Is there an ideal gut microbiome with Thomas Guilliams PhD
Dr. Michael Ruscio: Hi, everyone. Today I speak with Dr. Tom Guilliams and we elaborate on his paper that was just published in Alternative Therapies in Health and Medicine — the same journal that my SIBO paper was published in — titled “Dysbiosis or Adaptation: How Stable Is the Gut Microbiome?” Just a few highlights from the discussion that I want to provide you with here. Probably the bottom line for you, according to Dr. Guilliams, is that the results that you see on a microbiota mapping test are not really clinically actionable, something I’ve been saying for years. More specifically, the effect of stool frequency and stool consistency may be the primary drivers of what you see on a microbiota test. Or, said another way, if we can improve someone’s stool consistency and frequency, we can improve the results of their microbiota test. If you follow that through one step further you arrive at the conclusion of, “So what you’re saying is to get better test results I need to fix my poop?”. Yes, that would be the answer. As I’ve been trying to share on this podcast, tests, especially in this realm, don’t help us better decide how to treat someone’s gut to get better outcomes, better stools, consistency, frequency, bloating, other GI-related symptoms, or even the gut-brain or gut-skin symptoms. What we focus on, chiefly, is improving someone’s symptoms, and that usually ends up translating to better test results, therefore making the test results moot.
Another point that we also hit on is that stool testing is not really representative of what’s going on in the small intestine, as I elaborated on in ‘Healthy Gut, Healthy You,’ and Tom does in his most recent paper. Another point, which he hits in his paper and which I also talk about in ‘Healthy Gut, Healthy You,’ is that the gut microbiota adapts to various digestive disorders.
So what you’re seeing on the stool test is more a byproduct of inflammation, than it is the cause of inflammation. We also touch on the fact that stool testing has not been shown to be predictive for who will respond best to a given probiotic. So for all these reasons, it’s important to understand that testing, while interesting, at this point is more of an academic endeavor where you can track your stools over time.
As we amass data, hopefully, we will have a better ability to say what that data means and how it can be used to steer how you’re treating yourself. For right now, it seems the best way to handle this, meaning how to handle decisions to improve your gut health, is to use your symptoms. One thing I’ll remind you of here is if you have not gone through the 3 for Balance probiotic protocol, I would highly encourage you to do so. That tends to be quite effective for many gut symptoms, and therefore could bring you to this endpoint of better stools, better digestive symptomatology in general, and therefore, ostensibly, a better and healthier microbiota.
That’s really it for my summary here. We will now go to the full interview with Dr. Tom and, again, he did a great job with his paper scientifically documenting many of these points that we talk about that come down, bottom line, to “don’t get overly wrapped up in testing and pursuing test results and don’t overlook how important your symptoms are in steering the process of improving your gut health.” Now, on to the show.
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In This Episode
Episode Intro … 00:00:40
Dr. Guilliams’s Paper … 00:05:03
Taking Lab Results with a Grain of Salt … 00:09:58
Large and Small Intestine Role in Gut Health … 00:14:28
Limitations of Lab Analyses … 00:16:54
Bristol Stool Chart … 00:20:45
Personalized, Cost Effective Treatment … 00:22:53
Adaptability of the Microbiome … 00:30:46
Testing Multiple Probiotics for Effectiveness … 00:36:32
Is There an Ideal Microbiome? … 00:43:17
Episode Wrap-Up … 00:46:49
Is There An Ideal Gut Microbiome?
Gut bacteria play an important role in human health. Many people
with IBS, SIBO, or other conditions have used stool testing to try to get
better treatment recommendations. But the question remains whether stool test
results provide actionable insights. What do these test results really
In my interview with Dr. Tom Guilliams, he suggests that maybe they don’t mean very much, and we should instead focus on creating an adaptable gut microbiome.
What Do Stool Testing Results Really Tell You?
It’s easy to be seduced into thinking that stool test results give you a clear path forward for treatment. If a bad bacterial species shows up in your results, it’s easy to think, “I have this bad bacteria, so I can just take an herb or antibiotic and treat it.” But Dr. Guilliams doesn’t think gut microbiota tests tell us this at all.
Dr. Guilliams says, “It’s difficult in the literature to say that [a single stool sample is] diagnostic for something…I think the labs that offer these tests … should be cautious [with their] promises of interpreting their tests for immediate changes in those patients.”
He goes on to say that a stool test is only representative of a single moment in time. His research indicates that the microbiome of the gut can change quite rapidly, based on diet or other factors. He says, “…the stool itself is not necessarily a good measure of everything else going on in the rest of the gut flora…we’re learning that these bacteria can change very quickly within days or weeks, and certainly within months if you change your diet, if you go on antibiotics, or other kinds of things.”
Stool samples also only represent the gut flora in the large intestine.
“The stool bacteria are a very poor reflection of the upper GI, so small
intestinal microbiota is not represented virtually at all in the stool.”
Understanding what is going on in the small intestine
may be much more clinically valuable because it’s much more sensitive to immune system
reactions, inflammation, and gut barrier problems.
Lab Test Discrepancies
A further challenge to making clear treatment decisions from stool testing is that different labs use different algorithms to arrive at their results. Dr. Guilliams clarifies: “The problem is…many of those bacteria [in your lab sample] are still alive. So some of those bacteria are still reproducing as it’s being shipped to the lab and some are not, and every lab actually has a computer algorithm that tries to figure out what it was when you actually sampled it…but each lab has a different algorithm.” In other words, you could send a stool sample to two separate labs and get different results based partly on the algorithm each lab uses to determine how much bacteria was present when your sample was taken.
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Stool Consistency Matters
Dr. Guilliams says, “The Bristol stool chart is basically a way to tell how hard or how loose stool is, [and] is actually one of the factors that influence the type of bacteria found in the stool greater than anything else. So the faster the stool is, the organisms that can grow fast are going to be in there. And if you have constipation, the organisms that are slow-growing are going to be in there at higher concentrations.”
What this means is that stool frequency and consistency may
be a better measure of what is needed clinically than expensive stool tests.
Dysbiosis Treatment & Ideal Microbiome
If stool test results don’t provide useful guidance, what
should we do instead to create a healthy gut? As I’ve been saying for many years,
improving stool frequency and symptoms and adapting our approach to the
feedback your body is giving is the most cost-effective approach for patients.
Dr. Guilliams suggested we want to create a microbiome “that can constantly adapt, when needed, to help us maintain a healthy lifestyle.” How do we do that?
Can Stool Testing Predict Probiotic Response?
Dr. Guilliams says, “At this point [the data] suggest… that each individual is likely to have a different propensity to accept or reject certain probiotic strains, and we don’t have any data yet on stool analysis to tell us that.”
Dr. Guilliams commented, “I think probiotics are an adjunct therapy to help boost certain things, but you have to [primarily] use the diet. That is your primary goal in affecting your long-term microbiota.” The key question, he says, is “What is the suitable microbiota for this person at this time?”
“The most ideal microbiota is one that can constantly adapt,
when needed, to help us maintain a healthy lifestyle.”
The Bottom Line
Stool microbiome testing may not provide useful recommendations or clear diagnoses. A better measure of how your gut microbiome is doing is your stool consistency, using the Bristol Stool Chart, and bowel transit time. If your gut motility is too fast or too slow, shifting that with diet and lifestyle changes promotes a healthy, adaptable microbiome. In other words, don’t get overly wrapped up in testing and pursuing test results, and don’t overlook how important your symptoms are in steering the process of improving your gut health.
Links & References (click to expand)