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As humans, we've discovered so many new things on this planet.
We've even flown to the moon.
But hardly anyone has really adventured into their own gut.
We feel a lot of shame about our gut.
But it influences so much about our health.
About how we feel, if we are overweight or not,
what kind of diseases we can get,
how our immune system is being trained,
and, really with that, the course of our lives.
The nation got a report card on obesity today, and the country flunked.
Rates of colorectal cancer... Heart disease...
- [reporter 3] Irritable bowel syndrome... - [reporter 4] Increase in autism...
...depression, anxiety are skyrocketing.
What is healthy?
Why is eating painful?
What changes do I need to do to get healthy?
Why's it so hard for me to lose weight?
How do I still not know what's right for my body?
How do I fix my gut?
Do I have to spend $100 a month on supplements?
Mmm!
There's a lot of noise thrown at us.
Is it diet? Is it carbohydrates? Is it no diet?
- And if you just look at... ...the gut...
...all this gets much easier to understand.
We really just think about our gut as a place where our poop comes from.
But it turns out to be the center of a biomedical revolution.
Diseases like anxiety, and depression, cancer,
autism, Parkinson's are all related to the gut.
Huh?
This is new science, tip of the iceberg.
There's another 97% left to discover.
♪ I've got a gut feeling ♪
We're getting to the point where we can make a more precise definition
about what you should eat.
♪ I've got a gut feeling, feeling ♪
The gut is flexible. It really changes when we change the way we eat.
And once we've realized that, everything changes.
Until I was 16 or 17,
I was just as confused by my gut as everyone else.
I couldn't deal with lactose.
I had a skin disease.
I was suddenly chubby as a child,
although there was no apparent reason for it.
And so I read a lot about the gut,
and I realized that when you really look at the organ,
you find so many of those answers.
One morning, my roommate came into the kitchen and asked me,
"Giulia, you love the gut. You talk about it all the time."
"How does pooping work?"
And I had no idea.
So, I went up to my room, and I looked in, like, three books,
and when I found out, I was like, "What?"
"Even this part is really cool about it."
There's nothing to shy away from, really. All of it is cool.
We feel guilty and shame a lot when it comes to our gut.
And it's completely crazy when you think about it,
'cause this is the organ that keeps you alive.
And as soon as you just know a few facts, you feel a lot of respect for it.
Science can help us navigate the questions about our health.
I remember when I did this the first time with Professor Krammer, and he just said,
"See? Everybody looks the same inside."
We start with the esophagus.
It'll transport food to the stomach,
which passes it on to the small intestine.
What's left goes to the large intestine, the colon.
And whatever we really don't need goes out of the butthole.
And then we're done.
Gut science has been the hottest area in all of biomedicine
for the last decade or more.
It is the missing part of the puzzle.
Our gut affects our whole body.
It can even affect certain conditions in the brain.
Wow!
We've known for hundreds of years that this is so important.
All we have to do is look to our language.
When we're disappointed, we're gutted. When we're brave, we make gutsy moves.
When we have... we're nervous, we have butterflies in our tummy.
The gut really is the second brain.
Wow!
And from an evolutionary perspective, our brains have never existed
without signals coming from the gut.
I'm being swallowed by my gut.
I mean, you know, it's the gut fights back.
This whole field is disrupting modern medicine.
This is an exhibit that's based on a book
that my sister and I did about the gut.
And the purpose of it is to just turn the inside out.
This is probably better.
This is much more accurate, actually, when you look at it like this.
The intestinal tract, it's not a straight thing.
It's a bit, you know, crooked here, crooked there.
The stomach, for example, it goes like this.
So on top of it, there's an air bubble.
So when you really have a lot of air in your stomach,
and you want to get it out, lay on your left side
because then the air bubble actually can go out quite nicely.
Whee!
And then if I were a food particle, and I would arrive at the small intestine,
then all these folds and villi would stick out,
and I would be like, "Ah!"
And I could be, like, digested and be taken up into the blood.
What's interesting is that we can't digest on our own.
We need microbes in order to do that properly.
The tiniest virus works with the small bacteria,
works with a much larger yeast, works with a super big human,
and this is what we call the microbiome.
Most people think that bacteria are bad,
but, actually, 99% of them don't do anything to us,
and some can even help us.
Some bacteria have more important roles than we could have imagined.
If we let them live on us, they'll actually lend us their skills.
They help with digesting our food.
Yummy!
They help to quiet inflammation and make the immune system less likely
to cause autoimmune disease.
Approximately 70% of our immune system lives in our gut.
Bacteria train that immune system
to respond to bad organisms that might have a consequence on health.
Ouch!
They help produce chemicals which we can't.
Microbes can shape our hormones, and they can make us feel hungry or full.
They can be communicating with the brain. They're communicating with other organs.
They shape our brain early in life and as we get older.
If you looked at the genes in and on our bodies,
we would be more than 99% microbial.
We oftentimes believe that our human genes determine our health,
but now we know that the microbiome is very central to being obese,
being depressed, having allergies, or how stressed or relaxed you'll feel.
We don't know how big is the part that it plays in these entities.
For some people, it might be really relevant,
and for others, it might be smaller.
Take one.
Thank you.
We may not want to admit it,
but we all have problems with our gut from time to time.
People differ in their relationship to food,
in their diseases, in their response to medication,
in their overall life history.
If I eat pretty much anything that's not vegetables,
I start getting stomach pains, which makes my job incredibly difficult.
You realize how much you took for granted.
Like something as simple as being able to poop.
I've had to learn to become grateful for the tiniest things.
I've tried to control my weight all kind of ways,
but I would lose a lot,
and I would gain a whole lot more.
I hear people say they're hungry,
and they look very happy after they've eaten.
I'm jealous of those people because I no longer feel hunger.
We're trying to understand what's going on
with all this variance that makes people different.
