Dr Rupy: We're talking about ways to fight inflammation today and heal your gut with the incredible Dr Will B. If you've ever wondered about what inflammation is and how it supports and can be at the detriment of your health, today's episode is for you.
Dr Rupy: Hi, I'm Dr Rupy, I'm a medical doctor and nutritionist. And when I suffered a heart condition years ago, I was able to reverse it with diet and lifestyle. This opened up my eyes to the world of food as medicine to improve our health. On this podcast, I discuss ways in which you can use nutrition and lifestyle to improve your own well-being every day. I speak with expert guests and we lean into the science, but whilst making it as practical and as easiest as possible so you can take steps to change your life today. Welcome to the Doctor's Kitchen podcast.
Dr Rupy: We talk a lot about gut health as key to not only digestion, but also better immunity, inflammation levels, skin health, mood, even brain health. But even with good daily habits, modern life can make it difficult and many of us are living with a disrupted gut environment. Stress, antibiotics, intolerances, these can all have an impact. So what do you do when things go wrong and how does your body protect you in the first place? Today, I'm going to be asking world-leading gastroenterologist Dr Will Bulsiewicz for his best tips to help your gut recover and optimise its function. Plus, we're going to dive deep into the world of inflammation and how to balance this important process with diet. If you don't know Dr Will B, he's a celebrated gastro and gut health expert, founder of popular microbiome nutrition company 38 Terra, the New York Times best-selling author of two books, the US medical director for Zoe and adjunct assistant professor at Emory School of Medicine. He's a champion for preventing and reversing disease through the microbiome and optimising your gut health and he shares his expertise via social media at The Gut Health MD. I'm super excited about his next book as well that's coming out in January 26 called Plant Powered Plus. He's releasing or he's telling us about it today on today's podcast and we're going to be diving into some of the topics today as it's super close to his heart and inflammation is something that I spoke about in my latest book, Healthy High Protein, so we really jam on that today. I think after this episode, you're going to have a really clear idea using all the analogies that Dr B uses around how your gut works, what you can do to support it and this is definitely one to share with loved ones as well.
Dr Will B: Let's talk about inflammation. Now, what are some of the signs and symptoms of inflammation that you think people are missing?
Dr Rupy: Ah, missing. Well, so there's the stuff that is quite obvious and you can't miss it, right? Like if you have a swollen red, tender knee or wrist, it's pretty clearly inflamed. But there's the other elements that can creep up on people and they may not realise that it's inflammation. So, you know, I would argue that when your skin is breaking out, when you have poor sleep, I would actually argue probably the number one symptom Rupy, I'd be I'd be curious to hear what you think about this. I think the number one symptom of inflammation is fatigue.
Dr Will B: Yes. Yes.
Dr Rupy: That your energy level dips. And those can be fluctuations that occur during the course of like a 24-hour cycle. So for example, many people, they have a poor lunch and then they get tired at three in the afternoon. And they blame it on sugar and a sugar crash. But I actually think that's postprandial inflammation, inflammation after a meal. Or you have a drink, right? And you and you have alcohol and you feel pretty good for an hour and then you just are wrecked. Or you drink a lot and then you wake up the next day and you're hung over and what is that? And like people have like sort of commonly attributed that to dehydration, right? But if that was dehydration, then like you could drink an electrolyte beverage, rehydrate yourself, you would feel totally fine. Yet it takes 24 hours to really get over it. And I'm I'm quite convinced based upon what I've seen so far that what's happening there is you have really disrupted your gut microbiome with alcohol, which of course destroys bacteria. And in disrupting your gut microbiome, you break down your gut barrier and you have created inflammation, which we can talk more about those steps. But that's the key that people need to hear.
Dr Rupy: Yeah, absolutely. I I I completely agree. I think fatigue, this is the unfortunate thing about inflammation that the symptoms are very vague and they can be explained in some ways by other pathology and other mechanisms, but the ones that I I certainly recognise there are skin breakouts, fatigue, random pain as well, so generalised pain. And obviously the the macro manifestations of inflammation as well. If people are hearing this sort of word and just thinking to themselves, yeah, I get this inflammation and like most of the supplements in the in the supermarkets are telling me that this is anti-inflammatory or these foods are anti-inflammatory. What does that actually mean? How would you explain that to someone either in clinic or on social media who's asking you, okay, what what is inflammation?
Dr Will B: Sure. So we have to start by acknowledging that this word that in our culture has taken on negative connotations, like, hey, inflammation, that's bad, right? Well, you and I wouldn't be here without inflammation, right? Within our own lives or predating going all the way back, human evolution through the years where basically acute inflammation is what allows us to address infections and allows us to heal from bodily injury. And those were for 99.99% of human history, the two top causes of death that existed. You either were going to get hurt and not be able to recover or you were going to get an infection and that's what's going to get you. Right? And so our immune system was set up to defend against that. And that's acute inflammation. When your immune system reacts in response to a legitimate threat, that's acute inflammation. Where we are today is not acute inflammation. We have crossed over into a new breed where this is chronic inflammation and it's low grade. It's not quite as intense as what you get when you're fighting an infection. It's but it's there 24 hours a day, smouldering like a fire that just never goes out. And it's been activated by our lifestyle. So the reason why is because we have changed so much. We as humans were interesting because we have the ability to change and shape our environment. And we're really the only life on this planet that has the ability to do that. And by reshaping our environment, we can actually sort of change our environment to a point where we're actually causing harm to ourselves. And so, if you think about where we were and where we are, it's been a really insane change that's taken place in terms of the way that we live over the course of a very brief period of time.
Dr Rupy: Yeah, I'm really glad you started by explaining the benefits of inflammation because the fact that we're having this conversation in the middle of LA, surrounded by environmental pollutants, exposing ourselves to different microbes and viruses that could cause issues, could cause sepsis, could cause infections. The very fact that we're able to survive and thrive is because of inflammation. It's because inflammation is the language of your immune system. It's fighting off these pathogens and it's signalling amongst our immune system as well. And we're constantly utilising inflammation in a good way. But like you said, because of this change in our modern lifestyles, this simmering inflammation in the background that should have never really have been there, it's only really meant to be there in certain places. This is what is leading to the manifestation of of disease. And so when we think about this change in our lifestyles and how we've evolved, what do you think are the sort of big levers that are pushing inflammation to this smouldering level that are leading to some of the issues that we'll talk about a little bit later?
Dr Will B: Well, I guess in order to lead into answering that question, what is it about chronic inflammation? If there's no infection, what is your immune system reacting to? Right? And we have to start by understanding that inflammation is what occurs when your immune system gets activated in response to a threat. That threat could be real, like an infection or you hurt yourself. That threat could be fake, such as something in your diet. And so what I would propose for the listeners as we dive into this conversation about inflammation is a framework of how our body defends itself. There's three parts.
Dr Rupy: Okay.
Dr Will B: All right? So, I guess if it's okay, we'll circle back to your question.
Dr Rupy: Let's do, let's do that. Yeah.
Dr Will B: All right. So there's three parts to how our body defends itself and I would actually argue that inflammation is number three. The immune system is number three. So first is actually our gut microbiome.
Dr Rupy: Okay.
Dr Will B: Our gut microbiome lives inside of our intestines. There's 38 trillion microbes and they are constantly at work, basically like doing what they can to support our health. And that includes suppressing pathogens. And we know that this is true because if you knock out the microbiome, such as by taking antibiotics, you expose yourself to increased risk of infection. Right? So those infections that come on as a response, like a classic is C. diff. C. diff colitis, which we can talk more about in a moment, but basically C. diff, you already had it. That's not a new thing for your body. It was already there. And it was existing within this harmonious microbiome where the C. diff has no power. And then you take away the harmony, you destroy the microbes and you create this opportunity where the C. diff rises up and now it creates a mess and you're sick and so the first layer of defences is actually our microbiome. And the second layer of defences is actually our gut barrier.
Dr Rupy: Okay.
Dr Will B: So our body was created, like I'll speak for myself as a medical doctor, I'd be curious to hear how you feel about this. The more that I learn about the body, the more that I'm like, it makes so much sense.
Dr Rupy: Yeah. I I I always like to think about the body and what I learn through this whole journey of nutritional medicine through the lens of evolution and just how like incredible it is that we've got to this point and the reasons why we have adapted, you know, to even taking your earlier point, this this symbiotic relationship with foreigners in our body and the fact that we have 38 trillion of them just in our gut is pretty incredible, you know?
Dr Will B: And we need them.
Dr Rupy: Yeah, we need them. Yeah. And it's just like there is a purpose for everything in our body and there is a reason why we're here like with our bodies today and it's just magical to think about it through that lens and just like how smart evolution has been.
Dr Will B: Evolution is way smarter than we are as people and it's even smarter than AI is because basically it's like long form intelligence that has led us to where we are today. And I would actually argue that all the things that we're talking about right now are like billions of years of development, right? And so and you can upend them real quick with like some crazy human ideas. So, all right. So the microbiome is our first layer of defence. The second layer of defence is actually our gut barrier. So it turns out that our entire intestine, which is about 25 feet long, so like eight metres long, it has this layer, this lining that is meant to act like a filter where you let the good stuff in and you keep the bad stuff out. And we call that the gut barrier. And when you hear people talk about something like, for example, leaky gut, okay, I used to like scoff so hard at this idea. And there's definitely some stuff on the internet that is frankly not true.
