Kim (00:00.718)
Hi Dr. B, thank you so much for joining me today. We connected because of a gal in my community named Sharon. I won't mention her last name, but I talk about you all the time on my coaching calls and someone said you should have Dr. B on your podcast. And so here we are and I'm really grateful for your time and that we had the mutual connection. Thank you so much for joining me.
Dr. Will Bulsiewicz (00:24.332)
my gosh, it's a great pleasure to be here. Thank you for having me, Kim. I've been on a mission to bring awareness to the role that the pelvic floor plays in constipation. I feel like constipation is epidemic across our country and most people don't realize that it's not just slow motility in many cases. So I'm excited that we get to have this conversation because I'm hopeful that we can open this up because there will be people who hear this.
And there's the potential that their life will be changed by learning this information.
Kim (00:56.556)
Yeah, yeah, I think so too. So I always start with hearing people's stories. So what brought you to the world of gastroenterology?
Dr. Will Bulsiewicz (01:04.71)
Well, gastroenterology was something that I decided many years ago. Like, I guess it's been 20 years actually. So it was roughly 2004. Yeah. I started medical school in 2002. I thought I was going to be a pediatrician. After two years of classwork, I entered into the hospital. And during that time, you have to kind of try to figure it out pretty quickly. You got one year to kind of figure out what you want to do for the rest of your life. And
Where I was at is that I loved the idea of sitting down with a person and listening to them, talking to them, developing a relationship, and then trying to like basically take what they're sharing with me to peel apart the layers of the onion and fix their problems. But I also really admired and enjoyed the opportunity to use my hands on some level.
And so finding things that balance both of these actually is not that easy in medicine. Most sort of very strongly prefer one or the other. So anyway, gastroenterology was the unexpected thing that just started to make sense. And this is before I knew anything about nutrition or the gut microbiome. That was not an inspiration. And the things that I'm doing today of, you know, trying to pound the drum of gut health and the gut microbiome.
These are things actually that developed in a very organic, natural way, unexpectedly, because when I was in my early thirties, this was a little over 10 years ago, I found myself as the one who was sick. And in that moment, I didn't want my own medicine, even though I had, you know, invested
80 to a hundred hours a week from the time that I was 18 years old to the time I was 34. I still in that moment, it was like a light bulb went off. I want to get to the root of this issue. don't, I don't just, I don't want to pop pills. And so, and there was a natural discovery process that took place for me because I actually wasn't trained in this. So I didn't know what the answer was. And I.
Kim (03:05.171)
That's so interesting.
Dr. Will Bulsiewicz (03:17.346)
Actually discovered that the key for me was a dietary change and specifically implementing a high fiber diet by high fiber. I actually don't even mean high fiber. just mean normal amounts of fiber. Most people are not getting any fiber. and it completely transformed my life. And because it was so powerful for me as a person who has grown up with a dream of being a doctor who helps people.
I had no choice but to bring it into the clinic. And so in my gastroenterology practice from the time of roughly 2013, 2014, when these changes occurred in my life, I brought, started to bring these ideas into the clinic to treat my own patients who had ear roll bowel syndrome or acid reflux or constipation or Crohn's disease. And, and simultaneously I became obsessed with trying to learn more about this.
and studying nutrition and the gut microbiome. And this snowballed into something where I eventually came to a place in 2016 where I felt compelled to share this story more broadly, which led me to social media, which led me to the opportunity to write a book, which led me to this podcast with you today. So, and here we are.
Kim (04:37.148)
Here we are. Yeah. Yeah, I'm really grateful. Your book's one of my favorite books. I recommend it all the time. But okay, so as you say, you didn't want to take your own medicine, what you had been prescribing, and that led you down the path of nutrition and the gut microbiome. And I don't remember where I first heard the term gut microbiome. It was probably around the time that I had found your book and was following you. So what exactly is the gut microbiome and why is it so important for
things like Crohn's disease and constipation and acid reflux and all the things that you were talking about.
Dr. Will Bulsiewicz (05:11.714)
Yeah. And so much more, which we can get into. So, the gut microbiome is a community of microorganisms that include mostly bacteria and some yeasts and some other ones called archaea, which are my favorites, but we don't have to get into that right now. and because they're microorganisms, they're microscopic to the naked eye. So we can't see them, but they are there and they.
are completely covering us from the top of our head to the tip of our toes, right over the top of our eyeballs. Thankfully we can't see them. So that's not too distracting. In our nose and our mouth inside of a woman's vagina. But the area where they're most concentrated actually is inside of our colon, which is our large intestine. And in that spot we have 38 trillion microbes. And this number
is quite absurdly large and ridiculous and hard for us to even quantify and understand. But to the best of my ability, this is the way that I would put it. If we were to on the most beautiful, clear, crystal clear night, in a remote part of, you know, Northern Canada, where there's no lights, you look up and you see every single star that's in the sky.
And if I were to take all of those stars and put them into a ball, I would have to actually place 380 galaxies full of stars into your colon, not your colon Kim, but like a theoretical person's colon. I would have to put that many stars in there to equal the number of microbes that you have living inside of you right now. And these microbes, it's more than a number. They are active.
They're active participants in our health. We've had them since day one, the very first human that existed, whoever that person was, they had a microbiome and that microbiome was part of human evolution from the very beginning. It wasn't just us. It was a co -evolution process with our microbes. And during that co -evolution process, over the course of 3 million years of human history or whatever we want to call it, they took up really important roles in our physiology.
Dr. Will Bulsiewicz (07:27.949)
And so there's a number of things that they do. They help us to digest and process our food. They protect us from pathogenic, invading infectious organisms. They optimize our immune system. They help us to balance and regulate our immune, our metabolism. They also help us to balance our hormones. they're able to communicate with our brain. And so there's something called the brain gut access, which is
what we think about when we're talking about how our gut influences our mood or our cognitive function or our ability to focus and memory and things like this. They even, can manipulate our genetic code. So when we think about all these things, digestion, which is access to nutrients, which basically means life and, you know, immunity and metabolism and hormones and cognitive function.
