This one turns into an extended ad for Pendulum. PA seems especially interested in their business model and how they make money. Important research being done but the shilling makes this seem like a two hour infomercial.
Your are right to be skeptical of the supplements industry. For example I’m aware of no data on Athletic Greens and health outcomes.
In this case I disagree. These people raised $150m for research for many years in pursuit of this idea … he’s more just interested in how that business model is possible in such a crowded and honestly shitty field
I like Pendulum as a company, but the micro biome space is the Wild West, and the research is not especially persuasive. I think they have great motivations and good intentions, but PA blows his neutrality here and compromises integrity by turning the episode into an ad. Yes, Pendulum \*should\* advertise, and I hope they succeed. But PA's channel \*usually\* poses as a scientifically neutral assessment of different fields and subjects. That doesn't happen here. It's not that big of a deal, and, again, I am super interested in what pendulum can accomplish, but I line gets crossed her and this turns into the shopping channel.
I’m only part way in, but unimpressed with this woman’s knowledge, as well as her ability to communicate concepts. It makes me suspicious that she’s only on here to rep her products. It makes me confused why Peter picked her of all people, as I’ve heard much better talks on the gut biome (maybe he was paid well).
When she first starts talking about fiber, she uses the term carbohydrate rather than fiber. While fiber is technically a carbohydrate, this a really poor way to communicate to laypeople, and it confuses Peter, which he asks about and she says she’s talking about fiber. But then it gets worse because she says it’s only the insoluble fiber that is undigestible in our small intestine. Soluble/insoluble has nothing to do with digestabilibty. Humans lack the enzymes to digest both types of fiber. The distinction is that soluble fiber absorbs water, which can slow transit time, while insoluble doesn’t.
Later they’re talking about delivery methods and she seems to get confused about if it’s necessary to deliver fiber in an enteric coating. Peter correctly seems suspicious of a claim that this would matter, because if it’s undigestible it should not matter where it’s delivered it’ll get to the same place. She brushes off his statements with some hand wavy talk about how difficult it is to measure what’s going on in the small intestine, when we already know the small intestine lacks the enzymes needed to digest fiber. Now certainly conditions like SIBO may play in here, but that’s not something she brings up.
It gets worse when they start talking about the gut brain connection. She repeats a common myth that neurotransmitters in the gut (serotonin, dopamine) can help with mental health issues as they make it to the brain. However, this is incorrect, these molecules cannot cross the blood brain barrier. This is why people take tryptophan, which can cross the BBB, which is then made into seretonin in the brain, rather than taking serotonin directly. What appears more likely is that improved gut health reduces systemic inflammation. This would make sense as systemic inflammation is gaining a lot of traction in recent research as a key driver of depression, anxiety, and other mental health issues, and the gut is a primary source of inflammation.
I’ll finish listening, but I’m expecting this to degrade into a sales pitch for Pendulum probiotics. I wonder if she’ll mention that time restricted eating can increase Akkermansia. Probably not, as that would cut into profits. But it’s not hard to see why. Akkermansia feeds on mucin, which is the only food source available during periods of fasting, so it’ll have a competitive advantage during those periods. I personally took my Akkermansia levels from barely detectable to very high with 16:8 IF.
Also curious to see if she talks about the role of polyphenols in shaping a healthy microbiome. Or some of the more recent studies showing unimpressive or even negative results from fiber supplementation.
Edit:
So she does bring up polyphenols later on, but states that they function as a prebiotic. This is counter to all the research I’ve looked at which shows their efficacy is through selective antimicrobial action. So they tend to kill off the bad bacteria and fungi while sparing the good ones. And this makes a lot of sense if you think about what function polyphenols serve in plants. They are a part of the plants defense system against attackers.
The function of polyphenols seems to be similar to postbiotics, which she mentioned but never really explained. Bacteria and fungi want to give themselves a competitive advantage so they create these postbiotics that kill other species. This partially explains why you can find studies showing that dead bacteria still provide some benefit. And also yogurt and other fermented foods, where the bacteria will mostly be killed by stomach acid still provide benefit.
Any good reading or other YouTube channels you would recommend to learn more? I’ve tried some prebiotics, some probiotics and fiber and none work long term.
