ONe Th 1

About our guest: 

Minding your 

Microbiota

with

Andrea Hardy, RD

Minding Your Microbiota with 

Andrea Hardy, RD

About our guest

Andrea Hardy is a registered dietitian from Calgary, Canada. She specializes in gut health & gastrointestinal diseases, and is recognized in the media as 'Canada’s Gut Health Expert’. Using her skills in evidence-based knowledge translation, she empowers Canadians to make lifestyle changes to support a healthy gut. She runs a multi-disciplinary private practice in her province called Ignite Nutrition. She has spoken internationally about nutrition & digestive health, and has performed on the TEDx stage in a talk titled 'Quit Killing Human Connection With Science: Making Patient Care Meaningful’. To stay up to date on her work in the field of digestive health, tune in to her podcast ‘Let’s Gut Real’, or visit her website www.andreahardyrd.com 

Transcript on Minding your Microbiota with Andrea Hardy , RD

Adam Rinde, ND:  I’m here today with Andrea Hardy talking about Minding your Microbiota. Welcome to the One Thing podcast. Andrea, it’s great to have you on with us.

Andrea Hardy, RD:  Thank you so much for having me.

Adam Rinde, ND: You’re welcome. I thought we get right to it and speak a little bit about the microbiota. I want to share more about your background. You have a lot of extra credentials and I know you’re involved with a lot of things. But loved to hear how you came about to be interested in the gastrointestinal system and how you’ve focused on that if you can just share with us your journey into this space?

Andrea Hardy, RD:  Sure. I have been a dietitian for around 10 years now. When I started my career, I worked in clinical. I primarily worked in the C.B. ICU as well as liver disease and then to oncology. Throughout my time as an intern as well as working as a dietitian, I became diagnosed with irritable bowel syndrome myself. Back then ibs was still seen as that condition that was all in your head. There was a lot of stigma around it; I was embarrassed at my diagnosis. I knew there was something wrong with my gut but of course, there is nothing structurally there, everything has been ruled out. At the time of my diagnosis, I learn to live with it, drink more water, eat more fiber, things that I already did as a nutrition student at the time and then as a dietitian. I just followed along with the research as it developed even though it wasn’t my practice area. There was a lot of great stuff coming out in later years through Monash University about FODMAPs. Then, of course, the research around that gut microbiota started to explode. We started to understand more and more that functional gut disorders were gut-brain access disorder and the gut microbiota had something to do with that. As somebody who also loves research, I know you too love it Adam is, I just dove right into it started learning and became interested in how they got microbiota. Not only influences gastrointestinal disorders but a lot of other conditions as well. That’s how I started my career and became a big advocate for dietitians being gut health ambassadors or taking some of the research that is translatable and putting it into practice.

Adam Rinde, ND: From the outside, I’m not a dietitian but I’ve observed how this has become a specialty like GI  dieticians have taken hold over the last five to ten years as a sub-specialty, is that fair to say?

Andrea Hardy, RD: Yes. It's all I have time to consume. I’m not an expert in diabetes or cardiovascular disease anymore. It takes up all of my interest, all of my time and I work hard to make sure that I can stay on top of it. It is hard because there is so much research coming out now.

Adam Rinde, ND: All you have to do is open up a browser. At least my browser I get flooded with new studies daily on the microbiota, gut microbiome and all its interconnections with health it’s incredible. That’s how you and I connected. You’d recently returned from a microbiota conference. I was interested in some of the things that you were learning there and I touched base with you. Thank you very much for agreeing to share not only some insights from the conference but how that furthered your already strong understanding in the microbiota. So, I appreciate you coming on with us and discussing that. I thought we’ve watched into some of the topics related to the microbiota, if you could just give us an overview of the generalities of nutritional influences on the microbiota and just for people who don’t understand what the microbiota is or speaking specifically about the gut microbiome. If you could just give us a brief overview and then we can start talking a little bit about the nutritional influences on the microbiome.

