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The centrality of gut health in overall health cannot be overstated, and for many years researchers and practitioners have encouraged probiotic use to promote gut health. But their recommendations have been based on early and inchoate research.
Today, several decades after the emergence of gut health as the ground zero of overall health, science has been able to correlate specific bacterial strains with specific health outcomes—and one man has spent years anthologizing all that research and making it available to practitioners and patients.
Dr. Jason Hawrelak is a scientist, educator, and naturopathic physician. He’s one of the leading experts in microbiota manipulation and the use of specific strains for specific conditions. He is also the creator of probioticsadvisor.com, where practitioners and patients can access information about specific bacterial strains.
In this podcast, you’ll hear:
- How specific bacteria strains correlate with specific physiological actions in the body
- How lower doses of the correct strain can have potent therapeutic effects
- How to do pinpoint prescribing with probiotics
- About the availability of specific strains based on worldwide location
- About the dearth of scientific evidence in support of spore-forming strains
- About misinformation propagated by probiotic companies to sell more of specific strains
- About DNA testing of the microbiome vs. culturing
- About the best and most affordable tests for assessing the microbial profile of the gut
- How to restore bacterial colonies that fall below detectable levels in the gut
- The importance of prebiotics
- How to use targeted prebiotics for specific conditions
- Which strains promote gut integrity and help guard against intestinal permeability
Considered one of the leading experts in the treatment of gastrointestinal conditions with natural medicines, Dr. Hawrelak’s passion for gastrointestinal health, the gut microbiome, and probiotics was ignited during the final year of his naturopathic training.
Subsequently, Dr. Hawrelak did his Honours and Ph.D. degrees in the areas of the gastrointestinal microbiota and the causes of dysbiosis, with a particular focus on microbiota manipulation using herbal medicines, prebiotics, and probiotics. He has written extensively in the medical literature on these topics – including 16 textbook chapters – and has taught health professionals at both the undergraduate and postgraduate level for the past 18 years.
He is Chief Research Officer at ProbioticAdvisor.com, which offers a searchable database that enables easy, evidence-based prescribing of probiotic products and online resources for clinicians, and health-conscious members of the public, to learn more about the human microbiome and how they can positively influence these ecosystems.
Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine and today is no exception. You know, how often do you get to talk to somebody who’s really dedicated their career to the study of probiotics? I was thrilled to discover this person’s website. It is probioticadvisor.com. You might be familiar with him and when I learned about his resource I, we started to track him down to bring him onto the podcast.
Let me give you his background. His name is Dr. Jason Hawrelak. He is a scientist, an educator, he’s a naturopathic physician and he’s got more than 18 years’ clinical experience. He is one of the leading experts in the treatment of gastrointestinal conditions with natural medicines. Dr. Hawrelak’s passion for GI health, the microbiome and probiotics was ignited during his final year of naturopathic training. Subsequently he went on to do Honors and PHD degrees in the areas of the gastrointestinal microbiota and the causes of dysbiosis with a particular focus on microbiota manipulation using herbal medicines, prebiotics and probiotics. We’re going to be talking about that in this entire hour and I hope I am able to grab the questions that you might have.
He’s written extensively in the medical literature on these topics, including 16 textbook chapters and has taught health professionals at both the undergraduate and postgraduate level for the past 18 years. He’s Chief Research Officer at probioticadvisor.com], which offers a searchable database that enables easy, evidence-based prescribing of probiotic products and online resources for clinicians and health-conscious members of the public to learn more about the human microbiome and how they can positively influence these eco-systems.
Dr. Hawrelak, welcome to New Frontiers.
Dr. Jason Hawrelak: Thank you. It’s a pleasure to be here and chat to someone else who has a passion about gut bacteria. And health, as well.
Dr. Kara Fitzgerald: Yeah, absolutely, yeah absolutely, everybody listening to this podcast also has, is excited that you’re here. Okay. Probioticadvisor.com, folks, if you haven’t been there, go there. It’s a really amazing, very evidence-based resource. All things probiotics. Just give me a thumbnail on what that is because I want to pick your brain and jump into specifics, but tell me about this resource.
Dr. Jason Hawrelak: Okay. Well the probioticadvisor.com database essentially evolved out of paper documents that I started creating from essentially 2000, 2001 onwards when I started teaching naturopathic students about probiotics and at that point in time there wasn’t a huge amount of research out there so it could actually be summed up on a few documents. I’d have one document on what this study found with this particular strain, and another document, one page, saying where I could find that strain in supplement form. And then over subsequent years, as the research exploded all of a sudden there was 20 pages, 30 pages and both documents were huge and I thought this is unwieldy. Let’s see if we can put this together into a searchable database which is better for all and much easier to just add new bits and pieces in.
And who would have known at the time that the probiotic research would explode the way that it had? Certainly I didn’t guess that back in 2000 when I started my probiotic in-depth journey. But we had created a database where you could look at the research evidence on particular strains and where to find those particular strains. And it also means that you can just go into a health food shop or if a patient comes in and goes, “Hey, I’m taking this probiotic,” I’ve never heard of that one, you can just type it in and it’ll show up and go okay what strains are in it and what research has been done on those strains so you can see whether its worthwhile that patient taking that product or not.
Dr. Kara Fitzgerald: Yes. Absolutely. Thank you. And if you’re wondering about Jason’s accent, he is in Australia, it’s his, the sun is rising. Actually, you said it was dark and the sun is setting over here in Connecticut.
Dr. Jason Hawrelak: It’s still dark, yes.
Dr. Kara Fitzgerald: He’s in Australia via Canada. So you’ll pick up both. Listen, since you talked about actually starting to curate this database in 2000, I, the first thought that popped into my mind was the analytical methods have changed remarkably from when you first started gathering your data. So, culture was de rigeur, I think, back then.
Dr. Jason Hawrelak: Yeah, it was.
Dr. Kara Fitzgerald: Right now, we have newer technologies, you know, PCR and beyond. Any comments on that? Like how reliable the early data are and do you continue to incorporate those early studies in your thinking?
Dr. Jason Hawrelak: Yeah, good questions. I mean, I think around therapeutic efficacy of specific probiotic strands for health conditions, yes. I think the early data. Because we’re often using subjective markers of change of how people feel or sometimes instruments that are still used today in terms of quality of life changes or changes in specific parameters. So that’s, yes.
What I think has really shifted is our thinking around the microbiota or microbiome. Research that was done in the ’80s and ’90s showing how probiotics potentially impacted the gut ecosystem, well, that’s a bit different because we could show, we could only see a small amount of what was going on. So that bit that we saw wasn’t incorrect and now if we gave a probiotic strand to increase your levels of Bifidobacterium then yes, we can take that. But we just have no idea what it was doing beyond that because using culturing we can only pick up a small percentage of the species that are actually present in one’s gut. And some research has estimated that in some people, 90% of the species can’t be grown and cultured. Obviously if we’re relying on those older tools we could not see very well what was going on. So I think that data, yeah, is certainly limited but in terms of therapeutic effectiveness? I think it’s a different story.
