Hello, everyone.

My name is Amit Acharya, and I’ll be moderating today’s webinar titled “Gut Instincts and Nutrition Insights,” and I’ll be today’s moderator, as I’ve just said.

Before we begin, I’d like to take a moment to acknowledge the land.

While I sit here in Ottawa, which is the traditional unceded territory of the Algonquin Anishinaabe people, I recognize that many of you will be participating in this webinar from elsewhere across Canada.

I encourage you all to take a moment to reflect on the traditional Indigenous lands that you are on today and recognize the long-standing history that has brought us all to reside here.

Now, before we start, just a few housekeeping notes.

I’d like to thank Activia for bringing this webinar together.

And thank you for their support to make this conversation possible.

Today’s session is going to be recorded, and it will be shared with all registrants via email within the next week.

It will also be available on the Activia website, and that will be made available in the coming weeks as well.

If you have any questions during this webinar, please feel free to put them in the question-and-answer box—the Q and A box located at the bottom—and we will do our best to answer these in the Q and A section at the end, once the presentation section’s over.

OK, now it’s my pleasure to introduce our speaker.

Today we have Natasha Haskey with us.

She’s a leading expert in gastrointestinal health and nutrition.

Natasha’s work is grounded in evidence-based practice.

And she has a real talent for making complex science both relatable and practical.

She’s passionate about exploring the connection between the diet and gut microbiome, and today she’ll be busting some common myths and sharing the latest research in a way that’s both engaging and informative.

So, without further ado, I’m going to pass it over to Natasha.

Thanks, Natasha.

Thank you for the kind introduction.

So, hi, everyone, thank you for joining me today.

I would like to first, before I get started, just thank Danone and Dietitians of Canada for making this webinar possible.

So today, my goal is really to explore the fascinating intersection between gut health, nutrition, and some of the evolving science behind probiotics and fermented foods.

But before I begin, I just want to note that the views I’m expressing today are my own, and they don’t necessarily reflect the positions of Dietitians of Canada.

I also want to be transparent about my disclosures.

I have worked with Danone in the past as well as with this webinar.

I’ve also worked with LyfeMD [and] Takeda.

I’m on the executive for Nutrition Therapy for IBD.

I’ve worked with Crohn’s and Colitis Canada, and my research work is supported by a Michael Smith Health Research BC – Health Professional Investigator Award.

So, here’s what we’re going to cover today.

We’re going to understand why gut health matters for well-being, clarify what probiotics and fermented foods are, and just clear up some common misconceptions and really walk away with some practical evidence-based dietary strategies you can actually apply to not only yourself but your practice, just to support a healthy gut microbiome.

So, to make today’s session a little bit more interactive, we’re going to use a tool called Slido.

So, you can join in right from your phone or laptop; you don’t need to download the app or anything like that.

So, you can scan the QR code and then, when I bring up the questions, it should show up on your screen.

So, just if you want to keep this handy, the instructions are also in the chat box.

So, let’s begin with a case.

I’d like to introduce you to June.

June is someone you might see in your practice. [She] might be a friend of yours, maybe even you recognize this person in yourself.

So, June is a 32-year-old elementary school teacher, and over the past year she’s been feeling constantly tired, bloated, frequently sick with colds, also noticing that her mood is off, like feeling more anxious than usual, and despite eating what she thinks is healthy, she often skips meals, relies on coffee, eats on the go… You would say her diet is generally low in fibre and high in processed foods because she’s always trying to grab things on the go.

So, I just want to have you keep this case in the back of your mind as we work through the presentation because we’re going to come back to her at the end to provide some strategies on how we might assist her in improving her digestive health.

So, just as a reminder, the term[s] “microbiome” and “microbiota” are often used interchangeably.

However, just to re-emphasize, “microbiota” is a collective term for the microorganisms that live in and on our human body, whereas “microbiome” is a little bit more of a complex term, and it includes the full complement of the microbiota, their functional capacity, which is linked to their genes, and then the surrounding environmental conditions.