Andrea Hardy, RD: Your gut microbiome is the makeup of bacteria, viruses, and fungi that live in your gut. As we started to discover that we had a whole slew of these microbes living in our guts, we’ve realized that they often provide health benefits to us. They support us in our health and play a role in keeping us well as well as playing a role in the development of diseases. We realized that the gut microbiota requires nutrition inputs to make sure that it functions well. There is a whole bunch of things that influence the gut microbiota. Nutrition is the thing that often influences the microbiota the quickest as well as it’s the easiest way to influence the gut microbiota. That’s because things that we don’t digest, make its way through the intestinal tract to the colon where the majority of our microbes live and then can digest it and go to work helping our health or potentially even hindering our health.

 In terms of taking care of that gut microbiota, I like to think of this little ecosystem of bacteria living in our gut. Every time we consume something or even a lot of our lifestyle habits, play a role and whether we are taking care of that gut microbiota or negatively influencing the gut microbiota. It’s no longer what you’re doing to take care of your health; it’s what you’re doing to take care of your gut microbiota as well.

 

In terms of nutrition influences, first, we thought fiber was the primary influence of the gut microbiota. But as research develops, we realized there is a lot of other nutritional influence as well. We’re starting to uncover that it’s not only fiber that fuels those gut bacteria, but there are also proteins, fats, different food chemicals that also influence our gut microbiota too. So, we’re starting to learn about how those things influence the gut but we do know for sure that fiber plays one of the biggest roles. I know in the States as well as Canada, most people don’t get enough fiber. So, part of that theory involves as our fiber intake has decrease does our diet qualities decrease as our intake of whole food is decreased and now intake of processed foods have gone up. We’ve changed our gut microbiota in a way that has negatively influenced our health and possibly is one of the drivers behind chronic disease, autoimmune conditions and some of those other changes in health that we don’t necessarily see in developing countries. I’m sure that’s something you see a lot in your practices as well as a lot of increase in chronic disease and some of those autoimmune conditions too.

Adam Rinde, ND: Definitely. We’re looking for answers in the gut and looking for ways that we can prevent these diseases and also looking for ways that we can reduce the triggers to these diseases if they’ve already started to manifest. Interestingly, you point out some of the categories of proteins and fats and food chemicals that may influence the microbiota. I don’t think a lot of people think about that and we’ve been zeroed in on fiber and prebiotics. Can you go into that a little bit more? Talking about the proteins and fats and food chemicals?

 

Andrea Hardy, RD:For sure. Why don’t I take a step back first and explain how fiber influences the gut microbiota because that’s the mechanism we understand best.But certain types of fibers are non-digestible carbohydrates so  they pass away through the digestive system and when they land in the colon, those bacteria can go ahead and ferment those carbohydrates. When they can ferment those carbohydrates, they produce beneficial metabolites. Also, the catchword right now is postbiotics such as short-chain fatty acids that are now in to help improve our immunity, play a role in gut integrity, provide energy for our body and help to regulate some critical functions of the guts, the gut barrier and the immune system that is found in our gut.   As we started to dive into research around the fiber, we also started to look at how different other food components influence the gut microbiota. Specifically, there has been a lot of interest and uptake around animal proteins. Animal proteins can include things like our meats, chicken, beef, pork but also could include things like eggs as well. When we consume proteins, a lot of it is digested and absorbed in our small bowel; however, small amounts make its way through the gut undigested. Those small amounts of proteins can be metabolized by microbes. So, a lot of microbes like to digest fiber but some bacteria prefer protein in terms of metabolism. I like to say that your gut microbes are picky eaters. Some prefer certain types of fibers; some prefer certain types of proteins. As you know in North America, we eat a lot of animal products. More protein passes through our guts undigested and fuels the microbes that prefer to digest that. Higher protein diets appear to produce compounds that may be pro-inflammatory and may also produce certain types of compounds that increase our risk of disease. In particular one of the bigger areas of research is around a compound called Trimethylamine N-oxide, so, TMAO for short. What we have seen is in humans, patients that consume more animal products have a higher abundance of bacteria that produce these TMAO (11;28) stop. compounds and having higher amounts of TMAO is associated with cardiovascular disease and cardiovascular risks. We also see a reduction in of course species that we consider healthy and a microbiome which includes things like Rosburia species and Bifidobacteria. Those are bacteria that are thought of as health-promoting or producing those beneficial compounds. We see a reduction as protein intake increases.  When it comes to protein, a lot of time you see online and then on the media is that all or nothing message. I think for people that are carnivores that’s, “What? I’m not supposed to eat protein anymore?” that’s a staple.  For me really when it comes down to helping patients it’s ultimately about reducing intakes where we can and focusing on adding and maybe more of those plant proteins as opposed to cutting out all animal protein if that’s something you enjoy. (Eswaran, Muir, & Chey, 2013)