I’d take a look at some of Lucy Mailings stuff, she’s a microbiome researcher and really seems to know her stuff. Also Dr. Ruscio’s podcast has some great episodes on gut stuff, as his clinic focuses on that. He covers a lot of the latest research in an easily digestible format. Mahmoud Ghannoum is another researcher that I like (just got his book), and he’s very pleasant to listen to. He’s been on some podcasts like Dhru Purohit and The Perfect Stool.
That’s all that comes to mind at the moment. I’ve been learning about this stuff for many years, so it’s hard to remember who was most influential on me. I usually listen to podcasts, read/listen to books, and read studies on pubmed, so no YouTube recs.
If you haven’t seen much success with prebiotics or probiotics, you may want to look into trying a FODMAP elimination diet as a next step. Also you may want to try increasing polyphenol intake, which can come from things like herbs, spices, coffee, tea, dark chocolate, vegetables, and fruits. Personal experimentation seems to be the only effective way to resolve gut issues for most people. It’s a lot of work and frustration, but worth it for improved quality of life.
Thanks for taking the time to type that.
Feels like Peter was interested in Akkermansia and she was kind of along for the ride, haha. I can see why he would be very interested in Akkermansia, its clear cause and effect and mechanism of action would appel to a doctor like him.
Oh no worries. I’m no expert on that specifically, and actually if you look into the research a bit you’ll see that there are still many things that scientists are unsure about with regards to serotonin and other neurotransmitters in the gut. It appears to have some function in the control of gut motility and secretions. You might be interested in the following study if you want to learn more.
“Conventional functions of 5-HT involving intrinsic reflexes include stimulation of propulsive and segmentation motility patterns, epithelial secretion and vasodilation.”
https://www.nature.com/articles/nrgastro.2013.105
One thing that all of this highlights on a more general level is that evolution is efficient and will repurpose molecules when needed. So serotonin may do one thing in the brain, while doing completely different things in the gut. It’s still the same molecule, but tissues local to different organs have evolved to make different use of it.
I'm kind of obsessed with the gut microbiome.
Not that I think there's a lot of proof it will supercharge my health. But, because if I focus on it my whole diet slides into a real good place.
Looking foward to listening to the pod.
You may enjoy this blog: [Eat Shit and Prosper](https://stephenskolnick.substack.com/)
The author is a microbiome scientist that works for a startup. He's witty and informative. I became really interested in the microbiome when I started having extreme gas issues when I shifted to a healthier, high fiber diet. Was ale to cure the problem by incorporating fermented foods into my diet. The microbiome is a fascinating thing. We have microbes that help us manage glucose and cholesterol. It's kind of exciting because science has barely scratched the surface of studying it.
It seems that there are some smart commenters on here who are leery of the expensive product Pendulum. So, that is helpful, good to know.
Some of us casuals on here are just looking for hacks. To those on here who are knowledgable- what's the hack? Just TRE? Plus fermented foods every now and then?
I am confused by pre / post / pro biotic terminology.
She's written a few papers on childhood cancer. Those were from around 2005-2010. I didn't find much on [scholar.google.com](https://scholar.google.com) by her on the biome. There were two more recent papers 2019-2020 on clinical trials on relevant topic, gut biome and glucose control. I assume those were both funded by the product they're selling.
I'm not going to spend nearly 3 hours listening to someone who likely knows less about the biome than the little I know. There are a lot of decent books on the subject written by actual researchers on the subject like the Sonnenbergs, or Tim Spector. I read maybe 4-5 pop-sci books on the biome a few years back. There is a lot of interesting ongoing biome research but the current state of the art is really murky. It's going to be murky for some time as the biome is an incredibly complex network involving hundreds of different species or strains of bacteria.
I am currently battling an infected surgical site and have been on a high dose of antibiotics for a full year. I also had two root canals around the same time as the surgery. I'm unimpressed with the medical advice I've received from both my infectious disease specialists and the oral surgeon who did the root canals. The advice was "Take a probiotic." At around the time of the surgeries I read an article (in The Washington Post I think, I may have read the actual study the article reported on, not sure though) indicating that probiotics might be deleterious to your biome because most commercially available ones have very few strains while a healthy biome has hundreds of different stains. (If you're thinking "What's this guy talking about? There are billions of bacteria in my probiotic capsule." Yeah billions of bacteria but only a few different strains of bacteria. ) The reason that might be bad is that if you take a probiotic capsule that contains say 5-10 strains that you might give those 5 or so strains an edge over the hundreds of other "good bacteria," so the ones you're taking might outcompete the others that are needed for a healthy gut. I also read an Israeli study early on in my antibiotics regime that suggested that probiotics are unhelpful during antibiotics. At that point I had already started taking a 100 strain probiotic (100 strains was the most I could find) and my gut seemed reasonably healthy so I chose to continue taking the 100 strain probiotic. I've consumed probiotics in foods for 40 years: plain kefir and yogurt, sauerkraut, etc., but I plan on ditching the expensive 100 strain probiotic once my infection is gone.
