Inside Matters

Episode 004 - Andy Scott – gut health and bodybuilding, gaining muscle, losing fat

Visit the Inside Matters website for more information about the podcast and the guests - https://insidematters.health
Andy Scott is one of the UK's top amateur bodybuilders. In this episode, we dive into the world of bodybuilding and discuss in detail the psychological processes bodybuilders go through, along with the science of diet and the role the gut biome plays in their health and training performance.
Bodybuilding is the pursuit of aesthetic perfection, with perfection meaning different things to different people. Many of the core principles that are associated with success in bodybuilding can be applied to microbiome improvement and gut health. These include consistency, discipline, eating minimally processed micronutrient-dense food, training muscle groups and experimenting with diets to figure out what works best.
Prioritising gut health is becoming more and more popular in bodybuilding, with top athletes now undertaking elimination diets, taking probiotics and eating more ‘microbiome-friendly foods.
Some of the topics covered in this conversation:
Top bodybuilders take decades to build their physiques. Consistency, forming habits and discipline were recurring themes associated with success throughout the podcast.
Bodybuilding has evolved over time, just like other sports, with improvements to techniques, methods, supplements and systems.
Andy competes within the super heavyweight division (225lbs+) at 3% body fat. To put that into context, the average male is 19/20% body fat and typically abs become visible at 9/10% body fat.  Bodybuilders like Andy achieve this through year-round intense training and dieting. There are only a small number of days/weeks in a year where a bodybuilder doesn’t feel full all the time (growth phase) or is hungry all the time (dieting phase).
To achieve maximum muscle growth, bodybuilders train muscles to failure (when it is not possible to do another rep) with a controlled tempo (a slow eccentric, typically 2-3 seconds, and a fast concentric). This training philosophy can be adopted by anyone wanting to improve their physique and not necessarily only those who want to be a bodybuilder. Andy thinks that it is still possible to build an amazing physique without training to failure, but it would take twice as long.
In Andy’s opinion, the fastest way to lose fast is a low-carbohydrate diet. Some people recommend a zero-carbohydrate diet. However, to retain muscle, maintaining carbohydrate intake is important. Slowly decreasing calories in a tapered fashion while maintaining intense training is the best way to lose fat and preserve muscle.
Andy implements elimination diets for himself and his clients with a view to improving gut health and reducing gastric distress. In these diets, Andy removes a food source for 3-5 days, sometimes longer, in parallel with tracking how the person feels. Anecdotally he sees improvements in performance in the gym because of diet modification through elimination diets.
In terms of foods that typically cause problems, he finds that oats and broccoli can be a problem for his clients. Simple changes like moving the oats to a guaranteed gluten-free source and moving to another vegetable type can have a positive impact. 
Bodybuilders can take up to 20 weeks to get show ready. Towards the end of the show, they lack energy. So much so, that even getting up off a sofa to make a coffee is a challenging task.
Andy eats 6,500 calories a day from micronutrient-dense, unprocessed food. He prioritises animal sources of protein. Interestingly, Andy is not aware of any top professional bodybuilders being vegan or vegetarian. He does have clients who make good progress on these diets though.
Andy and James discussed something called ‘if it fits your macros’ which is a diet philosophy underpinned by hitting macronutrient targets through any food/drink sources i.e diets are not fixed/set in terms of food choices. It was agreed that food sources and the quality of food is equally if not more important than simply hitting a calorie/macronutrient target.
Andy’s advice to those getting started is to start slow and to make small changes that you can stick to every day and consistently e.g walking for 30 minutes each day, building up to walking and then lifting weights. The same can be said for diets.

Episode 003 - Dr Morgan Langille – microbiome bioinformatics, DNA sequencing, metagenomics

Dr Morgan Langille, an expert in bioinformatics, talks about developing novel technologies and techniques that enable a better understanding of human-microbial interactions. 
 
Dr Langille discusses advances in the microbiome field as well as combining computer science and microbiology to lead to new therapeutics and diagnostics.
 
Episode Time Stamps
00:00 Intro
00:30, How Dr Langille got into the field of the microbiome
04:30, Gene duplication and reverse transcription
05:48, What is bioinformatics?
06:34, The evolution of bioinformatics 
09:30, Genomic islands
1:04 - Phages
14:30 Dr Langille’s first bioinformatics tool 
16:00 Bacterial genome libraries 
18:20 Extremeophilic bacteria
19:00 Will there be bugs in space
21:42 Bacteria on Mars 
22:15 Human microbiome diversity 
23:30 Number of human cells vs microbes in the body 
25:00 Genomic diversity within the microbiome 
28:00 Perfect bioinformatics 
33:40 Bioinformatics and microbiome research
34:37 Short read vs long read sequencing 
45:30 Shotgun metagenomics 
48:00 Bioinformatic tool development 
1:01:00 Differences in bioinformatic tools and impact on research 
1:06:00 Solutions to current technology challenges in bioinformatics
1:10:06 Tools that Morgan has developed 
1:08:05 PICRUSt - bioinformatic tool 
1:18:35 Jarvis - bioinformatic tool 
1:24:00 Talent wars for bioinformatics 
1:26:36 Machine learning and AI
1:32:51 Colorectal cancer and AI 
1:36:35 Is blood sterile?
1:38:00 What does the future of medicine look like 
1:40:51 DIY FMT
 