Adam Rinde, ND: I like that because I think when the American Gut project first launched, it’s almost like this knee jerk reaction that we need to just go all-fiber and almost be vegan. That set us into an imbalance in some ways a lot of people just don’t feel well eating that way. It’s nice to hear your message of looking for more balance and to bring these worlds together and create an eco-system that includes a little bit of both.

Andrea Hardy, RD: Absolutely. I think ultimately you know your body best. Like I said at the beginning, I have irritable bowel syndrome and eating a vegan diet won’t work for me. I’m able to make small meaningful changes to my diet to include plant-based proteins. But I also strike that balance with foods I enjoy which includes animal proteins. For some people, a vegan diet works, for some more animal proteins work but we want to focus on what we can add-in. If we can get in some of those plant-based proteins, if we can get in fiber, if we can get in more whole foods then likely we’re doing a really good job. 

Adam Rinde, ND: I think research shows us if we do make wholesale nutritional changes, we can see the microbiome shift. Let’s take a practical example. If someone went carnivore, what would you expect to see? Would you see a microbiome shift or is that too soon to say?

Andrea Hardy, RD: You definitely would in the first three days. The microbiome changes rapidly in response to what we feed it. It’s a dynamic ecosystem that makes use of what we have. Interestingly there was a great study, a landmark study published in 2016. They looked at in animals how withholding what are called microbiota accessible carbohydrates. That would include our prebiotic fibers as well as other types of carbohydrates our gut microbiome can digest. Those bacteria had to find fuel elsewhere. They started to create the important mucus layer in the gut which helps to protect our gut wall and reduces the inappropriate reaction of ingested particles with our immune system. What we see is our gut microbiota is adaptive. It makes use of what you give it. When you don’t give it what it needs it’s going to find that fuel elsewhere. It’s hungry; it has to digest other things. What we see in patients that consume more meat, we have more studies particularly looking at a Paleo group which of course tends to be higher in animal products but there is a rapid shift in the gut microbiota. That shift doesn’t necessarily appear to be positive. However, with adequate fiber and adequate variety, some of those shifts can be prevented.

 

 

 

 

 

 

 

 

 

Image courtesy of:
Britton, Robert A. and Cani, Patrice D.(ed). 2018. Bugs as Drugs

Adam Rinde, ND: I think we’re learning more because we talk a lot about bacterial shifts but we need to learn more about viral shifts and other organisms because we don’t know the whole picture, do we?

Andrea Hardy, RD: Absolutely. The viral biome or the virome is very under research at this point and frankly, most of our research comes from the colonic gut microbiota. But we also have a small bowel microbiota that is largely under-researched and gets exposed to those food particles way sooner than the colonic microbiota. So, it’s interesting to know. 

Adam Rinde, ND: I want to push on that a little bit further because the sampling of the microbiota still leads to develop rights of a lot of what we’re talking about its considered intraluminal versus the sampling from actually at the intestinal wall. Is that resonating with how you look at this or what are your thoughts about?

Andrea Hardy, RD: I think a lot of the research right now supports the role of the gut microbiota and particular conditions as we know it or as we can measure it. But I’d say our measurements are still crude and there is a lot more room to move in terms of understanding that ecosystem whether it’s the luminal, gut microbiota or the gut wall microbiota or the virome or the small bowel microbiota. I think as we start to build up those pictures, we’ll understand how they work all together. That being said, I think there is a lot we can do with the information that we have so far. It’s starting to draw these associations and correlations. Not the best form of data but still a form of data that can derive some recommendations we make for patients. 

