Ask the Doctor (2017–…): Season 1, Episode 9 - Gut - full transcript

[Dr Shalin Naik] Whether
we've eaten something bad

or have a gut reaction
of a more emotional kind,

our belly is a pretty good barometer

of when something is not quite right.

So it should come as no surprise to learn
that our gut contains millions of neurons

and is sometimes called the second brain.

But what really goes on down there?

And how much attention
should we pay to it?

In this episode, we ask the question,

what can our gut really tell us?

As I'm put on two contrasting diets...



Mmm, bacony goodness!

...to find out which foods can actually
change and support our gut.

These foods produce metabolites
that are beneficial to our health.

Sandro looks at how
vital bodily functions are supported

by a vast network of gut bacteria.

In fact, there are more bacteria
in your body

than there are stars
in the Milky Way galaxy.

And Renee meets the doctors
at the forefront of gut health,

using faecal transplants to cure
a major intestinal disease.

- Success rate is 100%.
- Yeah? Wow.

No other medical stuff does that.

- Yeah!
- It's amazing.

[Dr Sandro] Right now, there's around
7.5 billion people on the earth.

It's an almost inconceivable number.



But our population is miniscule

compared to the number of bacteria
estimated to live on earth.

Check it out.

That's five million trillion trillion,

or a 5 with 30 zeros behind it.

And a whole bunch of them live
on and inside every single one of us.

In fact, there are more bacteria
in your body

than there are stars
in the Milky Way galaxy.

[babies crying]

We get our first big dose of bacteria
from our mothers, when we're born.

As we grow and are exposed to more
people, places and foods,

our microbiomes grow and evolve

and by the time we're adults,

our gut is home

to a population of approximately
40 trillion individual microbes,

made up of around
1,000 different varieties.

And if you're wondering what
all that bacteria looks like,

it'd look something like this.

But this brown, stinky goo isn't just
a stowaway in our digestive systems.

Good, healthy gut bacteria

contribute to metabolic health,
fortify our immune systems

and help us fight against viruses
and bad bacteria.

So for our complete well-being,

it really is in our best interest

to take good care of the microscopic
passengers living within our gut

and one of the best ways to do that

is through diet.

Most people who look at me
would say I'm pretty healthy

and I think -- or at least, I hope --
that they're right.

But our exterior appearance
can be deceiving

and to really understand how healthy I am,

we're going to need to take a closer look
deep inside this well-toned body,

at my gut.

I don't know what shape
my digestive system is in

but I do know my diet
could probably be better,

so I'm off to have my bacteria --
or gut microbiome -- tested

to see if it's in the normal range.

Claus?

The man with the dubious honour
of investigating my gut

is Claus Christophersen, a microbiologist
and nutrition lecturer

who also likes...

soccer!
[crowd cheering]

So, what is the gut microbiome?

The gut microbiome is a collection
of bacteria, viruses and fungi

that lives in our gut

but when you are on a poor diet,

the gut microbiome can produce
toxic compounds

that actually have a negative effect
on your health.

[Dr Shalin] Some foods, when processed
by our gut microbiome,

create by-products called metabolites,

which can either be good or bad for us,

with some even linked
to colorectal cancers.

But how do we make sure
our gut is producing the right kind?

I'm hoping Claus can help me find out.

What's this experiment
you've got planned for me?

So we've got, actually, a great experiment
planned for you.

We've got you on two different diets,

so we've got you on a junk-food diet...

- Junk food?
- Junk food, yes.

Pizzas, burgers, fish and chips.

Whatever you want.

Now, it's actually modelled off what the
average Australian

is eating at the moment.

- So...
- Is eating or should be eating?

Is eating.

So we're gonna see what effect
that is gonna have

on your gut microbiome
and on your health

and then see, when you go on your second
diet -- what you should be eating --

what effect that's then gonna have
on your health.

So, what are you gonna measure in me
over this time?

So I'm gonna want to have
your faecal samples.

You want my faecal samples?
No-one's ever said that to me!

[both laugh]

But as a twist to it,

I'll be going on the diet as well.

- So...
- You're gonna go on the diet as well?

- So we have another reference point.
- Solidarity, brother!

[Dr Shalin] So, in this experiment,

I'll be giving faecal samples
while on two different diets,

to see how the production of metabolites
in the gut

is affected by food.

And Claus and I will also provide
blood and urine samples for analysis.

There you go. And that's it.
Stand up tall.

But not before an encounter
with this peculiar contraption,

which measures my base-line level of fat.

Ooh.

- It's a spaceship.
- It is a spaceship.