So, our gut isn’t just bacteria, it also includes viruses, fungi.

Viruses are referred to as the viral fungi, referred to as a microbiome.

Archaea, which I haven’t listed here, as well.

I guess what I can say is, with the bacteria, it’s been the most well researched and, in general, that’s what this presentation will focus on today.

And so, what we do know is that the microbiomes are composed of a wide variety of microbes, and they all play an important part in digestive health.

So, here if… let’s warm up with a bit of a word cloud and so I would be interested in hearing what is one word you associate with gut health?

So, you can just type in whatever comes to mind, don’t overthink it.

And I’ll just give people a moment to respond.

So, it seems like gut health is associated, people feel it’s associated with probiotics, prebiotics, fibre, immunity, and mood, so the gut–brain axis and some different conditions.

OK, great.

So… What we’ll move to… We have one more participant typing… So, the key takeaway here is that we’re all here for the right reasons to talk about probiotics and fibre and and all the different ways we can improve gut health.

So just to sort of start, I think one of the questions I get asked a lot is, you know, “What does gut health actually mean?” And, in fact, when it comes to a scientific or medical definition, it really is a vague term, and at this point is not very well regulated.

So, what it can mean in its simplest form is that it can… gut health could be just basically the absence of disease, so meaning the person doesn’t have any digestive conditions, including per se, irritable bowel syndrome, Crohn’s disease, colitis, or other disorders.

But then where things become a little bit more complicated is when we start looking at, you know, what is the structure and function of the microbiome, so, you know, does it mean that the gut barrier is working fine?

Is there production of short-chain fatty acids?

Which bacteria are living there?

So, I think what’s important is, as health professionals, is to understand that these… we have to kind of understand what these nuances mean to better advise our patients.

So, this slide basically gives an overview of the kind of scientific definition of what we would say would be potential markers of a healthy gut microbiome.

So, what… I’ll just walk you through this side.

So there [are] two potential… components, that being the microbiota, and that being the gut.

And these are closely linked, but just starting on the left-hand side of the slide, when we’re thinking of the microbiota… when we’re thinking of a healthy gut microbiome, we think diversity, and so we’re looking at the range of different microbes that are present, so generally the science still stands in suggesting that higher diversity is often associated with a healthier, more resilient microbiome.

So, the more types of microbes there are, the better.

Composition—meaning the types of species that are there—and their abundances.

And so, we look at this through different types of tools, looking at this through metagenomics, which tells us the function of those microbes… looking at genes, proteins, etc., the functionality.

So, things have really moved forward.

It’s not just who’s present, but how they’re actually functioning, because these functions actually go throughout the body.

And that’s why we’re hearing more about these different [axes]—the heart–gut axis, liver–gut axis, brain–gut axis… because these compounds that these microbes are producing do actually travel throughout the body.

And then also gases, so… important… these microbes are also producing a number of different byproducts like hydrogen, hydrogen sulfide, and so they can actually tell us, through our breath, different… just give us a readout of what’s happening as far as microbial fermentation and what kind of metabolic activities are going on.

But when we look at the right-hand [side] of this slide, just as important in the gut, we can look at inflammatory markers in the stool.

For example, in IBD patients, we can look at calprotectin, which is an inflammatory marker… we’re looking… we can look at pH, so, depending on what is being produced in the gut can change the pH of the gut and then, again, going back to metabolomics, which is super hot right now in the diet field, looking at what all these microbes actually produce.

And so, the kind of key takeaway here is that this is the holistic picture, so we need to look at not only the microbiota, which includes diversity, composition, functionality, but also what’s actually… trying to understand what’s actually going on in the butt… gut!—sorry—to understand and, and develop different types of biomarkers that we can actually use to, to guide health.

So, here’s a quick true-and-false question, if you want to pull out your phone again.

So, my question is: Do the microbota outnumber the human cells 10 to 1?

Is this true or false?

So… actually… in fact, the answer is false.

So, what’s interesting, I was… it’s kind of a tricky question.