We think the microbiome is key to that.
In order for us to understand our differences,
we have to first look at where our microbes come from.
You're born largely without microbes.
Microbes colonize you once you enter the world.
When we're born, this is really the moment where it tips off everything.
When a baby is born vaginally,
they're being exposed to the bacteria in the mom's vagina.
And then, when you come out,
the face is going down in the direction to the butt.
You also get some gut bacteria because you're so close by the butt
that you already get your first microbial colonists.
And they start making this a habitable place to live
for other microbes.
We shape our microbiome by all the little choices and adventures
we have in our life.
Whoever we kiss, what we put in our mouth, where we travel.
The food you eat,
the relationships you have with your siblings,
whether you have pets, exercise, stress,
your experiences when you were a child, whether you had adversity or not.
Because of this, everybody has a unique microbiome.
So it's sort of this collection of microbial memories.
Knowing that the microbiome could be the key to health is really exciting,
because you can't change your genes,
but all of us have the ability to change our own microbes
through simple changes to our diet and our lifestyle.
Perfectly greasy. Oh my God.
The industrialized microbiome is probably pretty unhealthy
and may be pushing us towards a lot of our most common and serious diseases.
That could result in a lot of these chronic diseases
that are very, very prevalent,
like obesity, diabetes,
hypertension, food allergies.
So, I think the way we think about disease needs to change.
Big changes to our environment, Western diet,
the way babies are born, C-sections,
baby formula,
sanitation, antibiotics
all lead to decreased microbiome diversity.
Exactly what we see in the industrialized microbiome.
I was a C-section baby, who was breastfed for...
I'm not entirely sure for how long.
I'm always running for my children or my job,
so I'm always super stressed out.
Five-time Nathan's Famous champion, Takeru Kobayashi!
I don't think there's anything healthy
about what I do.
I wonder what damage I've done to my body.
It does make me kind of wonder
how that affects your health and what that does to your microbiome.
We've lost hundreds of species in our gut.
They've gone extinct.
And what we're realizing now is that the most important factors
of determining the health of this microbial community is your diet.
There are some major deficiencies in the typical American diet,
even the typical American diet that's healthy.
Currently in the States, nearly 60% of all the calories eaten
are ultra-processed food.
The food is ultra-refined.
It's been stripped of all its nutrients of the original natural ingredients,
and then they add back in all types of chemicals
and large amounts of sugars.
But people are confused about what to eat because it's made to look healthy
by adding labels on the packet that say this is low-cal
and therefore healthy, or this has extra vitamins.
When you look at some of these labels in detail,
really hard to work out what's actually inside them.
That's actually not too bad, that one.
It's not? I looked at it. It has tons of sugar.
Does it? I couldn't see.
It's 30% sugar. Yep.
Just looking at this, it's fiber-packed,
it's got fruit and nuts, it's got dark chocolate, it's got sea salt.
This to me, first look, it looks pretty good.
It's only when you look into the ingredients,
you see, "Oh! That is far too sugary."
You... You see? I was fooled.
It's hard to navigate what you should be eating
because you go to the supermarket,
and the lists of powders and tonics and things that you need just grows.
Can chlorophyll prevent cancer?
Medicinal mushrooms...
- [reporter 3] Red wine's healthy... Probiotics for your vagina.
Spirulina. Chocolate.
Collagen. Blueberry extract. Coffee!
So, yeah. I find the food world and wellness culture incredibly confusing.
Today we're gonna make teriyaki chicken.
We have... We have garlic, ginger, sugar,
soy sauce, sesame oil, and onions.
-First, you... - You have great confidence, I have to say.
- I was a confident cook when I was four.
Some soy sauce, a lot of ginger because we can't get enough of that ginger.
All of the garlic,
because we never can get enough of garlic either.
Cooking and food is truly in my blood,
and it's something I've been doing since I was really little.
And now it's my passion and my art and my career.
I received my first Michelin star when I was 23.
I won Eater's Hottest Chef. So ridiculous that that was even a thing.
But you do feel the need to cultivate this image
of the goth, cute pastry chef with tattoos.
There was just a massive amount of pressure on me,
and so then I kind of just let it get out of control.
I was really anorexic for a long time.
But now, my eating disorder has kind of shifted to orthorexia,
where I'm very obsessed with wellness and maximizing your nutrition.
So this is, yeah, like, guarana, suma, reishi, lion's mane,
Cordyceps, the spirulina, Chlorella, moringa.
Basically, I eat a lot of vegetables
and then supplement it with potions and powders
and things that the Internet tells me that I probably need.
I have taken so many things out of my diet
and tried to reintroduce, you know, "fun foods."
But when I eat sugar, pork, butter, things like that,
then I feel bloated, and I feel like I have to throw up
for three, four days afterwards.
Which is really hard because I am trying to fix my relationship with food.
And then when it feels like your body is betraying you,
it's, um...
It's hard to... to get past that.
I think ultimately I would really love to know
what I should be eating, or what I shouldn't be eating,
and what healthy is for me, specifically.
When my patients ask me, "What makes a microbiome healthy?"
I like to compare it to a forest.
You can't put a few healthy plants in it and expect everything to change.
A forest needs a healthy balance
where the plants and the life can be okay with the circumstances,
with the light, with the water, with the nutrients from the soil
and function together.
Our gut bacteria, they want just a few grams of fiber
from vegetables and fruits every day,
and it's weird that it's so hard for us to manage this.
Current recommendations in the United States suggest
that we should be eating 28 to 40 grams of dietary fiber per day.
And we're only eating 15 grams in the average American diet.
The field of microbiome science is realizing
that we probably should be eating in excess of 50 grams per day.
How much fiber is in one hot dog?
What? Zero grams!
Whether you have meat on your plate or not...
You can be vegan, non-vegan. Doesn't matter.