Low body fat can be an indicator
of overall good health,

which in turn can be linked to how diverse
your gut microbiome is,

although it's not yet clear
which causes which.

Shalin, before I pop you in, I'm just
gonna get you to pop a swimming cap on,

so that the volume of your hair doesn't
influence our measurements.

Do you have to do that, Claus?

No, no. I'm... clear. I should be OK!

- Sorry. I had to have a dig!
- I'll just get you to pop that one on.

Alright.

- OK. So, in you hop.
- Just hop in?

Hop in, yep, and have a seat.

It's been good knowing you.

As wacky as it looks,
this is a serious scientific device.

- Alright.
- Sounds like Darth Vader.

[imitates laboured breathing]
- OK. Are we ready to go?

OK. It's starting now.

It's known as a Bod Pod

and it works by measuring the amount of
air that's been displaced by my body.

OK. That was successful. We're all done.

Hi. You can hop out now.
It's not too bad in there.

Claus has already had
his fat levels tested

and while I don't know what he scored,

I reckon he and I are probably
both about average.

[Claus] My body fat was quite low.

- What?
- 6.1.

- 6.1.%?
- See if you can beat that.

And now for the big reveal.

OK. So, Claus will be
in the ultra-lean category.

Ultra-lean.

Shalin, your body fat percentage
was 30.1%

- Thir... thirty?!
- Yep.

Your body mass was 77.695 kilos,

which places you just into the risky area.

[scare chord]

- Me?
- Yes.

[assistant] You really want to be,
sort of, in that 12.1 to 20% range.

- I mean, I consider myself pretty thin.
- Yep.

But actually, inside
there's a pretty high fat content.

[assistant] Yep.

It seems it's high time
I gave my diet an overhaul.

Yes, I'll just get you a clean-up here.

Only problem is, before I can do that,

I've got two weeks of junk food to eat.

Thankfully, blood tests will monitor my
well-being throughout this experiment

but I'm still feeling nervous.

So you and I are gonna be
on a junk-food diet,

which will probably be pleasurable
for the first couple of meals.

- Maybe.
- And then it's gonna get pretty hard.

Yeah, I think that we'll just feel that,
yeah, um,

the consequences of having, maybe,

too much fat in our diet
and stuff like that,

that will put a, sort of, damp on what...

- Dampener on our moods, yeah.
- Yeah.

Do you mind if we chat via Skype and keep
up to date with how we're going?

[Claus] Oh, I think we should, yeah.

I'll look forward to hearing how you're
going with all your collections.

[laughs]
- Of stool.

My collections. Yeah.

Speaking of which,

how much, uh, sampling will I have to do?

Firstly, we need some urine samples.

So, 24-hour. You need to
fill those jugs for me.

- All the way to the top?
- Well, if you can try.

- See who gets the most.
- Competition is on.

- The competition is on!
[both laugh]

So, we also have some faecal sample
collections for you.

[Dr Shalin] Alright. Well, thanks
for the presents, Elise!

- I guess we're on our way.
- Yeah.

- No worries. Enjoy.
- Lots to do.

- Start sampling!
- Yeah.

[Elise] Thanks, guys.

[Dr Renee] We all carry a mix of good
and bad micro-organisms in our gut.

It's when the problem kind
are allowed to thrive

that we get into trouble,

as this can cause anything from
irritable bowel syndrome

to life-threatening pathogenic infections.

So a relatively new procedure,

that replaces bad bacteria
with a much healthier variety,

is going a long way to help certain people
with a serious condition --

and it's also shown some surprising
and rather interesting results.

But where does all this healthy bacteria
come from?

Just work our way through the bowel,

to try and suction away any residue.

[Dr Renee] This is a faecal microbiota
transplant, or FMT.

And bizarrely, the special ingredient...

is poo.

[doctor] Right.
It's still not quite thawed.

In an FMT, healthy faecal microbiota
is taken from a donor

and passed through a tube into the bowel
of someone who's sick.

[doctor] And that'll be going
into the patient's bowel.

[hissing]

OK. All finished.

Professor Jane Andrews is a leading
gastroenterologist and expert in FMT.

She also loves...

cycling.

- Oh, hi, Jane! So nice to meet you.
- Hi, Renee. Nice to see you.

But it's the donation of gut bacteria

from person to person

that the professor
is most passionate about.

Normally, the donor -- the healthy person
who's providing the stool --

will actually just bring
some stool to the lab

or pass it, you know,
in a toilet near the lab.

If you have particular donors,

you can actually provide them with,
sort of, little...

