Podcast – Gut Microbiota, Weight Loss and Obesity

In this episode, Dr. Ruscio delves into the gut microbiota and how it can affect weight loss and obesity. He looks at the current research to see if we can determine risk factors of obesity and if popular interventions actually work or if they are just hypotheses that didn’t pan out in actual human research.

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Topics:
Intro…..3:04
Early life risk factors for obesity…..4:10
Is the Firmicutes/Bacteroidetes ratio a predictor for obesity?…..10:10
Probiotics and weight loss…..16:51
Prebiotics and weight loss….. 24:10
Fiber and weight loss…..26:00
High fat diets, endotoxemia & LPS…..28:20
Low-fat vs. low-carb diets for weight loss…..31:28

 

Show Links:

  1. (2:57) Dr. Ruscio on Underground Wellness  http://undergroundwellness.com/podcast-314-ibs-autoimmunity-and-low-vitamin-d/uw-radio-314-2/
  2. (4:20) Antibiotic use during early infancy causes increased risk for obesity http://www.ncbi.nlm.nih.gov/pubmed/22907693
  3. (6:15) Initial dietary and microbiological environments deviate in normal-weight compared to overweight children at 10 years of age. http://www.ncbi.nlm.nih.gov/pubmed/21150648
  4. (7:30) Children of mothers with increased farm animal exposure while pregnant also showed increased levels of sCD14 cells. http://www.ncbi.nlm.nih.gov/pubmed/16630939
  5. (12:25) Dr. Ruscio’s AHS 2014 presentation https://www.youtube.com/watch?v=dlBWOT50GZE&list=UUSIUpXeC1QEjNm54X7KylkQ
  6. (17:20) Lactobacillus gasseri, was tested in 2 RCTs in 2 different forms (BNR17 and SBT2055 (LG2055) respectively) http://www.ncbi.nlm.nih.gov/pubmed/23560206 , http://www.ncbi.nlm.nih.gov/pubmed/20216555
  7. (19:08) Effect of Lactobacillus rhamnosus CGMCC1.3724 supplementation on weight loss and maintenance in obese men and women. http://www.ncbi.nlm.nih.gov/pubmed/24299712
  8. (24:40) Weight loss during oligofructose supplementation http://www.ncbi.nlm.nih.gov/pubmed/19386741
  9. (26:00) Glucomannan with low calorie diet http://www.ncbi.nlm.nih.gov/pubmed/15614200
  10. (26:40) Dietary fiber and weight regulation REVIEW study http://www.ncbi.nlm.nih.gov/pubmed/11396693
  11. (31:28) Low-carb vs. Low-fat diets http://www.ncbi.nlm.nih.gov/pubmed/19224658

 

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Gut Microbiota, Weight Loss and Obesity – Episode 1:

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.
Now, let’s head to the show!

Susan McCauley: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Susan McCauley from EvolveNutrition.com and EvolveRecovery.com., and I’m here with the Doc! Hey, Dr. Ruscio.

Dr. Michael Ruscio: Hey, Susan, how are you?

SM: I’m hanging in there. It’s a beautiful Monday today, and I’ve decided to start every Monday morning with the gym, so I feel…

DR: Nice!

SM: Yes, and I’ve been making great strides. I’ve struggled with some chronic back pain over the last year, and it resolved itself. And I’m lifting heavier, with a trainer, with perfect form, of course. And so, it gets me really excited. It’s a great day. How about you?

DR: Kind of in the same boat; beautiful day here, I’m enjoying that. I’m trying to get a little bit more amped up with my exercise. I’ve been getting a little lazy over the past few weeks. I mean, I still go, but I haven’t been really pushing myself. So, I’ve been trying to ramp things up. It’s amazing how just giving myself that extra push over the past week, I already feel better. Even after one workout that was more intense, you have that good post-workout feeling, a little bit sore, and just feel really good sleeping well. Exercise to such a powerful tool, so, right on to the both of us, I guess.

SM: I think it’s funny how one workout will get you feeling like you’re back on track. And, like, one good meal will also do the same thing for me. We’ll be on vacation and will come back and I’ll make, basically, meat and vegetables, and my husband will be like, “I just feel better already.”

(Both laugh)

DR: Yeah, the power of food and the power of exercise. Those fundamentals are huge, absolutely.

SM: And I did think of you this weekend when it was in the high 70s and we went for a walk – we went for a hike, actually – and I wore shorts and a tank top, so I figured I got my vitamin D. I have got my minimum, how do you say it?