Dr. Kara Fitzgerald: Good. Okay. Good, that actually makes a lot of sense. Alright. You have this probiotic prescribing paradigm. What is it?
Dr. Jason Hawrelak: I think that really grew out of that early research and my naturopathic studies as well. They certainly cover probiotics but it was really the opportunity I had when I did my Honors and PhD of spending, it was probably five, five and a half years of my full-time work was reading probiotic studies and designing research studies. It was great. It was a privilege to have that time. I worked part-time as a clinician on the side on the weekends, but I essentially spent the rest of the time just delving into probiotic research.
And what became clear was this idea of probiotic strains which wasn’t really taught to me at all in my naturopathic studies at that time point. And it was really pretty mind blowing that actually it’s just not Lacto-rhamnosus, there’s actually hundreds of strains and just a few genes turned off or on made a big difference in terms of therapeutic effectiveness, potentially, and what actions they were actually able to exhibit. I think that was what really started me on that, that I, of moving down that pathway and also just because of the broadening of research and I think before we just gave probiotics, okay, give it for dysbiosis. For dysbiosis and it’s like, “Oh, actually”…
Dr. Kara Fitzgerald: Very general.
Dr. Jason Hawrelak: Yeah. Exactly. And it’s like, no, some actually work to decrease blood pressure. Some decrease high cholesterol. Some alter brain neurochemistry. Some slow down gut transit time. Some speed up gut transit time. Some strains are effective against H. pylori, others are effective against the prevention of SIBO. And you can’t expect one strain to do all those different tasks. And it’s like they have, just like, I think the paradigm that I’ve come to really is using probiotic strains as I would herbal medicines or pharmaceuticals. It’s that, it has a specific action, and when you want that action you prescribe that agent. And I think the strains that are useful for high blood pressure are probably the best case in point. That … there’s a particular strain available in Europe that produces an ACE inhibitor. So when people take this strain or drink a fermented milk made from this strain, it lowers their blood pressure.
Dr. Kara Fitzgerald: And this strain is?
Dr. Jason Hawrelak: This one I don’t know on the top of my head. Because it’s not commercially available in my part of the world, I haven’t memorized that one.
Dr. Kara Fitzgerald: Oh, you haven’t?
Dr. Jason Hawrelak: No.
Dr. Kara Fitzgerald: Okay, well, listen, we’re going to circle back to you and you can look it up and we’ll just print it in the show notes because I know people will be wondering if that’s okay.
Dr. Jason Hawrelak: Yeah, that’s certainly do-able. But it just…
Dr. Kara Fitzgerald: Even though we probably can’t get it here, I’m assuming is the problem.
Dr. Jason Hawrelak: No. I think that’s the thing too. It’s not available in Canada, the U.S., or Australia so those ones I tend to just file in a different part of my brain that they’re interesting but I can’t clinically use them so there’s no point trying to remember that detail. Yeah. But I think it’s a clear case point here because as long as you drink that product or consume that probiotic your blood pressure will be lowered. But when you cease drinking it or eating it your blood pressure will go back up. So it’s…
Dr. Kara Fitzgerald: Fascinating.
Dr. Jason Hawrelak: … very much, just like we use, I use a herb called Rosella for decreasing blood pressure. It doesn’t treat the cause, which might be the fact they’re obese and don’t exercise and eat rubbish, but it’ll decrease their blood pressure that whole time. But as soon as they stop, blood pressure will go back up because we haven’t treated the cause. And I think that’s similar with the way we should be using probiotics. And what the research has really shown is that for the most part it’s matching the strain to the action and that they have to the disease state we’re trying to treat.
Dr. Kara Fitzgerald: And is this a tool that’s available at probioticadvisor.com? I mean, how do you … I mean, it’s a lot of research if a clinician is tasked with having to do a drill down and pull out either a strain or a collection of strains that they want to prescribe for a certain condition. I mean, that’s a big-
Dr. Jason Hawrelak: Yes. That’s huge.
Dr. Kara Fitzgerald: Yes. So-
Dr. Jason Hawrelak: The idea of the probioticadvisor is trying to make that process easier, because I’m a clinician too and I know how much time it takes just to prepare, read your patient file notes, you know, what they’re, what’s going on when you see them. Let alone all the background stuff that goes after that point in time in terms of going in depth. So any tools that speed up that process of finding the right therapy tool for this patient, or therapeutic intervention for this patient are very welcome. And it’s been designed in that way so you can type in different disease conditions and, boom, it’ll tell you what strains have been shown to work and conversely what strains have been shown not to work. And that’s good to know too because sometimes there’ll be strains that actually have been clinically trialed and found to be useless. So that’s obviously going to waste your patient’s time. Or there’s going to be other products on the market that have never been trialed, so we don’t know whether they’d be useful for this condition or not. Which, for me, I would seldom use them either. I would tend to use the ones that actually work for this condition.
And this is what, I think, has been fascinating to see grow over this 18 years of when I first started that back in the early days you would be experimenting more on patients because you … There was so little research done on specific probiotics for specific conditions that a lot of it was just making sure that probiotics had the right characteristics to enable them to have therapeutic effects, i.e. survive gastric acid tolerant, survive bio-salt tolerant. Those sort of basic characteristics that we look for and go, “Okay, that means at least it might do something. Let’s trial it on patients and see.” Whereas what’s grown from that over the years is now we actually know for a lot of conditions, not all, some strains that we can, that have been shown to work. And that’s where I would start from.
And does that strain that’s been well researched always work for every patient with that condition? No. Does anything? No. But it’s a great starting point. And it often works. And then for those it doesn’t we can try being a bit more experimental with other probiotics that have similar actions but might come in via a slightly different mechanism.
Dr. Kara Fitzgerald: Well, I’ll tell you what, you’ve just given me a lot of questions. And I want, so I want to ask you about mechanisms specifically. I mean, clearly what you’re saying, you’re prescribing the probiotic protocol to achieve in, it sounds like many cases, an extra intestinal outcome. And we know now, even clinicians in the trenches who don’t have their head in the research, that clearly manipulating the microbiome is going to have profound, system-wide changes. Talk about that. In the case of, well, you were talking about this one strain in Europe that we can’t access here that actually produces an ACE inhibitor-like compound. Give me, can you talk to me about some other examples, like leaning on … are you leaning on that specific strain to produce a compound that’s going to then exert an extra intestinal effect? Or, and or-
Dr. Jason Hawrelak: Often we are. Yeah.