Dr Rupy: For sure. Yeah.
Dr Will B: But where I am now is the general principle that the breakdown of our gut barrier is causing problems, which some people call leaky gut and I might call increased intestinal permeability. Sure, yeah. When this wall that was meant to defend us and keep the stuff out that's not supposed to get in, when it breaks down, there are serious problems.
Dr Rupy: Yeah. Can I tell you a little side story? Not not to derail you, but I I I concur with this idea of the leaky gut, right? So when I had my own illness going back like 15 years ago now, my mum, who's not a medical doctor, took me to see a naturopath and it was during my journey as a patient, right? I'd seen all the cardiologists and you know, they were suggesting to me that I should have an ablation to fix my atrial fibrillation that was paroxysmal. My my mum was very anti against this. She's she's sort of Ayurvedic principles, typical Indian mum. So to appease her, I remember being led around to all these naturopaths. And I was just a freshly newly minted doctor, right? And so when this naturopath started talking to me about how I may have a leaky gut and I need to ensure that my leaky gut is fixed through doing very simple things like increasing fibre and all that kind of stuff. I remember arrogantly turning around to this person and just saying, I've been through medical school for six years. I've never heard the term leaky gut. I think this is complete BS. And now, honestly, I I shudder at that.
Dr Will B: You want to apologise?
Dr Rupy: I really want to apologise. This is the apology right here. Uh, you know, about that scenario because I think particularly in medicine, and I I I'd be curious to know your experience with this. I think we have sort of this arrogance around knowing everything and this EBM approach that, you know, trumps everything else. And I think the more I learn about the body and the evolution of the body and the more I learn about traditional wisdom, I have a much greater appreciation and I'm actually humbled by a lot of these things that I used to think earlier were just BS. So yeah, sorry, sidebar there on your on your point about leaky gut.
Dr Will B: Yeah, well quick comment on that and then we'll get back to the the defence systems. But I agree with you and I think that uh, so I have a background in, I have a master's degree in clinical investigation that I got at Northwestern and so I come from this background that's very academic, very evidence-based medicine. And yet the more that I learn, the more that I understand that these traditional uh, medical approaches, they have 5,000 years. Ayurvedic has 5,000 years of experience. And so what they're describing is what they learned through 5,000 years of experience. Now we might roll in with our clinical trials and say, well, this is the gold standard, right? And the problem is that like that we should not be so quick to dismiss 5,000 years of experience based upon like whether or not there's a clinical trial or not.
Dr Rupy: Yeah, yeah. And even in the nutrition world, you know, there's a teleological reason as to why beans and grains are found in so many different cultures worldwide is because their trials and their experimentations about what works to ensure that we get enough protein in our diet has been done time and time again at different parts of the continent and different parts of the world. So there is a lot of wisdom even in the simple things like recipes that we should be a lot more appreciative of. So I'm I'm so glad, you know, someone who went to Northwestern and did the your masters and that like has come around to this idea as well. So.
Dr Will B: I think there's a humility to it all, right? Like you start to realise that you can't explain everything through evidence-based medicine. And ultimately, I think working with patients is really helpful.
Dr Rupy: Oh yeah, absolutely.
Dr Will B: Because at the end of the day, like your job is to guide them to outcomes and you realise that there's not perfect studies for every single thing that you're going to do. You're like you're guided by the research, but at the end of the day, you still need to be prepared to like adapt to the individual person because of the bio-individuality.
Dr Rupy: Yeah, absolutely. Yeah. So, let's bring it back to the defences. Bring it back to gut barrier. So are we going to be going and meandering a lot I think today, so.
Dr Will B: Yeah. So the well, the so the key here is that what I'm proposing is that there's these three parts, which is the gut microbiome, the gut barrier, and finally the immune system. The immune system sits on the other side of the gut barrier. So you have to actually cross into the body to get access to the immune system.
Dr Rupy: Just before we go into the immune system, sorry, can we double click on the gut barrier? So when you say the gut barrier, are you just talking about that sort of final layer where you've got the mucin layer and then you've got the different sort of gateways in between gut cells or are you also sort of incorporating the acidity in the in the stomach and and other sort of elements like bile acids along the way or when you think about gut barrier, you think about the distal part of it?
Dr Will B: So the part that I'm referring to is really the epithelial layer that's covered in a mucin layer.
Dr Rupy: Okay.
Dr Will B: So and for the for the listeners at home, let me make an analogy to sort of bring this all together.
Dr Rupy: Yeah.
Dr Will B: Imagine that we have a castle. Right? And what's inside of that castle is precious. It's you. You're the king or queen. And we want to protect you and keep you alive and well. So what we do is this this castle has a wall. That's the epithelial layer. Right? And the epithelial layer is held together by these proteins that are called tight junctions. That's like the cement that holds the bricks together. Okay? And then outside of the castle, we also have a moat. So the moat is this physical barrier that's hard to get through and it's a mess and who even knows? If it was my moat, there's alligators in there, right? I'd make it real cool. Maybe some sharks with laser cannons. Like who even knows what I'd have in my moat. But like the point though is that the moat is outside of the castle and it's this physical barrier that also exists. That's the same way that our body is set up. The gut barrier has a wall like a castle wall and has a mucus layer that's this thick thing that that includes these proteins that are antimicrobial that is also intended to defend us. And these two parts work in concert. And it's interesting, Rupy, because the body is constantly repairing and renewing this. So they don't just build the wall and then leave it and allow it to decay. They have an entire team that's working constantly to restore the wall every three to five days. You get a brand new gut barrier.
Dr Rupy: Oh, wow.
Dr Will B: There is no other part of your body that turns over cells as quickly and renews as quickly as your gut microbiome. So we hear about like how resilient the liver is and what I'm saying to you is this is turning over way quicker than the liver does. So brand new, every three to five days. And who who are the custodians? Who are the ones that are helping to work on the gut barrier, repairing it, restoring it, keeping it fresh, keeping it strong? Those are the gut microbes that live outside the castle wall. This is their job. They exist to basically build up this wall. Now, if you like we have a gate and that gate is going to allow stuff in that we want. And when something comes to the gate that we don't like, we close the gate. But if the gut if the wall is broken, if the wall has holes, if the wall is not standing strong the way it should be, then when that thing that comes to the gate that we don't want to get in, it'll find a way to get in.
Dr Rupy: I love that analogy. I'm going to steal that.
Dr Will B: Please do. Please do. So, uh, so anyway, and then if if like this this thing, this invading, you know, uh, barbarian horde comes to our castle wall, right? And happens to get through the castle wall, which I don't want that to be the case. I want to build up those microbes and allow those microbes to have a strong castle wall for me because that's going to protect my body. But if the barbarian horde manages to get through the castle wall, then they're going to come into contact with the third defence system, which is the most powerful defence system, which is our immune system.
Dr Rupy: Okay.
Dr Will B: And the immune system is like our army. Um, and I would break it into two major units in the immune system. So the the first is um, uh, the innate immune system. And the innate immune system is pre-programmed. And these are like the simple soldiers that like they just do what they're told. They're not really thinking and they're just going to go and do their thing. Right? And the innate immune system actually, it's very interesting, Rupy, uh, I would I would actually argue that our innate immune system is actually at least a billion years old.
Dr Rupy: A billion years old?
Dr Will B: A billion years old.
Dr Rupy: Wow.
Dr Will B: Because it goes literally all the way back. Our our immune cells are responding to things that evolved a billion years ago in the microbes. Because there was a very long period of time where the world was microbes.
Dr Rupy: Gotcha.
Dr Will B: And there was no multicellular life. There was let alone humans. We were way not even close to being around yet.
Dr Rupy: Absolutely. Yeah.
Dr Will B: And these battles that were occurring in ecosystems as microbes were trying and fighting to emerge created the framework that like we're literally talking about right now. Like these were like the precursors to what we're talking about now. And everything was in response to something else. And so that like billion-year build is what ultimately led to our immune system that is quite automated. So, um, like it's not intelligent. It can't think. It can react. It's like robots that are pre-programmed. And what they're taught to really react to, the thing that really like is uh, the sort of like, I guess let me put it this way. Think about like if you were to say what is your number one movie villain of all time?
Dr Rupy: Number one movie villain? I'd probably say Al Pacino in Scarface, which is a weird villain to have because he was like the sort of protagonist of that movie, but at the same time he was a villain. And I don't know why I've been thinking a lot about old movies, probably because I'm in LA right now and I think I had a conversation about some of my favourite movies, but I think Al Pacino in Scarface was the villain in a way.
Dr Will B: Okay. Well cool. That that was that was more complicated than I expected. But a simple villain, I don't know. I mean.
Dr Rupy: Let me get us back on track here. Which is uh, I'm going to keep it super simple. I'll play my theme song. Okay, fine. We're going to go with Darth Vader. So Darth Vader like he rolls in, you're like, yo, I don't want to mess with that guy. Right? And I realise like I'm kind of a Darth Vader fan. He redeemed himself in episode six, return of the Jedi. I've been watching this with my kids.
Dr Rupy: Well there you go. It's complicated as well.
Dr Will B: It's complicated. It's complicated. But at a minimum though, he had a big run as being like the classic movie villain. Classic movie villain theme song. Right? All right, so our our movie villain for what we're talking about is something called lipopolysaccharide. And lipopolysaccharide is actually the armour that exists on the outside of pathogenic bacteria. These bacteria like E. coli, they have this lipopolysaccharide surrounding it on the outer shell. It's like armour protecting it. And so what happened is that our immune system evolved to recognise that. If that shows up, we go to war.