DR: Minimal erythema dose. Awesome, good.

SM: Got a little tan lines going and it’s only February.

DR: Yeah, we are lucky here in California, huh?

SM: Yeah. So what hot topic do we have for today?

DR: So, I’ve been trying to work our way around the thyroid, and we’ve haven’t gotten there just yet, because I keep getting sidebarred by gut stuff, because it’s just so fascinating to me. I wanted to kind of elaborate a little bit on some stuff – I recently went on Sean Croxton’s podcast, and we talked the microbiota, amongst other things. I was kind of digging around that area. So I wanted to talk a little about the microbiota, how it pertains to obesity, and maybe set the record straight with some misconceptions or some hypotheses that are floating around the Internet with how the microbiota interfaces with obesity. And then how we might be able to modulate the microbiota with things like things like fiber, prebiotics/probiotics to impact, or maybe not impact, obesity, and then round that off finally with talking about endotoxemia, or endotoxins, or LPS. People may have heard – I think Steph Gienas has talked about one of the factors that seems to lead to obesity is this transmigration or leaking of endotoxins, from the gut into the bloodstream, which cause insulin resistance, and how high-fat diets seem to propagate that. And so I wanted to kind of address that issue from for my gut-focused vintage pointing, and give people a hearty dose of gut-stuff.

SM: Sounds like a lot of great information, so tell me more.

DR: So, maybe we should go all the way back to the beginning and start with early-life risk factors for obesity, as they pertained to the microbiata. Some studies – and we’ll put a link to one study particular I really liked – have shown early use of antibiotics, meaning use in infancy, can cause an increased risk of obesity later in life. We can’t say exactly what happens, but certainly we know that earlier antibiotic use disrupts the microbiota, and it’s likely some sort of proturbance in the microbiata, probably a decrease in microbiata biodiversity, is what causes obesity later life. I’m sure you’ve probably heard of that, Susan, right?

SM: So, if you’re have kids, say, and, you know, they get ear infections, they get you strep throat – So, how many exposures to antibiotics does the research say ends up to maybe increase your rate-risk of obesity?

DR: That’s a great question, and I wish I could say I read a study that maybe showed if you go over certain threshold then all of a sudden this relationship presents itself. Or, there were some sort of dose response. I haven’t actually seen that, and I don’t know if anyone’s actually done a study of that sort. You see this dialogue in various references supporting early antibiotic use correlated with obesity. You see that reference throughout numerous studies, but I haven’t seen one that says, ‘If you take more than,’ let’s just arbitrarily say, ‘four courses of antibiotics before the age of four, you have a thirty-percent increased chance. I’ve never seen any definitive numbers like that. So…

SM: Better to be safe than sorry, and not run to the doctor for antibiotics at the drop of a hat.

DR: Right. I would just reserve them for when you have no other option, really. And then you’ve really done the best you can.

SM: Okay

DR: So, something else interesting along these same lines is, studies have shown looking at – or one study in particular, and, again, we’ll put this link in the show notes – looking at children that were 10 years old. Half the group was obese and half the group was normal weight. What they showed was that the children that were normal weight had higher concentrations of this compound called serum-soluble innate microbial receptors, or SED 14. So, the children that were at a normal weight had a higher level of this receptor. And, what’s interesting is that this receptor helps modulate the immune response to lipopolysaccharide, or this endotoxin, this bacterial fraction that can leak in through the gut into the bloodstream and cause inflammation and insulin resistance. So, to reframe this, children that are at a healthy weight seem to have a better receptor for when stuff leaks through the gut.

SM: They’re more tolerant to it?

DR: Yeah, and I think that they’re probably more tolerant and, there’s another study we’ll put in the show notes, that showed – This study looked at mothers while pregnant around exposure to farm animals. And the more for minimal exposure that they had the higher the level of this receptor was in their offspring, likely because their immune system was really well-trained, and so expressed a lot of these receptors, So, again, it seems like this receptor helps people potentially not have a highly inflammatory response to when lipopolysaccharides, or this component of bacteria leaks through the gut into the bloodstream.

SM: So, it sounds like they’re more resilient.

DR: They’re more resilient, yeah.

SM: OK.

DR: And, that ties back to the antibiotic piece, because – potentially does – because it seems like antibiotics are going to decrease the amount of microbes you have inside of you. And then, along those same lines, when mom had increase exposure to dirt outside of her, eventually gets inside and that increase exposure to dirt and bacteria helps to train the immune system not to have his overzealous immune response that can cause inflammation and insulin resistance.

