Belly fat is not just external; visceral fat around organs is key.
Visceral fat increases cardiometabolic disease risk, unlike subcutaneous fat.
Transcript:
Suzanne Devkota
So belly fat, I mean, you can observe it externally. There's fat that just accumulates in the midsection. But when we talk about it, I think in medical and scientific terms, we're thinking the deeper layers. We really are looking at the fat that's attached to our internal organs. We call that visceral fat. And the fat, that visceral fat that's attached to the organs, when it expands with and often in obesity, the risk for cardiometabolic disease significantly increases with more visceral Fat accumulation. The belly fat often that we might see externally can be what's called subcutaneous fat, and that's a completely different depot of fat that does different things metabolically. Cosmetically, we don't like it, but it actually is less harmful than the internal visceral fat attached to our organs. If (Time 0:04:13)
Fat Storage Mechanics
Excess calories get stored as fat, initially subcutaneously.
When subcutaneous storage is full, fat accumulates around organs, impacting their function.
Transcript:
Suzanne Devkota
When we chronically eat too much and we gain fat, we need that excess calories to go somewhere. If they don't go into fat tissue, they'll go into places like the liver or places that can cause some serious problems metabolically. And so the subcutaneous fat underneath our skin tends to be the place where the excess calories will go first. Fat expansion is a healthy process. It's not something that we want to advocate, but it is the body's way of maintaining a homeostasis. Often when you might exceed your capacity to store it in subcutaneous fat, you will also start to build it in the deeper fat attached to the organs. And fat now when it's attached to organs that carry out critical functions in the body like the gut or the kidneys or even the heart, there's a cross-communication that we still don't Fully understand between fat tissue and the organs that can lead to kind of knock-on effects systemically.
Tim Spector
It's harder to use that fat as well, isn't it? So there's a difference between the superficial fat under your skin, which actually is more readily burnt when you're exercising, for example, than the deeper fat. It's harder to get it out of your system once it's there. So there's that difference in some temporary fat, if you like, and more hard to shift fat. (Time 0:05:28)
Jonathan's Toffee Discovery
Jonathan Wolfe discovered he was "thin on the outside, fat on the inside" through a DEXA scan.
This discovery motivated him to follow ZOE's nutrition advice.
Transcript:
Jonathan Wolfe
I actually have a personal story about this and it's right back to the very early days of Zoe because I had never really thought about my fat at all. I'd always been told that actually I probably needed to like put some weight on. And as part of the initial clinical trials that we were doing with Zoe in the early days, we had about a thousand participants come into hospital, get lots and lots of measurements taken. And one of them was this scan, which is called a DEXA scan, where it's very cool. It like looks at what's inside your body. So I thought that was quite exciting. And I thought that I was going to get a really fantastic, clean bill of health. And actually, I remember as I did it, the nurse doing this test being really surprised and looking at it really carefully. And then passed it on. And eventually, I got the results back a little bit later. And I remember Tim explained to me that basically, I'm like thin on the outside of fat on the inside. And actually I had a lot of fat layered into like this visceral fat you're talking about, which is the first time I'd ever heard that term. And this was very bad news. You were a toffee. Thin on the outside, fat on the inside.
Tim Spector
Yeah, which a lot of people are, in a way, don't realize that they have poor metabolic health because of that. And it's quite genetic as well. So it's seen quite a lot in Asian populations where they don't have external signs of fat, but on the inside, it's really important. So yeah, you were a great example, Jonathan. And it was a big shock to me, to be honest.
Jonathan Wolfe
It's like one of the things that really kickstarted my personal desire to really follow all the nutrition advice that we've sort of been working through with Zoe over the last few years, Because I sort of got interested in this actually because I'd had food intolerances. I know we're going to talk a little bit about your own experiences. But actually, that had pushed me to eating this, you know, very classic Western diet, amounts of refined carbohydrate. And I'd assumed that it was having no impact on me. So, it was really amazing to sort of realize that I was not as healthy on the inside as I had thought. And that's the first time I'd experienced this. (Time 0:08:11)
Crohn's Disease Overview
Crohn's disease, a type of IBD, affects the GI tract and is prevalent in Westernized societies.
It involves chronic inflammation, pain, food avoidance, and frequent bowel movements.