Dr Rupy: Gotcha.
Dr Will B: Right? If that shows up, we know that's not a good guy. And we got to fight it. So the problem is that E. coli or these other bacteria that have this lipopolysaccharide armour, they exist naturally in our microbiome and they're not really a problem when they're just there. If you could keep them contained within your microbiome, they're fine. They become a problem when that wall starts breaking down. Because when you start to have weakness in the wall, they're like rats. They find the hole and they're able to sneak in. And when they come in, now the immune system, it has no choice. It's pre-programmed. That's its age like age old enemy for a billion years. We're going to war. And so the problem that we really have with chronic inflammation is that the weakness of our gut microbiome has led us to a scenario where when the gut barrier needs to be repaired and restored every three to five days, we're not doing a an adequate job of doing that. And so a weak gut wall leaves it open so that these bacteria that shouldn't be causing trouble for us are in fact causing trouble because they're sneaking across. And now you have an immune system, this army is going to war to attack these uh, to attack these lipopolysaccharide bacteria. And the activation of the of the military, there's consequences. There's consequences. It because like you can't have, you know, people like if you live in the city, imagine you live within the walls of this of this castle. I mean, you can't have like go like walk to work and people are like killing each other and you're going to act like it's nothing and it doesn't change anything about the way that you live, right? Like this inflammation has consequences. It causes long-term organ damage. It causes long-term organ dysfunction and ultimately leads to the manifestation of disease. And many of the chronic diseases that we're fighting against today are the result of chronic inflammation. But what I'm saying is when you hear chronic inflammation, don't just think about the immune system. When you hear chronic inflammation, I want you thinking immediately about the gut microbiome, the gut barrier and the immune system because they rise and they fall together.
Dr Rupy: So within this picture, and this is this is great and I think people are going to recognise the analogies that you've used as well as the explanation of the different defence systems and just breaking it down like that. I think it's super clear for folks. When we think about the rise in inflammation as a result of the breakdown of these different systems, you mentioned it and alluded to it just then, what are the consequences of this downstream? What are the things that, I mean we talked about symptoms a little bit earlier and feel free to refresh them if you like, but what are the other things that could be related to this excess in inflammation?
Dr Will B: Right. So, um, when you have activation of of the immune system and chronic inflammation, yes, like there's the acute symptoms, fatigue is possible. Um, it may affect your sleep. It may affect your ability to focus. That's a little bit different than fatigue. It may affect your mood in a negative way. Um, it also, we discussed skin, there's GI effects. So it could cause bloating or constipation, diarrhoea, digestive discomfort, sensitivity of the gut, which is like a hallmark of irritable bowel syndrome. Um, it could manifest with allergic diseases where your body starts reacting to things that it's not supposed to. So when it's an allergic disease, you're reacting to something that's foreign to your body. So that could be like pollen, but it could also be food. Um, or it could manifest with autoimmune disease. And autoimmune disease is where your body is reacting against itself. And a confused immune system has like it's it doesn't even know who to fight. It's just fighting everyone. And so then it turns against your own cells, starts attacking them and now you have the manifestation of rheumatoid arthritis or lupus or multiple sclerosis. And then there's Crohn's disease and ulcerative colitis. They're an interesting topic because those are what we call inflammatory bowel diseases and as a gastroenterologist, I've taken care of thousands of people with these conditions. And um, I used to call them autoimmune. I actually don't call them autoimmune anymore. The reason why is because your immune system is not reacting to your cells. The immune system is not actually attacking your colon. The immune system is attacking your microbiome.
Dr Rupy: So this is like auto microbiome.
Dr Will B: Yeah, you are attacking your own microbiome. And what you once accepted, right? Because during childhood, we learn that these microbes are our friends. And then the turn happens, your immune system determines that it's the enemy, that it needs to be taken out. And in the process of going to war against your microbiome, what's stuck in the middle is your colon or your intestines. And so you manifest inflammation as a result of that.
Dr Rupy: Yeah.
Dr Will B: So, um, uh, other things. So like let's talk about metabolism. So, um, inflammation actually affects our blood sugar. Inflammation affects our blood fat, whether that's after a meal or that is uh, sort of like the chronic state of our lipids, like the typical blood work that people get when they go to their doctor. Inflammation affects our ability to feel full. It affects our appetite. Think about this within the context of obesity. But inflammation also affects our ability to gain and lose weight. In other words, we we actually shift more towards weight gain as opposed to weight loss. So there's an interesting thing, Rupy, a real uh, double click on that. I hope you don't mind.
Dr Rupy: Yeah, yeah.
Dr Will B: So, um, it turns out that insulin resistance, which has inflammatory elements, it was uh, actually evolved to protect us.
Dr Rupy: Oh, really?
Dr Will B: Believe it or not.
Dr Rupy: Okay.
Dr Will B: Have you ever heard this theory?
Dr Rupy: Let's let's talk about it now. I think I've come across this.
Dr Will B: Okay. Yeah. All right. Like this would make no sense to a modern doctor because us to us, insulin resistance is type two diabetes. And it's a clear problem. And so how could that possibly be evolved for benefit?
Dr Rupy: Yeah. I just want to quickly explain what insulin resistance is to the uh, listener. So, uh, insulin resistance is where you essentially become resistant to the hormone insulin that's released by the pancreas in response to uh, sugar in your bloodstream. Uh, insulin has a very important role in terms of removing sugar from your bloodstream and putting it into cells where it can be either stored for energy or utilised as energy. Um, and when you have persistent high blood sugar and therefore persistent high levels of insulin in your bloodstream, your cells essentially need a greater dose of insulin to have the same desired effect. Ergo, you become resistant to the the dose of insulin and you need higher amounts of insulin to be released from your pancreas. So and this is a hallmark feature of um, uh, type two diabetes or pre-diabetes or metabolic dysfunction.
Dr Will B: Metabolic disease. Right. And and there's uh, examples of insulin resistance that exist prior to the onset of pre-diabetes or type two diabetes where like the earliest signal would be if you had blood work done, you could potentially detect insulin resistance even though you have a totally normal blood sugar.
Dr Rupy: Totally.
Dr Will B: Right? Because you're basically your body is now starting to fight against the current. And it's to the point at which it's failing in the fight against that current that you actually develop diabetes.
Dr Rupy: Exactly. Yeah. Which is one of my bugbears, sorry, with modern medicine because, you know, you could be passed off as normal with a normal HBA1C, but actually, you know, your your insulin system is working really hard to keep that blood sugar level down such that it's not detected by those uh, less those bloods with less fidelity. So.
Dr Will B: Yeah, well what you're speaking to is uh, having a more nuanced understanding of the mechanism by which the metabolic disease manifests. And the um, the problem is that the healthcare system has been fixated on the sugar. And this has spilled into people like, you know, thinking that sugar is always bad, whereas like, you know, for you and I, like we know that blood sugar actually is quite important because that's what feeds our brain. Like that's the energy source for our brain. Okay. So, but go back to like way before modern times, we existed in a period of food scarcity. We were way more likely to starve.
Dr Rupy: Right.
Dr Will B: And we there's basically no obesity.
Dr Rupy: Yeah.
Dr Will B: Okay? Like it basically didn't exist. And so it turns out, Rupy, that when you um, when you shift away from an uh, uh, an optimised body weight, it's always inflammatory. So we see it in the modern world in terms of obesity. And obesity is clearly associated with inflammation. There is no doubt about this. And when people who are obese lose weight and are moving back towards a more optimised body weight, inflammation goes down. Okay? So, and that is associated with like at the same time, insulin resistance improves, right? So you're moving towards better uh, metabolic health. Okay. But let's look at the opposite side of that, which is that if you lose too much weight, that's inflammatory too.
Dr Rupy: Yeah.
Dr Will B: And if you take a person who, for example, has an eating disorder with a very low body mass index, and you and you feed them, inflammation levels go down. This is part of the reason why uh, eating disorders, like there's a number of reasons, it's not just inflammation, but one of the reasons why eating disorders are very dangerous is they're it's your body's in extremis. And so now within that context, you're trying to preserve as much energy as possible. And so the so what evolved was in response to inflammation, in response to inflammation, your body activates insulin resistance.
Dr Rupy: Ah, that's fascinating.
Dr Will B: So you lose too much weight and the body wants to keep you alive. So it wants to save as much energy as it can. And so this is what it does is it activates insulin resistance. So this is um, the concept is called antagonistic pleiotropy.
Dr Rupy: Gotcha.