Adam Rinde, ND: We’ll talk a little bit more about the actionable data later on here in the episode. But I want to continue on this thread that you’ve set up nicely for us. Let’s go further into this. What are some other ways to influence the microbiota? You just shared with us nutritional food intake, what about probiotics?

Andrea Hardy, RD: Probiotics are interesting in that there is a big interest in probiotics in the media. There are a lot of different products out there. Some make accurate claims, some are a bit questionable. Probiotics are live organisms that when we take in the right amounts have a benefit to our health. That defers from fermented foods which a lot of times I see is being labeled as a source of probiotics for example where bacteria are involved in the actual production of the food products. But they may not meet that definition of probiotic. So, certain strains of probiotics can be helpful in certain conditions. What I like to say is we want to match the right strain to the right person for the right reason. Meaning that there are certain conditions in which probiotics have been shown to have benefits in the right amounts. But they are not a cure-all or needed for just general health and I see a lot of people taking probiotics for general health. 

Adam Rinde, ND: Do you feel they can latch into the microbiome and colonize or is your take on that when we take a probiotic we swallow it and goes through our digestive tract, does its benefit and then basically goes out of us? Is it a temporary move as long as you’re taking it and then as soon as you stop the benefits go away?

Andrea Hardy, RD: For sure. Your gut is highly stable. A lot of people think we can make these crazy changes to our gut microbiota with probiotics. But probiotics are quite transients. You take them they might stick around in your gut for a bit. But they do very little to influence your microbial profile and your gut. There isn’t a lot of space for them there. So, that doesn’t mean they don’t have benefits. When we take them for the right reason, they may have specific benefits. For example, reducing antibiotic-associated diarrhea or helping to manage the symptoms of irritable bowel syndrome, or there is a small body of evidence that certain probiotics may help reduce colic in infants, or can help with the treatment of C. dif. But outside of that, there is very little evidence to support probiotics colonizing your gut. 

Adam Rinde, ND: More of a treatment versus a cure?

Andrea Hardy, RD: Yes, absolutely at this point. That being said, you have seen the media there is wild reporting of probiotics or the Holy Grail probiotics are dangerous. Media tends to sensationalize and become alarmed about probiotics. A lot of times when some of that data comes out, it’s strain-specific for the specific condition researched. Interestingly, there was one study that did look at the role of multi-strain, some of the strains than there were probiotic. The research was done where the patients were treated with antibiotics and provided a multi-strain probiotic. Because of the antibiotics because of the reduction of bacteria in the gut, there was space in the bacterial niche in which the multi-strain probiotic was able to take that niche up. It took a long time for that person who got microbiota to go back to their baseline after antibiotics plus this multi-strain product. So, that created a lot of sensationalism in the research, should we be using probiotics and antibiotics? But again, I like to remind people that it’s strain specific. We don’t know how different products behave in the gut in terms of colonization after antibiotics. But we do know that taking the right strain of probiotic with antibiotics can reduce antibiotic-associated diarrhea. I’d say its person to person dependent as to whether probiotics are appropriate but a lot of times they can be helpful in specific conditions as long as we take a look at the person’s whole case.

Adam Rinde, ND: It seems like it’s a favorite topic among, even in my profession but even gastroenterologist that I speak with is, should you take probiotics with your antibiotic course? Should you take them after? Should you wait for two weeks? Should you only take a yeast-based probiotic with your antibiotics? This is evolving this topic in trying to figure out the right way to do this. In your community of colleagues, what are the general recommendations with probiotics you take them after the course? Two weeks after the course? What are you hearing?

