flush out fecal material, So using fibers to help grip is like adding more cars to fix traffic jams, But this is not the only argument.

People will say, "Well, it makes stools wet." Except that it does not. It has long been known It is well understood Stool humidity does not change, Regardless of how much fiber or how much water you consume. Fiber does not moisturize stool, Although not a technically diagnostic feature, constipation, Bloating is a known problem Many people realize that it is related to excessive fiber consumption The reason for this is that it is not digested in the small intestine, Remember to define fibers They cannot be digested So it travels to the large intestine, which has a large number of bacteria, These bacteria can then ferment the fibers, Especially soluble fiber It produces something called short chain fatty acids, Which is known to be one of the things that provides health benefits, But in the meantime, bacteria produce gas, too. Like hydrogen given that the size of the entire digestive system is only about one liter It takes only a relatively modest amount of gas production before you start to feel bloated, And it starts to get a bit of abdominal pain, And any person who lived during the eighties Does anyone remember the bran frenzy? Perhaps you can bear witness to that.

Well what we have left is: When we look at the best evidence they have, Fiber makes constipation worse Causes bloating and do absolutely nothing to moisturize our droppings. So how does this relate to low-carb diets? Well, there are a lot of foods that are low in carbohydrates and are high in fiber. So even though 45% of the fiber in the average Australian diet comes from bread and cereals, Many foods that we replace when we follow a diet low in carbohydrates are rich in fiber And some of the food we love Like broccoli and almond berries.

They are in this fiber rich group And if you understand that when the colon is metabolized by bacteria, They can produce gas and bloating, You can understand why if you have a whole bag of nuts, You may feel a degree of discomfort there. So some of you might look at this trend: "Do you know what? I ate a large plate of mashed cauliflower yesterday and felt a little funny overnight. " Let's turn our attention to something called short chain fatty acids. So you will remember That once the fibers have been fermented by bacteria, It produces these fatty acids, It is believed to offer some health benefits. So these bacteria allow the body to save energy from an unusable source, It is provided in the form of fat, Estimates vary widely, But usually about 5% of the energy That we actually get from our diet, when we're eating an average diet, It actually comes from these short chain fatty acids that are produced from fibers, These short chain fatty acids are said to nourish the cells that line our colon Which are called colonial cells, This is thought to help improve conditions like IBD, And although true, this is an illustration of some of the cells that line the colon, While these cells can use short-chain fatty acids for energy, They just do it After converting it into ketones first.

If ketones are produced from short chain fatty acids This is useful, It makes no sense, then, that ketones are In the blood circulation in the case of nutritional ketosis, Or in the keto system can be beneficial to these cells for their ability to reach them In fact, the ketones in the circulatory system may be more effective Because it can be attached to every colonial cell, And not just those they are in direct contact with, This is already demonstrated in studies comparing enemas That contain chained fatty acids, And the ketones given in the circulatory system, It was found that the ketones given in the blood circulation More effective in treating IBD, Which may mean that short chain fatty acids are not magic at all, Even if it is, fiber is not the only source of short chain fatty acids from intestinal bacteria.

This is a graph and shows the production of a short chain of fatty acids Between a vegetarian diet, with lots of fiber, and an animal-based diet, with lots of amino acids. Here in red, you can see that the production of short chain fatty acids is really higher in an animal-based diet Compared to the vegan diet. So there seems to be nothing uniquely useful Absolutely produced from short-chain fatty acids. So let's turn our attention to one of the supposed benefits of fiber in the diet, Which enables you to control your blood sugar levels, And when you take it in isolation, that's really true So this graph compares blood sugar levels between The diet recommended by the American Diabetes Association, Yes, with all this high blood sugar, Diabetes Association recommended a diet And below that, a diet rich in fiber. So you can actually see a diet rich in fiber It actually relieves insulin spurts somewhat.

But the point that needs to be clarified is That if you don't eat all the carbs in the first place, You will not have to worry about controlling fiber sugars Even with fiber, if we convert it to units, the blood sugar level still exceeds 10, In addition, if the diet recommended by diabetics had control of blood sugar level like that Maybe you started looking for another job Let's take a look at this graph. This study was also published in the American Diabetes Association, On top, you can see a sugar control diet that contains large spikes in blood sugar level, And at the bottom you can see that the height looks a lot better, And you know, much better than the diet you just saw with extra fiber added to it.

Now the diet below is called a low-sac diet, This means a biologically available low glucose diet. I think he can't use the term "low carb" in the diabetes journal, huh? Now for final thinking about whether fiber is an essential part of a healthy diet, Let's just look at the herbivore intestines that have a really large ascending colon Where the fermentation of fibers occurs, and compared with human intestine. Clearly, you can see our digestive system It is not prepared to metabolize or treat fibers the way herbivores are. So , Now I'd like to move on to the next section of the presentation, And look at something else that could cause stomach problems on a low-carb diet, This is something called FODMAPs. So FODMAPs, again carbohydrates, are a group of short-chain carbohydrates With some common features.