Dr. Kara Fitzgerald: You are. Okay. Well give me another example.
Dr. Jason Hawrelak: Well, we could look at, okay, a very interesting study that I just came across. It was published early 2018. And that’s using the DSM 17938 strain of Lactose reuteri which is the BioGaia strain, for the prevention of SIBO development in people taking PPIs. So very interesting approach.
Dr. Kara Fitzgerald: That’s great.
Dr. Jason Hawrelak: So they had people taking PPIs for just 12 weeks and they gave them either a placebo or they gave them five drops per day of the BioGaia preparation. And at the end of the 12 weeks they did a breath test and they worked out did it help prevent the development of SIBO or not? And it turns out it did. That 56% of people in the placebo group developed SIBO after 12 weeks on a PPI. Which is actually pretty mind blowing, because how many patients out there are taking PPIs for longer than that time period? Versus 6% in the probiotic group. So 6% developed SIBO.
Dr. Jason Hawrelak: And in this case the probable mechanism is the production of a compound called reuterin and reuterin is a bacteriocin produced by some strains of Lactose reuteri, including this specific strain. And reuterin is an antimicrobial compound active against E. coli, Streptococci, Staphylococci, Bacteroides, Enterococcus, so microbes that are commonly found in the small bowel of people with SIBO. So that’s the probable mechanism by which it actually works. In that case it’s the release of that compound as it’s traversing through.
Dr. Kara Fitzgerald: And that’s a really micro, that’s a micro amount. Three drops.
Dr. Jason Hawrelak: It was five drops. Yeah, it is.
Dr. Kara Fitzgerald: Excuse me, five drops.
Dr. Jason Hawrelak: Totally is.
Dr. Kara Fitzgerald: What’s the, how many colony forming units in that? There’s not a heck of a lot.
Dr. Jason Hawrelak: No. 100 million. 100 million CFU.
Dr. Kara Fitzgerald: 100 million. Oh, okay. Okay. So that’s, that is pretty robust. I’ve used that. I’ve actually used it quite a bit, I just don’t, I just didn’t remember how many CFUs there were per…
Dr. Jason Hawrelak: …compared to other products it’s extremely low. You’re right. because with the…
Dr. Kara Fitzgerald: Oh, wait, did you say 100 million or 100 billion?
Dr. Jason Hawrelak: 100 million.
Dr. Kara Fitzgerald: Oh, 100 million.
Dr. Jason Hawrelak: Yeah, It’s very different from…
Dr. Kara Fitzgerald: Okay, yeah that’s micro.
Dr. Jason Hawrelak: Yeah, exactly. It’s like matching the right strain that has the actions and attributes that we’re after to the condition that we’re trying to treat or prevent in this case. Fascinating.
Dr. Kara Fitzgerald: God, isn’t that fascinating? Fascinating. Okay, why don’t you … geez, where am I going to go with this now? Talk to me more about, I know you’re looking, give me some more examples of these strain specificity of probiotics.
Dr. Jason Hawrelak: Okay. There’s certainly … Lactobacillus Rhamnosus GG, which is found in the U.S. as Culturelle and in the rest of the world the market is more broad, there’s a lot of practitioner companies with LGG in it. And even some food sources. Like, here in Australia it’s been found in a yogurt even before it was found in a dietary supplement form. This particular strain is useful, we’ve got meta-analysis level data now so a number of clinical trials showing that it shortens the durations of viral gastroenteritis. Shortens it by, in some research, by two days. And that’s two days of less vomiting and diarrhea, big thumbs up from me because I’ve had kids, you know? Even four hours less of vomiting and diarrhea is a good outcome, let alone one to two days.
And we now know from more recent research, we knew it worked, but the mechanism is that LGG tends to bind to the rotavirus and prevent rotavirus from actually attaching on to your gut cells and causing damage. And it also regulates the production of Secretory IgA. And other strains of rhamnosus. In fact, there was one comparative study comparing the GG strain to another one, available in another product called Lactophilus and only the GG strain actually reduced the duration of the diarrhea and only the GG strain actually upped Secretory IgA production. So we know it’s working by two different mechanisms in that case.
Dr. Kara Fitzgerald: And you have to go to strain specificity? You can’t stop at species? In your…
Dr. Jason Hawrelak: No. because that, exactly. Because you start delving into the research around that, and there’s a tremendous amount of data. And transponder research teams out there isolating out unique strains, they wouldn’t bother doing this if there was no purpose to it, you know?
Dr. Kara Fitzgerald: Right, right.
Dr. Jason Hawrelak: You find the study where they were looking at, it’s got 90 different strains of Lactobacillus fermentum. And then they go, “We want to develop a potentially new probiotic.” So we put them through our probiotic obstacle course, which would be, does it tolerate gastric acid? Does it tolerate bile salts? Does it attach to the mucosa? And out of that 90 strains I think there was 4% that actually did tolerate bile and gastric acid. That’s it. 4% of those did. And then they take those 4% and then they expose them to other obstacles, I suppose. Do they interact with the immune system and in what way? Do they produce compounds that kill off other beneficial microbes or actually kill off pathogens et cetera. And then the research sort of grows from there.
There are a lot of research teams out there trying to isolate those strains. And they wouldn’t bother if they all did the same thing within the same species and there’s clear evidence that that’s not the case. It’s just a matter of a few genes being turned on or off that can dictate whether something works or not. And then that’s clearly the case with Lactobacillus reuteri as well, that the DSM 17938 produces reuterin and there’s other, there’s research showing that other strains do not and certainly not to a significant amount. And if that’s the mechanism by which that strain works, then obviously the other ones aren’t going to work for that scenario.
They might have other traits in common like the ability to produce lactic acid, which is in a pretty broad spread across Lactobacilli, and if that’s the action you’re relying on then it doesn’t really matter which strain you give. But if you’re after a more specific mechanism by which it’s working, and I think in most cases we are, there are exceptions to that but I think in most cases we are, then we really want to make sure that they display that action that we’re after.
Dr. Kara Fitzgerald: You know, I just wanted to point out that Lactobacillus Rhamnosus GG, you know, as in Culturelle is again not a megadose.
Dr. Jason Hawrelak: No, you’re right. And most of the research has used between 1 and 10 billion CFU per day. Consistently over the last 20 years and it works at that dose so I think that. And the example of the studies using the BioGaia strain where most of the research has used 100 million CFU per dose, or per day, or 200 million. Much lower dose, again a step down with very good clinical trial outcomes. I think it’s the right dose of the right strain. And certainly I think there is evidence for dose-dependent effects in many cases.