This is basically everything that matters for human health. And so they are our partners in health. And it's quite fascinating to consider that they're not human. They're not even a part of our body. And yet there they are right now with you and I, as we sit here and we have this conversation, they're playing a role in our ability to do these things.
Kim (08:36.813)
You
Kim (08:50.442)
So when you say it's back to the very first person that ever lived and that has played a role in the evolution, so we actively now, you and I and everybody else are also actively playing a role in the evolution of our species going forward as well. And so am I accurate in saying that?
Dr. Will Bulsiewicz (09:10.402)
Yeah, I think you are, but I also think that evolution is a complex topic because it's changed a lot in the last hundred years.
Kim (09:16.715)
Well, that was gonna kind of be my follow along. Like now the story around the soils becoming depleted, the amount of toxins that we have, like all of the other things that are, as I understand, playing a role in potentially damaging the microbiome. So the evolution is maybe not as positive as it once was.
Dr. Will Bulsiewicz (09:43.972)
A lot has changed in the last 100 years. The things that have changed for us as humans, which we have accepted as normal, are not normal when put into the context of human history of 3 million years. And the undue consequence has been on these microbes. And we just have been completely and totally unaware of it because frankly, up until roughly 2006, we didn't have the technology to study these microbes.
So while we knew that they were there, they were this invisible, you know, invisible partner or, or, you know, part of us that we just didn't have the ability to study or know anything about. you know, now thankfully, because of, you know, for example, the opportunity for you and I to sit down and have a conversation about this and, illuminate this topic. It allows us to bring consciousness to the fact that we have.
living microorganisms that are a part of our body and they are shaped by us, our choices and our more broad environment. And so, so they are basically the result of all of these different things. And yes, it has, it has gotten quite, quite complicated yet at the same time, I would not, strike up a pessimistic view on this because what I would say,
Is that we have such like, because we have been unaware and neglecting this part of our body, we have such a tremendous and wonderful opportunity to use what we have learned through science to make a positive effect to bring it back to life. And in a way that empowers our health. So, so yes, evolution has changed quite a bit.
in the last 100 years and our world has changed so much. And yes, it has had consequences in our microbes, but there are ways for us to be healthy within the modern lifestyle.
Kim (11:51.453)
Okay, so let's get into those. a big part of what I talk about from a pelvic floor perspective is constipation, diarrhea, and there are also people who will have Crohn's and IBS, and I want to kind of dive into each of those topics, but I want to start specific with constipation. So what is it about the last 100 years and the influence on our microbiome? Well, first of all, let me ask the question, has constipation increased? Maybe even since you started your practice, would you say
constipation is more common now than it was before.
Dr. Will Bulsiewicz (12:24.364)
I think it is. I also think that there are a lot of people who are not diagnosed with constipation. They don't necessarily realize that they're constipated and yet they are. You can poop every day and be constipated. You could have diarrhea and be constipated. That would be overflow diarrhea. And so there are a tremendous number of people who are out there who are dealing with chronic gut symptoms.
and perhaps have been diagnosed with irritable bowel syndrome or perhaps haven't been diagnosed at all. And they don't even realize that the driving factor behind those symptoms is the inadequacy of their bowel movements.
Kim (13:04.411)
You had in, I bought your constipation program, course, workshop, whatever you want to call it. And it was a section in there where you were defining what constipation is. And it wasn't the inability to poop, which a lot of people think that if you can't poop or if it's hard to poop, that means you're constipated. But there's a whole host of other symptoms that are constipation.
can be constipation. And you basically said that it's the symptoms that manifest because of our gut basically and our inability to poop or poop well and incomplete emptying. So what can you elaborate on what the definition of what exactly is constipation?
Dr. Will Bulsiewicz (13:49.911)
Yeah. so the common definition that is accepted by, often, you know, used by physicians has to do with the frequency of bowel movements. So they would say that if you poop less than three times per week, then you, then you are constipated. And, and the issue with this is that, constipation is more than just frequency.
So my focus is, and this is not the formal definition. If you dig into further the way in which constipation is being defined, such as in the Rome criteria, they do broaden it out. It's more than just the frequency. But, my focus is on us understanding what's actually happening with our body, which is the inadequacy of our, of our bowels emptying. Because whether it's pooping.
less than three times a week, or whether it's pooping once a day, or if it's even pooping multiple times per day. But if you're not adequately emptying your bowels, then you're backing up. And when you back up, there are consequences because your bowels are out of rhythm. And the most common symptom by far is gas and bloating. I would go so far as to say that in my experience, a person who is constipated, I mean,
I'm of the belief that it's basically a hundred percent of people who deal with gas and bloating on some issue. And one of the ways that I measure improvement of constipation is actually our ability to not only get satisfactory bowel movements that feel complete and total. And honestly are on some level, they feel good.
Kim (15:45.836)
Epic Dumps.
Dr. Will Bulsiewicz (15:48.022)
Epic Dumps is my simple way of saying that. But even beyond this, to me, if a person is not adequately relieved in their bowels and they suffer with gas and bloating, then we have work to do until we get them to a place where they are adequately relieved in their bowels. And as a result of that, the gas and bloating has resolved.
Kim (16:09.241)
So how do you do that when somebody comes to you and they're dealing with constipation in order to get them into the rhythm to get them to have complete bowel movements ideally. If I don't have at least one bowel movement a day I feel very cranky. I call it cranky -pated. It's not very fun, I don't want to do anything. The day can't go on very well. so the thought of pooping every three days is like I can't even imagine that.
Dr. Will Bulsiewicz (16:25.143)
Yeah, nice.
Kim (16:36.618)
If somebody comes to you and maybe they fall in that category, maybe it's even more worse than that. What do you do to get things moving? I guess part of that question is also going to be how are you quote unquote healing the gut or improving the gut microbiome to therefore help with the constipation?
