Gut And Microbiome With Dr. Alan Desmond
Gastroenterologist Dr. Alan Desmond and Clint Paddison discuss in this podcast:
- Western culture’s approach to food
- The importance of a healthy gut
- How microbiome plays a key role in the digestive process
- Foods and inflammatory states
- The TMAO experiment
- Assessing the bowel
- The connection between gut health and RA
- Crohn’s disease
- Aspirin and inflammation
- prednisone and it’s risk of usage from a Gastroenterologist’s perspective
Clint – Today’s guest I’ve been wanting to get on the show for a long time, we met in Melbourne, Australia back in February 2019, and he gave a presentation at the Doctors for Nutrition Conference, which was a sold out, wonderful event put on by some friends here in Australia. And he came all the way from the UK and gave a fantastic talk about the gut. He is a gastroenterologist and an expert in nutrition in the aim of having the most optimal gut health and therefore having the most optimal health overall. It’s Dr Alan Desmond and he’s joined us at six thirty in the morning. So I’m very grateful to have you on the show, Alan, thanks for joining us.
Dr. Alan Desmond – And delighted to be here, lovely to connect with you again. That was such an amazing conference in Melbourne. I’m really fond memories of that week in Melbourne. And regarding six thirty like yourself, I’ve got young kids, so I was up anyway. Clint, Let’s be honest.
Clint – I’m glad that you’re able to spend some time with us. I really want to learn all about the gut today. You know, my audience is very familiar with the relationship between inflammation and what they eat. And they have been well educated by many other guests in the past about how we need to eat well and how a plant based diet can be really, really helpful for reducing inflammation in the joints. And my program that I created some years ago, which has been very popular, is about using an elimination diet followed by a reintroduction process. And it’s all plants. So I want to know about what the gut actually looks like by someone who looks at the gut all the time. And I just want a 101 from when we digest our food in our stomach through until it comes out the other end. I mean, tell us what’s going on in there.
Dr. Alan Desmond – Yeah, it’s worth talking about, isn’t it. I always say to people that we’re obsessed with food Clint, absolutely obsessed with food. You pick up the weekend newspapers and it’s going to be weekend recipes and restaurant reviews and, you know, all this amazing stuff about food. But once we put can swallow it, we’re like a little bit embarrassed to get really embarrassed to even discuss what happens. But we all digest food, we all poop, we all use the bathroom. But if people were more willing to discuss that on a daily basis, my job would be a lot easier as a gastroenterologist. I get it, but I just don’t know why people get so embarrassed talking about their digestion. Can you imagine if it was cool to sit down at dinner with your family, at a family, get together and to come into the room and sit down and say, you know, guys, I haven’t had a poo for seven days, is that normal? Is that something I should be worried about? And then your aunty might say, yeah, that happens to me sometimes. You know, I eat more vegetables and, you know, I saw some blood on my poo. So I saw the doctor said it was a hemorrhoids, you know, so why don’t we talk about this stuff? Why are we so embarrassed about it?
Clint – Kids would love it. Right. That’s all kids want to talk about it.
Dr. Alan Desmond – The kids would have loved it.
Clint – Yeah. So it’s obviously a natural thing that we should be talking about that we use social etiquette to stop talking about as we get older.
Dr. Alan Desmond – And it’s so important to understand as well. I mean, over two and a half thousand years ago, to misquote Hippocrates is all health begins and the gut. And so that was a concept that’s as old as the concept of modern medicine. And when I first heard that in medical school, I thought, OK, yeah, that sounds like something you might say two and a half thousand years ago. But now, you know, we know there’s a lot of truth to that and there’s a lot of wisdom in that ancient saying. In many ways, all health does begin in the gut and in a way that comes back to the incredibly important role of the human gut microbiome, we’ll talk about that later. So we take our food, we chew the digestion process starts immediately, there’s enzymes in our saliva, Amylase is start breaking down the protein. We then turn that little food into like a little blog that we call a bolus. We swallow that goes through a throat, it drops through a tube called the esophagus, or Gullet, which is about 30 to 40 centimetres long. That brings the food down into the stomach proper, which is like a kind of a flask shaped sack, which acts like a little cement mixer, it keeps moving the food around. We’ve got powerful acid in there, hydrochloric acid, which helps to break the food down further. And the food will basically stay in your stomach until it’s a liquid consistency and we call it Chyme.