Transcript:
Suzanne Devkota
Graduate school, I was in an inflammatory bowel diseases lab. But my background is actually in nutrition and metabolism. So I was formally trained in studying metabolic diseases. And it's a long story, but I ended up in an inflammatory bowel diseases lab. And I said, okay, how can I bring these two worlds together? And so we really wanted to understand nutrition in chronic intestinal inflammation, but studying it through the lens of the microbiome. And how can the diets we eat shape the microbiome and then either potentially drive or prevent inflammation in the gut? That got me into IBD and I continued that work until through today. And I have learned a lot about, you know, no disease is one thing. You know, there's many different subtypes of disease, and it's true in obesity and diabetes, and it's true in IBD. And so I think that has been a big fascination for me in understanding where nutrition and the gut microbiome can help stratify these different subgroups. And IBD is really two diseases. It's Crohn's disease and ulcerative colitis. They affect different parts of the GI tract. They manifest differently.
Jonathan Wolfe
And Suzanne, the GI tract is?
Suzanne Devkota
Oh, the gastrointestinal tract. So really, your GI tract is from your mouth to your anus, the whole tube. And Crohn's can affect anywhere in the GI tract, from the mouth to the anus. Ulcerative colitis affects the colon primarily. And we're interested in studying both of those, but we focus a bit more on Crohn's disease.
Jonathan Wolfe
And lots of people listening to this won't be familiar with Crohn's disease. So could you just help us out very simply, like, what is going on? Is it very common?
Suzanne Devkota
The epidemiology of it is very interesting. How, where in the world, you know, how it manifests in different populations. It's definitely most prevalent in Western populations. Although it is increasing in countries that are becoming more Westernized. And diet is one of the things that is pointed to for that. Diet and lifestyle. So all the things that come with living a Western lifestyle, sedentary and poor diet and processed foods. There is a genetic component to it. So we say that with Crohn's and Clyde, it's a multi-hit disease. Not one thing will cause it. You need more than one thing. Often it's a combination of genetics, microbiome, unusual immune response, and the environment. And it could be any two or more combinations of those items can trigger the disease. Beyond that, we honestly don't know. You know, for every person who comes in with a new diagnosis, what caused it are usually very different. And so it's really hard to say this causes IBD.
Jonathan Wolfe
And could you give us a sense of what it's like to be living with Crohn's?
Suzanne Devkota
Yeah, it's pretty awful. So chronic inflammation, you'll feel it. You'll have pain. You won't want to eat. Often individuals who have Crohn's or colitis tend to be thin just because they're still trying to figure out what food triggers they have. They don't know, so they just avoid to avoid the pain. It's a common, you know, we would all do that, I think. Although it is kind of changing, there is more and more co-occurrence of obesity with IBD, but typically IBD patients are pretty lean because of the food avoidance. (Time 0:11:43)
Creeping Fat and Crohn's
In Crohn's disease, bacteria translocate from the gut to the surrounding fat tissue.
This "creeping fat" phenomenon is unique to Crohn's and guides surgical decisions.
Transcript:
Suzanne Devkota
Study came about by kind of accident, as many do. I had been interested in looking at bacteria and fat tissue under this broad umbrella of just, do bacteria leave the gut and go into other places, which is a difficult question to address Scientifically because you're always trying to manage contamination and things like that. But it has been observed by many, many people that bacteria can be recovered independent of sepsis, traditional blood infections of bacteria. People have reported recovering bacteria from the liver and other places. And so when I joined Cedars-Sinai in the gastrointestinal department, I was presenting some of our mouse work on bacterial translocation, actually in obesity. And there was a colorectal surgeon in the audience who we work with closely today who said, what about creeping fat? And creeping fat is this very, and we'll talk about it a little bit more, but this unusual manifestation of visceral fat attached to the gut that is unique to Crohn's disease. And it expands and wraps around the intestine when there is inflammation inside the intestine. It's been this long surgical mystery, but surgeons, when they have to do surgery on a patient to remove part of their intestine, they look for this fat wrapping as a demarcation for where They should cut. And I said, well, that's really interesting, but where would I get these patients and these samples? And he said, well, I can get them for you. I see them every week. And that started probably an eight-year collaboration with Phil Fleschner. And we've collected probably over 200 patients. COVID slowed that down a little bit, but collected surgical samples from individuals who are going in to get part of their intestines removed. And people have been observing this for a long time. We know there's chronic inflammation going on. Could it be that microbes in the intestine are leaving the gut because of this chronic barrier disruption. The intestine, when it gets inflamed, the barrier that keeps everything in the gut becomes loose and quote-unquote leaky.