Dr Will B: And that's my nerdy way of you may have noticed. Not just the rat thing. There were some other moments where I'm a bit of a nerd. Yeah, yeah, yeah. That was so good. So this antagonistic pleiotropy though is an interesting thing within the conversation that we're having about inflammation because um, basically what this means is that what we evolved to protect us at a different time has become a problem for us during modern times. And it's not just this, hey, uh, if you have inflammation, you develop insulin resistance. That's not the only example of antagonistic pleiotropy. In fact, if you walk into your supermarket, antagonistic pleiotropy is everywhere. And here's why. So, um, you mentioned sugar, right? And elevated blood sugar. Okay. So, like added sugars, massive part of the American diet, the British diet. And destructive to the gut, destructive to the microbes, destructive to the gut barrier and clearly inflammatory. And I could give you a list of about 20 different health conditions that have been associated with the intake of added sugars. So the so the point for the listeners at home is that sugar, like I mean, clearly is problematic. But we have a craving for sugar. There's a reason why we want it so bad because we need that energy source. We came from a place of starvation. So sugar was actually us finding fuel for our body. But you know what's an even more powerful fuel than that is fat. Because you get four calories per gram of carbohydrate, but you get nine calories per gram of fat. So there's a natural desire to consume fat. So there's this innate drive to like, hey, fatty food tastes good. This is why they're adding, you know, I don't know how you feel about seed oils, but like there's seed oils, but there's saturated fat and there's trans fats and like the bottom line is that fat tastes good. And if anyone's denying that, I don't know what to tell you. But like this is a part of your innate biological drive to have that taste good because your body was pre-programmed for starvation mode. And the third thing is salt. And so salt was uh, something that like clearly our body needs. It's a it's a um, an essential mineral. And uh, and it was hard to find. So we created an innate drive because you are more likely to survive if you had this natural desire to find salt. So there we were as cave people out there like searching for our food, trying to find sugar and fat and salt. Right? And now here we are and you and I are like, so what am I going to eat today? I'm on my third meal of the day. I can go to the supermarket or I could just run through the fast food, like, you know, drive through or right? And now we like there's no absence of food. But that innate drive to continue to consume these things continues to exist. And the problem, Rupy, is that the food industry figured this out before we did.
Dr Rupy: Absolutely.
Dr Will B: Right? Like the medical doctors weren't talking about this. We weren't studying this, but the food scientists were. And they figured out that if you combine two out of three, you create hyperpalatability. So of those three, sugar, fat, and salt. If you go sugar and fat, sugar and salt, salt and fat. Okay. Basically, we now have a definition for hyperpalatable foods. And hyperpalatable foods lead to overconsumption. Because actually the research shows that you never feel full. The satiety hormones get disrupted. You always want more. And there's actually elements of it that if you really dig into like what happens when you eat these foods, um, it's very, very similar to like biochemically what's happening in with people that have drug addiction. So, I mean, the intensity, not the same, clearly. But um, within in terms of the biochemical pathways, very similar. So we get food addiction. So, and you know, now here we are and we have this western diet that is prevalent in the United States and slightly less prevalent in the UK, but not that far off.
Dr Rupy: Oh no, it's getting there. Yeah, yeah, yeah.
Dr Will B: Yeah, I mean basically if you look at any curve, it's like the UK is parallel to the US. You're just a little bit behind. Australia, a lot of the same issues, EU, a lot of the same issues, Canada obviously same issues, right? This is the western diet. And it's built on these three main nutrients. And every single one of them, if you dig in, sugar, disruptive to the microbes, disruptive to the barrier, disruptive to the immune system. Salt, disruptive to the microbes, kills 90% of lactobacillus.
Dr Rupy: Really?
Dr Will B: Yeah.
Dr Rupy: Wow.
Dr Will B: 90% of lactobacillus. Activates, activates the um, immune cells that are associated with autoimmunity.
Dr Rupy: Ah.
Dr Will B: Yeah. Uh, and then last but not least, fat. Well, so okay, so I just want to be clear, fat is not innately bad.
Dr Rupy: Sure.
Dr Will B: But there are good kinds and there are bad kinds. Or there's like at a minimum, it's like there's a hierarchy. Right? And everyone, thankfully exists uh, agrees on one thing. This is like the only thing in nutrition that literally everyone agrees on.
Dr Rupy: Yeah.
Dr Will B: I used to think everyone agreed that fibre was good and then I discovered that's not actually true.
Dr Rupy: I know, there's a lot of people who are really anti-fibre and I just don't understand it.
Dr Will B: I would like to have a word with them. But I thought that was a universally accepted truth as well, but you know.
Dr Rupy: I think there's only one thing that's universally accepted and that is trans fats.
Dr Will B: Yeah, yeah, yeah. I think everyone can agree on that. You kind of got a little sick right there. You okay? Thankfully you're with a gastroenterologist. I'll take care of you, buddy. Yeah. So, but Rupy, if you think about this, like so here we are and you know, 60% of our diet is ultra-processed foods. Right? And so those ultra-processed foods are mostly made up of these three main nutrients, sugar, bad fats, and salt. And I'm telling you that like the food system knows that if they can put two at least two out of three, if not three out of three together, then they can bring you back for more. And I'm also telling you that each of these things on an individual basis is disruptive to the three layers of defences. And I'm also now I want to just add to that that there's a cocktail effect.
Dr Rupy: Yeah.
Dr Will B: There's a cocktail effect. It's not just like singular. They can actually synergise in a negative way.
Dr Rupy: So, you know, you've articulated very eloquently the issues with inflammation from an acute and chronic perspective. So some of those symptoms, I think, just as you were saying them, a lot of people are going to be recognising, oh my god, I've got skin issues or I feel tired all the time or I have fatigue or I've got brain fog or, you know, I know someone with an arthritic condition. I know someone with metabolic issues. I know someone who's overweight or underweight and might be having the signs and symptoms associated with excess inflammation. I think it's a relatively new phenomena that we understand the link between inflammation and mental health and I'm glad that's getting a lot more attention as well. Therein lies the question of, okay, I understand in part it's because of food and the types of foods that we tend to overconsume, salt, sugar, and certain types of fats in certain doses, obviously, you know, there's a certain amount that you can consume healthily. Um, but there's obviously uh, the threshold and most of us exceed that given our our dietary patterns. Um, what do we do about it? Uh, that is probably the the next sort of logical question and how do I determine that this is definitely going to be related to inflammation as well? What are the ways can we measure it?
Dr Will B: Yeah. Well, so I guess what I would say is like first of all, it's not just nutrition as the only thing that matters, right? And we can delve later in the episode into other topics. I mean, we we could go for six or seven hours here.
Dr Rupy: Oh yeah, absolutely.
Dr Will B: Um, but I I would argue though that nutrition is perhaps the most powerful lever that we have, particularly for people who are consuming the western diet. They have an entire world of opportunity in front of them. And I would uh, I would say, okay, our environment, Rupy, like the the general thesis here is that our environment changed, right? I I'm telling you that we evolved to live within a certain time and space and we as humans, we are like evolutionary pioneers, right? We can like change the world around us and now here we are and like I, you know, you are on a laptop right now and we are within this walled space that has air conditioning and someone probably cleaned this space last night. And I came here in a car and like all these things didn't exist 120 years ago. Right? And so so all of this has changed. So should we try to be cavemen? And the problem with this is like I'm look, I'm actually not trying to bash on the paleo diet because there's a lot that's in there that I agree with.
Dr Rupy: Sure, yeah.
Dr Will B: Okay. But uh, the concept of us like being paleolithic and then hopping in our car, you're busted. Right? The idea of us being paleolithic and then you just bought paleo chips at the supermarket, you're busted. Okay? Like I'm sorry. I don't care what is in them. They're not paleolithic if they come in a bag that you have to pop open. Right? The idea of us being paleolithic and I know you're on your phone because I saw you on Instagram. You're also busted. Right? So are we honestly going to go back to being paleo? No. So how can we live in modern days and make this work? The answer to that question is let's look out into the world and ask the question, who are the people who are thriving? Like despite modern the modern world, modern culture. And I would if if we could go on a world tour together, Rupy, if there's a highly affluent listener to your podcast who wants to fund this, we would hop on a plane and we would go first to the Mediterranean.
Dr Rupy: Yeah.
Dr Will B: Because there's overwhelming evidence for a Mediterranean diet. And this uh, this concept of a Mediterranean diet. So to describe this, um, it is like it really came from Ancel Keys who is the founder of modern day epidemiology where immediately after World War II, he was studying the risk for heart attacks, cardiovascular risk across the globe, not just in the Mediterranean. And he was like, okay, wait a minute. People in New York City are way more likely to have a heart attack than these rednecks in Italy who are poor and live in the country. Right? Uh, what's going on here?
Dr Rupy: Yeah.
Dr Will B: And so he drilled down and he discovered that they eat this diet that is rich, like abundant in plant-based foods, a lot of fruits, lots of vegetables, extra virgin olive oil, sourdough bread, includes fish and shellfish, includes some fermented dairy. And you know, and the other thing too is like I you could argue a Mediterranean dietary pattern, the Mediterranean is diverse. There's a lot of different dietary patterns that exist.
Dr Rupy: Absolutely, yeah.
Dr Will B: And I think that's cool. I love that. It's like a cultural crossroads for the world. Um, but when we do research, we do have a definition, right? Of what constitutes a Mediterranean pattern. And when we apply that definition to modern populations of people, study after study after study is showing us that they're healthier. And my favourite study is uh, the PREDIMED. So because the PREDIMED was like 7,500 people in Spain who were um, uh, high cardiovascular risk but hadn't yet had a heart attack, 55 to 80 years old. And they basically got randomised to one of three diets. It was either a low fat diet, which historically, like we were told this is what you're supposed to do. Low in fat. Okay. So let's put that up against a high fat Mediterranean diet with extra extra virgin olive oil. Like lots of it. Four tablespoons per day. That's 400 calories of extra virgin olive oil per day. Or a high fat Mediterranean diet with extra nuts. A handful of nuts. And what was amazing is they followed these people like for on average five years each. And what they found is that consistently the Mediterranean patterns, both of them, outperformed the low fat diet in terms of cardiovascular risk. So people, you know, people were following these patterns, they were less likely to have a heart attack, they were less likely to have a stroke, they were living longer, they had lower LDL cholesterol, they had lower blood pressure, they had better cognitive function. There was the inference that it might protect them in terms of dementia risk. Um, they had better blood sugar control. So like metabolically superior. And uh, and I think that like to me that blew the doors off of arguments that fat is inherently bad.