Dr. Alan Desmond – So that Chyme then passes through a little hole called the pylorus and it heads into the small intestine. Now, the small intestine is called small because it’s quite. Narrow, it’s only a couple of centimetres wide, but it’s really large, so it’s a very long and I think that’s often what people describe as their guts. You know, when you see like, I don’t like a horror show or something or someone’s guts are coming out. That’s the small intestine, right? So the small intestine is really important because so much absorption of nutrients occurs in the small intestine. And that’s where most of the absorption goes on in terms of absorbing your carbohydrates or fats, proteins or nutrients, et cetera. So the small intestine then delivers the residue to whatever’s left over to your large intestine. And what arrives in the large intestine is a lot of broken down food particles, stuff that hasn’t been absorbed, but also a tremendous amount of liquid, because in digesting your food, your intestine produces a lot of liquid, we call it Succus entericus, which is a great word, which means I think it’s an old word that means the juice of the intestines, Succus entericus, and that helps to digest everything.
Dr. Alan Desmond – So when the food or Chyme arrives in your large bowel, your colon, which is wider, shorter and leads to your bottom when the food arrives, it’s actually quite liquid. It’s already taken on that characteristic brown color because it’s digested bile that’s mixed in with it. And the large bowel, we used to think that the only thing your large did was absorb water because the stuff that arrives in the large bowel is very watery. And as it passes through the large bowel, which is about a metre long and makes its way to the bottom and it turns into what we would recognise as a poo. So it becomes drier and becomes more formed. So we thought that’s all it that just for. And if you have if you’re not able to absorb fluid in your body, don’t get the hydrated. But in fact, we now know that the large bowel is the home of the human gut microbiome. And it brings us right back to this ancient idea that oral health begins in the gut, because we know that each one of us is carrying trillions of bacteria, viruses and yeasts predominantly within our large bowel. You know, humans couldn’t I mean, the modern human is about two hundred thousand years old, but the bugs that make up our human microbiome are like the close relatives of the Earth’s very first living organisms. These little unicellular organisms are clumps of unicellular organisms, and they’ve been described as a control centre for human biology. And what we recognize now is that the guts in are the bugs and the microbiome are major determinants of human health. Our health depends on their health, their health depends on our health. And we can really influence what goes on in our gut microbiome and how it interacts with our body by feeding off different foods.
Clint – Hmm. Fascinating, fantastic introduction. Thank you. So tell us a little bit about how these bugs might influence our immune system and how, if we can get them in a good set of diversity and quantity, we might have a more stable immune system.
Dr. Alan Desmond – Yeah. So the foods we eat are really, really important in terms of inflammatory processes. So you know that an inflammatory response is a healthy thing. So if our body becomes damaged or injured, if we even if there’s early cancer cells in our body, our body responds to that by mounting an acute inflammatory response. So if you hit your finger with a hammer, there’s damage. Your thumb is going to get big and swollen and red because it’s increased blood flow and lymphocytes and repair cells. It’s really, really important for you to inflammation is healthy. However, if that inflammation becomes a long term chronic inflammation, then that becomes an unhealthy state, and chronic inflammation is a unifying problem. We know in arthritis, Crohn’s disease, ulcerative colitis, but also we’ve seen papers showing how chronic inflammation is a common characteristic in heart disease. Even things like depression have been linked to a chronic inflammatory state. The foods we eat have a huge influence on how much inflammation resides within our body. We saw a paper coming out of think last year from a team in New Zealand, which I think included our mutual friend, Joe Cradock, who’s a registered dietitian, where they compared systemic inflammatory markers between omnivores and depleted Long-Term plant based diet. And what they saw was that people who the long term plant based diet have lower systemic markers of information. So why is that? Well, if you are eating a diet that is rich in antioxidants and Phyto nutrients and carotenoids and polyphenols and fiber and healthy unsaturated fats, then you are reducing your inflammatory burden of the food you eat.
Dr. Alan Desmond – On the flip side, if you’re eating an omnivorous or very meat heavy diets, then your diet is not only are you missing out on fiber and vital nutrients and all the beneficial aspects of the vitamin deficiency in the vitamin E that you get in the magnesium and all the rest of us, the K2 and everything that you’d get by eating more plants, you’re taking those plants and what you have instead, well, you’re consuming he biron, which is inflammatory. You’re consuming animal protein, which is pro inflammatory. And one of the key mechanisms whereby an animal based diet promotes inflammation is through its influence on the human gut microbiome. So I’ll give you two examples. Number one about in 2014, a group of researchers in Harvard University, California, looked at the impact of profound dietary change on the human microbiome. They took a group, I think, healthy university students. And for four days, everybody takes a very meat heavy, low fiber, high fat diet, eggs and bacon and cheese, et cetera. And then they took a break, and then for four days, they eat a healthy, wholefood plant based diet, completely plant based, lots of lentils and beans and grains, etc. During the four days that these individuals were eating the meat, heavy, high fat, high on the diet, the researchers saw, remarkable changes in the gut microbiome. What they saw was very quickly within days, they saw an outgrowth of bacteria that are known to promote inflammation in the gut. And in fact, although these researchers weren’t inflammatory bowel disease researchers, which is one of the areas I’m really interested in, they did find and they commented that within days they had seen an increase in bacteria that are known to be have the ability to trigger inflammatory bowel disease. And that makes sense to me as a gastroenterologist. I know that animal protein consumption of high fat diets are very strongly associated with inflammatory bowel disease like ulcerative colitis and Crohn’s disease. And when they put those individuals on a plant based diet, they saw the exact opposite, where they saw healthy bacteria growing the sort of healthy bacteria that use fiber to produce short chain fatty acids. Which are incredibly beneficial substance that not only reduce systemic inflammation, but also help to control our appetite to control blood sugars. Help to keep the lining of our gut healthy, helps keep the (inaudible) and our large well functioning well. So it’s there’s such a different effect of these two dietary approaches on the human gut microbiome.