So we can look at another strain, the HN019 strain of Bifidobacterium lactis which speeds up colon transit time. We use it, I use it all the time for my constipation patients or C-IBS patients or methane SIBO patients. And the research showed that there, yes, there was effect of speeding up gut transit time and I think it went from, I might be a little bit off with my hours here but 45 hours down to 22 hours after two weeks of use. So mouth to toilet bowl. And there was some effect at 1 billion but there was a quicker effect at 15 billion.
Dr. Kara Fitzgerald: Okay. 1 billion for…
Dr. Jason Hawrelak: So yes, for some attributes there’s certainly a dose response. And one would expect it to be the case even with the L-reuteri BioGaia strain that a higher dose would have a stronger antibacterial effect because you’re having more of that strain coming through but it’s still fascinating that such a low dose can have such a potent therapeutic effect.
Dr. Kara Fitzgerald: And say that species and strain you were just talking about, say it again.
Dr. Jason Hawrelak: Bifidobacterium lactis HN019.
Dr. Kara Fitzgerald: HN019. Okay. Perfect. What, do you know off the top of your head, the product that one might have to procure in the States? For that specific…
Dr. Jason Hawrelak: That one, it’s found in Xymogen ProbioMax.
Dr. Kara Fitzgerald: Is it? Okay. Alright. That’s really interesting. Let me just ask you now about soil, bacteria, spore formers et cetera. They’re popular here in the States and what is your thinking around them and what is your clinical experience? What do you see in the literature?
Dr. Jason Hawrelak: Yeah. Well, I think it’s almost, there’s a dearth of information in the literature, which is always where I go to first and this is the thing that probably has precluded me from experimenting widely with them. With the odd exception of, like there’s the Italian product Enterogermina, that has a robust evidence-based, which again I don’t have access to here. That I would use, if I could use it, but I don’t have access too easily. It’s a dearth of evidence that has been more problematic.
So there’s been a lot of claims made by the people who sell it about the therapeutic effectiveness and sadly it’s all based on theoretical concerns. And sometimes, frankly, misinformation about other probiotic products where they’ll try to go, “Oh, these ones never survive gastric acid, these ones don’t survive bile, therefore it’s a waste of your money. Use ours, because they do.” And it’s like, oh, that’s a gross misrepresentation of data because there’s lots, there’s hundreds of clinical trials showing these ones work that are Lactobacilli and Bifidobacteria based. Hundreds of clinical trials showing that they work. So you’re … yeah. You’re trying to put misinformation out there to sell products, which I do find challenging.
But the body of evidence is growing that I’ve seen some recent research on some of those, the spore-forming probiotics that are actually, they are doing clinical trials. I think in the next few years when those results get published we’ll get a better chance of seeing what they’re good for, because I think just because something’s found in dirt doesn’t necessarily tell you what it’s useful for, you know?
Dr. Kara Fitzgerald: Right.
Dr. Jason Hawrelak: Clear example here is Saccharomyces cerevisiae variety boulardii that was isolated from the skin of lychees. Does it mean that every other microbe on the skin of lychees is going to have the same therapeutic effectiveness as that one? Of course not. It’s just that that happened to be the unique, where they isolated that and has a whole range of actions, that’s what we, that sort of main S. boulardia that people talk about was isolated from the skin of lychees by Henri Boulard, a microbiologist. And we can’t make those generalizations about where they’re found. Just like we can’t say, okay, because Lactobacillus Rhamnosus GG was found in a gut, some Swedish person’s gut, that every other bacteria in that gut’s going to have the same attributes as that and it’s going to be as equally as therapeutically effective.
I think there’s some, again, sort of misrepresentations out there that surrounds that whole area. I haven’t used them much in practice because of that sort of lack of data. And I’m not anti-them. Once there’s good data there showing that they’re safe and effective I will wholeheartedly use them in my practice. But I just think that data set is building up for most of those products. There’s a few like the Bacillus Coagulans GBI, this one’s weird code, 6086, I might have got that a little bit wrong, that has some good data for immune system function. Functionality for improving immune system function and diarrhea prominent in IBS, and more broadly IBS, so yes, I have used that one in practice too. But I think the other ones were, we’re awaiting more research to come and it’s somewhere where the hype was there first before the research was there. And I think that’s a bit problematic.
Dr. Kara Fitzgerald: Yeah, I got it, okay, so you’re just waiting for the science to catch up. I think that’s entirely respectable. The probiotic product that you did mention with some decent research on it, where can we source that in the States? Do you have any idea?
Dr. Jason Hawrelak: Enterogermina? Nowhere. I think it’s an Italian product and from my understanding they haven’t…
Dr. Kara Fitzgerald: They’re not shifting it, okay.
Dr. Jason Hawrelak: … released that product into the U.S. market. Yes.
Dr. Kara Fitzgerald: Listen, let me just ask you, this is kind of my Hail Mary pass, I guess, I don’t know if I’m using … that’s a football term, I don’t know if I’m using it right. But I remember I treated a patient in my practice a while ago who had trimethylaminuria. So she had an accumulation of trimethylamine and she wasn’t able to metabolize it out. Now as you know, trimethylamine oxide, there’s been a lot, a flurry of research around it in relation to cardiovascular disease. And they were in Australia, somebody was working on a probiotic that actually consumes, that uses trimethylamine as a substrate. Any … are you … do you have your finger on that? Are you aware of that?
Dr. Jason Hawrelak: No.
Dr. Kara Fitzgerald: Okay. So maybe it didn’t work and it just sunk.
Dr. Jason Hawrelak: Or it’s in the process of publication…
Dr. Kara Fitzgerald: …still being, yeah.
Dr. Jason Hawrelak: …because sometimes when they go through the, use the term proper scientific channels, it takes years.
Dr. Kara Fitzgerald: Yeah, it’s slow, yeah.
Dr. Jason Hawrelak: And you can look at two probiotic strains, the GR-1 strain of Lactobacillus Rhemnosus and the RC-14 strain of Lactobacillus fermentum that essentially had probably 15 years-plus of research on them before they were commercially available. And this drove me mad as a clinician and as a researcher because I could read the research, talking about, and these ones are used for bacterial vaginosis and vaginal candidiasis so it’s very much a uro-vaginal attributes of these particular strains. And that’s why they were selected. But it was frustrating because I could see the research and I was like, “Damn, when are these things going to come out?” But then after 15 years, they did. It’s just that, but we clearly know what they’re good for. That’s why. because there’s been a good body of research that’s been set up. But it can be frustrating if the initial data is coming from more conservative scientists then it’s probably a slow process from the, where they conceive the idea, do all the animal research to human trials before it gets kind of released into the public.