Dr. Will Bulsiewicz (16:54.903)
Yeah. So, first of all, I should say I just realizing that I misspoke and I said that constipation is less than three bomb was per week. meant, I, what I meant to say is less than one bomb movement every three days. so just to clarify that. So anyway, okay. First of all, speaking as a gastroenterologist, there are many potential causes of constipation. It's not all slow transit.
So it's often an assumption in the way in which we treat our patients that it's slow transit. Because if you look at the classic ways in which people initiate treatment, it's typically laxatives or things of this variety. And those are meant to basically like address this issue of slow transit. But there can be other potential causes. And one of the big ones that people need to be aware of is pelvic floor dysfunction.
which is not necessarily the transit of your bowels. It is the muscles that are in the bowl of the pelvic floor that are inadequately working in synchrony to allow and facilitate a complete evacuation, a complete bowel movement. So, and as an example of this, we use the term pelvic dyssynersia, dyssynersia, D -Y -S like
Like loss of DYS, loss of synersia, synchrony. loss of synchrony. All right. So in pelvic dyssynersia, I guess if it's okay, I'll use my hands to illustrate this. So for a moment, if you take the heels of my palms and imagine that this is the anal canal where a person is having a bowel movement and my palms are actually the rectum.
What typically happens during a bowel movement is that the rectum will actually pinch. And then in a rhythmic fashion, it will propel forward that pinch. And the pelvic floor, including the anal canal opens up and relaxes, clears a path and allows the bowel movement to fall out. All right. That's the way that our body is intended to work. When a person has pelvic dysnertia, this is not the way that it works. And what may happen, this is not always the same, but what may happen
Dr. Will Bulsiewicz (19:18.461)
is they may get that pinch, they may get that propulsion, but the pelvic floor is not opening up to relax.
And their brain is telling it to relax, but in many cases it's actually paradoxically doing the opposite. So the connection between the brain and those muscles is not working the way that it's supposed to. And so the muscles will actually clamp down. And so what happens here is that in this pocket between where there's the pinch in the rectum and there's closure of this anal canal that refuses to open up and relax, you got a pocket of poop.
And that pocket of poop, they bear down, right? Cause they're trying to push it out. And by bearing down, are pushing and creating pressure within that pocket. And you can create enough pressure so that these muscles in the anal canal that are closed, they get overwhelmed. Right? And this is what happens when a person bears down so hard, they're right in the face, perhaps even sweating, and they push out a little nugget.
Because the trap door opens and then it snaps shut. All right. These are pelvic floor issues. And things like pelvic dysanersia are the person who strains a lot to poop, has little nuggets, doesn't feel like they've had a good, complete satisfactory bowel movement, often needs to come back and have a second bowel movement in a short period of time, like an hour later or less. I didn't feel like I really emptied. I got to go back. There's still more in there.
Okay. That's not a new poop. That's the first poop. You just didn't empty it. and often these are people who will go an entire week, not just three days. They will go an entire week without having a bowel movement. And now you can hit them with laxatives.
Dr. Will Bulsiewicz (21:18.849)
And you will turn that poop into water or into diarrhea. And for these people, at some point it becomes so liquid that yes, they're able to push the liquid out. But that's not treatment for constipation and you have not addressed the root of the issue. So the first thing that I would say, although I don't believe that this is the majority of people, I believe that it's a much higher percentage than most physicians even realize.
of people that exist that have these pelvic floor issues. They often, by the way, as you know, Kim, as you treat in your practice, they often coexist with other pelvic floor issues that could include urinary issues, sexual dysfunction, incontinence, whether it's of the bowel or the bladder, poor sensitivity. So
If we believe that that's the issue, then we need a plan to address that specific issue. And that plan starts with diagnosis. Classically, the diagnosis can be made with tests such as anorectal monometry or defecography. But ultimately where this leads us to is working with a pelvic physical therapist. Because a pelvic floor therapist
allows us to take, for example, going back to that muscle where the brain is saying relax and the muscle is doing the opposite of relax. It's clamping down. We need to restore that connection between the brain and the muscular function. It's to me, conceptually similar to if I were to mess up my shoulder.
could take pills to dull the pain. But if I want to restore the ability to lift my arm above my head, restore that function to what it was prior to the injury, ultimately, I need the assistance of a physical therapist. They understand the process of working with that muscle to restore the function in that muscle, which restores function to that part of the body. The same is true with our bottom. Our bottom is a collection of muscles.
Dr. Will Bulsiewicz (23:33.249)
And sometimes they don't work the way that they're supposed to. This is why we need public therapists. So now, if a person comes in and they tell me right off the bat, I don't poop, you know, even once a week, I'm straining heavily. mean, basically if my index of suspicion is exceedingly high, then I'm not going to waste my time prior to moving towards this type of testing. I would move very early. But for the person who has more rudimentary symptoms,
I'm just not going that often. My stools may be hard. I have a lot of gas and bloating. I feel better after a bowel movement. They likely fall somewhere on a spectrum of mild, moderate or severe. For people who are mild, it can be actually quite simple. This is where like the simple foundational strategies of hydration and physical movement.
and things like fiber and fiber supplements. This can be all that you need in order to get you where you want to be and restore rhythm to your gut. But for people that have more moderate or severe constipation, oftentimes we need something more than that. And this is a quite nuanced topic and approaching this as personalized. But what I would say is that where I often would like to start in a person that I
that I don't have a high suspicion for pelvic floor issues where I often would start if I think that this is slow transit constipation is with a combination of a fiber supplement and something else. And what I tend to like are magnesium supplements.
Kim (25:17.527)
Fiber supplements are like when people I hear all the time that you know I'm constipated and people think more fiber or metamucil or Restorlax or you know psyllium husk and so they're trying to throw supplements and pills in there which they can play a role as you you mentioned but sometimes that's especially if they're not drinking adequate water it can create even more issues. What would be your preferred
fiber supplement that you would start somebody on and also what would be your preferred form of magnesium that you would recommend.
Dr. Will Bulsiewicz (25:51.906)
Okay. So, first of all, everyone should, know, cause if you haven't met me before, then you wouldn't know this. I'm the founder of a supplement company. So I started a company called 38 Terra and 38 Terra T E A is like my way of saying 38 trillion. So this is in reference to our gut microbiome 38, 38 Terra. And, our first supplement is a pre -biotic fiber supplement.