Jonathan Wolfe
Normally, should any bacteria be coming out of my gut and going into the rest of my body?
Suzanne Devkota
Well, that's something interesting that we found through this study is actually bacterial translocation is very normal in all of us. It happens. But when you have a normal working immune system, it's really of little consequence. You clear them and it's no issue. We would find bacteria in the fat of healthy tissues as well.
Jonathan Wolfe
You're saying in a normal healthy person, actually some of the bacteria is like sneaking through the gut and into the sort of surrounds of my gut all the time. But it's just that my immune system is sort of zapping it before it goes off and causes some horrible infection or something. Is that?
Suzanne Devkota
Correct. Yes. And it's very different types of bacteria in healthy individuals that are translocating than what we see in our IBD patients. So it's a factor of having a competent immune system and actually different bugs that tend to be more, quote unquote, benign from our experience. Bacteria are not trying to cause disease. A lot of what we study are accidents, being at the wrong place at the wrong time, but it persists and you get disease. Microbes really aren't trying to harm their host. It doesn't benefit them, but things happen. We might change our diet suddenly because we travel, and that can cause short-term defects in our gut barrier. It's not a major consequence. We self-repair, but you can get these periods of leakiness through simple things that we do in our day-to life, and those are probably the moments when bacteria translocate. But we really don't see, when we look at that tissue, any abnormalities like what we see in our (Time 0:17:20)
Bacteria in Fat Tissue
Bacteria found living in the fat tissue of Crohn's patients originated from the gut.
These bacteria are genetically adapted to metabolize lipids.
Transcript:
Jonathan Wolfe
Tell me what you found at the end of these eight years and all of these samples. What was the discovery?
Suzanne Devkota
So the big mystery was how does fat tissue on the outside of the intestine know where this inflammation is on the inside of the intestine? Because the fat's only wrapping there. If you go just two centimeters over to the healthy gut, there's no fat wrapping there. So there's this migration and there's some signal, you know, some communication between the gut and the fat. And as a microbiome researcher, I said, could it be that microbes are the signal, whether microbes directly translocating or some byproduct from the microbiome seeping into the fat Tissue? And so we asked, okay, let's take fat tissue from these patients. We had the gut and we had the fat attached. We sampled from the gut by sequencing and by cultivation in parallel because we wanted to see not just is there dead bacteria. We want to see if there are live bacteria there. So we would cultivate in parallel from the gut and the fat. And we were absolutely stunned to find the sheer numbers and diversity of different bacteria living in the fat tissue. And these were all organisms that live in the gut. So these were not skin bugs. These were not mouth bugs. These were the same bacteria that we're also recovering from the intestine. So the fat tissue is not a normal home for bacteria. We confirm they are coming from the gut. But clearly some will go and die and some will go and survive. And we're really fascinated in the ones that are able to go and continue living. And the work that we have continued from our originally published study is really diving deep into looking at these organisms that are surviving in fat tissue. And what we're finding is they have a very different genetic makeup than other bacteria in the gut. Namely, they have a much larger number of lipid metabolizing genes. So they can use fat more readily when presented with an environment that's rich in fat.
Jonathan Wolfe
Suzanne, just help me to understand that for a minute. I think, first of all, you're saying you did all this analysis and the answer is these bugs were still living in the fat outside of the gut. So they're like happily there munching on, well, if this was me, me, effectively, is that what you're saying? Yes. You're fat.
Suzanne Devkota
You're fat.
Jonathan Wolfe
And so they're like specially, when you said they're like lipid optimized, that's science to speak for like they eat fat particularly.
Suzanne Devkota
They can use fat for fuel. Yeah.
Jonathan Wolfe
So they literally manage to escape from the gut, get into your fat, and then they just start eating you from the inside out, which sounds like it might be this amazing new drug, but I'm Guessing it's not where you want it or in the right way, you know, before anyone is suddenly thinking this is... (Time 0:21:12)
Fat as a Band-Aid
Fat tissue acts as a "band-aid," expanding to contain translocated bacteria, preventing their spread.
This suggests fat tissue plays an active role in the immune response.
