Autoimmunity and the Microbiome Artwork

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a patient story

Autoimmunity and the Microbiome

August 05, 2026 • Daniel Baden ND

0:00 | 51:52

All feedback and questions welcome

Dr. Brad Leech G'day.

Hello, it's great to be here.

Mate, you have done so much and I've been watching your career for many years and watching your taking hold of the microbiome industry and profession and what you publish is just wonderful. My problem is you look like you're about 12 years old. So I'm trying to understand, has someone who's published so much and is so wise in the way of the microbiome has maintained this youthful appearance?

Well, I'll give you a couple of secrets. The first of all, there's an excellent filter on Zoom that makes me look 10 years younger. Fantastic. No. I actually, I got into this profession at a very young age. I, you may not be aware of this, but I actually dropped down to school and started my first qualification in healthcare at the age of 15. So I started with an advanced diploma in Ayurvedic medicine here on the Sunshine Coast, yeah, at the age of 15. I saw my very first client the week before my 16th birthday. And now bear in mind, this is, it was in stages. So the first stage was a cert IV in Ayurvedic lifestyle consultation, where it's about lifestyle medicine. And I remember seeing that first client, 50 year old female going through menopause. And here I am on the verge of hitting puberty, talking about hot blood. So yes, I do look very young, but I started at a very, very young age.

Okay, you could have also said, yes, that's because of all the probiotics I take.

Possibly, but that would be lying because I virtually, I don't take any probiotics. I'm very much of the belief of only take what you need to take rather than, I don't know, sometimes you read these summaries of different nutrients. Oh, I should be taking this, I should be taking that. Well, no. If that was the case, we'd be taking a handful of different interventions. Take what you need. I probably put this, the lack of grey hair down to work-life balance. Yeah, to get out in the sun and spend time with the family.

Okay, well there's the podcast. Thanks for joining us. Goodbye. But you started your interest in natural medicine or holistic medicine from the age of 15 or younger possibly. Where does that come from? Is it just innate or were you brought up in a family of people that just really were into it?

My grandmother was a Reiki master, was a massage therapist. I think that translated to my mother being health conscious. Now, did she have any formal qualifications? No. But did I grow up in a house where we followed the latest and greatest dietary trends? I'm talking juice fasting. You know, there was the 70, 30 acid alkaline diet. I remember eating a 70% raw diet in the middle of winter. And there's something about that I'm like, this is wrong. This shouldn't be how we should be eating. And how the start of doing qualifications were somewhat wanting to prove my mother wrong. So that the rebellious years, I'm 15 now, I need to know better. And I kind of, I enrolled in this advanced diploma of Ayurvedic medicine without actually knowing what I was enrolling into. I couldn't say the word Ayurveda. I had no idea what I was getting myself into. I just knew it had something to do with healthcare. And that's what I wanted to study. That's what I wanted to learn. And my career has just progressed from there.

Yeah, wonderful. Well, I'm glad you had it because you have gone on, my friend, to produce at least 19 publications and your PhD. Most of them I notice are orientated, and your PhD definitely was, towards intestinal permeability. And there is a absolute connection, and I'm not telling you anything you don't know right now, between the gut microbiome and autoimmune conditions. And it is extraordinary to talk about this because the rate of autoimmune conditions I don't know about you, but amongst my cohort just seems to be climbing and climbing and climbing. I read a statistic recently which talked about autoimmune conditions per se affecting 3 to 5% of the world's population. I can't believe it's that low, to be honest, just through people I know in my life. What do you think?