The key is getting the diversity of plants in all their forms,
as many as you can on your plate to feed your microbes.
Why should I eat my veggies? You know?
I'm a big fan of understanding this. Of course, there are many nutrients in it,
and not so many bad things that are in processed foods.
But also if the front part of your body was see-through,
you could actually see digestion, and you would be able to very easily see
the difference between processed foods and vegetables.
With processed foods, you could see
that within the first centimeters of the small intestine,
it's basically all taken up in the blood.
There's a surge of sugar in the bloodstream,
and we have to pack it in the cells really fast.
It's, like, almost a stressful event, actually, for the body,
because, "Where should I put all this sugar?" You know?
It has to really push it everywhere.
But with the fiber that we have in vegetables,
it's just more stable.
It would be taken up a little bit, go further,
be taken up a little bit, go further.
It would even land in the colon
and would be a good source of food for the microbes there.
Delicious!
So it's a completely different mode of digesting.
You know, like a long walk instead of sprinting.
If a gut microbiome is very diverse, has many different kinds of bacteria,
it'll just have this bouquet of possibilities
to react to what life throws at us.
Kobayashi continues to just pound 'em down.
Putting on a clinic. Look at him go. He's moving his arms and...
So what happens if we don't eat enough fiber to feed these microbes?
Takeru Kobayashi!
If you're not feeding your gut microbes dietary fiber,
your gut microbes will start eating you.
All these microbes are great. They help your body a lot.
But they're also microbes.
So there has to be a friendly border of respect, and this is produced by mucus.
Mucus is a good way of doing that because it's also a bit permeable,
so nutrients and everything can come through,
but the microbes are being held a little bit distant.
Well, it turns out if you stop eating dietary fiber...
No! No! No!
...the gut microbes still need to eat something,
so they will start eating that mucus lining as a backup food source.
And gradually, over time, they'll deplete that mucus lining.
Your bacteria are going to places in the body
where they're not supposed to go.
And when immune cells that reside there see that,
- they go into a defense mode.
And this can cause a battle of inflammation,
and it can change the microbial composition of your gut.
And that is one of the things that can lead to many diseases
like inflammatory bowel disease,
or some types of irritable bowel syndrome.
When we started to explore chronic inflammatory diseases,
scientists had this thought of,
can we find the microbe or the microbial community
that makes this disease or creates that feeling that's bad?
But now when we think about how this ecosystem interacts,
we have this newer approach where we also ask ourselves
if we are missing certain bacteria that are usually there to protect us.
My name is Daniell Koepke,
and I am a clinical psychology doctoral student.
It's really hard for me to remember what it was like to eat food
before it became associated with anxiety and pain and discomfort.
When I was in undergrad, I had a pretty bad diet.
And that diet, the high-sugar foods
and the absence of more fruits and vegetables,
led to IBS-like symptoms.
So I was experiencing indigestion,
stabbing pains from trapped gas,
constipation, not being able to go to the bathroom at all.
When you have multiple gut symptoms that can't be easily put into a box,
a lot of doctors don't know what to do.
Antibiotics are given out like candy.
"You don't feel good or think you might have this thing?"
"Here. Take some antibiotics."
In the last five years, I've been on six rounds of antibiotics in a year.
I lost a lot of weight when I started getting sick
and had to cut all of these things out of my diet.
I don't know how many things I can eat now,
but it's probably anywhere between 10 and 15.
It feels really limiting, and I often feel really deprived.
So I have to take these supplements to maintain my baseline functioning.
These are even more supplements that...
...I've taken in the past that no longer work. Um...
I know that pills aren't the answer,
but I feel stuck because I don't know how to grow these new bacteria that I need
when I can't eat a lot of these foods, uh,
that are required to, like, have a healthy gut microbiome.
If we cut foods out of our diet, we'll change our microbes drastically,
because who can live there if you don't feed them?
And if we want to reintroduce fiber,
we'll have a far more difficult time.
So people who suddenly eat healthy again will be bloated,
will have some stomach pain.
So it's a process of changing their diet, but not too drastically,
in a way that all the microbes in the gut can adjust.
Since I've had such a restrictive diet,
I wonder was I also starving the microbes in my body at the same time?
And has that changed how my body can process foods,
and does that mean, like, my future,
I'm always going to have issues with eating something,
or is it partially a mental block?
I'm not really sure... ...what's going on.
It's something that I would love to actually learn more about.
Oh. Cool.
It's like Christmas.
I wonder what this is.
Oh no.
It's weird. All of a sudden, I don't care about being healthy anymore.
"Collect one scoop of solid stool..."
"...or four scoops of liquid..." Ooh!
"...into tube."
"Mix well."
It's like the world's grossest recipe.
Ooh! This is like a spoon.
I guess you do this.
I've always found the idea
of gut testing really fascinating.
It would be awesome if I could understand
what's happening in my own body.
I've tried so many different things to lose weight.
Hopefully, this might be the thing for me.
I want the test to tell me why I don't have an appetite.
And about the relationship between my organs and eating.
I've never had my gut microbiome tested.
I don't think, at this point of time, it makes a lot of sense.
All the things you can do to have a healthy gut,
eating differently, treating your gut nicer,
you can do them without having an analysis first.
But if you just want to do a fun experiment, go ahead.
And for research, it's a great tool.
At the beginning of microbiome science,
we were really our own guinea pigs.
So myself and my colleagues were collecting our own poop
and sticking it in freezers.
So you take a little piece of used toilet paper, you color the piece you swab
with a little bit of poop, make it a bit brown,
then we extract the DNA from that.
But now we've expanded to thousands of thousands of samples
from thousands of people around the United States
and, indeed, around the world now.
If you gave me your microbiome sample, I wouldn't be able to tell you
a hell of a lot about how sick or healthy you are.
I can only do that by comparing you to a really large group of people
and seeing how you fit.