And the idea behind it is basically me creating the supplement that I always wished I could have had in my clinic for my patients. So in the past, I used many different forms of soluble fiber. So could be wheat dextrin or acacia powder. Those are some of the examples. But I always felt like this is not really in line with the gut microbiome science.
And the other major issue from my perspective is that I didn't honestly know what was in there. Is it, it, is it clean? has it been sprayed with glyphosate? you know, is it truly gluten free? We just don't know. So this, these are the motivations that I had is I really thought we could tap into the gut microbiome science. We could make these products so much better based upon everything that we now know, as opposed to what we knew in the 1980s.
And, and simultaneously subject it to extensive meticulous third -party testing so that we would really be completely clear on what's going on with these, with their product. So, and that's, that's what motivated me to start this company 38 Tera. Our first product that does this is called daily microbiome nutrition. Now, let me say, with complete transparency, and this is something that if you, if you dig into the materials that we provide for free on our website, for people who are constipated,
Fiber supplements can make it worse, like you're saying. So it's a bit of a nuanced topic. So I'd like to unpack that if we could. And it's not just fiber supplements, it's also a high fiber diet, or fiber in the diet. Many people who are constipated, they will introduce these things and feel unwell.
Kim (27:59.565)
Please.
Dr. Will Bulsiewicz (28:18.313)
and feel like it actually made it worse. I'd like to explain what's happening there. If you're not moving your bowels, if it's just a log jam, then the fiber that you put into your body, it will sit there and your gut microbes will have unlimited time to ferment it and produce gas. And when they produce gas, it actually creates a bit of a vicious cycle because what we've learned, and this is kind of interesting to think about.
gas that's produced in the intestines, meaning methane gas, actually slows down bowel motility. And when you slow down bowel motility, people produce more methane gas. So this is a vicious cycle of gas production causing constipation. We have to disrupt that. And so ultimately, if you have mild constipation, again, a fiber supplement or adding fiber to your diet,
increasing your hydration and a little bit of exercise, it will work. It's the people with moderate or severe that I'm talking to right now, where the way that you would approach this issue is first and foremost to get your bowels moving. You have to get your bowels moving first. Now, once they're moving, fiber is your friend.
And so you can add the fiber after you've already gotten your bowels started and it will help to keep them moving. So it's a two -step approach. You don't go with the fiber first in that setting. If you add fiber and you feel like you're getting worse, it's not the fibers bad. It's that you need to get your bowels moving first and then you bring the fiber on board. and magnesium can be the way in which we do this. Magnesium complements the fiber in a very nice way because the fiber
works on our microbiome, works on our gut barrier, works on our bowel motility. On some levels helps us to draw water into the intestines, but the magnesium really specializes in pulling water into the intestines to keep things moving through.
Dr. Will Bulsiewicz (30:35.391)
It has to be the right form of magnesium. So I'm going to give the three that I personally like. Magnesium citrate, magnesium sulfate, and magnesium oxide. So if you've heard of milk of magnesium, milk of magnesium is just magnesium oxide. so these three forms, what you do, of course, under the direction of your physician is you introduce these and you slowly
increase the amount you titrate up until you find the amount that works for you to get your bowels moving. And then again, once they're moving, that's then the opportunity to bring on either fiber in the diet, fiber supplement, or a little bit of both. And the way that you go about that is to ease into it. So you start low and you go slow and you ramp it up. then through these strategies, the complimentary interaction between fiber and magnesium, it allows us to get into a rhythm, keep things moving through.
And once we get into that place, you will have better bowel movements. You will actually be addressing the root of the issue and you will feel better.
Kim (31:45.772)
Yeah, I I I a pharmacist I knew it said Take start with one capsule of whatever magnesium of the forms that you just recommended See what tomorrow morning is like then the next day take another one and basically as you say titrate up and if you have a loose stool then you could and you had taken four capsules then you could back it up to three and That could potentially be your dose Would you agree with that?
Dr. Will Bulsiewicz (32:13.962)
Generally, yes. The only exception that I would like tweak on that is that I would probably slow it down a little bit. So, because the issue is that the effect of the changes in the Megadiz, you're not going to really know what it's going to do for a period of a couple of days in a row. So, and if you go too hard, too fast, you can get yourself into diarrhea. And then the question becomes, okay, I overdid it. What's the right amount?
Kim (32:40.987)
Got it, yeah.
Dr. Will Bulsiewicz (32:41.505)
And you don't exactly know. so, so to me, what I would say is, okay, time is on your side. Precision is what matters. We want to get this right because when we get this right, you will have the exact amount that your body needs in order to get into that rhythm and keep the bowels moving through. so, so to me, generally though, the idea of starting with one, which to me is somewhere in the range of 500 and then going up somewhere in the range of 750 or a thousand.
Now, if you get above a thousand, you definitely need to be talking to your doctor. And if a person has kidney issues, you should not be doing this without talking to your doctor in the first place. So again, like this is part of working with your physician, but this is a strategy that you can follow that magnesium has benefits throughout the entire body. It's not just for pooping. So this is just an opportunity for us to supplement magnesium, have better bowel movements and simultaneously derive other benefits from that magnesium.
Kim (33:42.029)
Okay, so now with the fiber supplement, you mentioned the one you have that you started with is a prebiotic. if you can, prebiotic as I understand is what basically feeds the probiotic. Is that right? Okay.
Dr. Will Bulsiewicz (33:54.448)
Yeah, that's right. Yeah. So this terminology, people have heard of probiotics. Probiotics are living microbes, bacteria, yeasts, or both that have been proven to have benefits for human health. Now, probiotics exist in capsules that you take as a supplement. They also already exist within our body. Right? So we can feed the ones that we already have.