Dr Rupy: Yeah. Yeah. Absolutely.
Dr Will B: So, uh, and I I I so to me, like you can't deny this like, you know, one of the great nutrition studies of the last 25 years looking at the Mediterranean dietary pattern against the low fat diet and cardiovascular risk and other outcomes. So, but it's not like that's not our only option. We have other options. We could hop back on our plane and we could fly across the ocean and come to the uh, the islands of Japan. And think about these people that ate consumed a traditional Japanese diet that was high in plant-based foods and soybeans and rice and fish and um, uh, real whole foods of many varieties. And this is why Okinawa is a blue zone where like you have some a disproportionate population of centenarians there. And the problem is that like uh, Japanese doctors, Rupy, have been struggling because they're now having to deal with health conditions that didn't exist 50 years ago.
Dr Rupy: Yeah.
Dr Will B: Because as as Japan um, uh, basically bounced back from World War II, they actually had tremendous economic growth. Like the modern version of Japan was brought during that time. And they abandoned their old diet and they westernised and they started consuming more like food much more similar to the way that we eat in our countries.
Dr Rupy: Sure, yeah.
Dr Will B: And suddenly they start seeing cases of ulcerative colitis and Crohn's disease, which they weren't previously seeing.
Dr Rupy: Yeah.
Dr Will B: Number one, that speaks to these are not just genetic conditions.
Dr Rupy: Yeah, yeah.
Dr Will B: Right? Like you can't the genes didn't change.
Dr Rupy: Totally.
Dr Will B: Right? Number two, that speaks to like the power of a dietary change or like a lifestyle change that you could have it where it's like very low and then things change and in one or two generations something totally different. The risk is really evolved. So these Japanese gastroenterologists, I want to meet these guys. Because as a GI doc, I'm like, I love you guys.
Dr Rupy: 100%, yeah.
Dr Will B: So they uh, they took it upon themselves to conduct a study, Rupy. Uh-huh. Looking at they basically their thesis was, okay, so we have and and I want to frame this for uh, the listeners who may not be familiar with these inflammatory bowel diseases like Crohn's disease and ulcerative colitis. We we touched on them a little bit here.
Dr Rupy: Sure.
Dr Will B: If you go to a GI doctor in 2025 and you are diagnosed with these health conditions, there is a very strong possibility that they're going to put you on a class of medications called biologics. And the classic biologic, which I've prescribed and had great success with, is called infliximab. All right? And we know that as Remicade here in the United States. And um, so now uh, there's newer ones that exist now. Humira is a reasonably newer one. There's other ones beyond that. Okay. But the point though is like these drugs, they do work. They do work. They work by sort of like putting a bandaid on inflammation. But we learned during our conversation that inflammation doesn't just exist by itself. There's the gut barrier and there's the gut microbiome. And if we want to get to the root of this issue, we need to heal those things. So these Japanese gastroenterologists started a study where they said, we're going to treat you with infliximab. But we're also going to put you on a flexitarian diet.
Dr Rupy: Ah.
Dr Will B: And it was like a traditional Japanese diet. It did include some meat, but not a tremendous amount of meat. But like getting back to more traditional Japanese food. Okay. So they like literally found that 95% of people who were on this combination of a flexitarian diet plus infliximab went into remission within a year. 95%.
Dr Rupy: Wow.
Dr Will B: The gold standard for infliximab is about 55%.
Dr Rupy: Wow.
Dr Will B: So this is uh, to simplify those numbers, imagine that I'm telling you you have a 50/50 shot or a 19 and 20 chance of success.
Dr Rupy: Yeah.
Dr Will B: That's insane. I'll take 19 and 20 every day of the week when you're talking about a chronic inflammatory disease that like makes me feel horrible.
Dr Rupy: Gosh.
Dr Will B: Right? All right. In addition to that, um, they tracked these people out for 10 years. And this is so cool. They found that 50% of people who were basically like put onto this diet, 50% of them stayed in remission and didn't have a single flare.
Dr Rupy: Wow.
Dr Will B: With these conditions like ulcerative colitis and Crohn's disease, a common question that patients ask is, is there a cure? The answer is no. There isn't a cure because you can't like I can't put you in a position where the disease doesn't exist and will never come back. But if I gave you a permanent remission where what I'm saying is you never have another flare for the rest of your life, then although I can't call that a cure, I cured you. Like it effectively is a cure because if you never have a flare again, it's like as if you're the same as me who doesn't have this this condition.
Dr Rupy: Absolutely.
Dr Will B: And so 50% of the people who followed this approach did not have another flare for 10 years.
Dr Rupy: Gosh. That's incredible. Hey.
Dr Will B: They looked at ulcerative colitis and they saw CRPs where the average CRP in the beginning was very high. It was nine. So now that's hard for the listeners at home to understand. Like you understand how high that is. It's crazy high. And they dropped it all the way down to a level of 0.5, which was within the normal range on this combination. So here's the point. We talked about the Mediterranean diet. Now I'm putting on the table a flexitarian diet that has proven its merit for reducing inflammation. And for the last time, we're going to hop in our plane, Rupy. We're glad that we have this rich benefactor. It's been a cool trip. We're having a good time.
Dr Rupy: I hope we get a good flexitarian diet on this uh, on this long haul flight.
Dr Will B: Yeah. All right. So we're on this trip. We have our families with us because otherwise you and I would get in big trouble.
Dr Rupy: Oh yeah, absolutely.
Dr Will B: We've got to have a big plane with your kids.
Dr Rupy: That's true. That's true. Um, and we're actually going to fly to actually very close to where you and I are right now.
Dr Rupy: Okay.
Dr Will B: We'll see the Hollywood sign.
Dr Rupy: Oh, nice.
Dr Will B: And we'll touch down in Loma Linda, California, which is not far from here.
Dr Rupy: Gotcha.
Dr Will B: And this is uh, a unique community, also a blue zone where people live on average 10 years more than the average American. They don't have a different healthcare system. They don't have a different food supply. They just live differently. These this is where the Seventh-day Adventists live. And part of their belief system is um, like there's a culture of health that exists. They care about their bodies. They see their bodies as being a gift from God. And so they like it's culturally normal to eat a clean diet, to not consume alcohol, to focus on community and social connection. And so, um, what's interesting is that has this has led to the largest uh, population-based study. By the way, there's the EPIC Oxford study, which we could talk about if you want to. But which is in the UK. But this is the largest population-based study that's allowed us to take a look at other patterns that are not super common in the United States. They're a little more common in the UK. But they're not very common in the US, like vegan and vegetarian and pescatarian. Um, and what was interesting is that they found in in their research in the Adventist 2 study of studying these populations, benefits to each of these dietary patterns in their own way. They're all beneficial. So vegan, vegetarian, pescatarian, flexitarian, they found benefits in this study. And so I think I want to just take a quick moment to zoom out and say that um, you know, we uh, have a culture that tries to force us to apply a label to our diet to be a certain thing. And I think the conversation that we're having today shows us that it's not about the label that you apply. It's about the overall dietary pattern and that you have options. And that there are many different dietary patterns that are anti-inflammatory and can promote your health. But um, I do think though that there's some common common nutrients, common bonds between these dietary patterns that we've described that you could basically say, well, if you nail those things, and I have thought about this.
Dr Rupy: Yeah.
Dr Will B: And there's four of them.
Dr Rupy: Okay. Yeah. And there's four of them. Before you go into those four actually, because we can get a bit more granular about the ingredients themselves or perhaps the categories of ingredients that would fit into an anti-inflammatory nutrition pattern. I just want to double click on inflammatory bowel disease and your position as a gastroenterologist. Do you see an appreciation for diet in this way given, you know, one of the studies that's shown such a remarkable improvement in people's experiences with UC? You know, do you see a greater appreciation amongst your gastro colleagues or are you still fighting an uphill battle with a lot of medics who just still have this idea that nutrition isn't important as it pertains to an inflammatory disease?
Dr Will B: I think we're still fighting an uphill battle. And there's a systems-based problem. I don't think the problem is the intent of the doctors. I think the doctors mean well. So I actually come in in in a way in in defence of doctors, Rupy, because um, like if their entire sometimes I feel like they get, you know, dirt thrown at them where people say, oh, well, you just want to be rich. And it's like, you don't understand. Like any person who goes to medical school, they could have been an investment banker. And you know what? My friends, when I was like working a 30-hour shift, right? My friends were investment bankers were in Iceland having fun and getting a million dollar bonuses. And I was in debt and working a 30-hour shift and smelled horrible. That's so like and I and I I mean, are there are there doctors that are problematic? Sure. And so are there's lawyers that are problematic and there's politicians that are problematic. It exists in every single field of humanity. But um, I I think that doctors are well-intended. And the issue here is that they're not trained that nutrition is essential. They're not trained that nutrition is the root like uh, like a root cause approach. Right? What they're taught, which there's reasons for this and I think it like a lot of it has to do with how we've structured medical school and also like the control of our organisations which are sponsored by pharmaceutical companies. What they're taught is if that patient comes in with ulcerative colitis and Crohn's disease, you can give them an amazing response and they will feel so much better by giving them this drug. And that's the extent of it. The pharmaceutical industry that shows up in your office with lunch is not going to say to you, and you should pair it with this dietary pattern because that dietary pattern will allow you to maybe one day take them off of this drug. They're never going to say that. I was actually kind of, you know what, you did an apology to someone uh, earlier in the show.