Dr. Alan Desmond – And then the second example, which I’m sure you and your listeners are aware of is the TAMO story. So I think also in 2014, a group of researchers in the US announced that they found this new blood test that could predict people’s risk of having a heart attack. And in fact, the first study had been they’d taken individuals coming to the emergency department and they’d done a bunch of new potential biomarker blood tests on them in addition to the standard tests that we do. And then they’d analyze the data a few months later and found that if your blood level of the certain chemical was high, then you were far more likely to go on and have a serious cardiac event. And further research showed that this same blood marker could be used in the community, that if you just went up to healthy volunteers and measured their level in the blood of this particular chemical, you could predict their risk of having heart disease in the future. And what was this chemical? It was TAMO, trimethyl Amien Oxide. So what is Tmall? Well, when you eat meat and eggs, your gut bacteria receive the animal Protein and particularly substance called carnitine and coli, which are found in animal products. And they metabolize them and break them down and your gut microbes turn them into a chemical called TMA trimethylamien, which is then absorbed by about transported to your liver and converted into TAMO. And multiple research studies have shown that not only is TAMO a pro inflammatory raising your inflammatory markers, it’s also pro atherogenic, promoting atherosclerosis and contributing to the formation of cardiovascular disease, renal disease, stroke, etc.. And for me, that’s incredible because this is stuff that is made by our gut microbes when we eat meat and eggs. And it may well be clear that the human body is designed to eat very little or none of those products because although COLENE, which is the substance from the eggs that causes the problem, although that is an essential nutrient, humans need it to be healthy. You can get all the COLENE you need by eating a healthy, wholefood, plant based diet. It seems that if you’re eating a healthy wholfood plant based diet, you’re probably going to get two or three hundred milligrams a day of colene. You’ll absorb it in your bowel. It never gets down to your gut microbiome. Your TMAO levels don’t go up, so you get the coding you need, but you don’t get the adverse effects of excess COLENE.
Dr. Alan Desmond – And we know further studies have shown that if you take someone who’s eating a healthy, wholefood plant based diet or a completely plant based diet for about 12 months and you give them some meat to eat, there was one study where they paid a vegan to eat a steak that really happened. And then they measured his TMA levels after he’d eaten the steak and they didn’t even they didn’t go up. And the reason they didn’t go up was because your gut microbiome is dynamic. You can change us, And by not eating animal products for a year, the bacteria in its gut microbiome that are required to turn the meat into harmful TMH had just died off. So they’d become so infrequent to those human microbiome that he didn’t even have the ability to produce this harmful chemical anymore. Although other studies have shown that if he had continued eating steak every day, he would promote those harmful bacteria and they would eventually reach the point where once again is TMAO levels would go up and his cardiovascular risk would drop.
Clint – Fascinating stuff the first time I read information about this from another gastroenterologist was from Dr. Harami Zinnia, who is a guy who now in his 70s who works at, I believe, the Einstein clinic in New York, and he invented a non-invasive way to remove polyps. So I don’t know if you’re familiar with him and for his historical contributions or not, but he advocates a plant based diet and his combination of some certain foods, which is buckwheat, quinoa, millet, amaranth, and these alkalising pseudo grains. It was he that planted in my mind to go down that path after being on a raw food diet for a long time.
Dr. Alan Desmond – Really, the gastroenterologists that (inaudible).
Clint – Exactly. He it was him. Him and Dr. McDougall were the two most influential men, like unaware mentors in my journey. Now, I was fascinated reading his book called The Enzyme Factor, and later The Microbe Factor. He talked intimately about the insides of the gut and why he recommended these foods and said these are the foods that are the least inflammatory. When I say these foods, I mean plant based foods. And it was just so convincing. And now I’ve got you here in front of me. I’d like you to talk about what it actually looks like on the inside. And is the investigative tool, is it a colonoscopy or are there other methods to determine what’s going on, on the inside? And what does the experience look like from behind the screen? Not as the patient. And what do you see when there’s inflammation and walk us through a bad bowel versus a good bowel and even colitis and if possible, someone with rheumatoid arthritis? And what do they look like?