They're like camping potties

and they collect the stool
without any air exposure,

- so they're called anaerobic.
- Yeah, right.

'Cause a lot of the bugs in your gut
don't like oxygen

and if you expose them to oxygen,
they die.

When safely transferred from gut to gut,

healthy microbiota can continue to thrive,

redressing the balance of problem bacteria

and resolving a patient's symptoms
entirely.

But as a treatment,
it's still in its infancy.

So, Jane, there's really only one kind of
well-defined use for FMT -- is that right?

Yeah, that's right at the current time.

So, Clostridium difficile, which is a bug,

can cause a nasty sort of colitis,
which means inflammation of the colon,

particularly in older people
who've had a lot of antibiotics

and have got a lot of other illnesses.

So we've been running an FMT service here
for about three years

and the success rate after one FMT
is around 90%

and if you need a second donation given,

the success rate is 100%.

- Yeah? Wow.
- No other medical stuff does that.

- Yeah.
- It's amazing.

Results like this are rare,

so it's one to watch.

Although... perhaps not when
you're eating your dinner.

The concept of FMT, or the poo transplant,

may seem kind of weird
and make us a little squeamish

but research is starting to show

that this procedure might actually
change some patients' lives.

Just ask Suzy Klepper.

When sudden digestive issues
put her in hospital,

the symptoms were so bad,

doctors were considering an ileostomy

and then a total colectomy,

where her entire large bowel
would be removed

and replaced with a bag.

So, Suzy, you were diagnosed with
a Clostridium difficile infection.

That must have been really scary for you.

I mean, to have that happen -- that sounds
like it happens in a week.

- So you basically...
- It's less than a week, yes.

I went from healthy, walking around --

I'd been at work on the Friday morning,
fell ill in the afternoon.

And we haven't had a week yet
and I'm thinking about...

finding shoes to match my ileostomy bag.

- So...
- Sorry.

It was a really surreal illness.

I had uncontrollable diarrhoea,

15, 16 times a day --

and that was one of the features
of this particular illness,

that it was associated with this terrible,
overwhelming urgency

and loss of control,

which made it a very undignified illness.

A keen swimmer and rower,

Suzy's illness impacted heavily
on her lifestyle.

So when an infectious diseases consultant
suggested a faecal microbiota transplant,

she jumped at the chance.

Oh, honestly, it was remarkable.

Within 24 hours,

uh, the diarrhoea had halved.

Wow.

The inflammatory markers had almost halved

and after 48 hours,

I had no diarrhoea at all.

[Dr Renee] Wow.

In addition to avoiding major surgery,

Suzy also thinks the FMT
helped treat her arthritis.

[Suzy] It seems as though the transplant

has tweaked my immune system
so that it stopped.

I'm functioning really well
without any sort of medication.

It's outcomes like this that inspire
real hope for FMT

as a treatment for more than just
Clostridium difficile.

While testing still needs to be done,

some research shows

that it could be used in the future
to fight further health problems.

Is it recording?

Is it facing me?

Is my hair alright?

Five days into my junk-food diet.

It's not great.

[Dr Shalin] I'm testing the impacts
of a standard Aussie diet

on my gut health.

Mmm, bacony goodness!

[Dimmi] You smashed that.

I've got licence to eat.

And I'm just over halfway into my two
weeks of high-fat, salt and sugary treats.

Although the novelty
has definitely worn off.

Five days to go.
My belly is not agreeing with me.

It feels sore.

It feels like it's struggling

with the amount and type of food
I'm putting in there.

And it's not just my insides
that are suffering.

The diet's playing havoc
with my social life too.

What did you make, Mum?

This is cauliflower and potato
vegetable curry.

[Shalin groans]

And I feel so bad
that you can't eat any of that.

That makes two of us.

The one weekend you're here...

I know! If I had known you couldn't eat...

- You wouldn't have come!
- I wouldn't have come.

What are you having, Shalin?

Tonight is fish and chips on my menu.

My mum's binda nushak, or okra bean curry,

is my favourite

and I'm annoyed I'm missing out.

It is really sad story.

[Dr Shalin] Heart-breaking.
[Dimmi] We'll freeze you some.

But a lot of things have been
getting me down this week,

as my poor wife, Dimmi, can attest.

Shalin has been grumpier than usual.

He's not generally grumpy but I'm looking
forward to the end of the junk-food diet,

because I'm curious to see if maybe
he's playing up a little bit

while he's on this diet

and perhaps getting out of doing a few
things that I might otherwise make him do.

So, clearly it looks like
I've got it easy --

despite the ritual indignity of harvesting
and posting away my poo.