SM: Wow. So go to the farm and play with the animals when you’re pregnant? (laughter)

DR: It was there was really crazy: When they showed in the graphs in the study, for every additional animal mom had exposure to, the levels of these receptors went up, up, up and up. So, it’s a direct and dose-dependent relationship. So yeah, the dirtier you can get with what I would term ‘Old Dirt’ – I wouldn’t say go jump into a dumpster and roll around. But, if you can get out to the farm and get what I like to call ‘Old Dirt’, or more hunter gatherer type dirt, that really seems to yield dividends for influencing the microbiota – and the microbiota really influences your immune system – and that really has a big impact on your insulin-resistance and inflammation, and, of course, your body composition.

SM: So, if your immune system is more robust, then your less likely to take antibiotics. So, it’s almost like a vicious circle if you do not have the strong immune system.

DR: Right.

SM: Then you take more antibiotics. Then you have a less-diverse microbiata, then you get more sick, more often. And then it’s like then you’re down the rabbit hole of autoimmune and anything else that can come behind that.

DR: Yeah, and oftentimes these cycles are self-reinforcing in one direction or the other. And oftentimes what a good clinician or practitioner will do is just help to unwind the downward spiral, and try to moving in another direction.

SM: OK.

DR: So, another piece that – gosh, how do I say this politely? I get, admittedly, a little irritated when I hear people referencing the Firmicutes-to-Bacteroidetes ratio. And, I’m not irritated because I’m mad at the person talking about it. But, I get upset because I spent a lot of time looking into this issue, and when you really an understand issue really well, and then you hear or see or read other things that maybe don’t fully represent the data, it’s hard not to get frustrated. And so, oftentimes I find myself getting frustrated because I see labs that report this ratio, and I see different practitioners or people writing stuff on the Internet suggesting that you should test this and try to manipulate this ratio in order to treat your microbiata, so as to unravel or unwind obesity. And so, the backdrop or the background of this conversation is – The hypothesis states that if someone has high-level of Firmicutes with relatively low levels of Bacteroidetes, that’s been correlated with obesity and it may even cause obesity. Now, I should state that initial hypothesis was formulated from animal data. And that animal data looked like the majority of the information reinforced that. But, when we did follow-up studies in humans to see this relationship was still present, it wasn’t. It was only present maybe 50% of the time. So, half the data support it, and the other half of the data completely contradicted it. And, there have been a few really good reviews published that have gone through this point-by-point-by-point. I’ve read these reviews I’ve read some of the papers and some of the abstracts of the papers the reviews are citing. I think in no way can we say that the Firmicutes-to-Bacteroidetes ratio is a predictor – or even a valid associative measure for for obesity. I talked about this maybe for about 10 minutes of my ancestral health symposium presentation of 2014 – We’ll put a link to the video in the show notes. I won’t go through all the details, but I supply the references that I use to support this contention in that presentation. But, long story short, animal data – it looked promising; human data – definitely not. So, if people are considering doing some kind of prebiotic therapy, or probiotic therapy, or no lots of expensive microbiome testing, I would really advise you against it because the science upon which the reason you would do that testing is built is really shaky science. Or, I shouldn’t say it’s shaky sciences, I should say the science doesn’t show a relationship.

SM: Right. And I think as a nutritionist, from a personal perspective, is that, you know, the diversity and the makeup of your microbiome is based on the food you eat, and where you live, and your lifestyle. And to try to manipulate that artificially, to me it doesn’t make sense. That, you know, you need to first fuel yourself appropriately – eat the good fibers, eat the good vegetables. And then live not a antibiotic antiseptic life and then it balances itself out. You get a healthy gut because of everything you’re doing. You don’t give yourself a healthy gut and then your health.

DR: Right, and I agree. I don’t think we’re ever going to be in a position where we can custom manipulate the microbiota to produce a health outcome. And something we’ll do in the future, for sure, is going to a whole – we’ll do a whole podcast; I’m probably going to write a fairly in-depth article on why the microbiatal testing is also way premature for us to be concluding things on. There are a few reasons; I think I’ve mentioned before. It depends on type of analysis. It depends on the depth of the analysis. It depends on what you’re considering the criteria for considering it to be a positive or negative DNA probe, if you will. And then there’s also the microbiota or looking at the microbiota function, because now we are learning it may not just be the bacteria that are there, but it may be the functionality of those bacteria, because different bacteria species can sub-in, if you will, and carry out the functions of other types of bacteria if the other bacteria aren’t present in inadequate amounts. So, there’s just so much that we don’t understand; we’re really light-years away from being able to really move on this stuff. It’s interesting academically, but I’m a big proponent of not having people waste money on stuff because of a pipe dream.