And they exist in our food supply, not the ultra processed ones that sit, you know, on the shelf for a year or two years before you take them home and eat them. But the living food and living food is fermented food, but it's not just fermented food. Raw food is also living food. Raw food has a microbiome. You know, an example of this, Kim, is that if I were to go to my local store and I buy
ahead of organic cabbage. I bring it home. I can chop it up and I can put it into a Mason jar with a sea salt brine solution over the top. And in a week I'll have sauerkraut. And that sauerkraut is the result of the microbes that were already living on the surface of the cabbage. The cabbage's microbiome that have transformed the cabbage from salty cabbage into this
You know, crunchy, tart, acidic, delicious, complex, sauerkraut flavor. So the point from my perspective is that like the, the, the probiotic bacteria, example of this is lactobacillus plantarum. You know, could go to the store and spend a significant amount of money to have that in a capsule, but it also exists on the surface of cabbage. And when you turn it into the sauerkraut, you actually amplify that lactobacillus plantarum.
And you get even more. All right. So probiotics are the living microbes. Prebiotics are the food that they eat. And when we feed them, they multiply and they are more powerfully represented. The classic prebiotic is fiber. But we also know that resistant starches are prebiotic. Resistant starch is what you'll find in a green banana or in a potato.
Dr. Will Bulsiewicz (36:21.88)
And they are powerful prebiotics that can really transform our microbiome and allow our microbes to produce postbiotics.
And postbiotics are what really matter. Those are the short chain fatty acids like butyrate, acetate, and propionate. And those are the things that are bioactive that all of the benefits that I mentioned a moment ago, fiber improves your gut microbiome, improves your gut barrier. Fiber restores rhythm to your intestines. Every single one of these benefits is the result of short chain fatty acids.
And if we go system by system, metabolism, immune system, hormones, mood, cognitive health, I can tell you how short chain fatty acids are the key there too. They're the most anti -inflammatory thing I've ever come across. They're the reason that I'm motivated to talk about fiber is so that people can get more short chain fatty acids and we get them from pre -biotic fiber. So, and if I were to make a quick analogy, to sort of
Try to wrap up this section and bring it to clarity for the listeners. Imagine for a moment that we're all hanging out. So I'm there, Kim's there, you're there. And we want to create a delicious meal. What do we need? We need ingredients. The ingredients are the pre -botox. We need a chef. The chef is the probiotic. And when you put the ingredients together with the chef,
When you put the pre -botox with the probiotics, you produce something beautiful and very different than the way that it started. You produce that meal. And so, and the meal is the post -biotics, the butyrate, the acetate, the propionate. So when people think about improving their gut health, yes, you can take probiotics, but if you're not feeding the probiotics, you don't really get that much from them.
Dr. Will Bulsiewicz (38:24.797)
We need to feed our probiotics with fiber and resistant starch. And that's what is missing from the American diet right now. And that's what I want people to add to their diet, which is why I write books. And that's also something that you can get in supplement form in addition to your diet, not as a replacement, which is what 38 Tera, our daily microbiome nutrition is all about.
Kim (38:50.305)
So on the fiber note then, you say, you you're saying high fiber, but really you're saying just fiber because a lot of people aren't even getting much fiber in their diet at all. what would you, how many grams should we be aiming for? And I think that's different for male and female.
Dr. Will Bulsiewicz (39:08.669)
It is, it's different. And a lot of that has to do with our size and also our metabolism. So men on average are larger. So the average man needs 38 grams of fiber per day. And the average woman needs 25 grams of fiber per day. Now to put this into perspective in the United States, the average man right now is getting somewhere around 18. So they're not even halfway there, right? 18 when they should be getting 38. And the average woman is a little bit closer, but not
That much better. the average woman is getting about 15 grams of fiber when she should be getting 25. So we are, 95 % of us deficient in fiber. So you're right. I say high fiber and really what I mean is adequate fiber. Yeah, more. And, so, but also I want to be also totally clear on something, which is that, I don't want to accidentally present this as, you just need to achieve a certain number of grams of fiber.
Kim (39:53.589)
Yeah. Yeah.
Dr. Will Bulsiewicz (40:08.222)
Because then that makes it where it's like, could take a supplement. There are supplements that exist that will give you 20 grams of fiber. That's not what I'm talking about. All right. So the key actually is dietary diversity. Our gut microbiome that includes bacteria and yeasts is a diverse ecosystem. And, much like any other ecosystem, whether it be a forest or, a, coral reef.
Much like any other ecosystem, diversity is key because the different life forms, animals and plants and microscopic organisms and bugs, they feed off of one another. They need one another. In our gut, diversity is key as well. And research has shown us that if you want a diverse microbiome, the way that you accomplish this is by eating a diverse diet.
Now this is not something that, you you mentioned off the bat the way in which our world has changed. Here's one of the things that's changed. If we walk into your supermarket, 75 % of the plant -based calories come from three plants. Wheat, corn and soy.
Dr. Will Bulsiewicz (41:26.269)
So our food system is not going to do this for you. If our food system has their way, you will reduce your dietary diversity down to three. And I'm asking you to increase your dietary diversity on a weekly basis to 30. Now that may sound crazy and overwhelming. And when we start by saying, no matter where you are, no matter what your starting point is,
Kim (41:36.35)
Wow.
Dr. Will Bulsiewicz (41:54.737)
I assure you, I have been worse. I was the ultimate, like I was the guy that my friends made fun of for my obsession with junk food and fast food. Okay. That was me. So don't feel bad. Just think about diversity of plants when you're in the supermarket and when you're in the kitchen and when you're at the dinner table, every one of these is an opportunity to add a little bit more. And when you start to do this consciously,
Kim (41:58.016)
You
Kim (42:04.17)
Well.
Dr. Will Bulsiewicz (42:23.919)
as opposed to passively existing within our food system. When you start to be conscious about the choices that you make and adding more variety to your plate, it will come quite naturally. So like if you are making tomato sauce, diversity of plants, how many can we get in there? If you're making a soup or some chili, how many different plants can we get in there? If you're making a salad or if you're at the salad bar, if you are making a smoothie, these are all examples of opportunities where you could so quickly and easily have
you know, six to 12 different plants in one meal.