There's only one other person who
understands what I'm going through.

It's been 10 days since
we started the junk-food diet

and I'm just gonna get in touch with Claus
to see how he's faring

and maybe share some notes.

- Hey.
- How are you?

How's Doctor Six-Percent-Body-Fat?

[both laugh]

Doctor Ultra-Lean

and Doctor Bordering-Overweight here!

I've been struggling a bit with
all the soft drink and juices and...

Yes! Me too!

But I'm enjoying the beer
that we get to have.

[both laugh]

But the diet that we're both on

is really modelled around what the average
Australian is eating.

Right. So it's not the extreme end
of the junk-food diet.

- It's...
- No.

...let's say a bad diet, a bad
Australian average everyday diet.

Yeah.

Have you had any issues with grumpiness
or shortness?

- No. My family hasn't complained, so...
- They haven't?

No, they haven't complained.
What about you?

I can't say it's the same for me.
I've had some complaints on this side.

[laughs]

[Dr Shalin] My mood swings are likely a
result of all the sugar I've been eating.

But there's also emerging research

to suggest a lack of legumes, such as the
pods, peas and beans in my mum's curry,

could contribute to poor mental health
longer term.

What's happening in our guts at
the moment, Claus, with this diet?

We're seeing probably a change

in the metabolites that the bacteria
are producing.

Right.

So, the good bacteria, so to speak, are
not being allowed to thrive in our guts.

Yeah. They will still be there but the
others are competing better on this diet.

- So...
- Right.

And that's what our gut is going through
all the time,

is this competition for space
and nutrients.

[Dr Shalin] I'm intrigued.

This is something that affects all of us,
all of the time.

Alright, Claus. Let's catch up again
once we're on the good-food diet.

- Sounds good.
- See you later, Claus.

- Thanks for chatting.
- See you. Bye.

So, how good is your gut health?

Do you think diet plays a role?

We took to social media to find out.

The evidence, A, here.

So now I've moved on to the gut-friendly
phase of the experiment.

There's one thing for certain --

I'm pretty happy I'm going to be
back on my healthy-food diet.

Um, I'm going to Sandro's
for dinner tonight -- Dr Sandro --

and I hear he's a great cook,

so I'm really looking forward
to what he's prepared for me.

Hello, Dr Sandro!

What is it you're making, seriously?

[Dr Sandro] So, these are
oven-baked eggplants.

We've got some stuffed capsicum.

It's all vegetarian -- rice, some cheese,
pine nuts, dried fruit.

[Dr Shalin] Mmm!

We've got a beautiful Italian
tomato salad.

Home-grown tomatoes, home-grown basil...

[Dr Shalin] Dr Sandro,
is there anything you can't do?

- Lots of things.
- Oh, my lord.

Cooking is not one of them, though.
Can definitely do that.

[Dr Shalin] Oh! I am in heaven.
Thank you so much.

Along with Sandro's delicious
vegie treats,

there is some meat on this healthy diet.

But also stacks of potato,
rice and pasta.

And I'm intrigued to know --
why so many carbs?

Professor Amanda Devine
is the nutritionist

who designed the diets in this experiment.

She also likes...

[bicycle bell rings]
...cycling.

What is it about these experts
and their bikes?

And what is it about all these foods
that makes them so good for my gut?

[Professor Devine] These foods are
foods that are high in resistant starch.

[Dr Shalin] What's a resistant starch?

Resistant starch is part of fibre
that we find in plant foods,

like grains, in our legumes --
peas and pulses --

and also in our vegetables
and fruit, things like banana.

Right.

So, it's a molecule that is very difficult
for our bodies to break down

and so really, our micro-organisms, in
our bowel or in our colon, do that for us

and they produce metabolites
that are beneficial to our health.

Unlike many processed foods,

resistant starch doesn't get absorbed
in the stomach or small intestine,

allowing it to make the journey
to the colon,

where it is transformed into a metabolite
called butyrate,

which is beneficial to the gut.

Resistant starch is found
in a number of different foods,

including grains, seeds and legumes --

but perhaps a more popular source
is rice, pasta and potato,

which, when cooked and cooled,

change at a molecular level from normal
starch to the kind our gut craves,

the resistant starch.

Australians tend to have a lot of protein
in their diet

and a lot of it can be animal protein,
meat proteins and highly processed meats.

Right.

And there has been evidence more recently

that these have an increased risk
of colon cancer,

so having a cold potato salad or a rice
salad or a pasta salad,

which is high in resistant starch,

with a piece of steak or a piece
of cooked meat,

can actually help counter that negative
effect of the animal product.