Dr. Alan Desmond – Yeah. So I guess how do we assess the bowel? We’ve got a number of things that we do in clinical practice. I mean, one, if we really want to look at how much inflammation someone has in the gut, the first thing we’ll often do is a non-invasive test. We’ll get the patient to provide the poo sample. And there’s various chemicals we can measure in the stool. The one that we use most is thing called fecal calpotectin, which is a chemical that appears in your stool if your bowel lining is inflamed. But what’s interesting is that even in the absence of a condition like Crohn’s or colitis or rheumatoid arthritis, if we do a whole bunch of stool samples from a general population in a high income country where people reading a standard Western diet, we do find a baseline level of gut inflammation, which is regarded as normal. So if you have no gut inflammation, that’s number comes back as zero. If you’ve got like Crohn’s or colitis or a really significant inflammatory disease, that number might be in the thousands. But there’s a lot of argument in the world of gastroenterology about what’s a normal level of gut inflammation. So some gastroenterologist that anything less than 150 is normal. So it’s interesting, isn’t it? There’s been studies looking at placing individuals with metabolic syndrome, type two diabetes, obesity, and heart disease on a plant based diet, as well as seeing beneficial changes in the gut microbiome you all and beneficial changes in blood sugar control. You’ll also see that baseline levels got inflammation reducing. So isn’t that interesting? So that the baseline gut inflammation may not be baseline at all, it may just be a symptom of this standard Western diet. So that’s where we’ll often start if we suspect a condition like colitis or Crohn’s disease.
Dr. Alan Desmond – And if someone has an elevated level with symptoms or if they’ve just had some symptoms that make us need to have a look anyway, like the passage of blood or mucus or whatever. What to assess? The bowel will often do a colonoscopy. So colonoscopy camera test, where we ask our patient to take a whole bunch of laxatives and clean out the inside of their bowel and then they lay on their side. We have some nurses and assistants helping and then a doctor or endoscopist will simply put a tube into your bottom end. So we call that a colonoscope, it’s a flexible tube and it’s got a built-In high definition camera. So just like TV sets, the cameras and the displays have gotten amazing in the last five or six years. So we get a big screen, high definition picture of what your colon and or your stomach are if we’re going in the top end looked like in real time. And that’s one of the things that really drew me into gastroenterology as a specialty, because if we suspect you’ve got Crohn’s or colitis or an ulcer or celiac disease or any of these common conditions, diverticular disease, et cetera. We don’t have to depend on a blood test or a scan to tell us, although we do use those a lot in our radiology colleagues are amazing. We can go in, we can go in and have a look at the living organism and see what it’s doing in real time. And what do we see? Well, if there’s so if you think about the healthy gut lining, it looks a lot like the lining inside your cheek. So it’s pink, it’s shiny, it’s got a protective layer of mucus on it. It’s healthy, right? It’s it’s functioning. It’s doing what it needs to do, it’s producing the chemicals it needs to produce, it’s absorbing the nutrients that it needs to absorb.
Dr. Alan Desmond – But when we see areas that are diseased, things that we notice are that nice, shiny glossiness is reduced or absent, that’s particularly relevant to things like Crohn’s disease, where the gut epithelial barrier and the protective mucus layer has been damaged and removed. And instead of the nice pink lining, we might see an area that looks like a red sore and in fact, it may even been ulcerated. So the nice pink shiny layer is gone. And what we see is an underlying kind of whitish area. It’s, you know, unpleasant to look at. And when I do presentations actually about Crohn’s disease in particular, I will show photographs just one or two, because sometimes you’re speaking just before lunch, just one or two of what an unhealthy bowel looks like. And although there’s a lot of subtlety and a lot of experience involved in interpreting the disease that you’re looking at, and with years of practice, you can look at a diseased bowel and say, oh, yes, I know what this is, just by looking at it, I hope I can narrow this down to two or three conditions. But when you show just a lay audience pictures of a healthy bowel and an unhealthy bowel, there’s people know which one is the unhealthy one. There’s something it just looks so abnormal and unnatural that I think people intuitively go at the that one is the diseased bowel.
Clint – Yeah, OK. And of all. Well, I really want you to talk about any observations, personal observations you’ve made with rheumatoid or psoriatic arthritis especially. And if you’ve been able to see a correlation between someone who presents with a lot of joint pain, debilitation, inflammation, potentially first measured by that stool test that you do. And then seeing a level of dysbiosis or imperfections on the colon lining, just as you’ve described. So have you personally seen that connection? And what you’ve learnt in that area about, you know, that interesting relationship?
