We discuss in this interview:

• Leaky gut and an unbalanced microbiome
• How the wrong foods cause inflammation
• Benefits of a high-fiber diet
• The importance of diversity in microbiome
• The impact of fermented foods on microbiome diversity
• When to introduce fiber and fermented foods
• Probiotics and their benefits
• Shelf-based and refrigerated probiotics
• Choosing the right probiotics
• Microbiome tests

Clint – Dr. Miller, welcome. Just a brief background about yourself for people who are going to join us on the call now.

Dr. Miller – Sure, thank you for having me tonight, Clint. My name is Chris Miller and I am probably invited here because I have an autoimmune disease myself. I was diagnosed with lupus 12 years ago now and had a horrific initial part of the visit on the illness, on multiple medications, just getting worse and worse, more and more joint pains and organ damage, kidney issues, and heart issues. The disease was progressing on multiple medications. Nobody told me about diet or lifestyle. This is back in 2008 and I don’t think all these podcasts and stuff were out yet, so I hadn’t heard of any of it. And I’m a physician, so I actually practice in the emergency department and was out there taking care of patients and I didn’t know any of this. And so on my own, I started doing a deep dive because I was struggling with 6 medications and started learning about diet and the possibility of a vegan diet. I started studying it, learning everything I could about diet. And then after diet, I learned everything I could about my body and how to reduce my stress level, which is a big issue for me. Over the course of years, I have totally improved and I’m doing great now. But along the way, through my challenges, I’ve learned a lot. So Clint and I love to talk about new articles and things going on and so hopefully we’ll do some of that today.

Clint – Yeah, that’s what we’re going to do. So thanks for that background, Dr. Miller. You’re at plant-based telehealth, which is a fantastic service that offers medical consultations to people all around the world. Yourself and Dr. Laurie Marbut and Dr. Michael Clapper were instrumental in growing that over the last few years, and we send so many people to you. So if you’re interested in having a second opinion or if you just want to talk about your condition with someone who knows, then contact Dr. Chris Miller, who’s with us today on this podcast. When we talk about specifically today, our topic of interest is the microbiome. And we’re going to talk about probiotics, and we’re going to talk about fermented foods like sauerkraut and kimchi and miso and things like this. We’re doing this with a sort of a quasi-live audience. We’ve got people live with us on this call, and these are people from rheumatoid support and rheumatoid solutions, our loved, adored members of our community. They are going to chime in with some questions towards the end and maybe even if I can manage the tech, interject some of their questions along the way. That’s what we’re going to talk about now, and why don’t we get started Dr. Miller. This came about because the other day you and I just had an informal chat about some other things on a phone call, and we got talking about this topic. We love nerding out about the science, and we’ll just happen to be talking about probiotics, and fermented foods. So but first of all, before we go deep into those, let’s talk about what’s the main objective for a healthy gut and a healthy microbiome.

Dr. Miller – There’s 3 things that I think about with the immune system and the gut. The gut gets out of balance, you get a dysbiosis, the microbiome is out of balance, you get inflammation locally and you get what’s called the leaky gut or the hyperpermeability of the intestines, which are supposed to be a little bit permeable, and they become hyper permeable, which we call leaky gut. When all of that happens, our immune system is right underneath it, and the microbiome and the immune system are talking all of the time. And so when all that is out of balance, then your immune system goes crazy. That may look like an autoimmune disease, Rheumatoid arthritis for you, lupus for me, that might look like histamine response. I just saw a patient today with histamine response syndrome, so we treating that similarly because it’s also the immune response with the microbiome. It might be allergies, it might be asthma, it might be all these chronic inflammatory states, diabetes, obesity, hypercholesterolemia. They all sort of go together and a lot of us experience a lot of those things at once for a reason because they’re linked there. So I worked on improving the microbiome balance, which is what we’re going to talk about tonight, and the gut integrity and inflammation state.

Clint – Yes. And what I’ve been looking at in putting my book together is a lot of the studies about how to have a healthy microbiome. You’re from plant-based telehealth, you’ve long reversed long-term inflammatory arthritis yourself. There’s a big clue here. More plants help, don’t they?

Dr. Miller – Oh, for sure. I mean, part of the immune system gets so out of balance, the microbiome gets so out of balance. Eating high-fat foods, especially saturated fats, oils, meat, and dairy products, they are directly causing inflammation and an inflammatory state, they’re eliciting the pro-inflammatory immune cells. So you’re getting an immune response immediately after eating that. They’re throwing your microbiome out of balance and they’re causing leaky gut all in one swoop by eating these foods, which, of course, we don’t know, which is why we’re all eating them. And so by switching over to a high fiber diet, one, you’re eliminating all of that, so right there, you’ve already helped by eliminating it. And two, the fiber itself has been shown to modulate the immune system and the microbiome and to help start to begin to heal that leaky gut and the gut integrity. So just by switching over, you are doing tremendous, that is the first biggest step that everybody with an autoimmune or any systemic illness should take. And then from there, as you and I can talk about, there are a lot more little tweaks to it, but that is a huge first start.