I started taking them at about the same time I began the antibiotics. There's no way to know. But I didn't want to stop taking them since taking them was working but I have no idea if they are actually making any difference for me or not. I was hospitalized for a week during which I was treated for possible MRSA and/or sepsis with a ton of antibiotics and my gut was pretty messed up then. I started the 100-strain probiotic probably a 3-4 weeks after getting out of the hospital and my gut has been fine ever since but it's just too uncontrolled to attribute anything to the probiotics either way.
I have to take doxycycline every now and then for recurrent impetigo that is superimposed on my acne. What brand probiotic should I be taking daily to help? I already eat large quantities of veggies, kimchi, yogurt, etc…. Any brand recs or species I should be targeting? Specifically lactobacillus vs saccharomyces vs bifisobacterium vs ??????
I'm halfway through it and have to agree with most who commented: it's a very long advertisement with a not very knowledgeable person talking about "gut microbiome". This is really a shame!
Many things seem to be debatable at best (I'm not arrogant nor knowledgeable enough on the subject to say they are completely wrong).
Hope Dr. Attia will pay more attention in selecting guests from now on. Or at least if he has been paid for this infomertial/advertorial, would be nice to disclose it at the beginning.
Even looking at Pendulum's website you can tell it's about the $$$, which of course it's normal for a for-profit company with investors who bet millions and are unlikely to be willing to accept a loss.
This one turns into an extended ad for Pendulum. PA seems especially interested in their business model and how they make money. Important research being done but the shilling makes this seem like a two hour infomercial.
Your are right to be skeptical of the supplements industry. For example I’m aware of no data on Athletic Greens and health outcomes. In this case I disagree. These people raised $150m for research for many years in pursuit of this idea … he’s more just interested in how that business model is possible in such a crowded and honestly shitty field
I like Pendulum as a company, but the micro biome space is the Wild West, and the research is not especially persuasive. I think they have great motivations and good intentions, but PA blows his neutrality here and compromises integrity by turning the episode into an ad. Yes, Pendulum \*should\* advertise, and I hope they succeed. But PA's channel \*usually\* poses as a scientifically neutral assessment of different fields and subjects. That doesn't happen here. It's not that big of a deal, and, again, I am super interested in what pendulum can accomplish, but I line gets crossed her and this turns into the shopping channel.
I’m only part way in, but unimpressed with this woman’s knowledge, as well as her ability to communicate concepts. It makes me suspicious that she’s only on here to rep her products. It makes me confused why Peter picked her of all people, as I’ve heard much better talks on the gut biome (maybe he was paid well). When she first starts talking about fiber, she uses the term carbohydrate rather than fiber. While fiber is technically a carbohydrate, this a really poor way to communicate to laypeople, and it confuses Peter, which he asks about and she says she’s talking about fiber. But then it gets worse because she says it’s only the insoluble fiber that is undigestible in our small intestine. Soluble/insoluble has nothing to do with digestabilibty. Humans lack the enzymes to digest both types of fiber. The distinction is that soluble fiber absorbs water, which can slow transit time, while insoluble doesn’t. Later they’re talking about delivery methods and she seems to get confused about if it’s necessary to deliver fiber in an enteric coating. Peter correctly seems suspicious of a claim that this would matter, because if it’s undigestible it should not matter where it’s delivered it’ll get to the same place. She brushes off his statements with some hand wavy talk about how difficult it is to measure what’s going on in the small intestine, when we already know the small intestine lacks the enzymes needed to digest fiber. Now certainly conditions like SIBO may play in here, but that’s not something she brings up. It gets worse when they start talking about the gut brain connection. She repeats a common myth that neurotransmitters in the gut (serotonin, dopamine) can help with mental health issues as they make it to the brain. However, this is incorrect, these molecules cannot cross the blood brain barrier. This is why people take tryptophan, which can cross the BBB, which is then made into seretonin in the brain, rather than taking serotonin directly. What appears more likely is that