Dr. Alan Desmond – Yeah, so that that connection? Well, we know that look, the first thing to say is that we view these as different systems. They’re not different systems medically, we have turned them into different systems. We don’t get the digestive system of the respiratory system and the rheumatology system. But that’s a completely artificial construct. It’s just one human body, just one system. So, of course, there’s going to be connections. I mean, that shouldn’t surprise anyone if I say to someone yet your got is connected to arthritis are really of course, it’s the same system. I mean, the whole concept that these are different departments, that a building is just a completely artificial construct, that that modern medicine requires. We know. So, for example, in Crohn’s disease and ulcerative colitis, patients with those conditions are prone to developing arthritis. They aren’t maybe more at risk of rheumatoid arthritis, but they are also at risk of developing very specific arthritis that are specific to patients with got health problems. And those are (inaudible) arthritis. And we will refer patients like that to see our rheumatological colleagues and often many of the medications that we use to reduce the inflammation that we see in the joints of people with Crohn’s disease and some colitis are the same medications that we use to control the inflammation of the gut and of course, the same mechanisms.
Dr. Alan Desmond – And it’s the same mechanism. So the same dietary change is also helpful so that, again, that shouldn’t surprise anyone. One of the key things we talked about the microbiome earlier. We talked a little bit about Crohn’s disease, which when I was in medical school, I was taught was an autoimmune condition where your immune system was genetically wrong had gotten unlucky in the genetic lottery, so your immune system is attacking your gut, there’s nothing we can do about it, but we can give you a medication to reduce the inflammation. We now know, of course, that the environmental factors, including diet, incredibly important in promoting that inflammation. And we also know that the immune system isn’t attacking your gut. It’s attacking your gut microbiome, and the damage to the gut is incidental. It’s collateral, it’s significant. But it’s but it’s collateral damage. So it’s not surprising that if you have a condition like Crohn’s disease or ulcerative colitis, where your gut epithelial barrier has been damaged, to the extent that your immune system is now being exposed to the gut microbiome in a way that it was never designed to be exposed. So your gut microbiome is being educated on attacking the viruses and bacteria and archaea and luminal contents of the food that you consume. So therefore you now have antibodies against all of these things. So it shouldn’t surprise us that those individuals can then start to get abnormal, chronic rather than acute immune reactions against different parts of their body, including their joints.
Dr. Alan Desmond – So I think that answers part of your question. I think the next part of your question is, do I observe a dysbiosis in patients with rheumatoid arthritis? So although I’m absolutely obsessed with the gut microbiome, doing routine microbiome analysis hasn’t yet entered the level where we can use it usefully within our clinical practice. So that’s not something I check routinely in my patients at clinic. However, I’m aware of the literature showing that individuals with rheumatoid arthritis have a particular form of dysbiosis or unhealthy gut microbiome. As do people with so many of these conditions of Western civilization, as Dennis Barkett called them in the 1970s. So things like obesity, Type two diabetes and heart disease and also colitis and from disease and rheumatoid arthritis, all of these conditions are associated with some form of unhealthy mix of gut microbes. And it’s difficult to look at cause and effect. But as I said earlier, your gut microbiome, whether healthier, unhealthy, isn’t fixed. It’s not set in stone. You can change your gut microbiome from a healthy to an unhealthy just by changing your food and by getting more sleep and by exercising and by not taking unnecessary medications and avoiding unnecessary antibiotics, you can improve or get a healthier balance within your gut microbiome.
Dr. Alan Desmond – When we do things like gastroscopy and colonoscopy in patients with rheumatoid arthritis and other arthritis, we sometimes find out that they actually have Crohn’s disease or ulcerative colitis in a very mild form. And so they didn’t suspect it, but they may have had some symptoms, maybe a little blood in the stool or whatever. And then when we do the camera test, we go home. Actually, you’ve got very mild Crohn’s disease or you’ve got very mild ulcerative colitis. So we see those ulcers and things that I mentioned earlier. So so that’s the first thing. And that speaks to the overlap between these conditions. And of course, the other thing that we often see is because individuals with inflammation are often on nonsteroidal and inflammatory drugs like ibuprofen, aspirin, et cetera, et cetera. Sadly, those medications can have a lot of adverse effects on your gut health. Damaging, causing ulcers, removing the protective mucus there that keeps everything healthy. So probably the most common thing that we will find when we do endoscopies on individuals with long term rheumatology problems will be the side effects of the medications they’re having to take.