Dr Rupy: Yeah, yeah, yeah.
Dr Will B: So I'm going to take a quick moment to apologise to the drug reps who used to come to my office because I wasn't very nice to them.
Dr Rupy: Really?
Dr Will B: Yeah. And the reason they're just trying to do their job. Right? They're just trying to do their job. And I was not nice to them because I was like, your company is telling us to put people on these drugs that are $5,000 a month. And you're not providing the patient or the doctor with any way to take them off of the drug and to actually fix this problem. So anyway, I think that the point is from my perspective is that doctors don't feel confident or feel like they really know how to have that conversation and they haven't been pushed to really have that conversation and we haven't created incentives for doctors to have that conversation. In a world that exists where doctors get like literally eight minutes with a patient, you can't have a nutrition conversation in eight minutes. It's not possible. So the guidelines in the United States for inflammatory bowel disease actually say that you should recommend a Mediterranean dietary pattern to your patients who have inflammatory bowel disease. That's they've been updated and they say that. I celebrate that they say that. But the problem is it's not enough to put those words on paper and not activate an army to go and do it for you.
Dr Rupy: Yeah.
Dr Will B: Right? That's the issue.
Dr Rupy: I agree. Completely agree. The guidelines for the UK have had diet and lifestyle, not actually calling out Mediterranean uh, uh, patterns, but they've just said you should have a conversation about diet and lifestyle with your patients for IBD and a whole bunch of other uh, conditions like hypertension and high cholesterol, hypercholesterolemia. Um, but the problem is exactly what you've articulated. If you've got eight minutes to do with a patient who's coming with more than one thing, by the way, um, and you are not versed in nutrition yourself, then of course it's going to fall by the wayside. Or you're going to say something flippant like, improve your diet and lifestyle, you know, make sure you eat better, lay off the cheese, something like that. That's probably been literally said in, you know, doctor's offices across the.
Dr Will B: How does that land? You flippantly walk out the door and say lay off the cheese.
Dr Rupy: And you know what? People are probably like nodding along to this like, yeah, my doctor said, you know, just lay off the red meat, lay off the cheese, you know, sort out your diet and move a bit more. You know, it's this kind of like lacklustre advice that of course people are not going to put into practice because they don't have the means to. They don't have the the knowledge around it. They don't have the motivation. And I think health coaching and dietitians is really an area that we should be spending a ton more money in because we just do not have the resources to to actually make this a reality.
Dr Will B: We need a team's based we need a team's based approach. But I do think that patients ultimately turn to their doctor as being sort of the quarterback of the healthcare team. And I do think that the doctors, like I don't think they're off the hook. I'm not defending them to the point of putting them off the hook. They need to step up as the quarterback of the healthcare team and say nutrition is important and I'm going to get you the support that you need so that we can make a a good assessment and know where the opportunities that exist there.
Dr Rupy: Yeah, totally. Um, so back to those four things that you're about to talk about.
Dr Will B: Yeah. Yeah. Well and again, we're we're sticking with the tradition of like we haven't been consuming enough of these four things. So my number four is healthy fats. Healthy fats because are we do we have fat in our diet? Yes, we have fat in our diet, but it's the wrong fats. And we need to be getting more. I'm going to tell you which two I want you to get more of. I want you to get more monounsaturated fats, which are the kinds that you find in extra virgin olive oil, which are the kinds that you find in avocados, and you'll find them in a lot of nuts. And I also want you to get more omega-3s. So omega-3 polyunsaturated fats are all of the polyunsaturated fats, by the way, both omega-3 and omega-6 are what we call essential. What that means is that you have to get them from your diet. If you don't get your body needs them to function properly and if you don't get them from your diet, then your body will not function properly. Now we don't have a problem with omega-6s. We overconsume them. And some people blame the seed oils and that's a part of the conversation. I don't have an issue with that. Um, but we don't get enough of the omega-3s. Where do they exist? So there's there's actually three types of omega-3s, ALA, EPA, and DHA. ALA is found in a lot of seeds and some nuts. So chia, flax, hemp, basil seeds, these are great sources of of ALA omega-3s. So are walnuts.
Dr Rupy: Yeah.
Dr Will B: If you make a smoothie, they should be in there.
Dr Rupy: Yeah.
Dr Will B: You're making a salad, they should be in there.
Dr Rupy: Yeah.
Dr Will B: So, um, by the way, those kids on Tik Tok who are blowing up the colon. Yeah, fibre maxing. My my weird groupies that I didn't tell them to do that and they've taken it too far on gut talk. Yeah. Uh, the chia and the flax, if you don't actually grind them, then you don't get access to the omega-3s. You would only have insoluble fibre. You would not get access to the omega-3s. So make sure with your this is a tip for the listeners, make sure you grind your chia and your flax to get access to those.
Dr Rupy: Yeah. I've started I tried this, sorry to take us off topic. I there's a a recipe for a two-ingredient bread with chia. I don't know if you've seen this. You just grind the chia until it's like a wet sandy um, texture and then you add a good dose of water and you let it sit there for like 10 minutes and then you roll it out just like you're doing a chapati or a roti and then you dry cook it on both sides and it turns into this malleable like bread that you can fill um, you know, up with like in a like a wrap basically.
Dr Will B: Gosh.
Dr Rupy: And it's delicious.
Dr Will B: That's amazing. I've never heard of that before. Do you have a recipe for that?
Dr Rupy: I I'll give it to you. Yeah, yeah, yeah. I'll put it in the show notes. Yeah, yeah, yeah. I tried it. It was not my recipe. It's someone I found on YouTube and I I I did it live on on Instagram just to show folks like I'm doing this because I don't believe it works. And it worked. And I was really surprised. I was like, this could be great for people with, you know, genuine gluten intolerance or people who are trying to increase fibre in their diet and they don't want to buy the wraps that unfortunately are quite ultra-processed because of the additives and the emulsifiers they use. But yeah, sorry, it's a short.
Dr Will B: No, that's amazing. I chia chia has this unique the reason why that works is that chia has this unique ability to absorb water, moisture. So and you can take advantage of that and create quite delicious food like chia puddings and things like this. So, um, anyway, to get the other uh, forms of omega-3s. So ALA is the one that you get from the nuts and the seeds. EPA and DHA are the other forms. The one that's most important is DHA. It is crucial for cognitive health, crucial for our brain. And it also is anti-inflammatory. More so than the other two. Um, in theory, there is a conversion that does occur from ALA to EPA to DHA. In theory, you can move it through that process. The problem is that it's um, not very efficient. It varies by person and particularly among men, it's extremely low. Extremely low. And among postmenopausal women actually, because it's the estrogen that actually enhances the ability to make that conversion.
Dr Rupy: Okay. Uh-huh.
Dr Will B: So, so there's this sort of like idea and I actually probably 10 years ago was on board with this idea. I am no longer on board with it. The idea was that if you consumed enough seeds and nuts, that you would get enough DHA.
Dr Rupy: Gotcha.
Dr Will B: And I'm not convinced by that at this point. There are people who will do everything right and still not get enough DHA.
Dr Rupy: Yeah.
Dr Will B: The the advantage that we have is you can test. You can test. There's a blood test. And the blood test gets your omega-3 index and where you want to be is 8 to 12%. That's where you want to be. So this is a ripe opportunity for potentially supplementation for people that want to take that approach. So supplements can be used and like if you know that you're deficient in a nutrient, you need more. That's where supplements come in. But the other aspect of this is that the the best sources of EPA and DHA come from the sea. Right? So so they they naturally exist in the ocean. And it actually starts with the plants in the ocean. It starts with the algae. But then the algae enter into the the basically food system through the fish. And then it basically can like accumulate up the up the chain. So like we think about salmon, there's no doubt salmon is like a wonderful source of omega-3s. And they originated as plants. The salmon didn't create it. The salmon stored it. So, um, for people who consume fish, I think that's a like can be a wonderful source and routine consumption of fish is in my book anti-inflammatory. And it's interesting because in the Adventist 2 study that we were talking about in Loma Linda, California, actually the longest lived population of people were the pescatarians.
Dr Rupy: Ah, interesting. Okay. So they're getting that source of long chain omega-3 fatty acids.
Dr Will B: And those long chain omega-3s.
Dr Rupy: Ah, interesting. Yeah.
Dr Will B: So now if in theory a person didn't want to consume fish, then that's where you you need to look at, you know, potentially supplementation. Um, and you could do fish oil. It's less expensive or you can do an algae-based omega-3. I tend to if you can afford it, I tend to favour the algae-based omega-3 for purity reasons.
Dr Rupy: Yeah, me too.
Dr Will B: Because the fish bioaccumulate other stuff. And so it'll still be in the fat.
Dr Rupy: Yeah, absolutely. Um, man, that's awesome. So we've got this list of four categories of things that we should be consuming as part of an anti-inflammatory nutrition strategy. Um, you know, if someone's trying to rehab their gut, would you recommend they go through these uh, these categories step-by-step or is there a certain strategy that you would take to sort of improve their overall digestive health if let's say they've had the stressor of antibiotics, stress, um, poor diet over a period of time?