Clint – Yeah, I think this podcast is going to be really fascinating and interesting for people who are already well down this path and want to hear about all the details because you and I have that in common. We’ve spent a lot of time looking at the great detail on all these things and have used ourselves independently without knowledge of each other for about a year ago.

Dr. Miller – I love following you because you are doing so many similar things and you share the data and why the reasons. I love reading about what you’re up to always.

Clint – Thank you. So the big picture here is we’ve got to eat more plants for all the reasons that you just highlighted, and avoid those inflammatory foods like dairy, meat, oils, and processed foods. Before we then dive straight into the next steps, we sort of give a little note to the other influencing factors of the microbiome, aren’t there? There are many. We’ve got stresses, we’ve got the water that we drink, the toothpaste that we use, we’ve got everything from even the toxic pollutants that are in the air. All of these things can impact our microbiome, there are so many things. Exercise being one of the major ones that I left out of that list we have, we see that elite athlete have more microbiome diversity than those of us mere mortals. And so, we have these multiple influencing factors, but diet is the biggest one. So if we can, get our diet to optimize our microbiome, we are going to directly have better health and less inflammation, it’s 1 to 1. Let’s talk about our diversity. Diversity is one area that’s recognized as a beneficial microbiome, it’s one that’s more diverse. So how might we increase the different little bugs that are inside our colon?

Dr. Miller – Yeah. It’s so interesting Clint. You and I were talking about this, like, if you’re born with a certain number of microbiome and everybody says eat more fiber to diversify it, so you start eating more fiber as we hopefully all are doing as we go more plant-based, we’re adding fiber in different types of fiber. So the bacteria that you have started to flourish, the good, healthy, anti-inflammatory bacteria flourish. So you’ve improved your microbiome, but have you improved your diversity? Well, if you don’t have certain strains of bacteria because you’re born without them, then you may not be improving your diversity as much as we think we are. That’s what you and I were talking about, which is so interesting. And we’re going to talk about why for everybody listening.

Clint – Yeah. Here we go. We’re now starting to dovetail into our conversation from the other day where we both are buzzing with excitement. So along that line to support that I and I can say at least one of the people that I’ve worked with both had advanced stages of healing. Like have had microbiome samples done, so poo samples that have been analyzed in the lab. And I found that even when I felt great, this is going back a few years that I had no lactobacillus, some lactobacillus strains were completely missing. Likewise, I have seen one other case where someone was feeling pretty good, no lactobacillus, I think it was acidophilus and maybe a couple of others. Of course, there are dozens of lactobacillus variants, dozens of bifidobacteria variants. But according to the sort of guidelines or the reference charts on my analysis, they should have been there. Okay, these are things that most people have. And so it’s an indication or a support of what we’re talking about is that if you don’t have the strains, no matter how much of that leafy green that you eat each day and how much of your, onions and garlic and all the little extra things, we are told, that are going to help us. If it’s not there to multiply, you need one to multiply, don’t you? If you don’t have that one, then what else can we do? Right? What else can we do?

Dr. Miller – Right. That is the question that I’m wondering what’s happened for people who don’t know is over generations, if people don’t eat a diverse fiber. So if people if your grandparents or your parents aren’t eating a lot of fiber, so they if they eat a higher fat diet or more processed food diet and they’re not eating a lot of vegetables, like my mom doesn’t eat any vegetables. She doesn’t touch vegetables, she doesn’t eat fiber. She says it bothers her gut and she doesn’t eat it. Her microbiome is going to be reduced in diversity, and that’s passed down to me. What they have shown is over years, it keeps getting smaller. So our generation has a much narrower microbiome than they did hundreds of years ago when they were eating over 50 and over 100 grams of fiber a day. And now we’re barely eating 12 grams of fiber a day and we’re much nearer and we just don’t even have those strains. So we go on a plant based diet, but and we’re helping the ones that we do have, which is good, but how can we diversify just by eating that fiber? And that’s what you and I were talking about, that’s what we were wondering.

Clint – Yes, that’s what we were wondering. At this point, I’d just like to say if anyone in the chat wants to ask questions as we go. I’ve got the chat open here and I’ll be able to multitask that adequately. So if you have some questions as we go, please pop it in the chat, I’ve got an eye on that as well. So let’s talk about a study that we both saw. Tell us about this study where we found that eating fermented foods does increase the diversity and does seem to give us these missing strains that we could benefit from.