I’ve done a number of presentations that I’ve outright said that the human cells, the microbiota, outnumber the human cells by 10 to 1, but now our thinking actually is that, in fact, the ratio is closer to 1 to 1.

And this ratio actually varies depending on a person’s size, the amount of fecal material that’s being analyzed… So, sort of the new numbers have changed, and so this ratio is now closer to 1 to 1.

So, moving on to probiotics, I think most of you are familiar with the definition, being that probiotics are live microorganisms that, when taken in adequate amounts, provide health benefits to the host.

So, probiotics [are] live microorganisms.

So, in order for a probiotic to be called a probiotic, it must contain live microorganisms.

If it is dead or inactivated, it doesn’t count.

When it comes to identification and classification… So, with a probiotic, each organism must be precisely identified by its genus, species, and even its strain.

So, because not all strains work in the same way.

When it’s a probiotic… [it] will be shelf stable, so [that] means that the probiotic will survive. until the expiry date listed on the product.

So, if that probiotic doesn’t make it to the end of that expiry date and is degraded, they, they cannot… cannot be defined as a probiotic.

A probiotic has efficacy in randomized control clinical trials and has safety assessments, especially in some of these vulnerable populations.

But, what probiotics are not… they’re not naturally resident beneficial microorganisms.

So just because a microbe actually lives in your gut and is producing beneficial effects, that doesn’t make it a probiotic.

So, we must deliberately administer a probiotic, and it has to meet that criteria in order to be called probiotic.

It’s not a live active culture; live active culture[s] are associated with fermentation.

So, fecomicrobial transplantation mixtures, even though they provide health benefit… so, when we transfer those microbial communities from one person to another, like I mentioned, even though there is a therapeutic effect, it’s not the same as a well-characterized probiotic strain.

I mentioned previously: the bacteria cannot be dead.

And then finally, bacterial products are not probiotics, nor are live vaccines.

And so, if you’ve joined me in the past, I’ve often showed this particular slide, but, just to re-emphasize, strain is really, really important.

And so, I still hear terms like Lactobacillus bifidobacterium being thrown around.

And so, it’s just not specific enough when we’re talking about supplementing with probiotics.

So, when we think of… just to reiterate, when we think of dogs, for example, not all dogs act the same.

You can see that the wolf and the terrier here are from the same genus, [the] canine genus and species, but in the same way, when we think of the genus and species in something like E. coli, you can see that these two particular strains are very different.

One causes disease, one has been shown to be beneficial in IBD and is considered probiotic.

So, again, strain actually is really important.

So here’s another true and false.

So, a key characteristic of probiotics is that it must withstand the acid in the stomach.

Is this true or false?

OK, so this is a bit of a trick question.

So, what’s interesting is that not all probiotics have to withstand the acid of the stomach because there now are a number of different probiotics that have been used on… we can use on our skin.

There [are] different types of probiotics that are beneficial for our oral microbiome, but, in general, for a probiotic to work, it has to reach its site, where it can do its beneficial effect.

So, when it does come to the small intestine or large intestine, obviously it does have to withstand the acid of the stomach.

So, what about probiotic foods?

So, if you just add a probiotic to a food in the food supply, does that just automatically classify it as a probiotic food?

And so the answer is no because for such a product to be called a probiotic food, it must meet that criteria indicated for a probiotic.

So, for example, I’ll use the example of a yogurt.

If yogurt contains a well-studied microbe like Lactobacillus rhamnosus GG and it’s added to the yogurt and it’s been shown through scientific studies to improve gut health, yes, indeed, it is a probiotic food, but if we look at the… we take a snack bar for example, where they have added a probiotic strain, but there’s really no evidence that, number one, it survives through… through to shelf life— there’s no scientific studies—well, then, in fact, it’s not a probiotic food.

And so, what we should be looking for on the label… and this is according to the International Science Association for Probiotics and Prebiotics.

So, in order for something to be called a probiotic food, it must contain the live microorganisms, it must be given at an adequate dose, it must confer a health benefit, and that has to be demonstrated by scientific evidence.