SM: Right.

DR: If you want to for academic pursuits, I’m in favor of it. But if you think running tests is going to help you overcome a certain health ailment, then that’s money that could really be much better spent somewhere else.

SM: And, I think it brings up a good point about looking at, you know, you’ve got your epidemiological studies and then you’ve got your hypotheses. And then you do your animal testing, and at no point in there can you make certain, like, set-in-stone recommendations because they’re all just trying to look at what your hypothesis is. Until you start working on humans, and doing the testing, you really can’t say if something is working or definitively that you – If you manipulate this, you’re not going to be obese anymore.

DR: Right, and that’s why I think clinical trials or at least some sort of interventional study are really, really important. That’s kind of my North star, where I’ll look for that sort of data first because that’s going to be the most powerful data. And sometimes you will see people making recommendations based upon observational or mechanistic studies, and they’ve missed the fact that there’s been clinical studies or interventional studies done. And so, I shouldn’t say there is no point, but if you’re trying to get to the bottom line, you want to look at the interventional studies, because that will tell you ‘Okay, I’m sick. A group of people who are sick like I am got this treatment, and it worked or didn’t work. I mean, that’s really what you’re after at the end of the day, at least from a patient perspective.

SM: Uh-huh, definitely.

DR: And that’s actually a good segue into the couple of pieces that we can talk about, in terms of what does the clinical or the interventional data show regarding different interventions, like prebiotics, probiotics, and fiber that manipulate or modulate the microbiota? And, what kind of clinical effect has it had on weight, for example? So, why don’t we jump into that?

SM: Perfect. Sounds like a great segue.

DR: All right. So, lactobacillus gasseri – Kind of like g-a-s-s-e-r-i. There have been two randomized clinical trials with that probiotic. They have shown 1.1 pounds of weight loss in 2.2 pounds of weight loss in obese subjects. So, for an obese person to lose 1.1 or 2.2 pounds, it’s not really that…

SM: What length of time?

DR: Twelve weeks.

SM: Oh, not really big at all.

DR: Yeah, you’ve had plenty of time. And here’s the real kicker about this: They don’t list the amount of weight lost in the abstract to these papers; they list that obese subjects, who were given lactobacillus gasseri probiotic, lost weight over a 12-week interventional period. And I say, “Hum, interesting.” I actually got excited at first, when I read this. So, I pulled the full paper, and I look and I go, “Wait a minute, this is 1.1 pounds.” This is -The abstract’s conclusion is very misleading from what the data shows. I don’t know about you, but I don’t get very excited about 1.1 pounds or 2.2 pounds in someone who’s obese.

SM: No, because I’ve had clients that would be considered obese, and just by taking the process carbs out of their diet. And sometimes I don’t even go to a paleo template. Sometimes it’s just the process carbs, and in a 12-week period, they can lose 30 pounds. You know?

DR: Yeah, yeah. Exactly, exactly. So now we’re starting to see why I get somewhat frustrated by some of these claims, right?

SM: Exactly.

DR: Now, there’s another study: The best probiotic-for-weight-loss trial I’ve been able to find, and I’ve done a pretty darn thorough search, was where men and women were treated. Men, there was no effect; women lost 3.7 pounds with lactobacillus rhamnosus. So, that’s the best data that we have. And even that is not super exciting, right, 3.7 pounds?

SM: So when they give you these weights, are they not changing their diet at all? Or are they keeping it iso-caloric and whatever they were eating before the trial, they are continuing to eat during the trial?

DR: Yeah, these studies have not – They’re just looking at the one intervention of the probiotic.

SM: OK, so they are keeping everything else the same. OK. Yeah, doesn’t thrill me, either.