Clint – Oh, my gosh, there’s a quotable right there, because I’ve been saying that for a long time, not because I you know, it’s just my opinion, but from all the studies. Right. So the studies are there must be a dozen different studies showing the relationship between nonsteroidal anti-inflammatory use and rheumatoid arthritis and inflammation of the gut and so forth. So I mean, it’s very clear, but I didn’t know that it was quite literally visible by looking at the surface internally and seeing that damage.
Dr. Alan Desmond – Very much so. And earlier on, we spoke about how one of our first tests that we’ll do in an individual with symptoms of gut problems is a stool test to check for inflammation. But when we ask people to do want to provide you to that stool sample, we tell them we always every single time we say, look, do you take any anti-inflammatory drugs like ibuprofen or? And if you do, will you stop taking them for six weeks before you do the stool test? Because if you’re on those medications, we will find gut inflammation when we check. So those medications counterintuitively, although they are designed to reduce systemic inflammation and they’re great short term pain killers, I mean, no doubt about it, you got a broken bone. A big dose of (inaudible) is going to help you to reduce the pain of a broken bone. But in terms of long term use, they do have significant adverse effects on the human gut.
Clint – Yeah, that’s fascinating. Yeah, there was a wall there where Dr. McDougall going back about 12 years, said that one of the exceptions might have been aspirin, but then he later found another study and revised his guidelines and said aspirin to causes the intestinal permeability and inflammation. Is that also what you’ve observed?
Dr. Alan Desmond – Yeah, and aspirin is one of the leading causes of stomach ulcers and bleeding in the lining of the gut. But I mean, when people I mean, within my practice, whether I’m treating Crohn’s colitis, diverticular disease or whatever the condition happens to be, I always make a point to educate my patients on the benefits of an unprocessed plant, predominant diet. But of course, just like rheumatoid arthritis with conditions like Crohn’s not apply to these chronic inflammatory conditions. By the time I meet a patient, they’ve already had this disease for eight, nine, 10 years. Often I’ll meet patients who’ve had the disease for longer than that, different parts of their bowel removed. They may have a stone. They no longer have a healthy gut. So in although many of the medications that we prescribe do have adverse side effects, and while I’ll always educate my patients on healthy dietary change when people are poorly and unwell and have reduced quality of life, we have to use every tool in the box. So I prescribe a lot of the I mean, personally, I make a point never to prescribe a nonsteroidal anti-inflammatory drug in my practice. I remember prescribing it once on the ward for someone who had gout, and I turned to my junior doctor, my senior health officer, and said, this is the first time I’ve prescribed ibuprofen in about 15 years. I never prescribed this stuff. But at the same time, I’m not against prescribing a medication if it’s going to help my patient. But they need to know about the healthy diet and lifestyle changes that can help them to reduce their need for medication in the long term.
Clint – Hmm. And now, you know, we hadn’t talked about this prior, but and I don’t want to go anti medication at all, but just another medication that tends to be very counterproductive for people with rheumatoid is the steroid range of prednisone, prednisolone. Have you also witnessed or know some studies that support that? I know the studies that support that. I guess my better question for you specifically is, have you also the need to tell them to stop taking steroids, too, because they show inflammation in the gut? Or is there a different observation in practice?
Dr. Alan Desmond – Well, steroid medications have a host of negative side effects on human health, not least of which is weight gain, hypertension, increased blood sugars, risk of type two diabetes, et cetera. But again, just like aspirin, steroid use can damage the gut lining and chronic formations of ulcers and bleeding. So we but I prescribe steroids. But within gastroenterology, when we prescribe steroids, we would usually prescribe them for a maximum of 12 weeks. And if we have to put someone on steroids more than twice a year, for us, that means that we need to start rethinking their management because when we always use steroids as a short term intervention.
Clint – Yeah, and that’s where it goes wrong for some folks with RA is because they find in some cases that they’re the rheumatologist is happy to sort of happy to dispense prednisone regularly, especially if the patient doesn’t want to take a disease modifying drug and they have to take prednisone and then the years go by and then the toll really starts to add up on the body and then, you know, all sorts of more challenges present themselves.
Dr. Alan Desmond – It’s interesting and I can only speak from the gastroenterology perspective is we use a lot of immune modifying medications as well.
Dr. Alan Desmond – Infliximab, Adalimumab, (inaudible), Methotrexate, et cetera, et cetera, et cetera. But a few years ago, when we looked at the patient outcomes from amongst patients inflammatory balances who are on medications, although we worry a lot about the side effects of this new expensive fancy biologic medications, the medications that cause the most damage are the corticosteroids. So in the gastroenterology world, the we are very keen not to use steroids. And it but again, that’s why dietary intervention is so important, because if you had a patient with a chronic inflammatory gut problem or a chronically inflammatory joint problem, there’s plenty of evidence out there to show that an unprocessed, predominantly plant based diet is going to help them to reduce their inflammatory burden and maybe not get off medication, but certainly reduce their need for medication. There’s a nice study published two years ago on use of infliximab for which is a biologic drug, which is shared, I think, between the rheumatology world and the GI world. And we use infliximab for Crohn’s disease, for inflammatory bowel disease. But one of the things that encouraged me to look for better answers to the pain, to the answer, what should I eat, Doctor? That patients always ask me. Is the fact that even with the best possible outcomes, the infliximab medication will get people into remission, maybe somewhere between 30 and 60 percent of the time, which for my patients, means that most of my patients, even with the best medical treatment, are living with symptoms and some level of disease activity every day of the week, which isn’t a good result for my patients.