So, simply sprinkling or putting in some probiotics into a yogurt or, say, cereal, by a food company doesn’t necessarily qualify it as a probiotic food.

And so, for example, when we do look at the label on an Activia product, we do see genus, species, and strain listed.

We do see that… the colony-forming units to shelf life… and how much is in a serving.

And it also shows how the product should be stored, and it does indicate the benefits the product confers, so that’s why they can use the label of gut health.

Now, fermented foods are a different story.

They are often confused with or are often talked about as being probiotic foods.

But while all fermented foods start with live active culture or live microbes, the final product may not always have live cultures in it, and the reason for that is that some products actually go through different steps of heating and filtering, which, sure, makes them shelf stable, but in the end, we don’t have those live active cultures present anymore, so think [about] things like sourdough or beer, things like that.

Yes, they’ve been fermented, but they may not contain those live microorganisms.

So, what I find really interesting is that there are so many different types of fermented foods in the world; and I do like this graphic because it shows all the different potential foods that have been fermented.

And it’s really shown that how different cultures in the world have found different ways to harness these microbes in the kitchen.

And so, some of the key microbes involved are some of the lactic acid bacteria.

So, those would include things like the Lactobacillus or Lactococcus species, and they’re there to ferment various types of lactic acid, lowering that pH to allow for [the] preservation of food.

And that’s what gives these types of foods that sour, tangy flavour.

So, think yogurt, different cheeses, and our vegetables like sauerkraut and kimchi.

Whereas yeasts are there to break down the sugars, convert them into alcohol and carbon dioxide… So, that’s what gives the bubbly content to kombucha.

So, mainly the types of microbes that are involved in this process for kombucha, say for example, are the Saccharomyces cerevisiae.

And then, finally, the acetic acid bacteria… the Acetobacter, Gluconobacter… they’re known… for… they’re found often also in, not only in kombucha, but different types of vinegars, and they basically oxidize acetic acid, and that’s what gives it that sharp vinegary bite.

And lastly, filamentous fungi help break down different types of plant materials into simpler compounds, and so that these different types of products can actually ferment.

So, this includes things like miso, our different soy products, like soy sauce, and then also tempeh.

So, we now understand that fermented foods certainly influence health, regardless of whether or not we call them probiotic or not.

And the nutrients that are produced by different fermented foods actually go well beyond the gut.

So, when we eat, say, a fermented food, it’s not just the nutrients, it’s the metabolites that are produced, and they interact with the body in a variety of ways.

So, number one being a metabolite–endocrine interaction, so this is where the microbiome is producing the short-chain fatty acids, and they stimulate gut hormones, which I actually find fascinating that it increases the expression of things like your GLP-1 and PYY.

So, imagine the benefits that has on health, in an increasing satiety, potentially decreasing food intake and improving insulin sensitivity, just like all these medications out there, the GLP-1 medications, fermented foods can do this, likely in a smaller way, but it’s actually quite fascinating.

Secondly, the microbial metabolites have a[n] interaction with intestinal inflammation.

So, for example, there’s dietary tryptophan in these fermented foods, which are converted into indolepropionic acid, which influence gut-barrier dysfunction as well as reduce intestinal inflammation.

And lastly, they’re also a metabolite–host immune interaction, so dietary acetate can actually influence the various intestinal T cells, which then produce various different types of cytokines, which then ultimately influence intestinal inflammation.

So, the definition for fermented foods tends to be a little less strict.

So, it may or may not contain live microorganisms.

It doesn’t… for fermented foods, they don’t have to have necessarily have efficacy in randomized control trials, but we’d still know that they can support gut health, and there’s no requirement for identification of the genus, species, and strain.

So, here… I’m just going to walk you through some examples.

So, I’m curious to know, looking at this particular kombucha, do you think this is a probiotic food or not?

So, just take a quick look at the ingredients.

One thing I will mention is that there’s not really any advertising as to any health claims; this is all that is actually on the label.