Dr. Kara Fitzgerald: Yes. Yes. Right. Absolutely. And where are those strains available now? I hate to be pinging you with this, but I know these are questions folks are going to have.
Dr. Jason Hawrelak: Yeah. Those one, that one I know so that one’s okay. That’s Jarrow Fem-Dophilus in the U.S. And there might be others too. But that was the first one that actually had it. So those ones, that product has got the RC-14 strain of Fermentum and the GR-1 strain of Lactobacillus Rhamnosus.
Dr. Kara Fitzgerald: And are you prescribing those orally or intra-vaginally?
Dr. Jason Hawrelak: Both, actually.
Dr. Kara Fitzgerald: Both, okay.
Dr. Jason Hawrelak: And this one’s cool because it actually, our human research studies showing that women ingested it orally it actually does reach the vagina and colonize, which is very cool.
Dr. Kara Fitzgerald: That’s remarkable.
Dr. Jason Hawrelak: Because it’s going to go all the way through the gut and then makes the journey from your anus to vagina, which is a bit of a perilous journey for microbes. But these ones can and actually set up shop in the vagina. So you’ll get higher amounts from an intra-vaginal application, for sure. But I like, I would often do both in most women so they’re getting that, a chance for those microbes to perhaps inhibit some of those microbes that are using the gut as a reservoir, and candida might fit this picture, for example, when they take it orally as well as inserting it intra-vaginally.
Dr. Kara Fitzgerald: God, that’s really fascinating. I always thought that they were exerting their influence intra-vaginally when you prescribed orally through some of the compounds that they produced. You know, impacting things systemically. And it’s probably both, right?
Dr. Jason Hawrelak: Yeah, yeah, for some strains definitely, yeah. But we know that these ones do. And that’s where, that was one of those initial obstacle course criteria that these researchers had is that it had to be taken orally and end up in the vagina.
Dr. Kara Fitzgerald: Fascinating.
Dr. Jason Hawrelak: And at least some of the strains did. Not all strains do end up in the vagina after oral use, but these ones do. So, yes. It is fascinating.
Dr. Kara Fitzgerald: We’re talking about pinpoint prescribing here, which is really important. And working on specific conditions using this pinpoint prescription. You’re doing symptom control and I think we’re doing some underlying correcting also with probiotics, it’s not just giving a drug for the vaginosis. We’re doing more than that with probiotics. But the microbiome is massive and interestingly I did my background, I did post-doc training in Laboratory Science at the first clinical lab to release a PCR stool analysis, Metametrix some years ago. So we spent a lot of time thinking about this.
Dr. Kara Fitzgerald: And our conclusion after being headlong into the literature for years was that ultimately we need to manipulate the whole microbiome towards balance and probably our biggest leverage is diet. I was actually extremely excited by what you’re doing and what your work is around. I thought, okay, now we’re analyzing the gut using PCR, we’re so fast forwarded, we’re able to look at all these anaerobes and da da da da da. And of course we were only looking at a smattering, we weren’t looking at the, we certainly hadn’t characterized the entire microbiome. We were just looking at a smattering of them so that was the first limitation. But…
Dr. Jason Hawrelak: …but that was still way ahead of where other people were at that time.
Dr. Kara Fitzgerald: It was. Yeah, it was, they were heady times, it was very exciting. But my hope was we would be moving towards this precise prescription that you’re talking about and that you’re developing over at probioticadvisor. So my hat’s off to you in a big way. But the end game for us most of the time was you have to think about diet. You’re looking at, you’re in clinical practice, you’re teaching and then you have probioticadvisor, but you’re working with patients and you know you need to work with the entire microbiome. And you need to assess it and you need to manipulate it. Talk about that. Talk about what you’re doing. What kind of lab tests are you using and then how are you getting in there and just moving the whole microbiome towards balance? Actually, and can you recover from probiotics where there’s some, or excuse me, antibiotics where there’s some research suggesting that we’re not going to, I know I’m throwing too many questions out at you, but go ahead. Just start. Just start.
Dr. Jason Hawrelak: Great questions. Ask them again if I don’t cover all of them. And this is in my first answer.
Dr. Kara Fitzgerald: I know, I’m sorry.
Dr. Jason Hawrelak: No, it’s … yeah, yeah. For me assessment of the microbiome is something I do with pretty much, or nearly every, patient. Looking at … I might do that with my initial consult and it may take six to eight weeks before I get the results, so I’ll start with other treatments in the meantime whilst I await the results to come in. But it is a key thing and I think as all clinicians would know is that the research linking dysbiosis to dysfunction or ill health has skyrocketed in the last 20 years. Where we used to have it linked in with Irritable Bowel Syndrome and Inflammatory Bowel Disease, whereas now it’s like Alzheimer’s, anxiety, asthma, autism, chronic fatigue, depression, metabolic syndrome, multiple sclerosis, type 2 diabetes, Parkinson’s, and the list goes on. It’s like, wow. Yeah.
So it’s important that we actually assess this and I think in all of our patients and also see where it’s actually at and how we can modify it. And you’ve hit the nail on the head in terms of dietary approaches are really the tools that have the biggest capacity to impact that ecosystem—certainly when the ecosystem is very disturbed like after radiotherapy or chemotherapy or antibiotics, for example. Probiotics can play a very pivotal role in helping it to restore that ecosystem more quickly and to prevent the overgrowth of potential pathogens, be that Clostridium difficile or Candida albicans, I think there’s, or other microbes. I think they’re very pivotal in that situation but a few years down the road probiotics will have minimal capacity to alter that ecosystem, particularly when compared to big dietary shifts or use of prebiotics. And I think, for me, that the core aspect of how I’m altering people’s microbiomes is with dietary alterations and prebiotics. Those would be the tools that I use most and that you see clearly with follow-up testing have made the biggest difference.
Dr. Kara Fitzgerald: What lab are you…
Dr. Jason Hawrelak: And the broader speaking of dietary stuff I’d include polyphenol-rich foods. because I know you love polyphenols as much as I do. And prebiotic-rich foods as well and just fibers in general. But the thing about prebiotics is they’re more specific and I think that sometimes gets lost out there. People go, “prebiotics are food for bacteria.” And it’s like, “no.” They’re food for specific bacteria. When people eat these things specific organisms change. Some go up and some go down and it means that we can look at their microbiome and go, “Okay, well, you’ve just had a couple of courses of antibiotics and your Bifidobacteria are 0.01% and we know in healthy people it should be 2 to 5%. So how do we correct that?” Yes, I could get them eating more fibers and that will have a small impact on that and over time more so, or I can give them a prebiotic that will specifically feed their Bifidobacteria and in two months it goes up to a healthy level.