Transcript:
Suzanne Devkota
What we actually found is a feedback mechanism. So the fat, what it is actually doing is responding to the presence of microbes. So microbes, as I mentioned earlier, do not belong in fat tissue. And so the immune cells and the fat, you know, the stem cells in the fat and so on, when they see the bacteria there, part of the, and this is what we've been working on the lab for some time, Is the fat is actually acting like the body's Band-Aid. It is saying, okay, there's a source of microbes coming in. There's a breach somewhere. Let's migrate to that spot and grow around it. Okay. So as long as the microbes are actually stimulating this Band-Aid response. So it's, and because the way we discovered that was when we looked in the blood of these patients, we did not see bacterial products in the blood. They looked like healthy people.
Jonathan Wolfe
So Suzanne, you're basically saying that I'm actually going to grow more fat to sort of wrap around this bacteria that's where it shouldn't be, almost like sort of encase it.
Suzanne Devkota
Encasing to protect the body from having bacteria spread everywhere. And so this visceral fat attached to organs, what we're proposing is that it's not just a vat for excess calories when we overconsume. It's actually, fat is this very dynamic response of active tissue that's doing more in our bodies. One of the things, one of the other things it may be doing is responding to bacteria to protect the body.
Tim Spector
So it's part of the immune system, really.
Suzanne Devkota
Yeah, and you could view it that way. (Time 0:24:17)
Gut Microbiome and Immune System
70-80% of immune cells reside in the lower intestine, constantly interacting with gut microbes.
A healthy gut microbiome is crucial for a well-functioning immune system, impacting overall health.
Transcript:
Jonathan Wolfe
What do we know about how the immune system is influenced by the gut microbiome? Hugely.
Tim Spector
Most of our immune system is around our gut, our intestines. So 70 to 80% of all the immune cells in our body are actually in the lower intestine where all our microbes are, and that's not chance. So they're interacting all the time along this gut barrier. And it's a two-way communication. So they're always talking to each other via chemicals. And this means that the immune system is sensing what the microbes are telling them all the time, which is a sort of gauge to the outside world. So, you know, what you're eating and the general health of the host is coming in all the time, these signals, which means that the immune system can then respond properly and see off threats Of infection. Hi, I have a small favor to ask.
Jonathan Wolfe
We want this podcast to reach as many people as possible as we continue our mission to improve the health of millions. And watching this show grow is what motivates the whole team at Zoe to keep up the really hard work of creating new episodes each week. So right now, if you could share a link to the show with one friend who would benefit from today's information, it would mean a great deal to me. Thank you. So what do we currently know about the relationship between the immune system and the bacteria in our gut?
Tim Spector
We know they're intimately connected, and one is crucial for the other one functioning. We can't have a proper immune without gut microbes and vice versa. We need both to survive, and they need to be seen as part of the same system. Over 70% of all the immune cells in our body are concentrated in the lower intestine, where all our gut microbes are. And they're constantly talking to each other, usually through chemicals that are produced from the microbes and then chemicals that are produced from the immune cells that are lining The gut. And this means that we have an immune system that is protecting us, is making sure we don't overreact to allergy, foreign, you know, we don't think every time we eat food that it's an invader, So we don't overreact. It stops us getting autoimmune disease. And yet, when there's an infection, we can really deal with it. And so the immune system is also important for us, surveillance, to help us fight accelerated aging, clear up damage from cells, fight cancer, does everything. And probably also is really important even for mental health as well, because it controls inflammation and the idea that everything needs to be nice and calm for us to function efficiently. And if things are out of sync, if the immune system has been getting messages from the microbes that things aren't quite right, it just ramps everything up a notch, like the thermostat Going up. So it's constantly looking for a fight, and that's really why there's such a close connection between them. So we never really realized this until just a few years ago about how important it is then that having a really healthy gut microbes means that your immune system is then functioning Optimally and then can help us. And in a way, why it fails and you get these autoimmune diseases like Crohn's or ulcerative colitis or allergies or whatever, is part of this process, that something breaks down in this Connection. So really important for all of us to have a really well-functioning immune system, which means that everything is efficient and we deal with problems, but then everything goes down To a nice quiet level. Whereas, unfortunately, at the moment, most of us have a slight increased, you know, we're at a DEF CON level that's not the right one. We think there's some emergency going on in our bodies, and this is the sort of Western diet, Western way of life. (Time 0:31:02)
Early Life Microbiome and Immunity
Immune system development begins at birth, influenced by microbes from the mother.
Early exposure to diverse foods and environments is crucial for training a robust immune system.
