Lucy Mailing is an MD/PhD student at the University of Illinois. She recently completed her PhD in Nutritional Sciences and continues to perform research on the impact of diet and exercise on the gut microbiome in states of health and disease. She has authored several peer-reviewed journal articles related to the microbiome and health and was recently named an Emerging Leader in Nutritional Sciences by the American Society for Nutrition. Lucy has also been a staff research associate for the Kresser Institute for four years and writes about evidence-based gut health on her blog. She plans to begin medical school at the University of Illinois in 2020 after a year dedicated to writing and the launch of a gut-related startup.

In this podcast, Lucy discusses the most promising trends and research in gut health. She talks about the best and worst ways to test for GI problems and the effects of exercise intensity and diet change on the gut microbiota. She also challenges the notion that ketogenic and high-fat diets are bad for the gut, and explains why your SIBO breath test results might be inaccurate.

Lucy is a fine example of one of the many wonderful experts who have shaped NBT into what it is today—an online clinic helping athletes and likeminded people overcome chronic health complaints and improve performance. If you're an athlete and you've been listening to the podcast for a while and you're still struggling with your gut health, feel free to come to the front page where you'll find a button to book a free starter session. During the session, we'll take a look at your history and share how we'd work with you. We now have a variety of billing options, one of which will make sense for you.

Here's the outline of this interview with Lucy Mailing:

[00:00:21] Ancestral Health Symposium; Lucy's presentation slides; Look for the video from Lucy's 2019 presentations to be posted on the AHS YouTube channel in the upcoming months.

[00:01:17] Becoming interested in the microbiome.

[00:03:01] Working with Chris Kresser; ADAPT Health Coach Training.

[00:07:49] Why the focus on the microbiome?

[00:08:25] Transplanted human microbiome into sterile mice, mice take on phenotype of donor; Study: Zheng, P., et al. "Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host's metabolism." Molecular psychiatry 21.6 (2016): 786.

[00:09:30] What does a healthy microbiome look like?

[00:13:09] Viome; metatranscriptomics.

[00:14:37] 16S testing; uBiome.

[00:15:06] Proteobacteria as a red flag that colonic epithelial cells are starving for energy. Study: Hughes, Elizabeth R., et al. "Microbial respiration and formate oxidation as metabolic signatures of inflammation-associated dysbiosis." Cell host & microbe 21.2 (2017): 208-219.

[00:16:24] Jason Hawrelak; Podcast: How to Use Probiotics to Improve Your Health.

[00:17:29] Butyrate; Is supplementing a good idea? Tesseract, ProButyrate.

[00:21:17] Dietary recommendations: Microbiota accessible carbohydrates (term from Justin Sonnenberg).

[00:22:37] Preliminary evidence that reduced carbohydrate diet may be beneficial for people with inflammatory bowel disease; Study: Suskind, David L., et al. "Clinical and fecal microbial changes with diet therapy in active inflammatory bowel disease." Journal of clinical gastroenterology 52.2 (2018): 155.

00:23:42] Carnivore diet.

[00:25:01] Dr. Michael Mosley; Robb Wolf.

[00:27:59] Fecal microbiota transplant (FMT) from ketogenic mice; Study: Olson, Christine A., et al. "The gut microbiota mediates the anti-seizure effects of the ketogenic diet." Cell 173.7 (2018): 1728-1741.

[00:29:54] Autologous FMT restores the ecosystem after antibiotics: Study: Taur, Ying, et al. "Reconstitution of the gut microbiota of antibiotic-treated patients by autologous fecal microbiota transplant." Science translational medicine 10.460 (2018): eaap9489.

[00:31:17] Mike T Nelson; Podcasts: 1. High Ketones and Carbs at the Same Time? Great Performance Tip or Horrible Idea…, 2. The Importance of Strength Training for Endurance Athletes, 3. How to Assess an Athlete: The Best Principles, Methods, and Devices to Use.

[00:33:35] Taymount Clinic for FMT.

[00:34:11] Recent FDA report on risks of infection related to FMT.

[00:34:49] Doctor's Data stool testing; PCR sequence-based testing.

[00:35:40] Culture vs PCR.

[00:39:27] Diagnostic Solutions GI-MAP as a PCR DNA stool test.

[00:41:04] Metagenomics; Onegevity, Sun Genomics, DayTwo.

[00:42:37] Small Intestinal Bowel Overgrowth (SIBO) breath testing; Mark Pimentel, MD.

[00:42:57] Dr. Bryan Walsh.

[00:43:33] Lucy's blog posts on SIBO breath testing: All about SIBO: Small Intestinal Bacterial Overgrowth, and What the latest research reveals about SIBO.

[00:43:41] A positive breath test may not be due to SIBO; Study: Connolly, Lynn, and Lin Chang. "Combined orocecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects orocecal transit, not small intestinal bacterial overgrowth in patients with irritable bowel syndrome." Gastroenterology 141.3 (2011): 1118-1121.

[00:46:11] Individuals with SIBO may in fact have small intestinal dysbiosis; Study: Saffouri, George B., et al. "Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders." Nature communications 10.1 (2019): 2012.

[00:48:00] What you can learn from a uBiome Explorer 16S test.

[00:54:17] Probiotics, prebiotics; Pomegranate husk powder.

[00:58:02] Response to prebiotics is highly individualized; Study: Venkataraman, A., et al. "Variable responses of human microbiomes to dietary supplementation with resistant starch." Microbiome 4.1 (2016): 33.

[00:59:50] Effects of exercise on the microbiome; Studies: 1. Allen, Jacob M., et al. "Exercise alters gut microbiota composition and function in lean and obese humans." Med Sci Sports Exerc 50.4 (2018): 747-757; 2. Allen, Jacob M., et al. "Voluntary and forced exercise differentially alters the gut microbiome in C57BL/6J mice." Journal of applied physiology118.8 (2015): 1059-1066; 3. Allen, J. M., et al. "Exercise training-induced modification of the gut microbiota persists after microbiota colonization and attenuates the response to chemically-induced colitis in gnotobiotic mice." Gut Microbes 9.2 (2018): 115-130.

[01:02:26] Research on the microbiome of marathoners; Study: 1. Zhao, Xia, et al. "Response of gut microbiota to metabolite changes induced by endurance exercise." Frontiers in microbiology 9 (2018): 765; 2. Scheiman, Jonathan, et al. "Meta-omics analysis of elite athletes identifies a performance-enhancing microbe that functions via lactate metabolism." Nature Medicine (2019): 1.

[01:02:39] Lauren Petersen; Study: Petersen, Lauren M., et al. "Community characteristics of the gut microbiomes of competitive cyclists." Microbiome 5.1 (2017): 98. Our 2016 podcast with Lauren: The Athlete Microbiome Project: The Search for the Golden Microbiome.

[01:05:51] Find Lucy: NextGen Medicine.

[01:07:04] Dr. Josh Turknett's Migraine Miracle. Our podcast with Josh: The Migraine Miracle.