Kim (42:57.248)
because herbs can be in there too, herbs and spices.
Dr. Will Bulsiewicz (42:59.377)
Herbs, herbs, spices, seeds, nuts, legumes, whole grains. So it's not just fruits and vegetables and it's also not just fresh fruits and vegetables. Frozen is good too. That counts.
Kim (43:14.14)
about if you can talk quickly about soluble and insoluble because that's there's a conversation around the two types and if we have too much of one maybe it's not ideal is there an ideal ratio of the two or is really as you're saying doesn't really matter per meal it's more the diversity throughout your day in your week that matters
Dr. Will Bulsiewicz (43:35.238)
We've oversimplified. So fiber is an intensely complex group of long, long chain carbohydrates. All right. That originate in plant food and on a biochemical level, like I was a chemistry major in college. If you pull up a fiber molecule, I'm like, what is that? I have no clue. And it gives me a headache. So
To simplify it, we've broken it into soluble and insoluble. Soluble means it dissolves in a drink. Insoluble is the grit that will never dissolve.
They do have certain properties. The insoluble fiber tends to be the thing that kind of runs through you in the way that we classically think about fiber. So it just kind of sweeps through and comes out the other end. The soluble fiber though is typically fermentable fiber. And fermentable fiber is the type that can impact our gut microbiome, make them stronger, produce short chain fatty acids and those short chain fatty acids have their healing effects throughout the body. So now
We want both. And when we consume a diet that includes a variety of different plants.
you will find both in every single plant. So in fact, every single plant will have many different varieties of fiber. Fiber is not like again, it's not just soluble and insoluble. The fiber in kale is different than the fiber in a black bean. Much like protein, the protein in a fish is different than the protein in a cow. Right? Or the protein in kale. They're not, they're not the same. And so
Dr. Will Bulsiewicz (45:15.898)
Different plants have different forms of fiber, including both soluble and insoluble. So when we eat a wide variety of plants, we naturally would get those different forms of fiber.
Kim (45:25.404)
The other day, my husband said something about, he brought up the lectin conversation, which I remember the book coming out and everybody being, you know, getting angry at plants and thinking they're gonna kill us. And I said, let's see what Dr. B says. So I said, I'm sure he has some opinion. We found a YouTube video of you with Thomas DeLauer. And it was, you were talking about, the clip was oxalates and lectins. And if you can just quickly share.
the people who think that plants are out to get them or know, kale's getting a bad name or the word anti -nutrient is being tossed around a lot. Can you shed a little bit of light on your opinion about oxalates and lectins?
Dr. Will Bulsiewicz (46:09.328)
The overwhelming evidence is that people who consume more plant -based foods live longer with less risk for multiple forms of disease. And we see this whether you look at dietary patterns or whether you look at fiber. And if that's the case, how can these things, how can these foods simultaneously be inflammatory or depriving us of nutrition? It just quite simply doesn't make sense. It's not fitting with the actual body of research that's overwhelming in one direction.
And what's happened here, just to kind of make it clear for people who may be very confused, because you can hear two different medical doctors saying two polar opposite things. Welcome to 2024 where anyone can post, anyone can post anything to the internet, right? And you could have 99, you could have 99 .9999 % of doctors all saying the same thing. And the one person in 25 million who has a different opinion gets the most attention for
for cutting against the grain. But to find evidence to suggest that these things are inflammatory, it's not human evidence. It's not what happens when a person eats beans or eats whole grains or eats these other different types of plant foods. What it is is being reduced down to some sort of isolate where they have extracted lectins out of the food and they're running test tube studies. All right. So now we, like any scientist will tell you,
You never ever use test tube studies without confirming them in the real deal, us people, because they often will mislead you and sometimes be the complete opposite of the truth. So extracting lectins from the plant is not the same as us eating the plant. And in fact, the lectins, if you actually dig into this, because the books that make them sound so scary, either chose to
completely ignore the majority of the evidence or, or are quite intentionally excluding this important part, which is that if she, you look at lectins, there does seem to be a substantial amount of evidence to suggest that they protect us from cancer. And here we are in the number two cause of cancer death, the number two cause of death in America is cancer. And, it's quite hard for me, you know, just on a intuitive level, Kim.
Dr. Will Bulsiewicz (48:35.254)
It's quite hard for me to buy into this idea that people are like destroying their health with beans When no one is eating beans No one's eating beans the the the the bean intake in the United States The bean intake in the United States is six pounds per year the bean intake in the United States For our grandparents after World War two was eight pounds per year. So we have reduced our bean intake. We're getting more sick
And meanwhile, in Costa Rica, where, you know, their diet is dominated by a simple concept, beans and rice, they're outliving Americans without access to the type of healthcare that we have. So it's, it's a fallacy.
Kim (49:23.769)
Quickly before we wrap up, I want to talk about the hydration piece. You've mentioned that that's one of the key components, drinking water. But I've also had the learning from people about the role that electrolytes may play. Do you think that that's an important part of being hydrated and can it help bowel movements and
Does it have any effect on our microbiome? I mean, obviously it can no matter what the ingredients are in that electrolyte. We can also even make our own, but what's your, what would you say with regards to the benefits are not about electrolytes?
Dr. Will Bulsiewicz (50:03.78)
So there are, first of all, electrolytes clearly can help in terms of bowel regularity. I want to unpack this though, if I could. like magnesium is an electrolyte, right? So when we do magnesium supplements, we're effectively boosting that specific electrolyte with the intent of actually like having enough electrolytes within our intestine to pull water in.
Kim (50:14.112)
Mm
Dr. Will Bulsiewicz (50:31.233)
And the water that gets pulled in, we call this an osmotic effect, allows us to float that bowel movement down the stream and then have a good glorious bowel movement. So, and there are other examples where it may be sodium, right? That's actually being consumed and then helps to facilitate a bowel movement. So like a fleets enema would be an example of an electrolyte enema that allows us to have a bowel movement.