Episode 002 - Dr Benjamin Mullish - FMT, donor selection, and the microbiome in immuno-oncology

Episode 002 - Dr Benjamin Mullish - faecal microbiota transplantation, donor selection, the microbiome in immuno-oncology.
Dr Mullish discusses the microbiome, the evolution of faecal microbiota transplantation (‘FMT’ also known as intestinal microbiota transfer ‘IMT’) including donor selection, novel microbial therapies, developing consensus guidelines for the benefit of patients and his involvement in exciting cutting-edge research into immuno-oncology.
Dr Mullish is a pioneer in the application of IMT to treat and prevent disease. He is the co-first author on the joint UK BSG/HIS consensus guideline guidance that defined best practices in all aspects of an IMT service. Dr Mullish has also published research that outlines the mechanism of action of IMT in recurrent C.difficile infection and is actively involved in several other research studies, trials and projects.
00:00 Intro
03:21 How Did Dr Mullish Get Started with FMT?
07:15 What Happened Next?
09:45 Were you convinced that FMT was going to be big?
10:30 When Was the First Time Dr Mullish Saw FMT With His Own Eyes?
13:43 Further Exploring the journey into FMT and its Expansion
16:34 In the Early Days What Guidance was there For Doing FMT Correct
20:01 What Evidence Suggested that Frozen Samples Were Just as Good as Fresh Samples?
22:25 Are We Still of the View that Frozen and Fresh are as Good as Each Other?
23:52 Is it Fair to Say that there was no Guidance From Formal Agencies on FMT in the Beginning?
25:59 How Did You Make Sure all Key Elements were Contained Within Guideline Documents Sent Out to Interested Parties?
27:30 Within the Document Which Areas Were Contentious?
29:00 Should Hospitals Always Maintain an FMT Practice?
31:26 Revisiting FMT Guidelines in 2012 in Regards to Today
32:42 Conversation on Do-It-Yourself FMT
34:52 Do We Have Somewhere for DIY People to go for FMT?
37:03 Discovering Better Ways for FMT
39:31 Conversation on Donor Screening
46:48 Interesting and Cool Aneqdotes / Observations
47:54 What Makes a Good Donor?
50:09 FMT and Weightloss
53:05 What is a Metabalone and Picking Donors Based on Metabalones
54:43 Non-Digestible Components and How they Affect Bugs Which Affect Us
56:35 Selecting a Donor Based on Short Chain Fatty Acids
57:55 Should We be Asking Donors to Eat Specific Foods?
59:37 Is There a Shift Towards a Particular Type of Donor? And are there Elements to the Metabalones that We Haven't Characterised?
1:03:55 How Do We Identify What We Don’t Know About Metabalones?
1:06:49 Elderly Donors (100+ Years)
1:08:51 Microbiome Promoting Health in Specific Cases of those Living Long Healthy Lives
1:09:53 Would these People Make Good Donors?
1:11:15 Alcohol Craving Post FMT
1:12:52 If Someone Has Used Alcohol Heavily but all Tests Show Good Signs, Could Their Microbiome be Protecting them? And Make Them a Good Donor? 
1:15:16 Bariatric Surgery Changing the Anatomy and Changing Microbes
1:17:15 Dr Mullish’s Experience in Trying to Enhance the Probability of Success with FMT
1:18:21 Potentially 1 in 3 People Have Non-Alcoholic Fatty Changes Which May Progress in Some People to Cirrhosis 
1:24:26 Is there Any Argument in Looking at a Donors Healthy Metabolic Profile?
1:25:57 Mixing Together the Starting Material Between Different Donors
1:30:14 Do we Know Why Lower Diversity Has an Impact on the Success of Stem Cell Transplants?
1:31:11 Dr Mullish’s Experience with Stem Cell Transplants Within FMT
1:37:37 Are Your Team Strong in the Conviction that Microbiome Therapies are Going to have an Impact on Cancer Patients?
1:40:46 There are Various Different Types of Responses, With There Being Full Response in Non-Responders Post FMT Which Offers Hope
1:42:19 With the Available Tool Kit Teams will be able to Decipher What Element of the Microbiome is Driving Response
1:43:45 How is the Tool Kit for FMT Going to Evolve in the Next 5 Years?
1:47:33 The Cure for many Ailments May be Living Inside Us
1:48:48 How Does Dr Mullish Respond to Questions on how to Improve Gut Health?
1:50:48 Are We at the Point Where People Can Get a Prescription For Prebiotics and Probiotics Through a Doctor Using Microbiome Profiling?
 