So, I’d love you to vote and tell me, is this a probiotic food or not?

OK, excellent. “Not,” because it doesn’t list any species… genus, species, or strain.

There’s nothing about shelf life, there’s no claim, and there’s no indication of how much of the kombucha culture, the live active cultures that are available in the product are there at the end of shelf life.

So, what about this one?

Do you think this particular product is a probiotic food or not?

Again, no claims, no… All we have here is that they ha[ve] the kombucha culture, and it does have the genus, species, and strain listed here.

So, is this a probiotic food or not?

OK.

So, a little bit of sort of a mix here.

In my opinion, although it does have an added probiotic to it, which is a legit probiotic, I’ve looked that up, I would not actually consider it a probiotic food.

Again, it doesn’t have enough information on the label, and, and to be fair, the company says there are probiotics in it, but it doesn’t call it a probiotic food at all.

There’s no dosage given, or else… and we don’t see, you know, if it can last to shelf life, etc.

So, in fact, I would say this is actually not a probiotic food.

And the other thing is that it has not been tested to prove health benefit.

So, here’s another question.

When we’re looking at yogurt, what would you call it?

Would you call it a probiotic food, a live active culture, or a fermented food?

So, curious what you think here.

OK, so… I like the answer, and I would agree with you; it really does depend on a few things.

So, if you were making yogurt in your kitchen, certainly it is a fermented food, because most yogurts would start with a starter culture like Lactobacillus bulgaricus and Streptococcus thermophilus.

That’s what actually gets… gives yogurt its creamy flavour, or, sorry, creamy… the creamy texture.

So, then it does have the live active culture.

If you take a yogurt… If you were making those yogurts or using a yogurt that perhaps doesn’t have the labelling, like, say, the Activia yogurt, then you… you definitely could say it’s a fermented food.

You could say it does have live active culture, most likely, but… but the next step is for the company to actually go ahead and do those scientific studies.

So not all yogurts… That process has not necessarily happened.

So, the Activia yogurt, yes, is a probiotic food.

In this situation, it has added strains like the Bifidobacterium animalis, which has undergone some clinical trials.

They have proven that there is enough live bacteria to have that proven health benefit.

But when it comes to yogurt, yes, it really does depend.

All yogurt is fermented.

Some yogurt will have live active culture, and then it depends on the particular brand and which strains are added.

That would make it actual… an actual probiotic food.

So, I hope that makes sense.

So, the next segment of our presentation really is going to focus on some practical strategies for improving gut health.

So, the first thing I want to say here is that whole dietary patterns, not just individual nutrients, really play a central role in shaping the gut microbiome.

And so these diet-driven shifts, as I have mentioned, do influence the microbes present, the metabolites that are produced, and then which, in turn, actually influence both gut and systemic health.

And so I really, really like this particular picture or slide here because it really compares four different dietary patterns.

And so let me walk you through it.

So, the patterns I’m comparing are the Western diet with the Mediterranean diet, high fibre, and a plant-based… plant-based diet.

So, each column really kind of gives you an illustration of what happens to the microbiome when people consume these types of diets.

So, the pie chart you see, really, basically just illustrates the micronutrient distribution of these different plant-based diets, and so what you see is that, depending on the macronutrient composition, it does affect the different microbes present.

So, let’s start with the Western diet.

So, generally, a westernized diet—low fibre, high in processed foods, high sodium—generally is associated with microbes like Blautia, Biophilia… These microbes have been shown over and over again to reduce the production of short-chain fatty acids and increase the production of compounds like endotoxins and trimethylamine oxidase, which has been associated with cardiovascular disease, whereas the Mediterranean diet, which is— oops, sorry—rich in different types of fibre sources… The key components of what the Mediterranean diet stimulates is this fecal bacterium Roseburia ruminococcus.

They’re all known to increase short-chain fatty acids, and they’re a result of increased fibre degradation.

And so, as a result of that, that’s where its health benefits come from.

When we look at high-fibre diets, same… Mediterranean diet is a little bit more of a broad-based diet.