Andrea Hardy, RD: The research that I’m familiar with is during antibiotics to prevent or reduce antibiotics associated diarrhea. A yeast-based probiotic isn’t susceptible to the antibiotics so you can take it whenever which is convenient. Of course, if you’re taking your bacteria-based probiotic, you want to space it out. Usually, in the hospital, we did it two hours before or two hours after antibiotics to make sure that in theory those probiotics don’t get killed off by the antibiotic. Then in terms of the most appropriate patients for me, it comes down to a person’s symptoms. I have IBS-C (IBS constipation). If I’m on an antibiotic, I don’t necessarily have that worry of getting that antibiotic-associated diarrhea. My bowels are slow. So, a patient however that has IBS-D and is worried about going on an antibiotic for let’s say they have a tooth infection or something. In that case, if it’s going to cause them a lot of urgency, a lot of stress, and  a lot of diarrhea and impact their quality of life, that’s probably a great patient to use probiotic with during antibiotics. That is how I make my case by case decisions. It’s based on the patient’s needs and the patient’s gut.

Adam Rinde, ND: That’s a really good point to tailor and adapt versus having just a standard recommendation. Thank you for pointing that out. When we come into the world, we’re given this microbiota based on several factors. We’re talking before we got on the episode of about how important it is to understand that the microbiome ages. I wanted to talk with you about that because minding the microbiota would give us a sense of taking care of our microbiome so that it is working in our favor as we get older. Take us through the aging process from birth to older age and some of the factors that we might think about in preventing improper aging of our microbiome?

Andrea Hardy, RD: We say your microbiota starts its development from the time you were born. There is some cool and new research coming out that mom's microbiota influences the baby’s microbiota by way of how she feeds her microbiota during gestation. But for the most part, your gut microbiota starts to be colonized from birth. So, the first three years of your life your microbiota is developing. It’s not very stable and it’s rapidly changing. But as we get into three years of age and older, gut microbiota becomes fairly stable. It’s influenced by things like nutrition, breastfeeding, skin to skin contact, where you grow up, your environment, your lifestyle, oral care, antibiotic exposure, stress; all of those things influenced the development of our gut microbiota. A lot of people are interested in what happens to the gut microbiota as we age because it’s stable through adulthood and then as we start to age, or as we become frail, we see changes in the gut microbiota. So, changes with decreases in what we’d consider good bacteria, and increases in what we currently consider to be “bad bacteria,” as well as decreases in diversity and abundance of bacteria. We see that some of these changes are driving or participating in low-grade chronic inflammation. That’s a big driver of some of those age-related diseases like dementia, Alzheimer's, osteoporosis, chronic diseases, diabetes, cardiovascular disease, cancers, all of those things. Researchers are curious. How can we prevent this age-related decrease in the gut microbiota or this age-related change of the gut microbiota? Ultimately, what we are seeing is the gut microbiota or not taking care of your gut microbiota likely plays a role in premature aging. For all of you people thinking, I’m going to start taking care of my gut microbiota and stay young forever, we still age but hopefully we can age in a healthy way and in a way that prevents that frailty and reduces that low-grade chronic inflammation that occurs as we age. Does that make sense?

Adam Rinde, ND: Yes. There is a couple of species I know that are looked at as far as markers of an aging microbiome or how well the microbiome is holding up. I think Akkermansia is one of them?

Andrea Hardy, RD: Akkermansia is one, Bifidobacteria is another, and sometimes we look at those Bacteroidetes to firmicutes ratio. There is a couple of species that we’ve identified as the core species that we see that reduction. These good bacteria ;the Akkermansia, the Bifidobacteria, all play a role in helping to produce those compounds that minimize or reduce inflammation as opposed to some of those other species that may be drivers of inflammation. There are a few proposed mechanisms when it comes to that aging or premature aging by way of gut microbiota. Most of them have been studied in mice but we do see that reduction and those short-chain fatty acids, or those postbiotic compounds. We also see an increase in those pro-inflammatory bacteria and with that, the lipopolysaccharides (LPS) that also drive age-dependent inflammation. In humans, we don’t have a ton of great data yet but there was a great study that just came out of Paul O’toole’s Lab in Cork). They do a lot of research around aging and the gut microbiota. They found that a Mediterranean diet not only influences the gut microbiota but also increased short-chain fatty acids, decreased CRP and other inflammatory markers, improved frailty, and improved cognitive function. These were two groups of frail elderly. One group got fed a Mediterranean diet, every day for a year. They hit the jackpot in terms of getting their food delivered, lunch, dinner, snacks. Then then the other group maintained their typical European diet, will say. So, diet even if there are already those changes related to the gut microbiota in regards to age, helps to prevent and almost reversed some of those outcomes.