Dr. Miller – In this study. This is what you and I started that conversation. It was so interesting to me and to everyone listening, this came out in July in the Journal Cell, which is an excellent journal, and it was done, to tell you the truth, the authors are plant based. So it was funded through two plant based scientists at Stanford and they looked at over a ten-week period and this is so interesting. They gave an extra seven weeks to adjust because you can’t just go high fiber, right? You have to gradually increase the fiber so your gut adjusts to it, so they did. But basically the study was measured over ten weeks and they took people and put them either on a high fiber diet, including legumes, whole grains, vegetables, fruits, nuts and seeds, or they put them on. So basically a plant predominant, I’m not sure if it was 100% plant based, but it was definitely plant predominant. And the other group, they kept them on the regular diet that they were on and they added fermented foods, 2 to 4 servings of fermented low sugar vegetables in foods. That included things like kefir that included sauerkraut, kimchi, things like that, low sugar ones. They did the study and the authors, to be honest, expected the plant based group to do better because they’re plant based themselves, that’s what they anticipated in the study. And they were shocked with the results.

Dr. Miller – The results showed that the plant based group did not have an increase in diversity of their bacteria. They did not have a significant reduction in inflammatory markers, and they measured like several over 30 inflammatory markers. They did have an increase in the enzymes to degrade bacteria, and they had an individual immune response based on those enzymes. So increase in short chain fatty acids, which we know is very beneficial. So they did see a response, but they didn’t have any increase in diversity or a decrease in inflammatory markers such as IL6 and others. So then the fermented group that was still eating a standard American diet, they with just these fermented foods, 2 to 4 servings a day, they showed a significant increase in biodiversity of their microbiome and a significant reduction in inflammatory markers. In 19 inflammatory markers were improved with the fermented food. And the more fermented foods servings they did a day, the more improvement they saw. They themselves were shocked, this was not what they expected all either. Anyway, you and I were discussing the results and why that would have been.

Clint – This could in part describe why sometimes people who are on other autoimmune dietary approaches than you and I know from the science are not as effective, but that still retain meat, for example may see a result in some people. For example, it seems to me that what that study just showed that if someone, let’s say, decides to do a paleo diet, they don’t want to stop eating their meat, but they decide to eat more vegetables and they add a lot of fermented foods which is allowed on some of these different plans. First of all, by eliminating the processed foods and eliminating dairy and eliminating most of their oils, they often keep coconut oil, but they’re going to feel better all right. I call that a halfway step towards fully plant-based. That’s like doing the basic things, dairy, you’re kidding yourself. Forget dairy and then get rid of your oils. And then by this point, a lot of people feel a lot better anyway, in spite of the retained meat in their diet. And then if they lump a whole bunch of fermented foods, what we’re seeing is that no wonder that this is getting them a fair way along. So I believe that if we were to extrapolate that you go plant-based plus fermented foods, you’ve then get the finish line in terms of an ultimate destination. Would you agree with that?

Dr. Miller – 100%. So the way I interpret study is just like you Clint that the answer to me is to remove all this pro-inflammatory foods like we talked about, increase your fiber, because that does improve your short chain fatty acids, which does help modulate a lot of your immune system. It also improves your enzymes to break down your fiber as you eat it. But then if you don’t have the diversity because you were born, which maybe a lot of us were with autoimmune diseases, you were born without the diversity that that alone is not enough. And so you and I were talking about when is the appropriate time to start adding in the probiotics to actually increase your diversity of your of your gut. And it has been shown that the fiber plus the diversity from the fermented foods actually improves the diversity as well as even further enhances the immune modulation. So the combination may be and this is new for me, I’m someone who’s been working with autoimmune for a long time and I don’t really I never really used to eat a lot of fermented foods. And as I see this study now, it’s changing things for me actually. And so I’m starting to think, ha, I don’t have a very good microbiome. I also have checked my stool samples a couple of times and I showed the stool deficiencies that is seen often in lupus people. I absolutely showed it even on a plant based diet, I showed it. So how can I improve that? Well, it looks like the answer is from probiotics, but there’s some caveats to it, which I know we’re going to talk about also, it’s more complicated than just that.

Clint – That’s right. So let’s pause there. I’ve got a couple of questions from our members here. First question, are pickles considered fermented?

Dr. Miller – It depends. That’s a good question, I love pickles myself. It depends, so in order to be a fermented food, it needs to be refrigerated. Usually if it’s not refrigerated, if it’s on the shelf, it’s pasteurized to prevent bacterial contamination. If it’s pasteurized, you’re going to lose that live probiotics. So it’s not, so it has to be refrigerated. Often, they say, contains live probiotics. And if it doesn’t say that, it may or may not, it depends. You can like Google the company and see how they do it. So pickles absolutely can be fermented, but not always.