Intestinal microbiota transfer (IMT, also referred to as faecal microbiota transplantation) is a medical procedure in which microorganisms are moved from a healthy donor (or donors) into the intestinal tract of a recipient.
The first randomised controlled trial of IMT was published in the New England Journal of Medicine in 2013 (https://www.nejm.org/doi/full/10.1056/nejmoa1205037). This study showed for the first time that FMT was an effective treatment. Dr Mullish described that this publication transformed the field and catalysed a wave of interest and research into IMT.
IMT has evolved over the last decade, with advancements made to donor selection and screening, material processing and patient preparation, as well as guidelines providing guidance to clinicians. Dr Mullish was lead co-author on the joint UK/BSG consensus guideline publication describing best practice and the evidence base for IMT (https://www.bsg.org.uk/wp-content/uploads/2018/09/The-use-of-faecal-microbiota-transplant-as-treatment-for-recurrent-or-refractory-Clostridium-difficile-infection-and-other-potential-indications-1.pdf)
There are risks associated with IMT, mainly relating to pathogen screening. There have been recorded deaths in the literature associated with the transfer of pathogens (https://www.nejm.org/doi/full/10.1056/NEJMoa1910437). These deaths emphasise the importance of robust and stringent donor selection, donor screening and controls relating to testing and manufacture. All of which are outlined in consensus guidelines.Dr Mullish is currently updating the guidance. Over the course of the revision process, he and the team have identified 20,000 publications that relate to FMT/IMT published since 2018. Of that 20,000 - 11,000 do not relate to C.difficile and 8,000 relate to C.difficile publications
Dr Mullish and James discussed what makes a good donor. In short - it’s complicated. Fundamentally a good donor is one what is free from disease and that produces high quality stool on a regular basis. Dr Mullish describes new studies and techniques that focus on analysing the chemical outputs of the microbiome - known the metabolome. The metabolome differs between healthy people and controls, as well as before and after IMT. Dr Mullish also describes bile acids as being substances produced by the body that are then modulated by the microbiome.
On the metabolome, it is accepted that there is more data than we can / know how to interpret. It may be that in the future donors for IMT may be asked to consume a particular diet to enhance the quality of their donations.
Dr Mullish describes the microbiome as being ‘co-evolved’ with our bodies and the microbiome living in symbiosis with us as hosts. We nourish them through food that we can’t digest and in return, they produce chemicals that benefit our health, such as short chain fatty acids, are energy sources for the inner aspect of the intestine.
There is emerging research linking the microbiome and IMT to outcomes in immuno-oncology (https://pubmed.ncbi.nlm.nih.gov/33303685/) and cancer (https://www.science.org/doi/10.1126/science.abc4552). Dr Mullish and the team at Imperial College London are actively involved in research into these areas.
Both James and Dr Mullish are hopeful and excited about the future of microbiome therapeutics.

Episode 001 - Dr Richard Hansen - microbial therapeutics and paediatric IBD

Visit our website to learn more about Inside Matters - https://insidematters.health/episodes/dr-richard-hansen
 
Watch the conversation on our YouTube channel - https://www.youtube.com/watch?v=nZma2Kh-umQ&ab_channel=InsideMattersPodcast
 
Dr Hansen is a Consultant Paediatric Gastroenterologist at the Royal Hospital for Children in Glasgow and an Honorary Clinical Associate Professor at the University of Glasgow. He is a principal investigator within the Bacteria, Immunology, Gastroenterology and ‘Omics (BINGO) group at the University which developed the CD-TREAT diet for Crohn’s disease.
 
His clinical interests are inflammatory bowel disease (IBD), paediatric endoscopy and Helicobacter pylori. His main research interest is the gastrointestinal mucosal microbiota and its importance in paediatric disease, particularly IBD. He is especially interested in the molecular characterisation of the microbiota and its subsequent modification for the purposes of therapeutic effect via microbial therapeutics.
 
In this episode, we discuss treating IBD in children, using entirely liquid diets to reduce inflammation, and developing novel strategies that target the microbiome to treat IBD.
 