So it’s really … allows, I think using the range of those tools allowed you to really impact that ecosystem in sometimes very specific ways. But also even more broadly as trying to define what a healthy microbiome is, is that there’s scientists debate everything and there’s certainly some debate about what that is and how we can define it and that’s fair enough. But I think there are some things we know that are core and that’s diversity. Diversity is pretty clear and I think every microbiome research scientist will tell you that diversity is key for gut ecosystem health. But also levels of potentially disease-causing microbes, that we might call pathobionts where if their population’s too high we start getting some negative ramifications. And then if we have too low levels of certain species like Bifidobacteria, Akkermansia, Faecalibacterium or other butyrate producing microbes then you see harm from that situation as well and inability for people to get well and for their gut to function properly.
Dr. Kara Fitzgerald: What lab are you using generally? Or labs?
Dr. Jason Hawrelak: I mean these days it has been an interesting ride. We’ve had 18 years of when I first started using CDSAs and I did that for my Honors degree where we did some initial clinical trials which may be actually very suspect on using culturing to asses the gut microbiota because of the lack of response shown in these particular population. We were giving them, I think, about 125 billion CFU per day of Lactobacillus, Bifidobacteria and giving them prebiotic supplements too, of lactulose and fructooligosaccharides and the CDSAs were unable to show any change in populations. My patients were farting a lot, as were my trial participants. So I know they were working, and my preparation was made just for my clinical trial so it wasn’t like the bacteria were dead, they were just right out of the manufacturing plant so that’s …
Even the first hesitations around culture, and this is back to 2000, so then it was fascinating looking at that broader literature around the time and you’d be familiar with that literature too but where there was very … Culturing is so inaccurate and so insensitive to pick up changes in the ecosystem even with big dietary changes nothing would seem to show up. It’s just when we started using DNA technology it was like, whoa. Jeez. We had no idea what was going on and what, how things are reacting so for me it’s been an evolution and going with that change of technology so certainly they have to be DNA-based in terms of assessing the health of that ecosystem. Because that’s the only way to find out what’s truly there. If you’re using culturing you’d get a handful of species, not a very good picture of what’s there and sometimes and over-representation of what’s there depending on how much those bacteria love growing in that paper media, in that petri dish, versus an accurate representation of the percentage of what’s there. So…
Dr. Kara Fitzgerald: What about…
Dr. Jason Hawrelak: Oh, sorry.
Dr. Kara Fitzgerald: Go ahead. Finish.
Dr. Jason Hawrelak: I was going to say in terms of actual labs, because I think you did ask that specifically, I do use a lot of uBiome in my clinical practice because of the price. The price is good, the technology is good, it’s the timeline is not so good. So I would love it if I could get results in two weeks. But I don’t. But for that price I can do a lot of follow-up testing and I’ve changed the way I practice a bit in terms of not expecting to get results quickly to work on that. And that’s, you work with that. But I still use the Genova GI effects stool profile at times too when you’re trying to get inflammatory markers and immune markers. And using DNA to look at 24 different species of gut bacteria, which is a pretty good start.
Dr. Kara Fitzgerald: Yeah, okay. Okay, good, uBiome, though, they don’t actually quantify. Does that cramp your clinical style?
Dr. Jason Hawrelak: It takes a while for your head to get around it, but they’re using percentages which is what almost all the microbiome researchers do, too. So once I had to make that shift from that old idea of CFU per mil of stool to actual percentage-wise in stool. If this one is at 2%, this one’s at 8%, this one’s at 30%. Once I made that leap it was actually better because most of the microbiome literature is talking about percentages, not about that CFU per gram.
Dr. Kara Fitzgerald: And you can see it relative to everything else.
Dr. Jason Hawrelak: Exactly, and that’s the thing too. You can go, okay, well, they’re Desulfovibrio which is one of the main hydrogen sulfide gas producers, might be at one and a half percent of their ecosystem and in this case they’re Bifidobacteria, so that’s 0.01. It’s like, geez. You’ve got that pro-inflammatory species at hundreds of times level above this anti-inflammatory gut species in this person so that will show up in that respect and I think also you get to see nuances and changes. So even subtle changes will show up I think more readily using the percentage
Dr. Kara Fitzgerald: That’s perfect. Okay. Great.
Dr. Jason Hawrelak: Readouts.
Dr. Kara Fitzgerald: Yeah, I appreciate it, I really appreciate that explanation. Are you familiar with Viome? Kind of a new lab on the horizon here in the States.
Dr. Jason Hawrelak: Yes. Not as much as I am with uBiome or American Gut Project, for example, because they’ve been around for longer.
Dr. Kara Fitzgerald: Right, right, right. And Viome I, you know, their Chief Medical Officer is a really dear friend of mine but we’re not, I don’t know that they’re releasing, I bug them about releasing their data. Not that Helen is listening. But Helen, if you are … They’re doing some really, really sophisticated work and I just hope to see it be made available to clinicians.
Dr. Jason Hawrelak: Is that the test that doesn’t provide you with the actual print out of…
Dr. Kara Fitzgerald: I don’t think you actually get the raw data, you get their interpretation.
Dr. Jason Hawrelak: Yeah, no, I wouldn’t like that. I want the raw data so I can see what’s there and how I can change it.
Dr. Kara Fitzgerald: Well, they’re actually looking at the transcriptome. They’re looking at massive, massive piles of new data. And I should say that it’s, I saw her, well, actually, I talked to her in February so it hasn’t been that long that I was with her. But I don’t want to misstate anything with regard to Viome because I do think they’re doing some pretty sophisticated stuff but hopefully they’ll, if they haven’t yet, they’ll make that data available.
Okay, but listen. I want to circle back to all the provocative statements that you made around prebiotics. Is your probiotic prescribing paradigm that you’re evolving including prebiotics, dosage, duration, which, to stoke which species et cetera? Because you’re absolutely correct. Prebiotics are, well, anything that you’re consuming is ultimately a prebiotic for your microbiome, so are you eating what you need to be eating and how can you turn the volume up on certain species and et cetera et cetera? So, talk about that.
Dr. Jason Hawrelak: Yeah, and I think that’s where we’ve got a fair bit of research that has helped fine tune some of those aspects. And there’s other, and I think, everything we eat or feed the microbiome, that is totally spot on. But there are, I think the definition of prebiotic is it’s a substance that selectively fermented and encourages the growth of one or a limited number of bacterial species that enhances host health. And I think those are key aspects that differentiate how, a prebiotic fiber like galactooligosaccharides or fructooligosaccharides from just broccoli fiber. I love broccoli. I’m still going to have lots of broccoli fiber, too.