Dr. Alan Desmond – So even in the best case scenario, a significant number of them are living with their disease. That’s a nice study. Done a couple of I think just two years ago in Japan, where they had, I think, four to six individuals hospitalized with Crohn’s disease who regained remission. And these patients were severely unwell. So they needed to go on the infliximab medication. I’m not arguing that at all. But what they did in that hospital was that an inpatient education program teaching these individuals the benefits of a Whole Foods plant based diet. And after six weeks, they had ninety six percent of those patients in remission, 96 percent. And that’s using every tool in the box, healthy diet and lifestyle, plus the best available medication. And we’ve got ninety six percent in remission.
Clint – Yeah, absolutely. Love it. So I just glanced at the time and realized how quickly time has passed and I don’t want to take up anymore any more time of yours than then I’m eligible to. But I wanted to just literally pretend I’m a patient and ask you of the of the exact foods that you recommend or if there is a program that you have of your own that you hand out as a leaflet or a booklet to your patients. That’s the question, number one. And then to close out question number two, do you see a relationship between people who exercise a lot and use exercise as a therapy or as a lifestyle promoting activity and their gut health, so they might. Two last questions for you.
Dr. Alan Desmond – So question number one, we live in a world, Clint, where people the baseline diet, the food culture, the default diet is a super unhealthy diet. Fifty five percent calories come from ultra-processed food, 90 percent of calories, fruits and vegetables, whole grains don’t feature. So when I start talking to my patients about food, I just start with three simple questions. How many pieces of fruit do each every day? How many servings of vegetables do you eat every day? And how many servings of whole grains do you eat every day? I’m hoping that they’ll say three or more to each of those answers, because that tells me they’re getting at least their modest five day target. But that’s where I start. That’s where I start. And those three questions, which just take a few moments, which any doctor or any health practitioner can implement in the practice, starts some super powerful conversations, because that person says to you, what to wholegrain, which sadly is often the response. Then you’ve identified your first target for healthy dietary change. So in the real world, that’s how we start.
Dr. Alan Desmond – And your second question was exercise, of course. Well, we could of just sort of gut microbes for the last hour easily. Right. So. If you want a healthy human microbiome that is a microbiome that loves fiber, that produces beneficial short chain fatty acids, has a great diversity of bacteria within it that can deal with any challenge that you touch that arises on a day to day basis. We know that the number one dietary determinant of a healthy and diverse human microbiome is the diversity of plants in your diet. But we also know that exercise benefits the human microbiome. So I graduated from University College Cork back in Ireland. I work for a time at the APC, the Alimentary Pharmacologic Research Center, now known as Microbiome Ireland. And a few years ago they published a really nice paper where they looked at the human microbiome within a group of elite rugby players, monster rugby players and mere mortals, normal people. And they found that the rugby players had increased microbial diversity and a greater richness of fiber loving bacteria. And subsequent studies show that we can all benefit from the benefits of regular exercise on the human microbiome. So, yes, there’s definitely some science there.
Clint – I love that. I’ll have to when I get the transcription of this, I’ll pull out and find that study because I think that’s going to be one that I can quote to in the future.
Dr. Alan Desmond – Yeah, I’ll send it to us and I’ll send you the abstract.
Clint – Could I beg you for a couple of more short ones? Yeah, of course. Yeah. Oil’s you know, within the plant based community, there’s often some debate about oils, you know, and I think the strict point of view is that it’s a processed food. So it’s not a Whole Foods plant based diet. Can you just comment on your personal take on oils or if you’re very able to support it from a literature point of view? And then I’ve got another quick short one for you.