1:06 - Intro
1:56 - Interview Starts
2:27 – How to study the microbiome – analytical methods and study types
3:22 - How has microbiome science changed over the last 5 years?
5:13 -  What is Exclusive Enteral Nutrition (EEN)?
7:39 -  What is Inflammatory Bowel Disease (IBD)?
10:18 - Why are people getting IBD earlier in life?
14:54 - Is there different immunology between Crohn's disease and IBD?
17:07 - How has the perceived importance of the microbiome changed in IBD?
21:48 - How did all of this influence your PhD? 
26:14 - Are we missing something with the current microbiome studies?
29:17 – The Bristol Stool Score
29:53 - Do you think that the microbiome drives inflammation in the gut?
34:01 – The Appendix 
39:15 – Using the microbiome to predict IBD?
46:16 – Faecal microbiota transplantation (FMT)
49:03 – FMT in UC – studies published to date.
52:17 – Super donors in FMT
59:17 – The 16S gene
1:03:06 – The microbiome analytical toolkit
1:07:55 -  AI and large populations
1:09:19 – The implantation of machine learning
1:10:39 - Are clinicians trained in how to use AI
1:13:01 - Discussion on the application of FMT in paediatric populations.
1:14:22 - Infants, diet and gut health.
1:18:01 – Further discussion on FMT in paediatric populations.
1:20:44 - FMT donor screening processes. 
1:22:21 – Donor selection for paediatric FMT.
1:26:30 – Potential risks associated with FMT. 
1:29:19 - Can FMT or other microbial therapeutics replace immune system dampening therapies?
1:31:13 - When IBD is at its worst, what is it like?
1:36:01 - What do we do about the EEN diet and Crohn’s disease?
1:38:20 - Which element of EEN is driving the positive effects in Crohn’s?
1:42:27 - How do we create a less socially restrictive diet than EEN but keep the benefits?
1:44:44 - What is the ultimate aim of CDTreat? 
1:47:19 - What is the relative importance of bacteria versus other components of the microbiome?
 
Key takeaways from this episode:
 
There has been an explosion of interest in the microbiome in recent times as it is becoming it easier and easier to analyse the microbiome through analytical methods that do not involve traditional culture techniques - which are labour intensive and relatively slow. 
 
The field of microbial therapeutics is still in its infancy. There are many ongoing clinical trials into new ideas. Richard is hopeful that these trials will result in new treatment options for patients. 
 
Inflammatory bowel disease is a chronic (long term) condition characterised by inflammation in the gut. There are two main forms of IBD, Crohn’s disease and Ulcerative Colitis. Crohn’s disease can affect any part of the intestinal tract, from mouth to anus. UC only affects the last part of the gut - the colon. 
 
There is a microbiome that lives within the lumen of the gut and on the surface of the intestine (mucosa). Richard’s analogy for this relationship is that they are like a beach and an ocean – they are different but inextricably linked. 
 
The incidence (when the disease first starts) of IBD across the population seems to be occurring earlier and earlier in life. At the start of Richard’s career it was rare to see a patient below the age of five presenting to hospital with symptoms, now days it is becoming more common. The environment and its impact on the microbiome may be the key driver for this. There are clear changes that are observed in microbiome studies in patients with reduced IBD, namely: reductions in diversity (how many bacteria are there and how evenly are they spread), and increases / decreases in particular bacteria. 
 
Exclusive internal nutrition (EEN) is a term used to describe a 6-8 week course of an entirely liquid diet. The data suggests 4 out of 5 paediatric patients suffering from Crohn’s disease enter remission (where the gut is healed and there is no active disease causing symptoms) after a course of EEN. It thought that the longer the course of EEN the more effective it is. 
 
EEN is becoming much more popular in adult therapy, however its uptake is limited due to social constraints. Richard and a team working at the University of Glasgow are developing a less socially restrictive diet that mimics the effects of EEN. The programme of work is called CD-treat. 
 
Intestinal microbiota transfer (IMT) involves the movement of microorganisms from one person into another with the intention of treating a disease. Six randomised controlled trials have been published in UC so far, with a definite signal towards IMT being effective. Richard is hopeful that these studies will pave the way for new treatment options in IBD. 

Extreme Microbiomes and Microbes in Space!

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Watch the podcast on YouTube.
 
Expect the unexpected in space microbiology! There are microorganisms that have adapted to survive in the most extreme environments. These microbiomes are being analysed to figure out what might be happening in space, especially with those that have been found to survive up to 3 years. What would happen if a human came into contact with them on another planet?

This is Inside Matters - An Introduction to Our New Podcast

Welcome to Inside Matters, the gut health podcast featuring conversations with the most forward-thinking minds in health, fitness, science, nutrition and business. In-depth discussions about how our gut microbiome impacts our health, well-being, mood and more. Inside Matters was conceived by microbiome expert Dr James McIlroy as a platform to raise awareness of the importance of the gut microbiome. Our aim is to inspire and educate listeners around the world about the importance of gut health, equipping them with the knowledge they need to transform their lives for the better.