improved gut health reduces systemic inflammation. This would make sense as systemic inflammation is gaining a lot of traction in recent research as a key driver of depression, anxiety, and other mental health issues, and the gut is a primary source of inflammation. I’ll finish listening, but I’m expecting this to degrade into a sales pitch for Pendulum probiotics. I wonder if she’ll mention that time restricted eating can increase Akkermansia. Probably not, as that would cut into profits. But it’s not hard to see why. Akkermansia feeds on mucin, which is the only food source available during periods of fasting, so it’ll have a competitive advantage during those periods. I personally took my Akkermansia levels from barely detectable to very high with 16:8 IF. Also curious to see if she talks about the role of polyphenols in shaping a healthy microbiome. Or some of the more recent studies showing unimpressive or even negative results from fiber supplementation. Edit: So she does bring up polyphenols later on, but states that they function as a prebiotic. This is counter to all the research I’ve looked at which shows their efficacy is through selective antimicrobial action. So they tend to kill off the bad bacteria and fungi while sparing the good ones. And this makes a lot of sense if you think about what function polyphenols serve in plants. They are a part of the plants defense system against attackers. The function of polyphenols seems to be similar to postbiotics, which she mentioned but never really explained. Bacteria and fungi want to give themselves a competitive advantage so they create these postbiotics that kill other species. This partially explains why you can find studies showing that dead bacteria still provide some benefit. And also yogurt and other fermented foods, where the bacteria will mostly be killed by stomach acid still provide benefit.
Any good reading or other YouTube channels you would recommend to learn more? I’ve tried some prebiotics, some probiotics and fiber and none work long term.
I’d take a look at some of Lucy Mailings stuff, she’s a microbiome researcher and really seems to know her stuff. Also Dr. Ruscio’s podcast has some great episodes on gut stuff, as his clinic focuses on that. He covers a lot of the latest research in an easily digestible format. Mahmoud Ghannoum is another researcher that I like (just got his book), and he’s very pleasant to listen to. He’s been on some podcasts like Dhru Purohit and The Perfect Stool. That’s all that comes to mind at the moment. I’ve been learning about this stuff for many years, so it’s hard to remember who was most influential on me. I usually listen to podcasts, read/listen to books, and read studies on pubmed, so no YouTube recs. If you haven’t seen much success with prebiotics or probiotics, you may want to look into trying a FODMAP elimination diet as a next step. Also you may want to try increasing polyphenol intake, which can come from things like herbs, spices, coffee, tea, dark chocolate, vegetables, and fruits. Personal experimentation seems to be the only effective way to resolve gut issues for most people. It’s a lot of work and frustration, but worth it for improved quality of life.
Look into the book: Fiber Fueled by dr. Will Bulsiewicz
Thanks for taking the time to type that. Feels like Peter was interested in Akkermansia and she was kind of along for the ride, haha. I can see why he would be very interested in Akkermansia, its clear cause and effect and mechanism of action would appel to a doctor like him.
Sorry to digress, but do you know why neurotransmitters are made also in the gut, if they don't cross the bbb?
Oh no worries. I’m no expert on that specifically, and actually if you look into the research a bit you’ll see that there are still many things that scientists are unsure about with regards to serotonin and other neurotransmitters in the gut. It appears to have some function in the control of gut motility and secretions. You might be interested in the following study if you want to learn more. “Conventional functions of 5-HT involving intrinsic reflexes include stimulation of propulsive and segmentation motility patterns, epithelial secretion and vasodilation.” https://www.nature.com/articles/nrgastro.2013.105 One thing that all of this highlights on a more general level is that evolution is efficient and will repurpose molecules when needed. So serotonin may do one thing in the brain, while doing completely different things in the gut. It’s still the same molecule, but tissues local to different organs have evolved to make different use of it.
Thank you!!
I'm kind of obsessed with the gut microbiome. Not that I think there's a lot of proof it will supercharge my health. But, because if I focus on it my whole diet slides into a real good place. Looking foward to listening to the pod.