Adam Rinde, ND: We talk about things that may harm the microbiome. I think it’s important to mention and maybe you can comment on this is that we’re in position throughout our lives where we have to take antibiotics or we might need to be put on the medication that might not be the best for our microbiome. More about being mindful of these decisions so that we’re not doing them just from a standpoint of without thinking about the impact it might have on our overall longevity or health. Also thinking about when we’re putting foods in our body that might be protective of our microbiome and again, being mindful. 

Andrea Hardy, RD: I always say, we want to consider judicious use of medications and what I mean by that is some medications are essential. I got cellulitis on the back of my arm from a I bite I got while traveling. I needed to go on antibiotics. That was necessary but there were things I could do to take care of my gut microbiota during that time. Of course, back in the day when you had a sore throat or colds, you go to the doctor and antibiotics would be prescribed without checking to make sure it was even a bacterial infection first. Or some of my patients get stuck long term on proton pump inhibitors and nobody ever stops to take a step back and say, “Do we still need this? Is it still providing benefits? Are there other ways we can manage that don’t require pharmacological medications?” I always encourage my patients to get their medications reevaluated really understand the purpose of their medications and then at least on a six month or yearly basis chat with your doctor, your pharmacist about what the medication is doing for you, do you still need to be on it, is that the right dose and reevaluate that.

Adam Rinde, ND: Thanks for pointing that out. You speak with people about their diet and I’m sure your staff also goes into details about planning and food to choose from. When you’re thinking about your favorite microbiome friendly foods, what are some of your favorites?

Andrea Hardy, RD: Interestingly, the research not only points to plant-based foods but also variety. It’s really hard for me to narrow down one particular food. I’d say in terms of getting people outside their comfort zone, I like to encourage people to learn how to cook with pulses. That’s your chickpeas, beans, peas, and lentils. I don’t know about your community but where I’m from Alberta, we’re like a beef province all the way. Not very many people are familiar even though we’re one of the largest exporters of lentils in the world. Not very many people are familiar with cooking with these things. I like to encourage people to try to include half a cup of pulses a week to start. So, people ask me, “Andrea, how do I do that?” I usually encourage people to start with cans just because it’s simpler. There is no cooking, there is no soaking, there is no waiting involves. Canned greens stringed to peas, beans peas and lentils work great. One of my favorite subs would be subbing out half of any recipe with ground meat for half lentils. So, I’ll take my can of rinsed drain lentils and I’ll use half ground meat in tacos or soups or stews or casseroles as a way to up our intake of pulses and make that transition a little bit easier. I have some picky eaters in my house so I have to find that compromise sometimes there. Other great options people are familiar with are things like chilies and soups and stews that include these things. But there is lots of fun way to include it in salads and mixed dishes and as an alternative to meat too. That’s a great place to start for people looking to get a bit more variety, fiber, phytochemicals in their diet.

Adam Rinde, ND: People with certain digestive problems like IBS or SIBO or other dysbiotic conditions, you might need guidance on how to incorporate pulses?

Andrea Hardy, RD: Yes. Some of my patients ultimately aren’t able to do that at the point that they are at in their condition. But that means that we can look to other foods that they may tolerate better. That being said, low fermentable carbohydrate pulses include things specifically like chickpeas and lentils. There is a little bit less of that fermentable carb in a serving and half a cup. The canning process breaks down some of those fermentable carbohydrates. That does some of the work there. When it comes to my SIBO patients, beans may not be the best place to start. But there may be some other things that we can do that are a bit more tolerable. Ultimately sometimes some of my patients aren’t able to hit their fiber targets. We do look to incorporating and other sources of fiber that are maybe not so fermentable or ferment more slowly by way of supplements as well. If you have that fiber gap, fiber supplements can be helpful in those particular situations. Though if possible, I always say food first.

Adam Rinde, ND: How about polyphenols?