Does your microbiome look like people who have asthma?
Do you have asthma?
Does your microbiome look like people who are obese?
Are you obese?
If that's true, then I can find a signature,
which can help me unpin that.
Each teaspoon of stool contains terabytes and terabytes of information
encoded in the DNA of the microbes.
So each dot on the screen represents all the complexity of the microbiome
of one person distilled just down to one point.
So what this display shows you
is what kinds of microbes are shared between samples.
So two samples that are close together
are ones that have very similar microbial communities,
whereas samples that are far apart
have entirely distinct communities from one another.
When we started studying the gut microbiome,
the field assumed
that if we looked at the gut microbiome of healthy Americans,
we would get a good picture of what a healthy microbiome is.
This visualization shows the differences between microbes
of the industrialized world down at the bottom,
versus the less industrial world up on the top there.
What you can see so clearly is how, in the non-industrialized microbiome,
you have more diversity.
So if we only focus on the Western world,
then we are not getting a full picture
of what a healthy gut microbiome composition looks like,
or looked like in the past.
It's difficult to walk here.
We're going to traditional communities
and asking people to donate their... their... their poop.
- Namaste. - Namaste.
When we go to communities
and say "Can we collect your poop?"
Most of the time people are like, "Oh no, no, no. Poop? No. Poop, no."
But when I explain to them what I'm doing, they're like, "Sure. Why not?"
It turns out that the gut microbiome of rural populations
have hundreds of more species
that we just don't see in the industrialized gut microbiome.
By studying populations that are still practicing traditional lives,
we will begin to understand
what microbes have been lost from industrial populations,
and how this is influencing our overall health.
We ready?
Hi, Maya. Nice to meet you.
So would you like to discuss your results now?
Sure. Yeah.
What we found in our studies is that overall, you're pretty healthy.
It's definitely above average.
All those vegetables you're eating every week have not gone to waste.
Cool.
You know, I've also struggled with having a disordered relationship with eating.
I've always been very, kind of, restrictive in my diet.
So, Maya, yeah, many people think like you,
that just having a really healthy kale salad every day
is going to keep them healthy.
That's not as healthy as we thought.
The more diversity you consume, the more rich your microbiome will be,
the more species of bacteria that will be present inside your gut.
And that does allow you to deal with allergies and intolerances better.
- Yeah. - It's not about restricting things.
It's about enlarging your world of foods that are possible for you to eat.
Well, I think part of the problem is that I have some kind of, like, mental blocks
for some foods, like pork,
and occasionally my stomach just reacts really poorly to it.
Is that something that I can overcome,
or is it just I'm never gonna eat bacon ever again in my entire life?
Oh! Don't say that. Sounds horrible.
- Yeah. It's a struggle, right? - Yeah.
We do think to alleviate it,
introducing these things in very small doses, microdosing,
and then building it up over time into large doses can play a role.
Try small amounts, you know, bring them into your diet.
And if you do that gradually over months,
you might start to regain the ability to eat a much wider range of foods.
I do really love the idea of microdosing chips, though.
Oh man. So do I now.
Yeah. Yay, that's so exciting.
I'm getting emotional thinking about it. I'm sorry.
But yeah, it's... it's been a really long, hard road.
I'm really excited by the idea of microdosing potato chips.
You know, just changing my diet a little bit at a time.
And it's been fun.
I mean, I eat, like, three potato chips a day sometimes,
and I don't feel bad.
It does make me wonder if I'm eating the right things,
or is it, something's changing chemically in my brain?
According to the world and all these graphs and charts,
because of my height and my weight, I'm considered morbidly obese.
I tried to control my weight before.
I went and got this expensive gym membership.
I've tried diets.
I've tried the weight loss medicine, and it didn't work for me.
I would lose a lot of weight at first, and then it just comes right back.
Diabetes runs in my family.
So even though I'm healthy now,
I wanna lose weight before any of that, you know, onsets in my life.
I wanna be here as long as I can for my kids.
Society, you know, makes women feel less than
because they're larger,
and I'm not looking to be skinny or 120 pounds, just more healthy.
I'm just gonna be this plus-size diva till the end.
♪ I'm feeling myself ♪
♪ Living it up, straight to the top I'm flexin', I'm flexin'... ♪
You can be positive in the body that you're in,
but also be conscious of your health because you ultimately need that.
♪ I'm flexin', flexin'... ♪
So my question about eating is,
what in the world are y'all eating that I'm not eating
that cause y'all to lose weight and not me?
As a physician, when we try to explain to our patients
why they're having such a hard time losing weight,
we have a tendency of blaming the individuals, blaming the patients.
The population has been doing what we were recommending
for many decades,
yet the obesity epidemic has not slowed down or reversed.
The word "diet" is really confusing.
Low-fat versus low-carb.
Most people understand it to be really a sprint that I'm gonna do
for some period of time to lose weight,
and then I can go back to my previous patterns
of eating whatever I want to eat.
But a diet, it's really about changing your lifestyle for life.
Another reason why diets don't work is that they really focus on the wrong thing.
And in that sense, they actually could be misdirecting us.
When we put these calorie labels on boxes,
we think, "Okay, this is the amount of energy
that we will all extract if we ate that same food."
But of course, that is not true.
If you would give an identical apple
to three different people,
each of these individuals would show a different response to the same apple.
You know I can't eat this, right?
They will each process it in a different way.
They will each extract different nutrients from it.
They will each extract different amounts of energies.
You go your whole life thinking, "Okay, it's calories."
"Me and you can eat the same thing,
and we should both have the same results, ultimately,"
and that's just not what it is.
So, rather than measuring the apple,
one needs to start measuring the people who eat the apple.
Now we focus on blood glucose levels
in the two hours after you eat a meal
because we understand that your blood sugar levels after a meal
are directly connected to weight loss and weight gain,
and also to the development of multiple diseases.