DR: Yeah, it’s really important because some other papers – In fact, in the video newsletter that I recorded last week – the researchers did a review article, and they talked about five studies that showed that probiotics led to weight loss. And so, of course, I’m suspect of this at this point. So I went and I pulled the papers. Two the papers were the ones we just went over. Two were on pregnant women. So, it’s really hard to…

SM: They shouldn’t be losing weight. (laughter)

DR: Yeah, and it’s just really hard because there’s a lot of other stuff going on there. So, I mean it’s only applicable to the pregnant women subgroup. And then the fourth and fifth study were essentially cardiovascular disease trials that have multiple interventions, meaning they were give, like, may never given lipoic acid, and a bunch of other supplements along with a probiotic. And, you know, the authors are using that to support their position of ‘This probiotic leads to weight And that’s really, in my opinion, misrepresenting, because if you just read abstract of the conclusion, you would think these probiotics lead to weight lost. But, when you actually read the facts, I mean, yes it’s true – 1, 2, 3 pounds were lost. But, is that justifiable to spend $70, $80 on a probiotic a month?

SM: No, and it does sound like…it sounds like somebody’s trying to use studies in order to sell probiotics.

DR: And, it could be, and that’s why I just think you have to really be careful with just reading abstracts, or just reading conclusions, because they can be misleading. And sometimes, it’s, you know, no one’s fault, necessarily. It could just be an honest mistake, or the researcher that we’re uncovering some data showing that probiotics can be helpful. But I think what the scientific community may consider significant weight loss, quote-unquote, could be anything above the placebo effect, or anything that was statistically significantly from the mathematical perspective. But, when the public hears significant weight loss, they’re thinking, like, ‘Oh, that’s significant. You’ve got to be talking like 10 pounds, right?’

SM: Uh-huh.

DR: But no, in this case 1.1 pounds was significant. But, it may not be significant to you on a personal level. And something else I should weave into that: We talked about Firmicutes-to-Bacteroidetes ratio, right? Where the hypothesis is that, if you have high levels of Firmicutes, that correlates with obesity, (and) maybe even causes obesity. Well, these probiotics I just mentioned that led to a small weight loss, but weight loss, nonetheless. Those are in the Firmicutes phylum. So, by giving the phylum or family of bacteria that the Firmicutes-to-Bacteroidetes hypothesis says will make you fat, you can actually lose 1-to-3 pounds.

SM: OK, so there goes that hypothesis. (laughter)

DR: Yeah, maybe not completely, but it certainly kind of challenges it.

SM: Yeah it does. And it just goes to the fact that one thing isn’t going to fix everything, you know? Just giving somebody a probiotic, taking that magic pill; it always seems like we are looking for that magic pill, that one thing that we’re going to be able to do that we’re not going to have to do all the work that it really takes to be healthy.

DR: Right. Yeah, and that’s why…I mean, I hope people are appreciating this…I know people are always looking for that magical cure. But sometimes what I think is equally as valuable to share what doesn’t work, because, again, that will save you money, and it will save you heartache.

SM: A lot of money, yeah.

DR: I mean, financial stress can be a significant thing for people, especially for people who are not feeling well and have invested a lot of money in their health care. That can be a really significant life-stresser for people.

SM: Uh-huh, yeah. On the questionnaire that I give my clients, I ask people to rate their stress in different areas. And finance is one of them, you know? That gives me an idea of what the total load that their carrying of stress and how that’s affecting their health.

DR: Yeah, yeah. It’s definitely an important issue. Some people have plenty of money to throw around. But, if you don’t, then, yeah, it’s going to be important. So, a couple other things along this same line: There have been some double-blinded, randomized controlled trials looking at prebiotics. And maybe even more common is: Let’s see what your microbiata looks like, and then we’ll give you the appropriate prebiotics to manipulate it back into shape, if you will, so you can lose weight. So, the best weight-loss trial for prebiotics – or one or two of the best – 20 mg of oligofructose a day, versus placebo, showed that the treatment group lost 2.2 pounds. So again, over 12 weeks losing 2.2 pounds…I wouldn’t really consider that anything to write home about. Another trial looked oligofructose again, and there was about 2.3 pounds of weight loss.

SM: Uh-hum.

DR: So, the prebiotics don’t show a lot of benefit – That high amounts pf prebiotic may be problematic for some people. There was a really good review paper published on prebiotics as a clinical intervention. They showed that most of the benefit for prebiotics was kind of in this Goldilocks dose, if you will. It wasn’t too low, it wasn’t too high. 3.5 grams a day seemed to show mostly gastrointestinal benefit without having the gastrointestinal side effects that can be associated with higher doses, like doses over seven grams a day. So at 21 grams a day, I would anticipate some of these patients…

SM: Not very comfortable.