Dr. Alan Desmond – Ok, so you want me to answer this quickly? OK, so we know look, I’m a Whole Foods person, OK? I like ninety nine, five percent, where I consume Whole Foods and I wish I could have my patients eating like that, that my patients who’ve moved to a wholefood plant based diet, the more wholefood plant“ based, the more benefit they’ve seen. And I’ve seen some really remarkable health transformations. My view of oils is that they’re very calorie dense, they’re very energy dense. Two thirds, maybe 70 percent of people living in the UK are overweight or obese, which is a major driver of poor health that’s been drawn into really sharp focus by the covid-19 pandemic. So if you are making the switch to a healthy whole food plant based diet and one of your aims is to achieve a healthier body weight, which will be the aim for the vast majority of people who are making this change, then oils are a rich source of calories that you could probably do without. However, if you are eating out the whole food plant based diet, you’ve already taken out the dairy and the meat and the processed food, which are huge sources of processed fats. So can you get away with having one or two tablespoons of extra virgin olive oil per day, which is full of polyphenols, which has been shown in population studies and mechanistic studies to help reduce atherosclerosis, possibly reduce inflammatory markers? And I would say yes. So that’s my approach to it. So do I add oil to my food at home? Not much, to be honest. We have some extra virgin olive oil and we will use this a few times a week. But if someone likes the taste and it certainly adds a different mouth feel to your food and people enjoy that, then you can have one or two tablespoons if they go for it, which you just asked me to answer your question quickly, that remains unanswered. So I don’t have the definitive answer, but nutritional science doesn’t have the definitive answer. But that’s my take on it.
Clint – Great. OK, thanks for that. And then finally, I promise, finally, probiotics. You know, we’ve had guests on the show who are just absolute experts on probiotics and using probiotics and so forth. Do you feel that that is something that is beneficial to folks who are trying to improve their microbiome?
Dr. Alan Desmond – I’d almost never recommend them, there are a few very specific clinical scenarios within, you know, the ulcerative colitis and Crohn’s disease world where I might use a very specific probiotic for a very specific indication. But should everybody be taking a probiotic? I don’t think so, I don’t think so. So when we look at the studies, looking at the effect that these probiotic supplements have on the gut microbiome, the researchers generally have to work really hard to demonstrate a small effect within the gut microbiome. And then we have this concept that, you know, it’s as these microbes pass through your gut microbiome, they exert positive change around them. And that’s fair enough. I get it. I’ve seen the papers on that. Yes, you can. You can if you try really hard shell benefits in the microbiome. There’s a lot of money in the probiotic industry. It’s worth billions of dollars a year. And for me, I think the probiotic industry is sort of tapping into that pill or potion mentality where I’ll just take this shake or I’ll just take this pill or I’ll just take this potion and that will give me the health advantage. So gives me the excuse to maybe not be so healthy in my diet and lifestyle. But when we look at the studies that take humans and make and put them on a healthy whole food plant based diet and take out the animal products and take out the process stuff and fill their diet with a rich diversity of plants, the changes in the human microbiome that we see are dramatic. I mean, they put anything that a probiotic can achieve way in the corner. So if someone can produce a study showing that if you take an individual who is on a healthy, healthy, plant based diet with a great diversity of fruits, vegetables, whole grains, nuts, seeds and legumes and their diet, if you take that person and then give them a probiotic supplements and if their gut microbiome gets even better, which I doubt, then I’ll start recommending them. But I haven’t seen that study.
Clint – Love it. Love that answer. Okay. mate well tell us, how can people follow you online, either a social media channel or if someone lives in the United Kingdom and they want to come and see you, is that what’s the best way for them to reach out?
Dr. Alan Desmond – Yes, if you Instagram is the best place to be honest. So I’ve only got enough time really to maintain one social media presence. So I’m on Instagram. So I’m Dr. Alan Desmond. Or if you just type my name and Desmond into Instagram, I’ll pop up. You’ll see this face and that’s it.
Clint – Ok, great. Well, for those people watching online, I’ve just been hit with the brightest light through the shades.
Dr. Alan Desmond – I’m getting it here as well.
Clint – Yeah. Thank God the glass stops you. Otherwise you’d be burnt on half your face right now. So this has been a thoroughly enjoyable and very, very interesting. Definitely worth my wait a year and a half to get hold of you and do this interview with you. I’m very grateful. And if you could thank your kids and wife for me, too, for giving you over for an hour of course. That’s the that would be really, really great. And look, thanks again. I’ve learned a ton enjoyed chatting with you and I look forward to meeting you again in person down the track. Once this kind of thing comes under control and we’re all able to travel again. I’d love to get over to the UK and hook up in person and enjoy a few good whole food plant based meals with you all.
Dr. Alan Desmond – We’d love to host you plant based health professionals. UK would love to host you. And that’s one final plug plant based Health Professionals UK. I’m a former advisory board member and ambassador for PBHP UK. So please check out our website And thanks Clint, it’s been an absolute pleasure. We could go all day. Right?
Clint – We could, I’m withholding questions, thinking another night, I promise one more and that’ll do so. Thanks very much. Once again, I’ll let you go and I’m very grateful.
Dr. Alan Desmond – Appreciate it and take care.