Good, good, good.
Some cream cheese.
I ought to check my sugar levels this morning.
Especially after that.
Let's see if I beat you.
Oh my God, you're going up really fast.
- Definitely beat you this time. Yeah.
Bagels have that effect on me.
That's okay for me.
One of the seminal works in the field of microbiome
was a study led by Jeff Gordon in which he took identical twins,
but one twin was obese, and the other was lean,
and he transplanted the gut bacteria from the obese twin
and the lean twin into mice.
The mice that received the bacteria from the obese twin
gained more weight on the same food as compared to mice
who received the bacteria of the lean twin.
And that's helping us to understand
why some people experience more difficulty losing weight.
For some people, you lose weight, put on weight,
lose weight, put on more weight, lose weight, put on even more weight,
and it keeps going up.
We think the microbiome is key to that.
You may have to go on a diet for 9 to 12 months
to reshape the ecosystem,
to prevent the weight from coming back with a vengeance
when you start eating a hamburger again.
Using the microbiome data that we collected from individuals,
we can start to predict which foods are the best for each person.
At least as far as blood sugar levels go.
Oysters, that's good.
Can't have eggplant sandwiches, that's bad.
For somebody like me where obsession is an issue...
...having scores is not necessarily helpful for me.
We should put hot dogs in there.
The hot dog and bun on its own is rated yellow.
- But that's not too bad, right? - It's not too bad, but also not good.
But it's better when it's with cheese and avocado.
Oh, I like avocado.
It's amazing.
The more toppings you add to it, the better.
Oh my God. Pork tenderloin.
So you mean to tell me pork is good?
Nobody better not tell me nothing else.
Hi, Kimmie!
Hi, Annie!
- Hi, Kimmie. Hi, Eran.
You know, you had asked before, like,
why is it that when you try to lose weight, you can't.
So when we looked at your microbiome,
we saw that you had a less diverse microbiome.
In particular, we noticed a specific type of bacteria,
it's known as Prevotella, you had zero.
Oh my goodness.
So people who have that pattern of no Prevotella
have a hard time losing weight.
Then the other thing we found
was that there were three other specific bacteria in your gut
that were in low amounts.
They're associated with the production of a specific type of gut hormone
that makes you feel full.
It could be why you're always hungry.
But it's never as simple as one bacteria, because no bacteria acts alone.
So you really need to understand how they act within an ecosystem,
which is why we analyze the microbiome as a whole.
Does that make sense?
Absolutely. I mean, I'm kind of amazed, actually.
I mean, just to be able to find out all those different things about myself,
simply from testing poop.
But I don't know. I guess it just seems so difficult.
Why does it seem like... like I'm stuck?
- Am I stuck? - Yeah. No, you're not... you're not stuck.
So, the good thing is you got here, but you can also get out.
You really want to do, I would say, a lifestyle change
where you really change your food,
such that it better matches your good bacteria.
Oh yeah.
And we might be able to find something that is enjoyable,
something that could be sustained for a long period of time,
and would also be good for you.
You know, we talked about ABCs, "always be counting,"
not calories,
but always be counting the number of fruits and vegetables
that you have per week.
Between 20 and 30 is usually considered good.
Okay.
It definitely clears things up a little more.
Different bacteria, you know, different lifestyles,
just different things happening for different people at different times
just creates different outcomes.
My life is pretty hectic.
I'm responsible for a lot of people.
I have a sick mom that I'm constantly taking care of.
I'm a single mom to three beautiful children.
My baby boy, he's autistic, so I'm always teaching him.
Eating in a household with different age groups
that all want different things,
you gotta cook for you, and then you gotta cook for them, and...
It can be difficult, and it can be expensive.
So getting my kids on board with one meal that everybody likes,
that's my project.
I'm sure that I've eaten 10,000 hot dogs
since the beginning of my career.
I am Japanese, but I've eaten like an American.
I think that's what's damaged my body.
Wow, this aroma.
This is real Japanese food, huh?
So beautiful.
- Mmm!
Is competitive eating damaging your stomach?
When we go out together,
I mean, the rest of us eat more than you do.
Yeah, it's true.
Kobi thinks he might be broken.
He doesn't feel hungry or full.
- He doesn't feel those things at all. Oh really?
There are times when he realizes that he hasn't eaten anything in three days.
It's that bad, really?
I feel like the more you eat, especially junk food,
the more you damage your body.
Hmm.
Ever since I started this career, I've wondered
what damage I've done to my body.
I want to know how it is damaging my brain and nervous system.
Earlier, I think I had this image of myself,
like, I'm this head and brain, and rest,
and this is how I go about life.
My feelings and everything, my thoughts, are just produced up here.
And this is a bit silly,
and it reminds me even about the way my little nephew draws people.
It's just this head with two little feet on it.
And we now know that the gut is an important adviser to the brain.
It'll collect this information, send it up to the brain,
and it'll become a part of how we feel.
So we all know our first brain up here,
but we have a second brain in here within our tummies.
And there are more nerves in this second brain
than there is in our spinal cord.
The gut-brain axis is the two-way street of communication
between what's going on in our bellies and what's going on in our brains.
Think of the brain and the gut as BFFs.
So if either one is not working, the other eventually is gonna follow suit.
It may be what allows us to enjoy the food we eat,
to tell us what to eat, when to eat,
and it's not only that the microbes could affect your brain,
but it's the food you take that can affect the microbes that can affect your brain.
So, today we're at the English Market here in Ireland,
and this is where I go shopping on a Saturday.
You come to the market with a list.
But I end up throwing it out every time.
The smell, the colors, everything here, you're drawn to,
but your gut is also drawing you to things maybe it shouldn't.
Our food choices, you know, we think about it all being driven by our brain,
but what if it's actually the signals from our gut
that are really pulling the strings?