High-fibre diets, again… We show similar trends in that there’s more of the Bifidobacterium… These fecal bacterium seem to be key microbial species, which, then again, increase that short-chain fatty acid production, have been shown to reduce a lot of the inflammatory markers in the gut and systemically.

And then moving to more of a plant-based diet… Again, similar concepts… Polyphenols, for example, again… are broken down by the microbes; again, have antimicrobial properties and increase short-chain fatty acid production.

So, the key takeaway here is, is that it’s not just one item of these diets that matters, it’s the whole quality of the diet. and I think we need to focus more on diet quality than specific nutrients.

I mean, obviously, the nutrients are important, but I think when it comes to the microbiome, diet quality is one of the biggest factors contributing to gut health.

So, when it comes to… I always like to show this particular slide.

I put this particular graphic together for a paper just to try and explain that fibre is critical to the microbiome, but that using the term “fibre” isn’t the most all-encompassing term because fibre can mean different things depending on which country you live in… And when it comes to the microbiome, different microbes feed off different dietary fibre sources, and it doesn’t… Dietary fibre may or may not… Sorry.

Prebiotics may or may not be considered dietary fibre, so, it gets a little bit confusing… So, the term we’re using more in the microbiome field—is the microbiota “accessible”?

Carbohydrates refer to as max.

So, just to illustrate what I’m trying to say in this particular diagram—moving left to right—is that different fibre sources are fermented differently by different microbes.

So, for example, the cereal brands, the cell wall of fruits and vegetables are, are very poorly fermented, but that doesn’t mean that they’re not good fibre sources; we need those for bulking.

But some of the soluble fermentable fibres that we were most familiar with are readily fermented by the microbiome, and these are the ones that will produce short-chain fatty acids.

Then we’ve got our inulin and fructooligosaccharides.

So, obviously, these are our prebiotics… the fibre sources that feed the microbes.

Again, prebiotic definition is very, very specific, so not all fibre is prebiotic, so… And, lastly, polyphenols… they actually don’t meet the definition for prebiotic yet.

Some may not even consider them fibre sources, but again, these different types of polyphenols, resistant starch, and conjugated linoleic acid actually are These likely… at this point, are candidate prebiotics, and in the future may eventually be referred to as prebiotic.

So, what about introducing fermented foods to that person that’s never actually had fermented foods?

My recommendations are really to start slowly.

For some people it’s going to be an acquired taste, and this may take time.

But even starting with small amounts, even a teaspoon with a mixed meal of, say, something like sauerkraut, may be more palatable for some of these people.

You can try choosing gentler options.

I think now people are a little bit more comfortable with yogurt, but introducing things like kefir, small amounts of sauerkraut, and maybe leaving the things… the spicy and more strongly fermented foods like kimchi, for a little bit later on.

For some people, it may actually cause some gas, bloating, and discomfort.

That’s why you might want to start slowly, including with meals, because sometimes on an empty stomach, that can bother people and just really… consistency is key to getting some fermented foods into these individuals.

So, what about special health considerations?

I still think we need to be a little bit cautious.

In particular, I’m referring here when it comes to fermented foods, in the immunocompromised population, pregnancy, those living with irritable bowel syndrome, or small intestinal bacterial overgrowth, also known as SIBO, because that can actually make… in some individuals, make symptoms worse, and then those that have a histamine intolerance.

And the reason for that is that fermented foods actually do contain histamine, and so this is produced when some of these microbes ferment various food products, and so, in some individuals, they are lacking in the enzyme that breaks down histamine, so they can end up with headaches, migraines, hives, as well as GI symptoms.

So, this is not a population we probably want to use a lot of fermented foods with, but, if someone is interested, making their own yogurt could be a potential option, and not leaving it sit, so there’s less histamine found in the actual product, or some people are able to tolerate coconut yogurt.

So, when it does come to special health conditions, I use the Clinical Guide to Probiotics as my guide because these products change constantly in Canada, so you can go on here and find which probiotic you should be using for which particular condition and how much would be advised.