Transcript:
Suzanne Devkota
Education of our immune system by a microbe starts from the moment we're born. Looking at the early life, you know, microbiome, the first year of life tells you a lot about the interactions with the immune system and the gut microbiome. There's a lot of research now on this really critical window where a baby is born essentially sterile, no microbes, until they get the first bugs from their mother. And immune cells, as more bacteria start to colonize the gut, so do more immune cells start to develop in the intestines as well. And what's really interesting is there's this weaning period, weaning meaning when you go from breast or formula onto your native diet or table foods or adult diet. And that introduction of food, you had this rapid expansion of immune cells in the infant. And a lot of that is attributed to the more diverse foods you eat, the more diverse microbes that colonize the gut. And so there's this beautiful evolutionary conserved interplay between microbes colonizing immune cells growing, which you want. That's a good thing. You want diverse immune cells so that when you grow up and see different foods, as Tim said, and different life exposures, you don't react and auto-react. And so there's a lot of studies saying, okay, what happens when we mess that up and we give babies a lot of antibiotics early in life or something like that? And studies show that their immune system doesn't develop as well as their microbes don't also. And the hypothesis being, could that be predisposing infants, children to autoimmune conditions, airway allergies, food allergies, and so on? (Time 0:35:18)
Dietary Diversity for Gut Health
Maintain gut health by consuming a diverse diet rich in fiber.
Aim for 40+ different plant sources weekly for a robust microbiome.
Transcript:
Suzanne Devkota
From our work, you know, in studying translocation, it really starts in the gut, you know, and healing the gut and maintaining a healthy gut barrier. And so foods that help support the integrity of the gut is really where it's at. And so then how do you do that? In my view, it is having, you need a lot of functional redundancy. What that means is you need a lot of diversity, which is a crude measure, but many different kinds of bacteria, their presence means that you have a lot of functions that can be carried Out. And if you do something inadvertently to your microbiome and one drops out, you have others there to carry out those functions. And so, how do you create diversity? We kind of touched on it earlier, but that is really a diversity of your diet. There's been some interesting research from the Microseta Initiative where they looked at microbiomes around the world and really looked at metrics of, you know, diversity and associations With disease. And what they found is the diversity of plants in your diet relate to the more diverse microbiome. And they found that individuals who consume 40 or more different plant sources within their diet in a given week had a more diverse, robust microbiome. And plant sources come in all forms. And so what does that do to? Well, it's probably the fiber content of the diet. And fiber is really the key. It's not sexy. It sounds boring, but it is critically important. And there's a lot of deep research on what fiber does to certain microbes, what those microbes do with the fiber. And they relate to everything from educating the immune system, which we talked about earlier, to maintaining an anaerobic environment, a low-oxygen environment in the gut, which Is key for maintaining a gut barrier. So it's all cyclical, but it really starts with the diet. And feeding your good microbes through fiber, in my opinion, is you can't get around that. Would (Time 0:49:03)
Fermented Foods and Ultra-Processed Food
Consume fermented foods regularly (at least three times daily) to reduce inflammation.
Minimize ultra-processed food intake to less than 10% of your diet.
Transcript:
Tim Spector
You add, Tim? Two things. I think fermented food has been shown, thanks to a study from Stanford, to have anti-inflammatory effects, which means we get this boost of extra microbes that are in food and the probiotics In food. If you have them regularly, and we're talking at least probably three times a day, you're getting a sample of it, can dampen down inflammation, keep your immune system in much better Shape, less likely to cause these problems, which that visceral fat we think thrives off. So I think the idea is to keep that inflammation down. And the other thing, in addition to what Suzanne said, is avoiding ultra-processed foods as much as possible. It's probably impossible to cut them out completely, but get it down to less than 10% of your diet so that you're getting many whole foods, because we know that there's a pro-inflammatory Reaction when you're having a lot of these foods and it causes problems for your gut microbes as well as depriving them of fiber and normal nutrients. So that's what everybody should be aiming at is to shift more towards real food, less fake foods in their diet plus getting more different fermented foods in their diet. (Time 0:51:10)
Choosing Fermented Foods
Fermented foods offer benefits beyond live microbes, including postbiotics.
Prioritize fermented dairy and vegetables, but be cautious of non-fermented pickles.