But it’s not going to have such a specific impact on that gut ecosystem and I think this is where when you have a look to see what’s there you can go, “Okay, well, they are low in Akkermansia they are low in Bifidobacteria and low on Faecalibacterium or apparently sometimes even no populations left.” And thankfully that’s usually, it’s not actual real extinction it’s what I would call below detectable levels or below detectable thresholds. So if you feed that species selectively, give it the right conditions, it will come back up. It happens, thankfully, in about 80% of my patients it’s just those that have taken a lot of antibiotics or, have done a lot of herbal antimicrobials and very restricted diets, where they’re sometimes completely lost.
Dr. Kara Fitzgerald: What are the main prebiotics that you’re using? What would have the most broad application that could be a good take home referral for the clinicians listening today? No pressure.
Dr. Jason Hawrelak: Well there’s just so many nuances and that’s the challenge too is one from, I’ve been using prebiotics as clinical tools orally and even intra-vaginally for probably 18 years now. So there’s a lot of clinical observation as well as the research that’s gone into that and now I get to see the impact on ecosystems that I didn’t get to see so easily 15 years ago. The main prebiotics I would use would be Inulin FOS which is, or I think the proper name is oligofructose-enriched inulin, which means it’s a preparation that contains longer chain fructooligosaccharides and shorter chain fructooligosaccharides together. Which feeds a, ensures the feeding of a wider range of…
Dr. Kara Fitzgerald: A broad swath.
Dr. Jason Hawrelak: Bifidobacteria.
Dr. Kara Fitzgerald: Yeah, it does.
Dr. Jason Hawrelak: That’s right, compared to one of the other. Galactooligosaccharides, lactulose and partially hydrolyzed guar gum would be probably the key prebiotics I would use in my practice. Now there are some differences between them, obviously, both in terms of side effect profiles and tolerance levels as well as what microbes are fed. So partially hydrolyzed guar gum, usually well tolerated by the vast majority of patients, there are exceptions, but most tolerate it well. Specifically feeds up your butyrate producing microbes. So that would be species that I tend to see go up, it would be Roseburia, Anaerostipes, Subdoligranulum and research tells us it also feeds another species named SS2/1. Eventually it will have a proper name but it doesn’t yet. And has a minimal impact on Bifidobacteria. It’ll bring it up a bit but I’ve never seen it bring it up past 0.7% of an ecosystem whereas I can use Inulin FOS for example or galactooligosaccharides and they would target Bifidobacteria really well, to a greater degree, and Faecalibacterium. Yes, and Inulin FOS would also feed Akkermansia too.
Dr. Kara Fitzgerald: Now FOS is not necessarily well tolerated though. So are you going to be mindful in your SIBO patients?
Dr. Jason Hawrelak: Yeah, yeah. So there’ll be some patients, groups, that I wouldn’t use them in. And that SIBO patient I wouldn’t use Inulin FOS but I do use PHGG, the partially hydrolyzed guar gum and I will sometimes use Galactooligosaccharides. And it also depends on what stage of treatment that I’m in, too. Am I in the they’ve-got-SIBO-now treatment phase? Or they-had SIBO, we treated it, and we want to…
Dr. Kara Fitzgerald: Now you’re restoring it.
Dr. Jason Hawrelak: … make sure the gut is in good nick? Yeah, yeah. Or they were treated for the last two years with really what I would call more extreme measures and now their colon ecosystem is really in a bad state and then I would come in differently with prebiotics in that case too. Often because they’re immensely sensitive because they’ve caused so much collateral damage to their colonic ecosystem is part of trying to deal with their SIBO that they’re in many ways worse off than what they were pre-treatment.
Dr. Kara Fitzgerald: I have a handful more questions but we’ve been talking for a while and I could continue to pick your brain quite a bit but what about … I guess, I want to talk about endotoxins. And what you’re thinking about with regard to addressing them and then the general impact on our health and turning it around but I also want to talk about intestinal permeability because, undoubtedly, you’re working with this in your practice a lot and you’ve got probably a relatively creative way of dealing with it. Or maybe not. But talk about that.
Dr. Jason Hawrelak: I think endotoxemia is huge and I think as a naturopath I feel pretty vindicated in this area because it’s an old naturopathic idea.
Dr. Kara Fitzgerald: Yeah, that’s right.
Dr. Jason Hawrelak: When you go back to the first edition of Pizzorno and Murray’s classic Textbook of Natural Medicine, wish I could remember the name of the author but he wrote a fantastic chapter on endotoxemia and it was really what got me excited about doing microbiome and gut research and follow that pathway was his textbook chapter at the time. And it’s been fascinating to see the growing list of conditions that we now see associated with bacterial endotoxins. And I think it’s only going to grow.
At the moment we see endotoxemia is associated with alcoholic liver disease, Alzheimer’s, atherosclerosis, chronic fatigue, depression, metabolic syndrome, non-alcoholic fatty liver disease, blood sugar dysregulation, but importantly just systemic inflammation and I think that’s … how many diseases aren’t driven by inflammation? That are patients are dealing with. It’s like, it’s huge. And yet we’ve got this potential reservoir of inflammatory compounds in our gut that we’re often not considering because I think the way I tend to look at it is your gut bacteria can either be adding to your inflammatory load or decreasing your inflammatory load. And they can decrease your inflammatory load by improving gut integrity and there are certain species that I see as pretty pivotal, that’s what their role and function is…
Dr. Kara Fitzgerald: Which are?
Dr. Jason Hawrelak: Akkermansia
Dr. Kara Fitzgerald: Oh, okay, yes.
Dr. Jason Hawrelak: Bifidobacteria, and your butyrate producers. That category. And then you have other groupings like your proteobacteria which is a phylum level combination of microbes which are all gram-negative and all proteobacteria have very pro-inflammatory endotoxins. So it’s not, Bacteroidites which is another phylum, they’re all gram-negative too but thankfully, because they’re there in often much larger amounts their endotoxin is nowhere near as pro-inflammatory. But proteobacteria which are, include microbes like Shigella,Salmonella, E. Coli, Klebsiella, Enterobacter there’s a number of names there that we would be familiar with as pathogenic gut species of bacteria.
Well, part of what makes them so pathogenic is that endotoxin loading. And for some people when we do the stool test, and what I love about uBiome is I actually get this data, this phylum level data going you may have 0.2% proteobacteria in your gut, which is like, okay, you’re not going to get much endotoxin coming in from there. Or you might have 15% proteobacteria which is, geez, that’s a lot. 15 out of every 100 bacteria in your gut are proteobacteria, loaded with endotoxin. And endotoxin makes up I think about 80% of the cell wall of gram-negative bacteria and endotoxin can cause leaky gut.