Another place to go for some good resources is the International Scientific Association for Prebiotics and Probiotics.

They have wonderful tables like this, which break down basically everything we talked about today, but they have some great patient-friendly, [patient]-facing resources for health professionals, and they’re the ones that set the world definitions on these prebiotics, probiotics, fermented foods, and prebiotics.

Finally, after all the years of study, when it comes to gut health, I have put together sort of this particular table to show you different ways we can enhance gut health, and this is taking what we are aware of in the actual science to date.

So, let’s go back to our case, June.

So, what I’m curious about is that after some of the discussion we’ve had today, what are some recommendations you would make for June, to help her improve her diet?

I hope some of you are still awake out there.

OK.

So, thank you. “Starting small”… “introducing fermented foods”… That’s something that I had. “Plate model”… Yes, she definitely needs more fruits and veggies. “Planning meals”… “colourful fruits and vegetables”… Great, thank you.

These are all great suggestions.

OK. “Work to create a list of feasible options”… Exactly.

OK.

Just to sort of wrap up today’s presentation, so I can take some questions; I think, though, the exciting part here about dietitians, for dietitians, is really that we are entering this era of precision nutrition.

And so, to me, it’s a very exciting field where we can really focus and tailor our diet recommendations to individuals’ unique biology.

So, using not only their microbiome but their dietary records, physician reports, lab reports, physical activity… all the information from these wearable sensors, to really, really dig down and personalize patients’ diets.

And so… using some of this AI technology, we will see changes in our particular practice, and we will be able to hone in on whether… this diet potentially will work for you, but perhaps this diet might not work for you, and that’s not just based on a patient’s preference, but the microorganisms that are living in our gut.

So, this is… I really think this world is not far off, and I do think it’s going to be the future of nutrition.

So, I will just leave my contact information here… And just a little bit of a plug: if you do have patients living with IBS, I was able to co-author a recent publication that is a good read for patients to try and help them with not only diet, but tips for gut–brain axis, as well as how to improve their microbiome.

And so, if that’s something you’re interested in, please share.

So, with that, I’m happy to take some questions.

I’m a little bit over time.

Sorry about that.

Thanks, Natasha.

That was great.

As you mentioned, we can go straight into the Q and A section now because there [are] quite a few questions.

OK, good.

The first question I have is: Have you come across histamine intolerance, where a person can’t eat fermented foods?

What would you recommend for that person in that condition?

Yeah.

So, when I talked about that earlier, histamine intolerance is becoming more common, and there are some really interesting studies coming out that… there’s a strong linkage to irritable bowel syndrome.

Again, what the science says is that if they did want to eat fermented foods, it needs to be like fermenting the yogurt themselves, but it needs to be eaten.

It’s not something that … can ferment for days… it would need 24 hours and then eat it and see if they can tolerate it in smaller amounts.

Some can tolerate coconut yogurt, but other than that it’s probably not the best way to go about improving the microbiome.

We should look at other ways.

Great.

We got another question here.

What about emulsifiers and artificial sweeteners in UPS?

Does that impact microbiome?

Yes.

So, I’ll start with emulsifiers.

Definitely… very interested in my… in my own research looking at emulsifiers because there’s pretty strong evidence to suggest that the emulsifiers do thin the lining of the gut mucus.

So, we are recommending proactively in our IBD patients to limit their consumption of emulsifiers.

The interesting thing about non-nutritive sweeteners is that it really it seems to be individual dependent.

So, the studies are showing that depending on your own microbiome it may be detrimental, but in another person it won’t be.

So, again, this comes down to that personalized approach, and so they haven’t really figured out why that is, which microbes, but, in general, it really depends on the individual.

Stevia is one of the only ones that… we haven’t seen… It seems to be one of the safer ones when it comes to the microbiome.

Great.

What options would you recommend for a client that has to limit salt, sodium, but wants to include these healthy gut bacteria?