DR: …some flatulence and some gas. Yeah. Moving right along to fiber. The best fiber study – now this was fiber in conjunction with a low-calorie diet. So, you have to really take that into consideration.

SM: So, did they say what the macronutrient ratios were in this low-calorie diet? Or just that it was a low-calorie diet?

DR: You know, I don’t have the macros offhand; I apologize. But they were using glucose monin fiber with a low-calorie diet. And it yielded 8.3 pounds lost.

SM: Wow. That’s better than the one, and the two, and the three.

DR: It’s way better. But, they did pull diet in. This next study – and we’ll put all the references for these in the show notes. But another study was done – I’m sorry, this was a review. So, again, a review paper looks at multiple other studies, analyzes a large number of other studies to try to see what the overall relationship is when looking at a number of studies. The average weight loss from fiber was 4.2 pounds. So, better, right? Probably the best that we’ve seen so far. But when there was just the effect of the fiber isolated for, about 4.2 pounds.

SM: And how much fiber where they giving them?

DR: They varied in amount, but usually about 14 grams of fiber per day was the average.

SM: And that was supplemented, not through the diet?

DR: It was actually either through…some studies did this through dietary ingestion, and some did it through supplemental ingestion.

SM: OK.

DR: And it was over the course of about 3.8 months. So, we see diets creeping its way more so into these results, and the results are becoming better and better. I want to come back to some weight loss trials that are using diet in just a second, because that’s were really have the best results. And I think that’s not really a huge ‘Ah-huh’ for a lot of people. I think most people realize that diet is a really powerful way to lose weight. Hopefully this scientific narrative will help people from maybe not getting pulled into spending a lot of money on other things for weight loss. Or at least understanding what the anticipated benefit would be if they were to use a probiotic, or fiber, or prebiotic. But, before you come to the dietary trials, I want to circle back to the whole piece of endotoxemia, or lipopolysaccharide migration from the gut. Susan, is this something you’ve heard of before? Do you have familiarity with this?

SM: Yeah, I do. I think some of the syrinx tests I’ve seen test for the lipopolysaccharide. Was it the leaky gut test?

DR: Yes, I don’t run that test, but I believe that they do use the LPS as a marker for leaky gut.

SM: Yeah, and I don’t run a test either, but I’ve had it run on me back when they first came out, because you get enticed into that kind of stuff. (laughter)

DR: Right, right.

SM: But, yes. And so, yeah, I’ve have heard it on a couple podcasts, people talking about lipopolysaccharide getting into the bloodstream and what happens.

DR: Right, OK. So, the brief back-story there is – Bacteria have this component of their cell walls called polysaccharide. Eating a high-fat diet – or I should say fat seems to be the macronutrient that most successfully helps this leak from the gut, or absorbed from the gut, into the bloodstream, OK? So, higher fat diets, or just fat in general, seem to help with that leaking of LPS – it’s also called endotoxemia when this happens. Now, the criticism has been that, when LPS levels become high, that can cause inflammation and insulin resistance. That seems to be true. But, this this is where context is extremely important, because while that is happening, if you’re also getting a low carbohydrate diet at the same time…

SM: Which you usually are when you’re eating a higher fat diet, you’re usually eating a low carb diet.

DR: Right, exactly. So, the net effect is going to be one way to become less insulin resistant or more insulin sensitive, and less inflamed. And the reason I say that is because numerous diets have shown low-carb diets to be highly successful for weight loss, right?

SM: Yes.

DR: And so, I harp on this because I think is important for people, especially people who have been eating a paleo diet, maybe it’s low-carb, maybe it’s moderate carb – I don’t care what people are eating in terms of the macronutrient ratios, as long as it’s working for them. But what I want to save people from is, let’s say you’re the sort of metabolism that you notice that a high-carb diets work well for you; you’ve done much better on a low-carb diet. You hear someone’s presentation about how a high-fat diet causes this endotoxemia, you freak out, and you change your diet, and you start gaining weight and feeling like crap because you hear all this stuff emerging from the microbiata research telling you shouldn’t eat that way. The context is really important, because, while that is true, when you zoom out and look at the whole organism as a whole, you see that mechanism actually pales in comparison for a lot of people, in terms of insulin effect rental effect, compared to a low-carbohydrate diet. Which is a perfect segue into one of the studies that I wanted to mention, which was looking at a low-carb diet versus a low-fat diet. Both can be effective. In this case, the low-carb diet showed 16.7 pounds of weight loss; the low-fat diet showed 13.2 pounds of weight loss. There have been a lot of studies that have looked at low-fat versus low-carb. I think they can both work for weight loss. One of my favorites is probably the A-to-Z weight-loss trial by Christopher Gardner, who looked at the Atkins, Ornish, Pritikin, and zone diets. So, everything from the classical low-carb, all the way through the classical high carb, low-fat. All groups lost weight, but the most weight was in the Atkins diet. And the highest complaint was also the Atkins diet. Now, I think paleo is a bit healthier than Akins, but looking at just your macronutrient ratios – high current low-carb, what have you – I think that study was also really good evidence for the fact that, even though this LPS migration may occur when you eat fat, it doesn’t mean that it’s going to cause you to be insulin resistant, if you’re eating low-carb in conjunction. Because your net-effect will be to improve your insulin sensitivity, if you a higher fat lower, lower carb, or even a moderate fat, lower carb diet.