So you get into this sort of vicious cycle of it damaging the gut, then you absorb more endotoxin, which then causes more damage. But also just having that much there independently of how good your gut integrity was, it starts becoming worse. And I think that’s one of the drivers of a leaky gut in some people is not just things like gluten, for example, and celiac disease but dysbiosis and having high levels of endotoxin containing bacteria in the gut as a driver of gut damage and, obviously, systemic inflammation. And even things like depression and anxiety that are now being tied in with that.
Dr. Kara Fitzgerald: Interesting, interesting. And so certain antibiotics could allow for the proliferation as we see in C. diff Colitis.
Dr. Jason Hawrelak: Yes. And that’s often the case. It’s interesting post, and even during antibiotics to see what’s there and I’ve had one patient that was doing a triple antibiotic cocktail for the treatment of, I guess, a life-threatening uterine infection. So it was good reason for taking the triple antibiotics, life-saving, but she was on the ball enough to do a fecal specimen half way through that process and send it to uBiome and it was just interesting to see what was there. It was like, her diversity score was 0%, which isn’t very good. But there were about 10 species there that were tolerating and thriving in that new environment that was essentially where most microbe competition, most food competition had been wiped out and all of a sudden these microbes that could tolerate the antibiotics had a lot of space and a lot of food to grow into. And that’s often, one of the main causes is this antibiotics for that sort of dysbiotic picture that persists for a long time after, even six months afterwards her ecosystem was, despite a lot of work, was fairly dysbiotic still.
Dr. Kara Fitzgerald: Listen, I want to ask a couple more questions. We’ve going to head home on the, be on the home stretch here. But what about vitamins? I’ve been interested in the fact that obviously we’re making vitamins in a healthy gut. We should be, anyways. Do you ever think about that? Do you think, “I’m going to rebuild some of these bifido species or maybe supplement, so I’m either going to rebuild the microbiome or I’m going to supplement with specific probiotics in the expectation that I’m going to see folates rise, or I’m going to see biotin” et cetera. Do you prescribe with that in mind, ever?
Dr. Jason Hawrelak: I do have that in the background of my mind when I’m restoring … so if someone’s Bifidobacteria shows up as extremely low or below detectable level then it is in my mind that, okay, then they’re going to be lacking potentially their, endogenous producers of B-vitamins. Because Bifidobacteria do make B1, B2, B3, B6, folate and biotin. So we do have transporters in our colon cells to bring in those B-vitamins. And it just shows that evolutionary connection that we’ve got there. And there are consequences of not having them there too. So thankfully there are other species in the gut, some of which we don’t even know that can…
Dr. Kara Fitzgerald: …pick up the slack.
Dr. Jason Hawrelak: Exactly. The functional redundancy that’s there. But that is certainly back of my mind of kind of going, okay, this might have an impact because the B-vitamins that are produced are often inactive forms and very well absorbed. So there’s a big drop that’s actually happening that might have consequences in the system.
Dr. Kara Fitzgerald: Well, let me ask you, let me just kind of springboard off that question and ask you a really important question that comes to, that has been posited to me. I’ve dialogued about it with colleagues and so forth. That is when you see high serum levels of, say, B12 and B6, most commonly, and a patient hasn’t been supplementing. So we know that B12 can be made in the gut and there’s actually inactive B12 isomers, I think, that can apparently be made in the gut, but these could jack up our serum numbers, is that correct?
Dr. Jason Hawrelak: Yeah. But I think with B12 you’d be thinking of SIBO specifically because we just don’t have colon transporters for B12. We do for all the other B-vitamins, yeah? So if you had high folate then you could see that associated with gut, colon production. But if it was super high B12 in a patient that wasn’t supplementing B12 then I’d be thinking SIBO.
Dr. Kara Fitzgerald: You would be? Okay.
Dr. Jason Hawrelak: Because we do have the capacity to absorb B12 in the small bowel, it’s just not there. Because there are a number of species that make B12 in active forms as well as the analogs, you’re spot on. In the colon it’s just that we don’t have the right pathway to absorb it there and for whatever reason we haven’t evolved that pathway. We’ve got pathways for other B-vitamins but not B12.
Dr. Kara Fitzgerald: Fascinating. Okay, so then if you could not track down where this B12 was coming from in an individual with very high B12 levels then you would be looking to the gut as the cause?
Dr. Jason Hawrelak: Yes. That would be the case.
Dr. Kara Fitzgerald: And what about B6?
Dr. Jason Hawrelak: I probably would be thinking similarly but it could be colon production in that case too because there are transporters for B6 in colon cells. So it wouldn’t be just SIBO in that scenario. And we’ll probably have to wait for further research that teases out what other species are involved with production of B-vitamins. We mentioned Bifidobacteria and they certainly are, but you’re right, there’s a number of other species, many of which have not been named yet let alone quantified or discovered to any great degree or detailed that can also be doing that, that sort of function as well. That aren’t going to be obvious to us yet. But in 10 years-time when that research has been done, we’ll be able to see what’s there.
Dr. Kara Fitzgerald: Perfect. Perfect. Well, listen, Dr. Hawrelak, it was a really great conversation. I just enjoyed picking your brain and we could go on and on here. Are you available, do you consult with clinicians if somebody wanted to discuss results and patient presentation? Do you do that?
Dr. Jason Hawrelak: Yeah, I regularly do mentoring sessions for practitioners. Typically at this point in my life that’s one-on-one scenarios.
Dr. Kara Fitzgerald: Okay. Alright. Perfect.
Dr. Jason Hawrelak: And teaching clinicians is one of my … you know, I’ve been doing it for a long time and it’s one of my passions because it really gives you a chance to affect lots of people’s lives, when you think about it, rather than one on one with patient. Yes, great. Now I still love doing that too but if you’re able to change the way clinicians practice for the better, this is a ripple effect and you would know this too. This ripple effect that goes out hugely, which is just phenomenal.
Dr. Kara Fitzgerald: Well, I have a clinical development program where we, there’s a number of physicians and clinicians tracking with us and we do expert teaching. So we’ll have to swing back and bring you on, I think that they would absolutely love it. We’re going to, so for folks listening to the podcast of course in the show notes will be all of Jason’s contact information so you can access him in any, with whatever you want to do. And certainly, go over to probioticadvisor.com and check out the work he’s doing there.
Dr. Kara Fitzgerald: Again, thank you so much for joining me today on New Frontiers, I think this was really productive, full of great pearls, and it was just a pleasure talking to you.
Dr. Jason Hawrelak: It’s a pleasure speaking to you too. Thank you for the invitation.
Dr. Kara Fitzgerald: Absolutely.
Dr. Kara Fitzgerald: And that wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible, through the years, without our generous, wonderful sponsors, including Integrative Therapeutics, Metagenics, and Biotics. These are companies that I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them that I sent you and thank them for making New Frontiers in Functional Medicine possible.
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