Now, this is what my microbes really love,
and I have to have this internal struggle
because it's just a recipe for me to gain weight.
How hungry you feel, how much you want to eat something,
could come from a tiny bacterial population in your gut being like,
"I really would like to eat those fries," or something, you know?
You eat a lot of sugar, you get sugar-loving bugs.
You eat a lot of fat, you get fat-loving bugs.
So when I go to China, and I'm not consuming so much sugary food
because there's very little sugar in the Chinese diet,
I completely lose my desire to eat chocolate, for example.
Normally, in North America, I'm craving chocolate every single day.
Morning. Morning.
- How are you? Good, and you?
Good, good.
Morning.
Ah!
Today, my microbes win,
so it's gonna be the chocolate that we're gonna go with.
I get cravings a lot.
Sometimes, literally, the only thing that sounds good
is, like, a super rare steak.
I kind of try to just push it into the back of my mind and ignore it,
but I'm trying to listen to my body more.
My body craves ice cream or sweets or hamburgers.
I really wish I could eat this.
I love seafood. I try to eat as much seafood as possible.
I used to crave
cakes and curry when I was little.
I don't feel that joy about eating anymore.
Digestion was very much likely
the first form of thinking that animals developed.
It was there so that the nerves could tell the quality of the food,
how the surrounding tissue was doing, the immune cells that were passing by.
And only after that worked really well,
it was like a nice add-on to also have this brain up there
that can coordinate senses.
Hi, Kimmie, we're ready for you if you wanna come on back.
I'm going to get my MRI done today.
I'm a little worried.
But I'm looking forward to understanding what's going on in my body.
I'm still a little confused.
I'm just trying to figure out how my body works,
so moving forward, I can be a better me.
All right, Kimmie. How you doing in there?
Good.
We're gonna go ahead and put up a slideshow for you
of a bunch of pictures.
And we're just gonna ask you to watch it like you would watch TV or a movie, okay?
Okay.
What we're looking at is activity in the brain.
Seeing how Kimmie and Kobi respond to a stimulus. In this case, food cues.
We have high-calorie sweet foods,
or high-fat, high-calorie savory foods.
And what we see with Kimmie's brain is that when Kimmie sees food,
the emotional part of her brain gets activated,
but more importantly,
the ability to control these emotional responses are diminished.
With Kobi's situation, it's definitely more complex.
Hunger is a complicated process.
There are multiple systems involved.
The brain, the gut microbiome, inflammation,
but also your mood, your memories, your environment.
There are so many things that are related to hunger,
and we need to think about the whole body.
Doctors are divided up into specialties
where they just focus on this one organ,
and they ignore the entire rest of the body, essentially.
It's minimizing our understanding of how everything is connected.
The beautiful thing about the microbiome is it's everywhere,
and its effects are felt everywhere.
We have to think more holistically.
And so, one of the things that I'm really interested in
is when we have co-occurrences of gut problems with brain problems,
and it's very common.
It's very common in autism, in Parkinson's disease,
but also in stress-related psychiatric illnesses
like anxiety and depression.
And so, which came first is always the question.
In the last five or so years,
we found that people with certain depression-like symptoms
are missing bacteria in their gut
that produce chemicals which shape brain chemistry.
That changes how you feel.
And it can lead, we believe, to the onset of depression-like symptoms.
When you give a normal mouse microbes from a healthy person
and give them the opportunity to explore,
they'll want to see bright areas and be generally inquisitive.
Whereas if you give them the microbes from a depressed individual,
they'll huddle into dark areas,
and they will develop stress, anxiety, and depression.
There was changes in the chemicals involved in serotonin,
the mood molecule,
- in their gut and in their brain.
When we added bacteria into our animals
that's often missing in people who are depressed,
it actually dampens down that depression response.
So they may still have depression, but they don't feel it as severely.
Yeah, it makes sense.
When I'm training for a competition,
I feel aggressive,
and I don't feel like talking to other people.
It's scary to think that the brain and gut are so closely related.
It makes me want to be more careful with what I eat.
That's really cool.
Ah, man. You're doing really well.
As a father with a son with autism and another son with ADHD
and having depression in my family,
I've been very interested in seeing if there's maybe a link
to disruptions in the microbiome.
And that's shaped my research career.
And I've gone after looking at which bacteria might be playing a role.
We found that in many cases of autism,
there are children who have diarrhea or severe constipation.
In other diseases in the brain, like Parkinson's,
we often see an onset of constipation,
sometimes even decades before the actual brain disease manifests.
To understand this connection,
we take bacteria from humans with a certain disease like Parkinson's,
and put them in mice.
When we add missing bacteria into the mice, their symptoms improve.
It's a natural thing.
Just naturally rebalancing that ecosystem and that chemistry inside the body.
And so, we're really starting to see that the relationship,
our study of the body as a whole unit, is essential
if we're really gonna get a handle on some of these chronic conditions.
Well, very nice to meet you, Kobi.
Hi, doctor.
- Hi, Kobi. Hi, Maggie. Nice to meet you.
So I have some results.
We were excited to see that,
that your bacteria actually looks pretty good.
Wow. That really surprises me.
So even though the competitive eating,
you know, may have had an effect,
the fact that you eat a normal healthy diet, Japanese diet,
it influenced your microbiome.
Because the bacteria in your microbiome
responds, like, within 24 hours of eating.
Wow.
But when it comes to the loss of appetite,
it could be a combination of many things,
like the actual stomach stretching,
your hormones, some sort of slight inflammation,
or also the speed of digestion.
- Just to name a few things. - Okay.
But the other part is the head.
And usually, I am not a fan
of doctors telling people it's in your head,
but when I looked at your brain scan, everything was firing.
Basically, every area in the brain
that can have something to do with eating, with food,
with feeling nauseous or full, like, everything is on.
It's almost like it's confused.