Clint – And would it be fair to say that 9 out of 10 times in even health food stores, they’re not the way that you and I truly are thinking about getting it properly? I feel that, there’s I won’t mention any brand names, but there is some favorite whole food company-supported brands in America that look like they’re totally like your grandma’s recipe kind of pickles. I found out that even they have been flash heated.

Dr. Miller – It’s totally going to ruin it for us. But my husband, who does not do a lot of cooking or prepping, he actually makes our own pickles. So it’s not that hard for people to learn, which we can talk about later. But yeah, it’s questionable, that’s a good point.

Clint – Lauren’s asked, what are the best sources of fiber and how much fiber do you recommend every day?

Dr. Miller – The best sources are going to depend on your state of healing, I would say, for your autoimmune disease, wherever you are. If you’re healed, then all whole food plant base are going to be great sources. So eating unprocessed or minimally processed or intact whole grains such as quinoa and whole oats and buckwheat and those types of things, whole rices or legumes. All legumes are going to be good for you. All vegetables especially include make sure you include raw vegetables because they have their own microbiome that actually also modulates the immune system. So make sure you’re including raw vegetables and cruciferous vegetables and then fresh fruit and a small amount of nuts and seeds. So all of that is going to be fabulous. If you’re at an early healing stage or immune systems of mass as mine once was. Some people’s are you’re having crazy symptoms and all these foods are affecting you. Then you may want to stick more to the vegetables and kind of eat simply at the beginning and then add the others in.

Clint – Wonderful. Back onto our main sequence of sort of guidelines here. We’re going to talk about when to add the fermented foods in. In our program, we have Miso early in the program now. Quite a few things to cover off here. First of all, Miso long term as a generic health product, does it have long-term adverse effects? The studies out of Japan, long-term decade-based studies show, no, you’re not going to increase your cardiovascular risk. Yes, it’s salty, but that tends to be offset by the beneficial soy proteins in there for a health reasons. And so long term, you can eat soy without having adverse health effects. What about for immunoreactive folks, those of us who are following this program, and your clients, what about those? So it seems like it’s a mixed bag. It seems like the majority of folks because of Miso in particular, with the soy proteins being broken down into amino acids, the fats, the fatty acids and the simple sugars that remain, it’s very easy to digest. However, we notice that there is a histamine thing with fermented foods in general that is associated with inflammation when we have dysbiosis. Now, that’s the key point, let’s talk about that, Chris. It seems like if you can eat fermented foods now, good for you, do it, pat on the back, tick the box. However, if you cannot, you’ve got more work to do on your microbiome, then try again. Thoughts on that?

Dr. Miller – Agree. You and I are always agreeing, it’s so interesting to me. But yes, and I think a lot of people listening today are going to recognize this. And I recognized it in myself and in a lot of my own patients that fermented foods trigger our symptoms. So if I would have eaten sauerkraut a couple of years ago, there’s no way I could have eaten that, it triggered joint pains almost immediately. And I too had a histamine response, it triggered my immune system was triggered, my gut was out of balance. All of that same as so many other people. So if you are at a place where you have a lot of food sensitivities and you’re not tolerating these different foods, I don’t recommend trying the fermented foods at that point. You’re welcome to try it if you want, but be careful because you could elicit a huge response. As you listen to these studies, I caution you that this is something you’re working towards. And so when you get to a point, once your microbiome is in a better balance from eating high fiber foods it’s almost like the first stage of it is reducing inflammation, calming your immune system down. And that’s done just with the high fiber foods before you start. And then once the microbiome is a little bit more stable, then you can start with the fermented foods. But if you start to early, it could definitely cause a problem in people. So yeah, I just caution you to wait. But once you are at a place where you’re doing really well, that’s when now my new advice, Clint, and This is new since I saw the study is I’m starting to recommend people add in fermented foods. Because we need to broaden our microbiomes so we age healthfully and don’t get chronic illnesses later in life. And that’s going to be from improving our microbiome diversity later on.