Andrea Hardy, RD: Polyphenols, I love this topic. I’m interested in polyphenols. I’m also really interested in red wines. There are over 20,000 food chemicals lots of which we haven’t even identified in food and all of which probably interact with our gut microbiota at some level. However, one of the most well-known food chemicals is polyphenols. Polyphenols are found in dark purple, dark red, dark blue fruits primarily and then a few vegetables. Polyphenols are compounds that we don’t absorb that well so they make their way through the guts. They appear to have prebiotic like effects in the guts. Some qualify as prebiotics but they are available to fuel your gut microbiota and they appear to fuel good bacteria. Specifically, Akkermansia which we touched on is one of those bacteria that we see has an impact on diabetes risk, cardiovascular disease and maintaining a healthy weight. We see primarily in rat studies that mice that are fed a higher polyphenol diet have a major increase and abundance of these Akkermansia bacteria. Akkermansia is responsible for creating a nice mucus layer in the gut. They are mucus degraders they act as custodians for the mucus layer and your colon and take care of it. By fueling them well and by having a more abundant population of those, there have been the associations drawn between some of those chronic conditions I mentioned. So, how can you get those in? Brightly colored fruits and vegs. So, your berries, you want to think about grapes, plums with dark purple skin. Blueberries, raspberries, blackberries, all of those things have polyphenols. Wine also has polyphenols but of course, alcohol can be a gut irritant for people. If you do consume alcohol and you enjoy the red wine not a bad choice in moderation. But of course, I like patients primarily to focus on the fruit aspect of things.

Adam Rinde, ND: Also I’d like to add olive oil; is a good source of polyphenols….

Andrea Hardy, RD: Yes. I believe it’s a different kind of polyphenols than the ones that specifically the Akkermansia break down but I’d need to double-check in particular. I know they’re just starting to look into the role fats plays in influencing our gut microbiota.

Adam Rinde, ND: This has been helpful. I appreciate how you’ve taken us through the microbiota like you have and I’d love to just get a few take-home messages from you and then also from there if you could just share about what you’re up too professionally and how people could follow your work and get in touch with you if need be?

Andrea Hardy, RD: I think the number one take away a saying I’ve borrowed from Dr. Colin Hill. “You get the microbiota you deserve” You are truly the custodian of those bacteria in your guts and what you do to take care of that gut not only influences your health but it’s going to influence future generations. So, you pass on that gut microbiota to your kids and your grand-kids. It’s not just for you that we’re taking care of it. In terms of taking care of it, we don’t just want to think about nutrition. Nutrition is a key part but we also want to think of exercise, sleep, stress, proper use of medications and consider how our whole lifestyle influences gut microbiota. Nutrition science isn’t necessarily changing because we got microbiota research but it’s enhancing it because we now understand a little bit deeper about the mechanism. I like to encourage my patients to aim for half a plate or about two cups of veg at lunch and supper every day, try to choose whole grains when you can in the first 30 different plant-based foods a week. It sounds like a lot but jots them down everything from your whole grain pasta to your kale to your strawberries all counts. Then make sure that you’re trying to reduce your intake of red and processed meats simply by including plant-based protein. Start with once a week and see how that goes. We don’t need to make this wild and crazy change right off the bat. We can just start with those small meaningful changes. Those are my tips and in terms of where you can find me. Adam and I were just talking. I recently launched a podcast as well. It’s called, “Let’s Gut Real.” We are focused on easy to digest nutrition science all about you and your gut. So, you can find that on Apple iTunes or you can find it on andreahardyrd.com. I also run a private practice here in Alberta at ignitenutrition.ca.

Adam Rinde, ND: Thank you for your time and your expertise. This has been very helpful. I learned a lot. I’m sure our listeners did as well. It will be interesting to touch base with you periodically as we learn more down the road because this is the frontier for microbiota research and so every year we’ll learn way more than we know now.

Andrea Hardy, RD: Absolutely. It’s expanding quickly. Thank you for having me.

Adam Rinde, ND: You’re welcome and thanks for being here.

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Bellevue, WA 98005

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