Okay, I don't like the sound of that.
The only way this made sense for me was
if everything has to work together to suppress
so that you don't feel full,
so that you don't get disgusted by more and more food.
You can see how far your body goes for what you want,
even if it has to harm itself.
He said, "I know." He said, "I'm already scared."
He's like, "I don't know if my brain is okay."
Yeah, but it's not that something is turned off, or gone, or broken.
It's all there. It's all turned on.
It's just wired differently maybe now.
Your brain is still trained to think that you're competing
or eating those highly processed foods.
Here I think the situation is very complex.
Something that would be interesting to try
- would be to learn to listen to the body. - Yeah.
If it's just a smell, or just sensing very basic things,
and just learning to feel it, sometimes.
It's a long journey. A long one indeed.
He said, "This is gonna be a long journey though, right?"
I overeat because I am a competitive eater.
But ordinary people overeat too sometimes.
When you eat too much, you don't savor the taste
or fully enjoy the smell of the food.
You ignore your body's signals, like fullness.
It starts early.
Many kids are raised telling them,
"Clean your plate. Eat the whole plate 'cause that's what good kids do."
So we learn to ignore our appetite,
but get accustomed to just times where we eat.
We're on the phone the whole time,
or on the computer with the brain and screen.
Reconnecting, it's really more about just listening to your body.
I hope to live a long and healthy life.
Good morning.
I've decided to retire from competitive eating.
It's all I have done for the last 20 years.
I am worried about what my next step will bring,
but I'm also excited about my future.
I have mixed feelings.
But first,
I want to fix my brain and my gut.
We're actively working to enhance the number
of different microbiome therapies that are out there.
If your microbiome's damaged, can we actually use poop to fix it?
This is very, very valuable, more valuable than gold.
What would you say if a doctor told you someone else's feces could save your life?
A Fecal Microbial Transplant, simply called FMT,
puts feces from someone else into the body of an infected patient.
He offers a treatment through colonoscopy, an enema, or pills.
Fecal microbiome transplant is the first FDA-approved therapy
which involves the microbiome that's available to clinicians today.
However, it's only allowed to be used for one particular type of disease.
C. diff. When bacteria inflames the colon and causes extreme diarrhea.
We take the bacterial community from a healthy person,
just spray it up inside the colon, literally,
in order to re-poop-ulate, repopulate your gut bacteria inside there.
It's a procedure that has a 90% cure rate.
Scientists are now trying to figure out
if it can treat hundreds of other conditions, mental and physical.
With fecal microbiome transplants, there is really compelling evidence,
but the science is still developing.
We're still working on
if it actually has benefit in wider populations,
if the benefit is long-lasting.
Here it is, next to the food we're gonna eat later.
Is it in the healthy range? This is a good one.
I think for most people,
it would be scary to do a fecal transplant,
especially when it's DIY.
I also think that most healthy people don't know what it's like
to get to a place where your quality of life is so low.
I felt like I had no other options.
Is this love?
Yes, true love.
The first time I did a fecal transplant, I used my brother as a donor.
I slowly started gaining weight, despite not changing my diet at all.
And I was able to go to the bathroom
for the first time in, like, three years on my own.
But I started getting worse acne,
and my brother has a history of hormonal acne.
And then I decided to use my boyfriend as a donor.
He has no physical health conditions,
but he does have some mental health issues.
I took my boyfriend's pills for several months.
Stopped getting the acne.
But over time, I noticed
that my depression was worse than it's ever been in my life.
I got whatever bacteria he normally has,
and it exacerbated the depression that I already had.
I went back to using my brother as a donor.
Within a week, that depression completely went away.
Going right in there...
with the ice cream.
There are risks with FMT.
When you get an FMT, you get the good bacteria,
but the bad bacteria could also come along for the ride.
I would love it if this was the perfect solution.
But all the gastroenterologists I know are extremely cautious.
We could transplant the susceptibility to all sorts of diseases.
So I ask people, don't try and experiment on yourself
with some of these more aggressive therapeutics.
If a fecal transplant would give you back
your feelings of hunger and fullness, would you do it?
Yes, if it could help me with my problems,
I would definitely try it.
I'll be the guinea pig.
Someone else's feces could save your life.
Fecal microbial...
I thought it was weird as hell,
but all this talk about poop just kind of helped me understand
that pooping is normal.
It's everyday life. It's something everybody goes through.
So why not talk about it?
I'll bring it up, and it's just a random poop conversation.
And when I hang up the phone, I'm like, "Was that weird?"
Before it was, but now it's like, "No, it's normal."
Fecal microbiome transplants are quite a blunt tool.
We prefer to use a targeted approach,
like a precision probiotic to improve health in a very specific way.
Most probiotics you can buy in the store aren't really gastrointestinal bugs.
They're not designed to live inside our guts.
They're normally bugs that you would find associated with fermented milk or cheeses,
Lactobacillus organisms.
So they're not really designed to take up residence.
It'd be like taking a houseplant, and throwing it into the Amazon jungle,
and hoping beyond hope that it would suddenly grow.
Modern medicine is very much about treating the symptoms of a disease
rather than the underlying problems that lead to it.
Moving forward, we want to have a smarter approach
to target the microbes in our gut to actually have positive effects
and prevent many of the problems from even starting.
And so, the microbiome is a game changer for medicine
because everyone can be their own pharmacist
just by picking the right foods to eat.
Inspired by our findings, one of my colleagues decided
to start drinking smoothies with 60 different kinds of plants a day.
And so what you can see is he's over here in this red region with his regular diet.
But now, he's moved over to this orange region
after eating the smoothies.
Took a few weeks, but he's really changed
to this completely different region of the plot.
And by the time this ends, which is a few months later,
he's now got a much more diverse microbiome configuration
than he had at the beginning.
But you haven't started drinking these?