Clint – Beautiful. A question from Michelle. Hi Clint and Dr. Miller, I have this histamine intolerance that you’re speaking of. I haven’t been able to tolerate fermented foods. Would miso be a good fermented food as a starting point? I personally think so. Interestingly about meiso is I’ve tried my hardest to find what is the composition of bacteria that come from miso? It seems like it’s very difficult to identify what that is because all manufacturers are using different Stata cultures. There are different ways of actually creating the I guess in a kombucha there’s like the what’s it called the mother something. Anyway, there are different ways to get the fermentation started that are used in different products. And then there are different compositions like hybrids of brown rice and soy and then are the ones of barley, and then there are others. It seems like there are no real guidelines around this. It’s just generally accepted that yes, there are live cultures and yes, they are in significant amounts, but there’s no real standard as to what that looks like. So ii miso a good place to start? Well, it was for me and I was inflamed as you like, blew up like a Christmas tree, so it was for me. It might not be for everyone, but I think it’s a good first thing to start with. And it’s a small dose, i’s just like a spoonful on your bowl of pseudo grains or rice. It’s a small intervention.

Dr. Miller – I would say, I would be nervous to start with it too early on. If you’re that Christmas tree person, I would probably wait for just a smidgen to calm that down and then I would that might be the first one to add pretty quickly. And plus it adds delicious flavor and it can really enhance salad dressings and things so you can keep eating your greens. So, it’s really individual, you just have to test it. So it worked for Clint that’s awesome, so he can eat all he wants. So I would recommend everyone out there try just a smidge and see how you do, and if it does, okay, try more. If it bothers you, you’re not ready and that’s okay. Just put it off for a little while. With so many to this autoimmune disease, we are different and there are similarities with people with rheumatoid arthritis. We know you’re deficient in lactobacillus, we know you’re missing lactic acid-producing bacteria. I have lupus and there are certain ones that we’re deficient in, and I was deficient in those even on a plant-based diet, so depressing for me to see that but it was true. And so we know that with different autoimmune there are different deficiencies that are kind of known, so we are going to react differently to these different foods. Plus you yourself might react differently just because we’re all individuals, so the best way is to test it. And yes, I do, I do stool testing and check microbiome. Some people, I don’t do it on everyone and it’s not always necessary because we kind of do a standard thing to help improve it. But we absolutely can if people are interested the way I was interested, it’s fascinating to see what you have and don’t have.

Clint – Let’s move on now to probiotics. Let’s talk about why would we want to take a probiotic first of all? Let’s say we’re eating well, we’re even starting to toy with a few fermented foods because we’ve learned about the diversity benefits of doing so. Maybe if we’re not quite feeling all the way there, or maybe some other reasons, what are your thoughts about taking a probiotic?

Dr. Miller – You and I talked a lot about this, Clint. So I definitely recommend them, but I recommend them differently from fermented foods. So fermented foods are shown to increase our diversity, we now know this from this excellent study that just came out, but not everyone can tolerate them until later on. Probiotics have not been shown to increase the diversity of your microbiome, so you’re not taking them for improving your diversity. And you’ll hear other gurus out there, other plant-based doctors, experts saying don’t take probiotics, they don’t help your diversity. And that’s true, they don’t. So we’re not taking them, Clint and I are not recommending them for that reason. The reason that we recommend them is probiotics have been shown to modulate your immune system. And there is clear evidence that when you take a probiotic, especially certain strains and these strains of bacteria can help your immune system go from like T-cells, their type of immune system cells, and they can go inflammatory or they can go anti-inflammatory. Probiotics have been shown to lean them towards anti inflammatory. So you’re going to make more T regulatory cells which calm your immune system down from probiotics. So a person who has a leaky gut, that’s lighting up like a Christmas tree, I love that analogy. That person should be on a probiotic to lean them towards anti-inflammatory regulatory cells. It also helps decrease other inflammatory cells and it modulates the immune system. It actually also helps heal leaky gut. So it’s quite important for those purposes to start to bring balance while you’re calming your immune system, you’re quieting everything, all this craziness and inflammation going on, you need to calm that down. That’s when I recommend probiotics for the healing phase. And I’m not recommending fermented food at this point because you’re most likely you’re not going to tolerate most of those fermented foods. So that’s kind of their benefit, I think.

Clint – Absolutely. I love describing how the lactobacillus and the bifidobacteria range both exert a molecule that helps to fuel the repair of damaged epithelial cells. And so if we think of almost tiny hair-like follicles that line all the way along our gut lining that can collect and bring nutrients into the cell wall. That cell wall is so, so delicate. It’s only one cell thick. It’s not microscopic, it’s less than microscopic. And so it’s very, very, very thin, it becomes very, very delicate and it turns over quickly. It’s quick to damage and quick to heal if it has the right fuel source around it, and that fuel source is coming from the products of the bacteria. So without that bacteria, that gut can experience severe permeability and inflammation. We like the probiotics for that because if we’re low on like eyesore in my stool sample and I’ve seen in others, if we’re low on some of the beneficial bacteria that can help kill leaky gut, we can supplement and we can benefit from them, even if, as you say, Dr. Miller, even if they don’t become our own commensal bacteria, even if they still remain a little foreign in the in their transient movement through our body, I love that. What about dosage levels? I’ve always been a little bit of an adventurer when it comes to dosage levels. I like to sort of find out if I can get get a positive impact from a supplement by doing it a little bit higher dose than maybe on the bottle. And I’ve done that in the past with particularly digestive enzymes and also with probiotics. Is there an upper limit? And should we really push a little bit to try and get a result here? What are your thoughts?