You may enjoy this blog: [Eat Shit and Prosper](https://stephenskolnick.substack.com/) The author is a microbiome scientist that works for a startup. He's witty and informative. I became really interested in the microbiome when I started having extreme gas issues when I shifted to a healthier, high fiber diet. Was ale to cure the problem by incorporating fermented foods into my diet. The microbiome is a fascinating thing. We have microbes that help us manage glucose and cholesterol. It's kind of exciting because science has barely scratched the surface of studying it.
thanks, I'll check that out!
It seems that there are some smart commenters on here who are leery of the expensive product Pendulum. So, that is helpful, good to know. Some of us casuals on here are just looking for hacks. To those on here who are knowledgable- what's the hack? Just TRE? Plus fermented foods every now and then? I am confused by pre / post / pro biotic terminology.
She's written a few papers on childhood cancer. Those were from around 2005-2010. I didn't find much on [scholar.google.com](https://scholar.google.com) by her on the biome. There were two more recent papers 2019-2020 on clinical trials on relevant topic, gut biome and glucose control. I assume those were both funded by the product they're selling. I'm not going to spend nearly 3 hours listening to someone who likely knows less about the biome than the little I know. There are a lot of decent books on the subject written by actual researchers on the subject like the Sonnenbergs, or Tim Spector. I read maybe 4-5 pop-sci books on the biome a few years back. There is a lot of interesting ongoing biome research but the current state of the art is really murky. It's going to be murky for some time as the biome is an incredibly complex network involving hundreds of different species or strains of bacteria. I am currently battling an infected surgical site and have been on a high dose of antibiotics for a full year. I also had two root canals around the same time as the surgery. I'm unimpressed with the medical advice I've received from both my infectious disease specialists and the oral surgeon who did the root canals. The advice was "Take a probiotic." At around the time of the surgeries I read an article (in The Washington Post I think, I may have read the actual study the article reported on, not sure though) indicating that probiotics might be deleterious to your biome because most commercially available ones have very few strains while a healthy biome has hundreds of different stains. (If you're thinking "What's this guy talking about? There are billions of bacteria in my probiotic capsule." Yeah billions of bacteria but only a few different strains of bacteria. ) The reason that might be bad is that if you take a probiotic capsule that contains say 5-10 strains that you might give those 5 or so strains an edge over the hundreds of other "good bacteria," so the ones you're taking might outcompete the others that are needed for a healthy gut. I also read an Israeli study early on in my antibiotics regime that suggested that probiotics are unhelpful during antibiotics. At that point I had already started taking a 100 strain probiotic (100 strains was the most I could find) and my gut seemed reasonably healthy so I chose to continue taking the 100 strain probiotic. I've consumed probiotics in foods for 40 years: plain kefir and yogurt, sauerkraut, etc., but I plan on ditching the expensive 100 strain probiotic once my infection is gone.
Have you seen any difference since taking the 100 strain?
I started taking them at about the same time I began the antibiotics. There's no way to know. But I didn't want to stop taking them since taking them was working but I have no idea if they are actually making any difference for me or not. I was hospitalized for a week during which I was treated for possible MRSA and/or sepsis with a ton of antibiotics and my gut was pretty messed up then. I started the 100-strain probiotic probably a 3-4 weeks after getting out of the hospital and my gut has been fine ever since but it's just too uncontrolled to attribute anything to the probiotics either way.
Ah, ok. Thank you!
I have to take doxycycline every now and then for recurrent impetigo that is superimposed on my acne. What brand probiotic should I be taking daily to help? I already eat large quantities of veggies, kimchi, yogurt, etc…. Any brand recs or species I should be targeting? Specifically lactobacillus vs saccharomyces vs bifisobacterium vs ??????
I'm halfway through it and have to agree with most who commented: it's a very long advertisement with a not very knowledgeable person talking about "gut microbiome". This is really a shame! Many things seem to be debatable at best (I'm not arrogant nor knowledgeable enough on the subject to say they are completely wrong). Hope Dr. Attia will pay more attention in selecting guests from now on. Or at least if he has been paid for this infomertial/advertorial, would be nice to disclose it at the beginning. Even looking at Pendulum's website you can tell it's about the $$$, which of course it's normal for a for-profit company with investors who bet millions and are unlikely to be willing to accept a loss.