Dr Will B: You know, there is this paradox that exists where uh, the thing that's the most healing of the four that I've mentioned is also the most challenging to a disrupted or damaged gut. And that's fibre.
Dr Rupy: Yeah.
Dr Will B: So to me, fibre stands among even among those four as the most powerful. So what we want to do with this person who has a disrupted or damaged gut, if they're not in a position of being able to really tolerate fibre, is to make some adjustments to how we approach this. One adjustment that you can make is to go at it low FODMAP. So FODMAPs are the fermentable parts of our food. You can still get access to prebiotic fibre that's good for your gut microbes. But when you go low FODMAP, it will reduce the bloating that exists. So, um, uh, my second book, Rupy, was a cookbook. Now, I don't know if I'll ever do another cookbook.
Dr Rupy: Oh, really?
Dr Will B: Yeah, we could talk about that. That's a separate issue. That's a separate issue. That is more to do with I just want to make as big of an impact as I can possibly make. And I think when people think of me, they don't think of recipes. Whereas I think with you it's a little bit different.
Dr Rupy: Sure, yeah, yeah.
Dr Will B: So, um, but anyway, in that in the cookbook, the reason why I created the Fibre Fuelled cookbook was actually like I I view books as tools for healing and an opportunity for me to insert myself into a person's life and counsel them for a weekend.
Dr Rupy: Yeah, yeah.
Dr Will B: And the the cookbook, I had so many people who were like, I can't tolerate fibre. I don't feel well eating fibre fuelled. What can I do? And I was like, well, let me create the protocol for you. And so that's what that cookbook is. And it's got an entire chapter that's low FODMAP. So if you are this person who's struggling, that chapter is for you. And you can just crack it open, you can read it, you can educate yourself and empower yourself with knowledge. But at the same time, you can also keep it super simple. Try some of the recipes. See how you feel. And for a lot of people, they're going to feel better. Um, the other thing that that we have, I'm going to get back to the food in a minute. But since we're on the topic of FODMAPs, I feel compelled to say like I mentioned earlier that I own a supplement company. So the supplement that we have available right now, we have more coming very soon and we're excited about that.
Dr Rupy: Oh, really? You have more?
Dr Will B: Yeah.
Dr Rupy: Sick.
Dr Will B: Oh yeah. It's going to be really cool. I mean, basically like this entire company is about me not feeling satisfied. Like 70% of people that go to see a gastroenterologist are using supplements already.
Dr Rupy: Yeah, yeah, yeah.
Dr Will B: And I was never satisfied with the quality of the products that exist. So I wanted to create products that serve a purpose. The beauty of like GI is that it's not uh, it's not this abstract thing. People don't feel well. So if I make them feel better, they know. They know that my product works. Right? So I wanted to create better products. And so I created basically the prebiotic that I always wished I could have had. And that includes that it's certified FODMAP friendly.
Dr Rupy: Yeah, that's incredible.
Dr Will B: So that way it's gentle for people that have gut issues. But like the other thing about this, like a couple a couple of other quick things on this, quick hitters are like we haven't really touched on this yet, but variety is really key. So all the fibre supplements are like a single source of fibre.
Dr Rupy: Yeah, yeah.
Dr Will B: That's always been one of my biggest issues with some of those fibre supplements that you're referring to because it is just one type, but.
Dr Rupy: Yes. And you feed certain families of microbes that that like that fibre. And you potentially overfeed those families of microbes. And this is where we see some fibre supplements sometimes get negative studies. So let's let's diversify the product. So that's where basically my product contains seven unique prebiotic sources. They're all prebiotics. Representing fibre and resistant starch and polyphenols. We didn't talk about resistant starch, but basically you can think about resistant starch as being like similar to fibre.
Dr Rupy: Gotcha.
Dr Will B: Where it produces short chain fatty acids. So having all three of those categories where we're representing now the different types of prebiotics and several of those ingredients have human clinical trials where it's like, look, I know when people take this ingredient for four weeks, this is what happens. Right? In terms of their gut symptoms, in terms of their gut microbiome, in terms of their bowel movements, there's changes that are beneficial. Right? Um, but then like the last thing is that like how do you feel about a product that has no transparency and you're just expected to trust that the company is taking care of you in an honest way. That's just I don't think that's right. So we are as transparent as we can possibly be. Um, where we run every single batch for about 130 different tests, including pesticides, including glyphosate, including heavy metals, including things that like I have to push the laboratories to be like, can you run salicylic acid? Can you run methyl salicylate? Can you run oxalic acid? Like these weird things, histamine levels. Yeah, yeah, yeah. Um, so but and we give the entire report to our customers.
Dr Rupy: Gotcha.
Dr Will B: So they can download that. Every single every single lot, you just enter the lot number and you can download your report to see the numbers.
Dr Rupy: This and this is something that I talk about a lot on this pod and people will recognise this. You have to go to a supplement manufacturer's website and demand to see this transparency because this is so important considering the number of supplements that are polluted, knowingly or unknowingly, it doesn't matter, but you have to go the extra mile, which is sounds like exactly what you're doing to ensure the purity of product.
Dr Will B: Yeah. The other thing that you can do is look for certain certifications. So in the United States, there's a certification called NSF. And NSF basically like they run your so um, by the time this episode airs, we will be NSF certified. And they run your product through an entire gauntlet of tests to show that it it is what you say it is and it's clean and it doesn't have all these different things. So and that's the other thing that you can look at. It's a marker of quality, but it's hard for a manufacturer to do it. So you can't like do NSF certification and then sell the product inexpensively. It's just not possible.
Dr Rupy: Yeah.
Dr Will B: So it's a it's a mark of a premium product.
Dr Rupy: Gotcha.
Dr Will B: All right. So with this person who we're trying to heal, there there's a role for this kind of thing, right? Because even though they struggle with fibre, if we could give them this type of fibre that's low FODMAP, it will help them. Right? The other thing about them is that um, we can lean into the things that are less challenging to the gut. So we can lean into the healthy fats. They're good for you. We can lean into the fermented foods. They're good for you. We could sprout our food. Like uh, like legumes and whole grains. We could sprout our food.
Dr Rupy: Yeah, yeah.
Dr Will B: It becomes easier to digest. It still has tons of fibre.
Dr Rupy: Yeah.
Dr Will B: Right? If you're making beans, you soak your beans, pour out the water, add some more water, pour that out too. And you will notice that they're easier to consume.
Dr Rupy: Yeah.
Dr Will B: Right? So there's all these tricks that you can start to apply. But I think the last thing too, Rupy, I don't think we'll have time to like dig into all these things today. So that's for another day.
Dr Rupy: Yeah, yeah, for sure.
Dr Will B: Um, so, uh, again, these are like the high level things that you can do without even lifting a fork that can improve your gut health. I sincerely believe that we have a loneliness epidemic that um, people, although they are on social media, they are more disconnected than they've ever been.
Dr Rupy: Yeah.
Dr Will B: And we are inherently social creatures. And it actually comes, we've been talking a little bit about our uh, evolutionary origins today. Right? So let's think about this. If we went back to those primal times, um, your tribe is literally your source of survival. You face threats of many varieties. Maybe another tribe, maybe an animal, whatever, a storm, whatever it may be. Or famine, you know, access to food. The tribe protects you. There's support in numbers. And we became dependent on each other. These were not fleeting relationships. This wasn't a like or a swipe. This was literally like if we are attacked, I will fight for you and you will fight for me. Right? Those are true bonds. They weren't thousands of people. It was a limited group. It was your family and then it was the other families that were a part of your tribe, right? Like when we were taking our trip over to the Mediterranean, we became a tribe on that plane. Right? So but like literally like this is the way it worked is that is that we have those we are hardwired to require those social bonds of support to feel safety. If you don't have those social bonds of support, you don't feel safe. And the absence of safety leads people to feel anxiety and fear. And that's what we're living through right now. And I think that it's more important than ever for us to acknowledge and to like so the average adult spends six hours a day on devices. The average kid, our poor kids, seven hours. We have to put it down.
Dr Rupy: Yeah.
Dr Will B: Like dinner time, sit across from people, have a conversation, make eye contact. Right? And and like form those real legitimate bonds. So I think it's like really important to have those social connections because that actually the way it works, I know you can appreciate this, but for your listeners, is that it shifts us from a fear, fight or flight state, which is the sympathetic overdrive, sympathetic nervous system being in overdrive. It shifts us from that to actually allows us to get into a parasympathetic state, a vagal state, which is rest and recovery, which is what actually our gut microbes need. That sympathetic drive destroys our microbiome. That's why when people get nervous, they get they get the shits.
Dr Rupy: Yeah, yeah, yeah.
Dr Will B: Right? Like when people get nervous, they get nausea and they feel it in their gut. Right? The sympathetic overdrive destroys the gut. The parasympathetic nervous system when activated restores the gut. So we have to shift that back over. And along these same lines, I I also sincerely believe that like we need to re-acknowledge our spiritual purpose. Like I sincerely believe this. So and it's actually been very important in my life where I spent most of my life totally ignoring it.
Dr Rupy: Really?
Dr Will B: Yeah.
Dr Rupy: Yeah.
Dr Will B: And actually, you and I were talking before the show, so your listeners weren't there for this, but we were talking about having kids.