Dr. Miller – I also push a little bit. There are some people who have gut issues and they don’t tolerate the probiotics. So then for those people, we may have to go lower and it’s people who might have the small intestinal bacterial overgrowth, we give them a probiotic and they may get a little bit worse. But that’s a small percentage of people, to tell you the truth. The majority of people I would push it to, and I do it twice a day with meals and I’m going a little bit higher, sure they tolerate it. Absolutely.

Clint – Wonderful. I also saw a study that answered my question on this, which was when should we take a probiotic? So they studied this and it turns out that we should take it about 20 minutes prior to a meal that apparently gets the most of the capsule into the place where we’re trying to get it, which is all the way past our hydrochloric acid levels and so on. That’s a little tip as well. The studies are strong on probiotics and rheumatoid arthritis, have you seen studies on probiotics in lupus?

Dr. Miller – Absolutely, 100%. I studied this quite a bit, and they absolutely have been beneficial. The immune system in lupus is crazy, and it just doesn’t shut off its PH to an antibody to humoral antibody induced and it goes crazy. It just keeps going and going and going and going and going, and the probiotics have been shown to increase the anti-inflammatory and calm that cycle down. And so they are extremely helpful for Lupus.

Clint – Wonderful. What about post antibiotics or even during a course of antibiotics? What are your thoughts on the best approach to that?

Dr. Miller – Well, especially for an autoimmune person I absolutely recommend it. Because if you’re throwing your own microbiome out of balance, then you have potentially you’re going to increase your leaky gut again and you’re going to cause dysbiosis again. And that’s what we’re trying to overcome, so the antibiotic will modulate your immune system at that time. Studies have shown that probiotics after infection do not help improve diversity. But we know this, right? We’ve already covered that probiotics do not improve diversity. So you’re not taking it to restore diversity after you took a microbiome that’s going to be fermented foods. If you want to restore your diversity, we’ve got to get you on to some fermented foods. But if you’re going to get a lupus flare or a rheumatoid arthritis flare or some other autoimmune flare because you just took antibiotics and now you have dysbiosis and your leaky gut acts up again, your food sensitivities have come back. Absolutely get back on that probiotic. Again, we’re taking it for a little different purpose. So if you hear and I have a lot of my patients and myself, too, you hear these specialists out there saying, no, no, no, don’t take them. We’re taking it for a different reason to modulate our immune system, which is very different from an increase in diversity.

Clint – Yeah. Love it. Thanks for clarifying that again so that everyone’s all on the same page here. I asked a health food store owner some years ago about whether or not shelf-based probiotics are as effective as the more traditional, the legacy kind of refrigerated required probiotics. And I’ve always trusted their answer, which was the shelf life one is just manufactured in a different way. They have just as much live bacteria, just as good for you, etc., etc.. Have you seen studies on this or is that just you’re also your belief?

Dr. Miller – Yep. I agree. They are just manufactured differently and they still both have benefits. So the live ones are usually live bacteria in the refrigerator to keep them alive. The shelf-stable is freeze-dried, but the important proteins are what are there and they’re preserved. And so it’s been shown that even if you’re not eating a live bacteria, those proteins might are still modulating your immune system. So you’re still getting a response, even though they’re not live, so you can still get responses with both.

Clint – Okay, Lauren says, and by the way, I take a shelf probiotic, that’s the one I take. I actually I do also take a refrigerated lactobacillus acidophilus because I saw my stool sample four years back and because I believe in some of the benefits of that. It also has some in there, something that I haven’t looked much into the studies on. Are you familiar with that particular?

Dr. Miller – I am, so it’s yeast and it’s very beneficial. It has different benefits, it’s been shown in studies. It does help redistribute your microbiome, it adds even a little more immune function because it’s totally different. Actually, it’s helpful for people with sugar cravings, so I often recommend it to people like that. It’s helpful for people with diarrhea, it’s been shown to be extremely beneficial for certain types of diarrhea, like C diff and other types of diarrhea. But it’s helpful for people trying to lose weight, and it also modulates the immune system. So it has a lot of benefits separate from the lactobacillus and bifidobacteria, which are the two most commonly recommended for autoimmune diseases. And they’re broad group, there are families, different types of lactobacillus and they’re studying the different types now each species of lactobacillus for rheumatoid arthritis, for lupus, for Sjogren’s, for psoriasis, for all these different autoimmune. As well as the Bifidobacteria there are all different types of those and they’re studying the different ones and there are certain ones that are more beneficial than others. When you’re choosing, your probiotic, it’s possible you’re going to choose one and feel worse if you get some strains that actually cause inflammation. So you’re going to want to look at the studies or talk to Clint or me because we’ve kind of narrowed down some of them that are proven to be beneficial. But yeah, so it’s really interesting.