I see. Thanks very much, Amanda.
This is absolutely fascinating.

I'm really keen to see how this diet
does affect my microbiome.

There are many classic meals that combine
meat with resistant starch

and high-fibre pasta
is a particularly good source.

But an even better option is to go vegie,

with something like lentil burgers,

which are both protein-rich
and full of resistant starch.

One cup of lentil.

One cup of lentil. So, I have pre-measured
this, so I'm just gonna pop that in.

- That's one cup?
- Yeah, I already measured it.

OK.

- One cup of potato.
- Mashed potato.

Now, as a scientist, like me,

my wife, Dimmi, does like to get
her measurements just right.

It's gone, honey. It's not...

I'm gonna prove to you this is one cup!

Oh, this is why I stay out of the kitchen.

As complex as we're making this look,

a regular serve of lentil burgers

is a really simple way
to make our diets more gut-friendly.

[Dimmi] Mmm.

It's really tasty.

The curry powder, I think,
makes a difference.

[mouth full] Mmm. It's really good.

After two weeks of this food,
my gut feels much better.

Yum. That was really good.

But is it producing the right metabolites
to keep me in good overall health?

There's only one way to find out.

Now I just need to send some samples
back to Perth for analysis

and compare them to the previous ones.

Got my esky, got my dry ice --

Give me a couple of minutes.

[toilet flushes]

Well, there it is.

The dry ice keeps it nice and cool
for its trip across the Nullarbor.

I wonder if it gets Frequent Flyer miles?

Talk about a crappy flight!

With a few weeks to wait for my results,

I'm intrigued to know your secrets
to a happy, healthy gut.

So, my gut experiment
has finally come to an end.

Now I'm back in Perth to get the results,

to find out what's really
going on down there

when we alter our diet.

Alright.

- Oh, so, how are you feeling?
- Good.

I mean, it's been a while now
but that was... that was intense.

- Let's see the results!
- Let's have a look at the results.

- So...
- I'm keen.

OK. Let's look at some of the metabolites
that the microbiome produces.

Alright.

So, what I've displayed here is butyrate.

Butyrate is important because
it's the preferred energy source

for the cells that line your gut,

so it helps them repair, it helps them
get rid of cells that might be damaged.

So, we feed the bacteria
resistant starches...

- Yep.
- ...they produce butyrate

and the butyrate is good for us.

- Yep.
- OK.

It's this relationship that's
really, really important.

So, when you go from your base line
to your junk diet,

where you're taking out all your fibres
and having a lot of sugar,

really, you drop your butyrate by 15%.

- So...
- That's quite... Is that big?

- That's quite a lot.
- That is quite a lot?

That is quite a lot.

When you went from your junk diet
to your healthy diet, you see...

- It bounced back again.
- Yeah.

So you really see that 15% increase,

because we put more fibres in our diet,
the resistant starch.

- Yeah.
- From our legumes, beans and so on.

Yeah. I mean, the change
is quite extraordinary.

In this very short period of time,
it's dropped

and then you switch it back
and it goes back up.

Yeah. And so did I.
I responded exactly the same way.

[Dr Shalin] Yeah. I mean,
our graphs are almost identical.

[Claus] Yeah, yeah.

I mean, this is telling me that
the effect is almost immediate,

so we should all start pretty much
straight away on these...

on this high-resistant-starch diet

to get the beneficial effects of the
butyrate and the other things.

Yeah. Small changes to your diet can
really make a huge impact on your gut.

Yeah.

When I started this experiment,

my diet probably wasn't the best
for my gut

but with just a few small changes,

such as eating more full-grain bread

and adding a few more beans and legumes,

I'm hoping to keep it in the healthy zone.

This experience has really
demonstrated to me

the importance of good diet,

not only for my mood and energy levels

but also how it affects my gut bacteria
and longer-term health.

The fantastic thing is we can start today

and see the benefits almost immediately.

What I've learned is we really should
listen to our second brain,

the gut.

It turns out it plays a pivotal role
in our well-being.

Good, healthy gut bacteria
contribute to metabolic health,

fortify our immune systems

and help us fight against viruses
and bad bacteria.

[Dr Shalin] And healthy gut bacteria,
when transplanted,

are achieving outstanding results
in the treatment of Clostridium difficile.

So you're saying that a poo transplant
gave you your life back.

Absolutely. Yes, it did.

- And I've never been so grateful for poo.
[laughs]

Who would have thought
that our body's waste --

something we'd ordinarily
turn our noses up at --

could have the power to heal
and change lives?

It's poo-tiful.