Dr Rupy: Yeah.
Dr Will B: So I have four.
Dr Rupy: Yeah.
Dr Will B: You have an eight-month-old.
Dr Rupy: Uh-huh.
Dr Will B: And I was talking about how like my the birth of my oldest daughter changed my life and helped me to understand so many things.
Dr Rupy: Yeah.
Dr Will B: And one of the things for me is this is just being totally honest, is like people, I'm not telling you what to believe. But what I am telling you is that there's a there's a place that exists in your heart that needs to be satisfied. And that's not a human connection thing. It's a spiritual connection thing. It's tapping it plugging into your purpose and and seeing the world through the view of a higher power. And when my daughter was born, it's like this is not just like a series of cells. This is not just genetic programming. Right? This is like it's not it's not that simple. There was a breath of life that came into this person and she has a soul and an identity and she's unique and special. And where did that come from? Right? And I think that like those are questions that we should all be asking whether you have kids or not. And thinking about these things because at least for me in my life, I am so much happier and so much more satisfied by so much and also more resilient, more capable of dealing with noise, distractions because I've resolved this aspect of my life. And I'm still working on it a lot.
Dr Rupy: Yeah, of course. Yeah, yeah.
Dr Will B: Um, so anyway, so I think that like it's important for people, your listeners to hear that this is not just a food thing.
Dr Rupy: Yeah, 100%. It's not just about. I'm so glad we're talking about this subject matter beyond the fork because you know, nine, 10 months ago, I wouldn't have understood what you just said about the spiritual connection and the importance of purpose. And obviously I know the studies and looking at loneliness and how this is, you know, as damaging as smoking and how it's pro-inflammatory, etc. But like there's a difference when you start creating your own tribe. And I I think kids is one way of connecting with a higher purpose. There are multiple other ways. You know, faith is super important. And I think as conventionally trained doctors having this conversation, I think this should be really, really empowering for people to recognise as well because as people of science, we appreciate like what we can prove in in this day and age, but there's also an appreciation for the wider aspect of living that we we will never be able to prove, but we we feel, you know?
Dr Will B: Oh, 100%. And how much do you think that we've actually proven? I'm curious.
Dr Rupy: Yeah, yeah.
Dr Will B: Like seriously, like out of every out of all the knowledge that exists, how much do you think we actually know right now?
Dr Rupy: Oh no, I mean we're talking less than 1%. 100%. Yeah, it's less than 1%. That's absolute in absolute terms.
Dr Will B: I mean even even in medicine, like we're so sometimes arrogant, honestly, that we think we got it all figured out. And then you step back and you're like, you we don't even understand the basics of like microbiology.
Dr Rupy: Yeah, yeah.
Dr Will B: Let alone the basics. Like we're like looking at big organs and like, you know, hey, we got it all figured out. We can diagnose cirrhosis and it's like, no, no, no. Like we need to be able to see things on a microscopic level because that's what that's where things are occurring. And this brings it back to inflammation. Like that inflammation, that chronic inflammation that's present in that person is going to predate that cirrhosis is absolutely the result of inflammation. You don't get cirrhosis without inflammation. And that inflammation is predating the manifestation of disease by decades. And if we could see that, diagnose it, we have an opportunity to do something huge.
Dr Rupy: Absolutely. Well, um, your book, I can't wait for it to come out. So it's coming out in January. Tell folks about it.
Dr Will B: Yeah, so we got through all this and I didn't even say, maybe you have to edit this and put it in the beginning.
Dr Rupy: I mean it's going to go at the intro.
Dr Will B: Yeah. All right. So we got through all this and I literally haven't had a chance to talk about my book until now. This is the first podcast where I've been able to talk about my book.
Dr Rupy: Super privileged, man.
Dr Will B: And the book is actually called Plant Powered Plus. And plant powered because these are the plant powered diets. Like to me, plant powered is a new way of eating that welcomes and includes so many different people and so many different uh, approaches to eating. They all have a seat at the table with me. And but the plus is the fact that there's opportunities for healing that exist in our circadian biology, in uh, creating patterns of consistency, in timing of meals, in sleep. The plus is that we have opportunities to heal through social connections, through spiritual connection. The plus is that there are people who we didn't even get to talk about this that trauma is a driving factor. And my uh, the thing that I get excited about, Rupy, is that there will be people that will read my book and like for different people it's different things. And for some people, that's what they actually need to hear. And it will and it will change everything for them. And I'm not the person who treats you for that, but I am the person who can help you to understand that. And then you can change and address those issues. And so so and oh and and there's uh, a supplement chapter, of course, a meal plan and an entire an entire three-phase plan that is holistic. And it's not just about um, what you eat. It's all these things that we're discussing.
Dr Rupy: Amazing. Amazing. Dude, I can't wait for it. You better be sending me a copy. Um, and 38 Terra, can people get that in the UK now? Is that globally available or is are you still working on that?
Dr Will B: So 38 Terra, we launched in January of 24. Okay, let me answer the question and then I'll tell you the story. Okay, go on. Yeah, go on. The answer to the question is we're not available in the UK. We probably will not be available in the UK when this episode airs, but we will be available in the UK. My expectation is by the end of the year.
Dr Rupy: Okay, okay.
Dr Will B: Um, it's I'm sure people can appreciate there's complexity to the terror situation. Well, it's not so much the terror situation. It's more so just just moving into other countries and and sort of wiggling through the different regulatory processes that exist. So different countries have different sort of rules about how things work. So it's not uniformly the same. So we've had an even bigger issue with Canada.
Dr Rupy: Right.
Dr Will B: Canada is like so hard. It has nothing to do with our product. It's literally just red tape that you're trying to move through. So but the the funny story is that so 38 Terra launched in January of 24. Okay, so we're about a year and a half in. And I didn't know. We're I have no sponsors. It's actually a beautiful thing. I love it. Like I have no one, there's no outside money. It's literally just me and my I have one business partner, Simon Hill.
Dr Rupy: Simon Hill, yeah.
Dr Will B: And like basically like we decide like this is why we can like spend the ridiculous amount of money on third-party testing because we're like we decide we want to do this. Right? All right. We didn't know if there would be any enthusiasm or interest at all. And we are we are funding this ourselves. I have to ask my wife for permission to do it. And so we buy what we think is enough product. And we basically like set up a website and we're like, yo, wherever you are in the world, doesn't matter where you are, if you're willing to pay the shipping fees, we'll ship it to you, baby. Right? And we launched on January 15th of 24. And the problem is, this is a good problem, is that I went on the Diary of a CEO right before this.
Dr Rupy: Yeah, yeah, yeah.
Dr Will B: And like uh, Steven was kind enough to make me his January first health transformation episode. So it blows up. And now we got all these people in the UK that want 38 Terra. And like they're clicking and sending. And the problem is what I didn't know, this is me not understanding the business side until this happened, that it gets shipped and the minute it leaves the United States, I have no clue where it is. And so people are like, uh, it's been three weeks. Is it where is it? Well, like literally it's working through customs and it'll be there, you know, hopefully really soon. But it got to a point where I was like, okay, I can like definitely sell this product into Canada and the UK. We I know that there are people there who want this product. But it's not fair to them that they get a substandard experience with that product. So I made the decision to shut it down. And what's what's because we the way I see it, we have a phenomenal product. Let's not take a phenomenal product and give people a substandard experience with that product. So we're working and we're going to be launching into the UK and the EU by the end of the year. I can't say when we're going to be in Canada. We've been working on it with a consultant for 18 months and it continues to be a challenge, but I'm hoping hoping soon.
Dr Rupy: Yeah, absolutely. Look, I've got no financial affiliation with this supplement whatsoever, but I can say I wholeheartedly trust and respect the transparency that you've given to this supplement, the fact that you're going above and beyond to do this extra testing. I think that's a mark of a very, very good company. And so when it's available, you let me know and I'd love to inform my audience and my community about it because I feel that it's going to be valuable for certain folks who are interested in it and it could be, you know, life-changing for a lot of people. I know how much effort you put into this. I respect both you and Simon as well. I was chatting to Simon yesterday. So I'm excited for you to to get this into the UK and EU as well, man.
Dr Will B: The other thing that we do, I probably should not be saying this, but I will anyway. So we um, we believe in like being as honest as possible. And so and we want people to get results. Right? And if you look at the reviews on our website, they're incredible. Why? Because people get results. But that doesn't mean that everyone gets results. So basically what we what we did is we set it up where um, if during the first 30 days, this is not for you, just tell us. We'll give you your money back.
Dr Rupy: Yeah.
Dr Will B: And like that to me is a level of honesty that um, any person who's anti-supplement, I like I'm just like, look, if it works and it helps people, you got no argument. And if it doesn't help people, I'll give them their money back.
Dr Rupy: Yeah. Amazing. Love you, man. This has been one of my favourite episodes. I can say that wholeheartedly and it's just such a pleasure to get to do this in person as well. We're in the same part of the world because last time we did this was virtual and I remember I had to cancel because I had my Indian wedding and you were like so understanding about it and I just knew you were a good guy and I just love your work online and I love what you're doing and what you're bringing to the world, man. So massive, massive respect.
Dr Will B: I feel the same way. It's been a this has been a lot of fun. I think the listeners will hear that. And uh, and I thank you so much for coming over to the states and I hope to see you more over here and I hope to also see you over in the UK.
Dr Rupy: Definitely, man. Yeah, brother.