Clint – Yeah, it’s actually exactly. One quick question, Lawrence, is is it possible to take the wrong type of probiotic? And would you recommend doing a gut analysis first to see what’s going on with the gut microbiome and ensure we’re selecting the proper probiotic for our unique condition? Well, Lauren, there is a group in Tasmania which is a state at the bottom of Australia that’s disconnected from the mainland. The head researcher there is Dr. Jason Hawrelak, and I interviewed him probably about two years ago on this podcast. So you can go back and type in his last name, you’ll find it and its topic is microbiome probiotics. That’s what his company does, literally match a probiotic to your dysbiosis. It’s a very forward advanced kind of science and his group is really, really interesting and that’s the sort of thing they do. For the 99% rest of us who don’t have that kind of desire to do that, I really think that you’ll more than likely be fine with just one of the sort of common popular brands that you can find on Amazon that probably has maybe six or eight strands of Lactobacillus or 4 to 8 strands of bifidobacteria. So your probiotic might have 50 plus billion strains cultures per capsule, of which there might be around 12 to 16 different strains in each capsule. That’s what I’ve done over the years, I’ve felt quite comfortable with it. And I’d be curious, Dr. Miller, about what your approach has been personally.

Dr. Miller – I agree. If you can start with a mix of lactobacillus and bifidobacteria, those are going to be the safest. As we get more data, and I’m following this all the time, they’re doing studies constantly right now on seeing which bacteria affect rheumatoid arthritis, and which bacteria affect lupus patients, we don’t have that data yet. So if someone’s doing studies right now and trying to match it, we don’t have enough to know 100% for sure. But we do know we have the data that adding strains of lactobacillus and adding strains of bifidobacteria is going to calm your immune system down and help with these autoimmune diseases so I would start with that as well. If you react to that probiotic, then I would stop for a little bit and we’ll switch it out for something else.

Clint – Michelle says, how helpful this discussion is and that the probiotic that she tried years ago before she went plant-based caused her to get worse. I loved what you mentioned before about small intestinal bacterial overgrowth as a possibility. Some people might not know what that is. Can you explain what that is and why taking a probiotic might stir that up?

Dr. Miller – Your microbiome, the majority of the microbiome in the intestines, lives in the entire part of the intestines. But the majority of them that we’re talking about now that degrade fiber are in the colon. So the lower part of the intestine down there and they’re anaerobic, they don’t have oxygen and they’re way down there. What can happen is from having a poor diet, not eating fiber, taking in Pepcid and medicines to suppress proton pump inhibitors, things like that, antibiotics, several reasons, your bacteria that are supposed to be in your lower colon can migrate up and be in your small intestine. So then when you eat your high fiber foods and it goes in your small intestine, those bacteria right there, and they’re going to ferment all that fiber and you get gas and bloating and discomfort. Those people have small intestine, bacterial overgrowth, where the bacteria that are supposed to be lower, they’re now higher up. So if you give more bacteria, more probiotics to those people, that can worsen it, actually. And so what we want to do is do stay plant-based but lower fiber plant-based foods and calm that down. We do some herbs sometimes and there are some little tricks to it, but we can get that to calm down. Then the gas bloating improves all of that, and then you’re ready for your probiotics in a little bit.

Clint – Love it. Yes, interesting. Also, I think that increasing hydrochloric acid is helpful as well to reducing small intestinal bacterial overgrowth. I believe that there are some real older studies that I haven’t looked at for a long time, but I used to talk about this in presentations on stage. Is there a correlation between low hydrochloric acid, meaning that everything around us is covered in bacteria, you know, even in the area, the food, the water, everything we touch, everything, right? And so those bacteria are prevented from getting any further normally by the hydrochloric acid, which acts as a disinfectant, essentially. So having good hydrochloric acid levels prevents the SIBO. And like you said if we take something like proton pump inhibitors where antacid.

Dr. Miller – Exactly, it blocks your hydrochloric acid, that’s exactly what it’s doing. As well as some of these other medications that we don’t even think of, steroids and NSAIDs, your anti-inflammatories, all of this. You’re messing with your acidity levels, so you will have different digestion. And we’re seeing the acid usually suppresses the bacteria right there because it’s so acidic. Now we don’t have the acid-producing and so the bacteria are able to migrate up. So that’s part of the mechanism, exactly.