No, I tasted them.
I think this is one of those things
where you really need a collaboration between scientists and, say, chefs
to not just get all the things you want in there,
but to make it taste good as well.
Well, I have no idea what that means, but that's cool.
Um, all right, let's get started.
Red and green lettuce, check.
Spinach, check. Purple kale, check.
Carrot-top greens, check.
Tomatoes, carrots, zucchini, some avocados.
Radishes and dates is a combination I have yet to try,
but maybe that'll be my new macaron flavor, who knows?
How much smoothie does he eat?
The produce out here is about what I eat in produce for, like, a week.
So one cup of water.
It does feel a bit like doing a science fair experiment.
I'm going to throw in a whole knob of ginger.
'Cause you can't get enough of that ginger.
I mean, my initial reaction is, who has time to do this?
We'll do a whole fig. I like figs.
I feel like the pink color is probably extra good for you or something.
Antioxidants.
Oh, the potato. I'm also...
It's going to be so, like... Ugh!
First time for everything.
And a teaspoon.
I think that's it.
Okay.
I think this is going to be an incredibly interesting color.
Doesn't look bad. I mean, it doesn't look great.
But I've drank grosser smoothies.
Smells real green.
Oh, it's so thick.
It's got texture to it.
It's actually not bad.
It's fine. It tastes healthy.
How would you make this better?
Just, I mean, removing things like the brussels sprouts
that will kind of, I think, overpower it.
Or if you're gonna do that, just turn it into gazpacho.
I think a lot of the green smoothies I eat would be so much better
if they embraced what it is and added some salt
and, like, a little bit of vinegar, and you're just drinking gazpacho.
It sounds great, but they just need to season their smoothies, I guess.
Mm-mmm.
It is kind of spectacular what food can do to you,
and how what you eat really does change your body.
What you eat today will impact your microbiome tomorrow, within 24 hours.
My rule is ABC, always be counting.
Always be counting the number of fruits and vegetables you're eating.
If you eat about 20 to 30 different fruits and vegetables each week,
I think you're good.
If you want some simple rules to follow,
think about what the generations before us ate.
I mean, vegetables, fruits, nuts, beans,
even fermented foods that are teeming with different types of microbes.
Fermented foods were really the original probiotics.
You can just take vegetables, add salt, and let them sit at room temperature,
and you're gonna have this delicious fermented food in a couple days.
- Doing great. You doing great?
- Uh-huh. That's good, baby.
Is this what corn looks like when it's just not corn?
You mean when it's fresh and not out of the bag? Yes.
There's corn in here.
Yeah.
I was definitely confused in the past.
Learning the science helped me to know that,
"Okay, you can't just say I'm on a diet."
You literally have to change your lifestyle
and doing little things every day.
Potatoes cut and rinsed. - Cut and rinsed.
My kids are super competitive.
I get them to help me. I've made it like a cooking competition.
I get them to go to the grocery store with me.
Then we get to cook.
So we've been spending a lot more time together while doing it.
What are you doing?
I'm helping you. I wanna be a chef, forever.
You wanna be a chef?
Yeah, I wanna cook every single day. I want to be a chef.
I've experienced how people talk about their body,
and what way of relationship they have with it.
Two eggs and two egg yolks.
There's not one super health food that you can eat,
or this one advice that you can follow so everything gets better.
It's really more about building up a relationship to the gut.
Y'all are doing such a great job. High five.
Reconnecting can be done by science, and can be done by knowledge,
but only also if you, you know, get a feeling,
get a smart feeling for it.
Carbonara is kind of like the complete realization
of the foods that I am most scared of.
Since I've gotten into the topic of the gut,
I have become much more relaxed, actually.
I feel like I know how resilient and strong and stable this organ can be
if I treat it right most of the time.
It's really more about just listening to your body
to create a smarter body feeling.
Throughout my career,
what's influenced me more than competitive eating
is the hot dog.
Okay, we're adding avocado, shiso, shiitake, and garlic.
Yeah! It's so good.
I want to create a healthier hot dog
by combining it with healthy Japanese ingredients.
Mmm! This is good.
Very delicious!
This is something new. Unstoppable.
You can eat something and then see, how do I feel,
one and a half, two, or two and a half hours later
when it's being taken up in my blood.
A piece of cake or fries, chips, tastes great in the first second.
You'll be like, "Ah! More of these,"
but later on, you'll feel really tired, or foggy, or whatever.
And a meal of, like, rice and vegetables might not be as addictive,
but it'll make you feel more stable.
Or it might not with you. You can check.
It feels very validating
that I can allow myself to enjoy food more.
The idea that I could have a bowl with my husband
and not punish myself by not eating the day after,
it would be nice.
Mom, good job on the corn.
We're gonna do a cheers towards Mom's good cooking.
All right. - Yes!
♪ I'm feeling myself ♪
♪ Never give up ♪
♪ Straight to the top... ♪
The only thing that matters
is how you feel, what you think, what you do.
Nobody else matters.
And maybe my body being different is the best thing for me.
♪ I'm flexin', I'm flexin' ♪
Your body is really the expert, and you should listen to it.
Knowing more about the gut made me feel more proud of it.
I guess I could even say
I have a feeling of loyalty towards my gut,
and even my butthole.
Not everybody should talk about their poop all the time,
especially if they don't feel like it.
But I think you should know something about it.
There are, for example, seven different consistencies of poop,
neatly described in the Bristol Stool Scale.
Seven and six are a rather liquidy stool.
This can happen if digestion was disturbed by something like an infection.
Four and three is what you want to find in the toilet,
and is described as a sausage or snake, smooth and soft.
And then we get to the droppings of a goat,
and these are the areas of constipation.
So the consistency or shape can be a very helpful solid information.
Like a little text message from your gut.
So you might as well sometimes just turn around, check it out,
and then, you know, take the hint.