The problem is, from my perspective, Kim, is that approaching this with an electrolyte drink, which I think is what we're referring to here, as opposed to like a specific, you know, amount of magnesium oxide, citrate, sulfate, using an electrolyte drink to try to improve your constipation. I don't think this makes a ton of sense to me. And the reason why is because...
We already on average in the United States are over consuming salt. Now don't think that salt is the enemy when it's consumed in balance. But anything when consumed to excess becomes problematic. And salt does impact the microbiome. There is no doubt about this. That's the reason why we have to add salt water to cabbage to to make a good sauerkraut.
And so in the United States right now, the vast majority of people are over consuming salt, which is the result of ultra processed food. But then we're not addressing our fiber deficiency where 95 % of us are deficient in fiber. And instead we're opting to further exacerbate our excessive consumption of salt because we do have a desire to consume that food, that nutrient.
So to me, that's not the way that I would approach this issue. To me, the way that I would approach this issue is trying to restore a more balanced environment where we actually address our fiber deficiency, where if needed, we add magnesium to help to get, it does allow us to address our magnesium deficiency, but also simultaneously to help to soften our stools and allow them to move through. That's the way that I would approach this.
Kim (52:49.467)
matter the type of salt. hear the opposite of what you said where there and many of the drinks now are way higher sodium than what you would have seen before from certain electrolyte drinks. so you're saying that we consume more salt, especially the people who are consuming the ultra -processed yet there's the other side of the coin selling electrolytes saying we don't have enough salt in our diet.
And then there's people saying it matters the type of salt that you have. And if it's Himalayan pink salt or is it table salt and which one is better. So does that matter at all from the gut microbiome perspective?
Dr. Will Bulsiewicz (53:30.681)
haven't seen clear evidence to suggest that, for example, replacing table salt with Himalayan sea salt is, or Himalayan salt is preferable in terms of the gut microbiome. So I haven't seen evidence of this. know, arguing that we have inadequate amounts of salt, I just don't know what evidence they're citing because we have pretty clear cut data to suggest that our salt intake is excessive.
I think that we have a very strong biological drive to find salt in our diet. And that is something that exists because you could not survive unless you got enough salt into your diet one way or the other. And those are in the days that predated our ability to have a salt shaker or even to consume a bag of chips.
And I think that that biological drive, much like our biological drive has been exacerbated by many other aspects of our modern lifestyle, that biological drive towards salt is part of what is compelling us to make 60 % of our calories ultra processed foods. And there is no doubt. So like, let me say, do I enjoy drinking electrolyte drink when I exercise? Yes. I drank Gatorade when I was an athlete in high school.
I would much rather drink that than drink water. I have tried the electrolyte drinks that are popular right now these days. I'm not going to name any names, but I've tried them. Do I enjoy them? Absolutely. I enjoy them. You know why? Because I have a strong biological drive for salt. But it doesn't mean that I'm salt inadequate. It doesn't mean that I need more salt in my diet.
Kim (55:19.368)
Yeah. As a wrapping up, the last question I have is with regards to cleanses and detox parasite cleanse. I don't remember who it was I was listening to. They were talking about gut microbiome and the bacteria and saying even parasites. we think of parasites as always being bad. This person was making an argument that there can be some benefit to some parasites. So what's your take on?
Should we be doing, should we ever do a parasite cleanse? Should we be doing a regular one with every full moon? Should we be detoxing our bodies? Or is, I'm gonna plant the seed that I think what your answer will be is eat a diverse diet and your body will do the work.
Dr. Will Bulsiewicz (56:07.191)
Yeah. So there are parasites that are beneficial. All right. There, there are parasites that, I think that they've got a bad reputation in the same way that bacteria got a bad reputation. And then we entered into this place where actually I would describe it as a mistake to say that the way in which we should exist is to destroy our bacteria or destroy our microbes or even to destroy our parasites. So, and industrialization.
and living in an urban world the way that we currently do is naturally destroying these things. And they're very hard to find. I have done a bazillion Oval and Parasite tests throughout my career and I've only diagnosed a couple. They're very hard to find. Now, people who have like unstandardized tests,
I can't explain why these tests. know I will give you those examples where I've seen test results from a lab that I then go to actually do the gold standard test during an endoscopy to like prove whether it's present or not present like H .Pylori. And it doesn't match up to what the test says. So I think we have to be careful about where we choose to send our, our tests to for laboratory. But to really get to the heart of your question.
Really what we're getting at here, whether it be talking about a cleanse, a detox, parasite cleanse, you're talking about an acute intervention, somehow intended to reset our gut and take it to a place where suddenly it's better. And this is not the way that I think about these things because consistency is the key. The choices that we make on a routine basis.
the way in which we structure our day -to -day lives, we can create habits that become our standard, our natural approach to our day. And those habits can be every single day contributing to better gut health. And it's not just our nutrition. There's all these other aspects, whether it be our sleep patterns or morning sunlight, or having ways to connect with other humans outside of social media.
Dr. Will Bulsiewicz (58:26.903)
you know, there's all these different aspects that are very important to who we are. then ultimately when they contribute to who we are, they do contribute to our gut microbiome and shape our microbiome. All of them shape our microbiome. So rather than trying to do some, some sort of quick fix, some sort of shortcut, some sort of thing that's, you know, a cleanser or a detox, I instead of, the, of the belief that we need to instead approach these with consistency and make small choices.
And by doing those small choices on a consistent basis, they will have massive results.
Kim (59:03.269)
Yeah. Well said. Great place to end. Where can people learn more and purchase your books? As I said, I recommend both books. I recommend people read the full fiber -fueled book first and then get the cookbook. I appreciate the recipes and there is some information covered there, but I think going really deep into the science and the way that you've explained it in the first book was really, really helpful. So I do recommend both. Where can people learn more about you and find your books?