Clint – Wonderful. Well, you and I have covered everything that we wanted to cover in this conversation, this was our intent. If there are any last questions, if you want to post them down now into the chat, we’ll be able to take a quick look at those if I see them before we wrap up here. But let me just summarize now before I just glance at the questions, what we have come to agree on, these two minds, myself and Dr. Miller. Based on the studies and based on working with people, me with people on this journey, and also Dr. Miller with her patients and working with their lab results and in some cases even their stool samples and so on. Also, our collective combined personal experiences, both Dr. Miller’s with lupus over a long term, mine with rheumatoid arthritis now of 16 years. We have found that the following to try and put this into a sort of a little bundle here, is that we want to increase the diversity of our microbiome by eating as many plants as possible and by adding fermented foods. However, if we cannot add our fermented foods yet because we have a histamine response due to a still persistent dysbiosis or imperfect leaky gut, then we can take probiotics in the interim, which enables us to get a lot of the benefits, even if those probiotics don’t end up becoming our own cultures. They do pass through our colon after some time and are eliminated. They offer the benefits that a diverse microbiome would offer us without having yet gotten there. But then with time, we definitely want to be adding fermented foods into our diet. Have I missed anything, Dr. Miller?

Dr. Miller – No, that’s a great summary of what we talked about. Yeah.

Clint – Oh, what about a question from Kathy here? Is there a preferred microbiome test that people could use in the United States that you’re aware of? I’ll talk about Australia.

Dr. Miller – I don’t have a preferred one. I have one that I use, I use Genova labs. That’s just what I’ve used for many years. So I’m very familiar with it, it shows us the short chain fatty acids. So your butyrate, which is important to heal your gut lining and the integrity of your gut while the butyrate, the acetate, the propionate. That’s what you can see, it shows a display of the microbiome. And so we can see your lactobacillus, your bifidobacteria, we can see your acidophilus. All these different things or akkermansia is another good one that really helps calm the immune system down, I had zero of them for the record. And so we can see that there and we can start adapting your diet, your supplements based on that, so I like that one. But I will say that there are so many new companies coming out right now and some of my patients are getting all these different companies and bringing them to me and it’s showing a whole lot of information. I’m learning them right now, I’m trying to figure out what this means. Is this science? Is it real? Can I really trust this? And you may be, I’m just learning there are so many new companies, so there might be better ones. You might know more about this than I do, but I’m following it because it’s very exciting.

Clint – Yes. So Genova is obviously sort of the Rolls-Royce, the big brand that takes care of all of these different sampling things across the United States. I’ve seen results from those, and I was looking at doing that when I was living in the United States as well. So that’s one that everyone could go to as a no-brainer. They might be sort of more boutique places or places that may be even cheaper as well. Ubiome, which used to be really popular, actually stopped operation about a year or two ago. It was like its rise to success was rapid, and then I was very surprised to find that it had stopped operation. So I don’t know of an alternative at the moment, but it sounds like there’s plenty out there. In terms of in Australia, there’s one called Nutri Path, and I got my sample done through them. Also one of our podcast guests in the past used them as well. Very good, really detailed analysis including I’m looking at the screen here of semi-formed brown and negative mucus on that stool sample. So you get all these extra little bonus grossness as well as all of the stuff that you actually wanted to see. So thank you, Dr. Miller. This has been really fun. Next time we have an itch to talk to each other about a certain topic, maybe we just go straight to the zoom and bring our members on and we do it like this.

Dr. Miller – Yeah, it was so fun. I really appreciate the conversation with you and with everybody here, so thank you for inviting me. This has been great.

Clint – Yes. Well, thank you so much. You offer so much to our community. The podcast I just recorded before this one was with one of your patients, one of my sort of success stories, if you’d like, in inverted commas. We share a lot of our community because you’re plant-based, you have your own autoimmune condition that you’ve mastered. You’ve helped so many people with their autoimmune conditions. You’re intimately familiar with our program, so people immediately can talk about details on that level. You’re over it. www.Plantbasedtelehealth.com. I highly recommend if you’re interested to talk to Dr. Miller head over to plantbasedtelehealth.com.

Clint – Thank you so much, Dr. Miller. I hope you have a wonderful rest of your day and thank you everyone else for joining us. People who are members of Rheumatoid Solutions, Rheumatoid Support. I love you guys. You help me to support my mission, and help me to be able to allocate all my time to help others via free podcasts like this or inside our coaching platform. Okay, bye for now, everyone. Thank you. Thanks, Dr. Miller.