So, if they’re limiting salt, I mean, I think… We know that right now, that… Or we’re concerned about the ultra-processed foods and… If they’re limiting sodium, and if they remove those ultra-processed foods, that’s where a lot of the sodium is coming from [in] our diet.

So, all of our… Like, our natural food sources aren’t generally high in sodium, right?

So, it’s coming from that added salt.

Great.

Got another question here.

What do you say… What are your thoughts on fibre supplements like [“Metamucil”]?

Metamucil?

Yes.

Yeah, I mean, definitely some people can benefit from it.

I think the interesting piece about fibre supplements is that, again, at some point I hope we will have a personalized approach.

It’s that concept that some people can take the Metamucil and it helps them immensely, and the next person says it causes a lot of digestive upset or they become constipated again.

It really boils down to… a person’s own tolerance, but it is a great way to get more fibre into the diet because unless somebody is really conscious about their diet, I don’t think they’re getting fibre, enough fibre.

Great.

Do PPIs impact gut microbiota?

Yes, and so the scientific evidence would actually say that long-term usage of the PPIs will change the microbes, and what was interesting is that I read a paper that said initially these PPIs were only supposed to be used for six weeks when they first came out, but now people take them for years and years and years on end, so there are definitely changes to the microbiome with these particular meds.

Great.

Lots of questions here. [Do] apple cider vinegar and miso have effects… have active bacteria, and [are they] considered probiotic?

So, [they’re] not considered probiotic but considered fermented… They’d be considered fermented food, and [they] may contain live active culture.

It’s hard, it’s very difficult to know.

But if I will say, again, it’s less about the bacteria, sometimes of fermented foods, than it is, like, well… They’re… they have all these beneficial metabolites that can add… provide the beneficial health effects.

Great.

How does diet influence the gut–brain axis?

Good question.

So really, we have a whole bunch of endocrine cells, that line, our gut, so because of that, different types of neurotransmitters are not only produced in the gut—an example of that is serotonin— they communicate with the brain through the vagus nerve.

We do know that some of these neurotransmitters go back and forth.

And so a lot of these metabolites that are produced in the gut, even from different food sources, can travel to the brain, and that’s why there is this whole influence on mood, depression, anxiety, and certainly more and more research is showing that those with altered microbiomes—you could say dysbiotic—have a higher risk for anxiety and depression.

Great.

We’ve got [the] last few questions.

I’ll try and get through for you, if that’s possible.

Is there any link between long-term iron supplementation and microbiome?

I guess… Again, it’s one of those questions that it depends… If the… gut is inflamed and someone has a chronic condition, it will have a different effect than, say, somebody that’s generally healthy.

Yeah, I’ll just leave it at that.

I think it really depends on the actual condition.

Like, some of the microbes do break down these iron sources, but you need the iron for other reasons.

OK.

Let’s take one last question here.

So, are there any kind of resources or key studies that provide an overview of how cancer therapies such as chemotherapy, radiation, or immunotherapy impact gut microbiome?

I’m not a cancer expert, that’s a whole other field, but it certainly is one of the emerging areas where, when we talk about personalized medicine, that they are using the microbiome to harness the effects of this therapy, and so there are lots of different studies out there that would support that the microbiome is really key to influencing how some of these therapies work.

OK.

Well, great.

Thanks!

Thanks, Natasha.

I can see we’re getting kind of closer to the allotted time.

So, I’m going to bring the webinar to a close.

Again, thank you for volunteering your time.

Do you have any last thoughts that you’d like to share with everyone?

Not so much.

Thank you for listening, everyone; and I’m always open for questions.

So, please feel free to email me.

Otherwise, yeah, I think as dietitians, we are poised to change the microbiome… diet… and diet is becoming more and more key to managing a lot of these chronic health conditions, as they always were, but I think just even in a more powerful way.

Great.

Thank you, and thanks to Activia for making this webinar possible.

If you’d like more information, you can visit the link that I’ve just put in the chat.

Thanks, everyone, for your time today, as well, and I hope you have a good rest of the day.

Thank you.

Bye.