First, they are poorly absorbed in the intestine Because of this they go down to the colon where possible Fermented by bacteria, causing gas again. The same way it occurs with soluble fibers Also (the problem with this) the FODMAPs are: Carbohydrates attract fluid due to the high level of osmotic activity Which can lead to watery stools, Each of these symptoms is seen in a condition we call Irritable Bowel Syndrome (IBS), Likewise, (besides) it causes this stool FODMAPs can also cause constipation, something else seen in IBS, And the way to do that, when the bacteria metabolize them, They produce methane, and methane has already been shown to cause constipation And when people with this irritable bowel syndrome, in many different studies, When they are put on a low diet in these FODMAPs, About three-quarters of them receive major improvements I would like to clarify this point with a very interesting study published earlier this year, There is a condition called a gluten-free indigestion These patients develop bowel symptoms when they eat gluten-containing foods But when we test them for celiac disease, everything looks normal. Now the thing to understand is that foods that contain gluten, It also contains something called fractals, This is one of FODMAPs.

This study was conducted in patients who do not have digestive disorders but who are sensitive to gluten. And I gave them specially made pieces Some of them contained scrub, others contain gluten and some did not contain any of the above And what you can see on the right Their symptoms were much worse when they were given fractants compared to gluten. So it seems that the diagnosis of gluten sensitivity without digestive disorders is actually a problem with FODMAPs. How does this relate to a low-carb diet? Because we don’t tend to eat much wheat, do we? True, but FODMAPs are found in a number of other foods that we find some of in low-carb diets. Unfortunately, this includes cauliflower. Again, one of the nutrients that we saw was rich in fiber. So, if you've ever wondered why you're feeling bloated Or constipation after mashed cauliflower, You may have found the answer.

Now let's take a look at P at FODMAPs This refers to Polyols Which represent the artificial sweeteners called sugar alcohol. It basically provides a calorie-free sweetness, Polyols are widely used in many bars and low-carb sweets. The problem is that it is poorly absorbed, as it attracts water and produces gas It gives you light stools Many people on a low-carb diet have suffered from diarrhea as a result To eat one of the many Atkins bar. Now I would like to touch on what we call microbiome. Now this reflects the colonies of bacteria or microbes that exist within the human body. But we will especially focus on those in the colon, in the large intestine. It has often been said that we have ten times more bacteria than human cells. This is an exaggeration, when we actually look at science, They are 1.3 to 1 in number, but not 10 times. So, we'll focus on the microbes below this arrow here The question that I specifically want to ask is Do these bacteria make us fat? Because that's what we've heard so much recently. Now we have more than a thousand different types of bacteria Inside our intestine, but 90% of it comes from One of two major groups: (firmicutes phyla) or (bacteroidetes) In a number of studies, phyla firmicutes have actually been associated with obesity, While bacteroidetes have been linked to weight loss And the graph here shows how when you lose weight, The bacteroidetes increase But the thing to understand about bacteria is that They have very specific conditions for their growth.

Some prefer oxygen, others do not. Some people like fibers, others don't, etc. And bacteria, if you like the conditions that you give, If she loves the nutrition she provides, she will multiply. So by simply providing a different source of nutrition, We can change bacterial colonies in our gut. These changes happen quickly. Within one day It has been documented that you can get major changes in bacteria inside your gut. But the big question is: Can we deliberately change the balance of bacteria to lose weight? The main point here is that phyla bacteroidetes, associated with weight loss, It also happens that they are associated with high-fat ketogenic diets. This was found in children's studies following this type of diet When their epilepsy was being treated.

So it became the state of the chicken or the egg. Is it a change in the number of bacteria? Or a change in diet that leads to weight loss? So in 2006, this famous paper published that showed that microorganisms are associated with obesity It can make mice fat. They had some germ-free mice, And they gave these germ-free mice some bacteria from some fat mice And from some slender mice, And they actually found that bacteria are fat mice Germ-free mice made fat This is why this graph illustrates Short chain fatty acids production Comparing the two groups What you can see is that obesity bacteria increased the energy yield By producing more short chain fatty acids. But this does not mean that you can simply plant bacteria in our colonies for weight loss.

First, the bacteria were transplanted into germ-free mice. There was no competition from other bacteria. It is very unlikely that if you culture bacteria in the intestines of an existing colony, It will give you the same results Second, the extra energy is derived from fiber. So if you are on a low-fiber diet, There will be no results And the fact that there are short chain fatty acids that are then converted into ketones, It is, as we know, an appetite suppressant In fact, it means when we are not following a calorie diet When we're not just in a cage with a limited amount of food Our optional diet becomes important. So the ketones that are produced are short chain fatty acids It may have an appetizing effect, It is expected that the mice will eat less. Therefore, it is not clear that we can simply change intestinal bacteria for weight loss. It seems even further Changing diet allows losing weight, This is linked to a change in the gut bacteria, not the cause. It is an ancient mystery. Is it causal or is it a relationship? So, as a final clarification that what we eat It affects the intestinal bacteria, not always in a good way.

Let's take a look at this study Trhalose is sugar consisting of two molecules of glucose. But it is fairly modern and it is contained in our food supplies. It was only approved for use in Australia in 2003 This was after some Japanese scientists discovered a way to reproduce it in large quantities in about 2000. It was not so sweet But it is very effective in reducing the degree of freezing of food. Because of this it is used in a lot of things like ice cream. The problem now is That there are harmful bacteria called hard clostridium that are very fond of thalalose sugar. Increased consumption since the first decade of the second millennium is linked An increased serious condition called pseudomembranous colitis Associated with this article So what we eat changes the intestinal bacteria. In conclusion, I would like to leave you with three main messages: Fiber is not a necessity for a healthy diet.

Second, even with a low-carb diet, some foods have high levels of fiber Or FODMAPs that can cause stomach upset, You should be aware of this. Finally, the whole concept of changing our microbiome to lose weight It is a bridge too far from the current understanding of science. Thank you .

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