Dr. Will Bulsiewicz (59:33.335)
So my books are available everywhere that books are sold. So you could go to Barnes and Noble. You could go to your local bookshop. I'm always a fan of supporting your local bookstore. But of course you can also go to Amazon, works best for you. You can come to my website, which is called theplantfedgut .com. you know, I should mention you can get it at the library too. So if it makes you happy to check it out at the library, please, please do. what I care about.
is the time that I get to spend with you in a book. That's what I care about. It's a beautiful thing as an author when a person spends time reading my book. So that's what it's really about for me. My website is theplantfedgut .com. I have a completely free email list that people really love where on a weekly basis, I like to send out emails where I discuss whether it be new research or tips on gut health, something that I learned or something about what's happening in my life.
So and people seem to really enjoy that and then you know, we did discuss 38 Terra Quite a bit and so for those of who are interested 38 Terra is available in the United States Australia, New Zealand We're not yet in Canada the UK or the EU, but we're planning to be there and hopefully early 25 But if you go to 38 terra comm you can learn more about this product check it out read the reviews and and also make sure if you do go for it to download the product guide and
When you get your can on the bottom of the can, you will, this is the product on the bottom of the can, you will find a lot number and that lot number you can enter into our website and we'll give you the entire test report for your specific batch, which includes more than a hundred different things that have been tested.
Kim (01:01:19.169)
Wow, that's really cool. Love it.
Dr. Will Bulsiewicz (01:01:21.525)
Yeah. Yeah. It's like, it's like I said, I, you know, in creating this product, like the vision is I think we can do way better than the products that were developed in the 1980s from a single form of fiber, right? Diversity of plants is the key. think we can do way better. I think that we should include different forms of prebiotics. So there's fiber resistant, starch and polyphenols. And then beyond like what I conceived to be a great formula. It also needs to be third party tested to show people the cleanliness of their product to, like.
demonstrate to them so they can have great confidence. So there's over a hundred things that we tested for. The product is certified glyphosate free. The product is certified will FODMAP. There's more certifications coming. We're working on it. We've tested it. It's gluten free. You'll see that in your report. We've tested it as GMO free. You'll see that in the report. There's a number of different things in there.
Kim (01:02:11.651)
That's very cool. Can I ask one more question because you just said the word gluten.
Dr. Will Bulsiewicz (01:02:14.955)
Yeah.
Kim (01:02:16.896)
What are your thoughts on should everybody be gluten free because of the glyphosate?
Dr. Will Bulsiewicz (01:02:20.846)
Do we have another hour? Gluten is a very complicated topic. All right, I'll try to simplify this as much as I can and be efficient with it. Number one, if you have celiac disease, you need to be gluten free.
All right. In people that are not celiac, that don't have celiac disease, there are definitely people who get symptoms when they consume gluten containing foods. That's wheat, barley and rye. There are a couple of potential explanations for that. One is that wheat, barley and rye don't just contain gluten. They also contain fructans.
Fructans are a form of a FODMAP. FODMAP is the fermentable parts of our diet that can cause gas and bloating. Now, like I should be clear, fructans actually are really, really good for us. They're prebiotic. They're prebiotic. They're good for the microbiome. But for people who have gut issues or if you have constipation, you will definitely notice more gas. If you eat too much of these types of foods, wheat, barley, and rye,
If you eat too much, you will definitely notice it. And that's the result of the fructans. So in people who get gut symptoms with these foods, they've been labeled as having gluten intolerance or gluten sensitivity. And actually the evidence is suggesting that in many cases we've misplaced it and we've even misnamed it. That actually it's a fructan intolerance, a fructan sensitivity. And that's a form of food intolerance.
But I also say, because Kim, you asked me about this. So glyphosate. Okay. We are told glyphosate is safe for human consumption. But is it safe for microbial consumption?
Dr. Will Bulsiewicz (01:04:12.721)
Because things that we put into our mouth that contain glyphosate, they come into contact with our microbes and they're very small. And when things are very small, you don't need large amounts to affect them one way or the other. And I do have concerns. I do have concerns that people who again, don't have celiac disease and yet will say, I break out into a rash.
Or I have this, you know, neuropathy, or I have these other things, or I could joint pain. Right? I have concerns that it's not necessarily the gluten, that it may be the glyphosate. And the way that we avoid this is by buying organic. And I'm a fan of people learning, and you can find this in my cookbook, the second book. I'm a fan of people making their own bread.
Because real bread is the most simple thing in the world. Flour, salt, and water. That's it. And you don't need a starter or any, like you could get a starter, but you can make this with your own hands at home and create a starter and you control the flour and you can get organic flour. So,
To me, do have concerns. People who think that they have gluten issues, here's my advice. If people think that they have gluten issues, number one, get good testing for celiac disease. Make sure that you don't have celiac. If you don't have celiac disease, then I would explore the possibility of organic, and I would also explore the possibility of this being a fructan intolerance. One of the ways that you would know that it's a fructan intolerance is if you eat sourdough.
You will tolerate it.
Dr. Will Bulsiewicz (01:06:05.52)
because sourdough is woven in fructans, but it still has gluten.
Kim (01:06:10.147)
Yeah, and that's bread that's recommended to a lot of people. And I did try to make sourdough. I made one and then I couldn't keep the starter alive because I went away. So anyway, I'll try again. Yeah. Yeah.
Dr. Will Bulsiewicz (01:06:21.314)
It can be tricky. There's, definitely a morning process. think fermented foods are very intimidating, including to me. the first time I made sauerkraut, my wife was very scared that I was going to poison myself. And then actually she became addicted to it and I couldn't keep up with her sauerkraut consumption. She was eating so much of it. So it definitely, there's a morning curve to that, but it's worth trying. And the, I'm glad that you tried and the, and the, the starter can be placed in the fridge and then restored later on if you need to.
Kim (01:06:44.921)
Yeah.
Kim (01:06:51.214)
Yeah, yeah, it was fun. I'd like to do it again. anyway, I've kept you way longer than I was wanting to. But thank you so much for being so generous with your time and your knowledge and your expertise. And I know people will take a huge amount of value from this episode. Thank you.
Dr. Will Bulsiewicz (01:07:06.826)
my gosh, thank you so much, Kim. Thanks for having me. Thank you everyone for hanging out with us.