SM: And the low-carb diet taste better than the low-fat diet. So, there’s that.

DR: Exactly.

SM: I ate low-fat for so many years, for so many years. And it’s just like now – And I’m one of those people, I tolerate carbs very well. I have to earn them. I went and lifted weights today, and so I’ll have rice with dinner tonight. But, if I don’t work out, then I don’t add that starch in, because I can get a little soft around the middle because it’s still just the way…that’s my makeup. Not every diet is right for everybody. What works for your neighbor might not work for you. That’s why we can’t get worked up. If it’s working for you – just because you hear a presentation doesn’t mean you stop doing it, if you’re healthy.

DR: Exactly, exactly. And that’s why I really wanted to kind of drive that last point home, and also why I want to share this study looking at low-fat and low-carb – both groups lost weight. So, I’m not necessarily against a low-fat diet. (It’s) not what I use in the clinic as my first intervention, but certainly there have been patients who have come in, and we’ve tried going through kind of the autoimmune paleo template, with a little bit lower carb. Some patients of small minority, but some, do notice they do better with a little bit of grain in their diets. And so for those people, we just make the appropriate adjustments. There’s a there’s a whole spectrum macronutrients that can work well for people. Just find your own truth and listen to your body, and don’t let whatever’s en vogue influence you one way or the other, if you’ve found something that works really well for you. I’m all for experimentation, but don’t get fear-factored out of something that’s working for you.

SM: Yeah, I used to get wrapped up in that years ago, and whatever with the current au courant of that day or that month, I was, ‘Okay I got to change it to that.’ Now, I know what works for me, and I can tell with my clients, I can tell what works…I can get what works for them. And I always remind them, this isn’t your destination. We’re doing an intervention. Like, say it’s low-carb. It’s for these 30, 60, 90 days, and then we’re going to add some carbs back. Because, I want people to learn to eat, so it’s not ‘I’m on a diet. I’m off a diet.’ You’re just eating, you just are, instead of this on-and-off mentality. Because, that’s the yo-yo dieting, and that’s what is going to make you more unhealthy than anything there is.

DR: Right, right. What I like to do in that regard is start people off on the autoimmune paleo diet. Also, I don’t give them a carbohydrate restriction, but, usually when people go on the autoimmune paleo diet, they end up kind of curtailing their carbs quite a bit anyway. Then, once we’ve gone through our process – we’ve done our testing, and our treatment, and what have you – then we go through a reintroduction for non-AIP foods. And then after that we go through a carbohydrate-range reduction, just like we do was with the food allergies, or the potential food allergies, bring dairy back in (and) see how you respond. I have people bring carbs back in and see how they respond. And, it’s the same thing there, really just letting your body be the guide and the judge, is going to be a great way of figuring that out. And doing it in that reintroduction fashion will help isolate the variables so that you don’t get confused and confounded by other stuff going on at the same time.

SM: Yeah, it works. It’s just amazing how much just changing a few things, and taking a few different foods out – I think when I am…with autoimmune protocol, when you’re taking some of the snacks out, like nuts, I think that really helps with the weight loss, too, because, you’re not always going to the pantry and grabbing handfuls of nuts. I know I did that in the beginning – like, ‘Oh, nuts, that’s my snack now. I don’t have these bars anymore. I have nuts…

DR: Right.

SM: …and I dried fruit, too, which isn’t one of the recommendations on AIP, either.

DR: Sure, sure. Well, this was a good one. We took a couple weeks off here, and I feel recharged. I’m happy with the way this podcast came out. Hopeful people enjoyed my rambling and got something out of it.