Transcript:
Suzanne Devkota
And just to add to that, I'm a big fan of fermented foods. Thank you for adding that in. The additional benefit to the fermented foods that we don't talk as much about is not just microbes in them, but all the post-biotic the microbes are producing. Fermentive foods are like a living food. And so you're getting not just live bacteria, but you're getting this sort of soup of all these beneficial products the microbes are making. And then when you consume it, you get the benefit of those chemicals as well. So there's multiple benefits. Immune soup.
Jonathan Wolfe
Immune soup, yeah. I love that. I absolutely love that. For anyone listening to this, do you have any easy fermented recipes that they could get started with having sold on the benefit of the immune soup?
Tim Spector
They don't get any easier than some of these. So everyone should be able to make sauerkraut is the one I go for, which is you take a cabbage, you slice it up, you weigh it, you mix it with 2% salt and stuff it in a jar and wait for a week. I mean, what's easier than that? Anything easier than that might be to get some milk kefir or kefir, and you buy a good one from a store. When you're running out, you keep the last inch of it, and you add that to a bottle of fresh milk, and then you keep that out on the counter for over 24 hours until it changes and goes solid. And then you've got some more kefir to last you.
Jonathan Wolfe
So you've literally just taken the previous kefir and made a new kefir. Without having to the expense of going to the store, yeah.
Tim Spector
So that's called back slopping. I did not know that. Which is a bit of a, yeah, the name needs a bit of working on. But that's the technical term. So they're my two tips. Have you any other favorite ferments?
Suzanne Devkota
If I'm honest, I buy mine. But you mentioned the Stanford study that looked at the benefits of fermented foods. And when they looked at different fermented foods on a scale of the ones that had the most benefit, it was fermented dairy and vegetable brine, which you can actually buy. For those of you who don't or don't have the ability to make your own, you can buy vegetable brine at the store as well. It's a certain acquired taste, but you can get these things. And it may vary depending on where in the world you live. But the dairy and the fermented vegetables seem to have greatest benefit. And so kefir is great and certain Greek yogurts and kimchi, sauerkraut, all of those are really fantastic. But be wary of pickles. Not all pickles are fermented. And so you want to kind of pay attention to, usually they'll be labeled a little bit differently if they are truly fermented.
Jonathan Wolfe
I've heard people say that it doesn't guarantee it, but the fact that it's in the fridge or something, it's definitely a suggestion that there's something alive, but people cheat now, And so they put the dead thing in the fridge to make you think about it, so you still have to read the label.
Suzanne Devkota
Right, exactly. Got (Time 0:52:25)
Gut Repopulation after Antibiotics
After antibiotics, focus on dietary diversity for gut repopulation rather than probiotics.
Probiotics may delay natural recolonization, so prioritize diverse whole foods.
Transcript:
Jonathan Wolfe
As we think about actionable advice, and I know this comes up a lot through your work, what's your advice for repopulating?
Suzanne Devkota
I used to be in the camp that actively recommended probiotics, especially after a course of antibiotics. I don't recommend that anymore, mainly because most people haven't tested their microbiome and know what they might be missing. If you have tested it and you have an obvious depletion of a certain beneficial microbe, then a probiotic could be helpful. But in the absence of that, I advise people, again, it isn't going to sound like a broken record, but eating a diversity of foods. Your microbes will repopulate. They will come back. Largely similar to where you were, there's been studies showing that if you take antibiotics, you might go to a new normal. It may not necessarily be bad, but it might be different than where you started. But really the key is repopulating. And bugs, their function is carried out by what you give them, essentially. And so if you eat a lot of diverse foods, you will support many diverse bacteria in your gut. And generally, if you are eating, you know, diverse could be spam and a lot of processed, you know, candy and things like that. I don't necessarily mean diversity in that sense, but diverse common sense. You know, we know what a healthy diet looks like, and really expanding within that concept is a diverse diet. And so after, of course, antibiotics, I would try to bring back, really focus on, you know, your salads and your, you know, different proteins and different carb grains and things like That in your diet, maybe more so than you would normally in that window of repopulation.
Jonathan Wolfe
And that's because you have a concern that potentially the probiotics, not just that they're neutral, they might actually potentially be harmful in the process you're describing?
Suzanne Devkota
There has been some studies suggesting that taking a probiotic after antibiotics can actually delay normal recolonization of your gut. And there's the very specific disease conditions where a probiotic can actually be not good for your immune system, but those are rare cases. But it's really just going off of some papers that have come out suggesting that it may delay the normal recolonization compared to just diet alone. Thank (Time 0:55:42)