SM: Yeah, I think you made a lot of good points, especially with the probiotics, the prebiotics, and the fiber, because, like I said, people like to jump on the bandwagons. It seems like every month, every week it’s a new thing. I have a supplement graveyard (laughter) in my upstairs room, because I used to jump on those bandwagons. And now it’s like I look at the research, and I read the research, and I talked to people. I found how I eat works for me, and I do the same thing with my clients. And, you know, unless somebody has a lot of digestive issues, I don’t recommend a probiotic. I try to get people eating of probiotic foods. You ca change so much with food in the beginning. It’s amazing.

DR: I agree. I’m right there with you. Even though I spend most my days doing more interventional-type stuff, it has to be stacked on top of the foundation of food, absolutely.

SM: OK, well that wraps another week of Dr. Ruscio Radio, everybody. Come back next week and we’ll have another great topic. Hopefully we’ll get to the thyroid, and to whatever else Dr. Ruscio has up his sleeve, because I know he’s got a lot of stuff up there -or in the brain.

DR: Well, thanks, Susan. And thanks, guys. We’ll see you next week.

SM: Take care.
Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

6 thoughts on “Podcast – Gut Microbiota, Weight Loss and Obesity

  1. Hi Dr. Ruscio, Firstly, thanks so much for putting together such a good site and collection of podcasts. I’ve only very recently discovered you, and am so pleased I have! Anyway, the question is – in your research around the microbiota, have you seen any studies that look into the microbiota of living in the UAE – specifically Abu Dhabi or Dubai? The reason being, I’ve been living here in Abu Dhabi for 2 years and in that time have had many issues with my gut. Before arriving here I had a healthy diet and lifestyle, taking great care to include plenty of pro/prebiotics, fibre, veg, oils, etc. Since about 1 month into being here, I didn;t change a thing, but experienced very bad IBS for 6 months. After that time, I started to experience weight gain and water retention- although my exercise and diet hadn’t changed too much. I then experienced over the course of this year very heavy menstruation, dreadful PMS, terrible cystic acne along the jawline/chin and finally, depression which took me back to the UK to recover for 3 months. I have come back to the UAE now but am returning to the UK to live in the next couple of weeks as I’m convinced it is the environment out here that has impacted my gut bacteria which has lead to all the above. I’d love to know if there is anything out there that talks about this, and if not, I’m going to start my research on this in earnest! The population out here is a hybrid of diabetes, obesity and heart disease – partly due to poor diet and lack of exercise, but I believe it’s also something to do with the environment not supporting a healthy gut microbiota. Keen to hear if you think this is a deluded hypothesis!

    1. Thank you! Very interesting. I have not heard of anything in this regard. It sounds like you may have acquired an infection, which can happen with travel to a new area. It would be worth while to have a thorough gut workup. If you come across anything in your research please let me know. Hope this helps!

  2. Hi Dr. Ruscio, Firstly, thanks so much for putting together such a good site and collection of podcasts. I’ve only very recently discovered you, and am so pleased I have! Anyway, the question is – in your research around the microbiota, have you seen any studies that look into the microbiota of living in the UAE – specifically Abu Dhabi or Dubai? The reason being, I’ve been living here in Abu Dhabi for 2 years and in that time have had many issues with my gut. Before arriving here I had a healthy diet and lifestyle, taking great care to include plenty of pro/prebiotics, fibre, veg, oils, etc. Since about 1 month into being here, I didn;t change a thing, but experienced very bad IBS for 6 months. After that time, I started to experience weight gain and water retention- although my exercise and diet hadn’t changed too much. I then experienced over the course of this year very heavy menstruation, dreadful PMS, terrible cystic acne along the jawline/chin and finally, depression which took me back to the UK to recover for 3 months. I have come back to the UAE now but am returning to the UK to live in the next couple of weeks as I’m convinced it is the environment out here that has impacted my gut bacteria which has lead to all the above. I’d love to know if there is anything out there that talks about this, and if not, I’m going to start my research on this in earnest! The population out here is a hybrid of diabetes, obesity and heart disease – partly due to poor diet and lack of exercise, but I believe it’s also something to do with the environment not supporting a healthy gut microbiota. Keen to hear if you think this is a deluded hypothesis!

    1. Thank you! Very interesting. I have not heard of anything in this regard. It sounds like you may have acquired an infection, which can happen with travel to a new area. It would be worth while to have a thorough gut workup. If you come across anything in your research please let me know. Hope this helps!

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