So the stat that I have for you is 3 to 9% of the population will have one or more autoimmune conditions. Now, what we need to consider here is there are 100 different types of autoimmune conditions. Now, can I recite them all? Absolutely not. Do I know them all? Absolutely not. But it's that concept of, and I say this to my patients all the time, Once you develop one autoimmune disease, you're three times more likely to develop another. And so it's this clustering effect. And so what we do in complementary medicine in this holistic health care is not just about managing the presenting autoimmune disease. It's about preventing other autoimmune conditions from coming on. So addressing those core driving risk factors for the development of autoimmune conditions. Yes, There are a number of autoimmune conditions. Once you've developed it at our current level of scientific understanding and management, it is lifelong. Type 1 diabetes, celiac disease. We've come a long way on how we can manage these. But I wouldn't be surprised in the very near future, we may be able to completely reverse these autoimmune diseases whereby someone may not have those or have that diagnosis anymore.

I get that. But I'm just curious as to the increase. And obviously we all have our theories. If you're in the health game, you develop your theories as to why there's been an increase in autoimmune disease. But I think there's some things that most of us would agree on most of the time. And one of those is definitely going to be around diet. And I noticed the media is talking a lot about processed food these days. And certainly processed food has got to be one of the driving issues towards inflammation and immune confusion, stress, and probably in the Western world, we're far more stressed than we ever were. One of the interesting ones which I hope you can talk to is around over exercise. Now I know we all like to exercise and we all should exercise. In fact, we must exercise. But I also notice that people really go crazy on it. And I've certainly seen people that have been crazy exercising for 15, 20 years and the effect that has on their body and their gut over time. So what are your thoughts around those areas?

So I've got a few things I can mention here. Now, first of all, let's one step backwards. In my practice, I follow the belief that there are four driving modifiable risk factors for the development and exacerbation of an autoimmune disease. They are dysbiosis, intestinal permeability, immune dysregulation, and inflammation. So taking that concept of leaky gut or intestinal permeability, bear with me because it goes into this exercise concept. There has been many, many proposals within the literature and some quite strong research to indicate that the rate limiting factor between developing an autoimmune disease and not are a number of factors, but the presence of intestinal permeability. We see this with type 1 diabetes. We see this with multiple sclerosis, rheumatoid arthritis. Where I'm going here is there's a lot of research in and around exercise and intestinal permeability, okay? And there was actually a systematic review that was published, I wanna say around 2017, 2018, out of Monash University, where they looked at the max amount of exercise somebody can do before actually induces intestinal permeability, right? And so there's all these different, different studies, there's probably about 25 to 40 plus individual clinical trials looking at the severity and the rate of exercise and inducing intestinal permeability. And so with this systematic review, they actually calculated that there is this threshold, 2 hours at 70% of your best. If you go over that, or let's say another example is 45 minutes at 90% of your best, that's able to induce intestinal permeability. So exercise can induce intestinal permeability. And so that over exercising can drive up that quote unquote leaky gut, that hyper permeability.

Do you have any concept as to the mechanism that's driving that?

Yeah, so there's a few. First of all, when your core temperature increases, so does your intestinal temperature increases, and that causes a breakdown in intestinal cells within the small intestines. It signals the protein called zonulin to start expressing itself. Zonulin then opens up those tight junctions, causing an increase in intestinal permeability. I give you an example. Have you ever been at a marathon? Okay, and you're towards the end, maybe not running it yourself, but you observe people at a marathon. The number of people that will have loose bowels, fecal matter, actually being present, coming out of their ****** on their clothes. Zonulin increase due to exercise brings in fluid into the bowel, contributes to loose stools. That is the mechanism of action and that's why you get runner's diarrhea or those overtraining over exercise can actually have loose bowel motions.

So it's not just those jills that they take while they're running.

That's not helping. Or the mental state of running a marathon. I love the exercise. Am I going to run a marathon anytime soon? Maybe not.

What is an ideal amount of exercise to maintain overall physical health, mental health, protect your gut at the same time.

And it's an interesting one. I'm in the midst of diving into my core pillars when it comes around to healthcare and looking at that exercise component, okay? And there's a few things that I like to discuss with clients and kind of separate, and that is walking and exercise. A lot of my clients, and I'm going to categorize this group as 50 plus females. They come and I ask them the question of how much exercise do you do? Do you do exercise? Oh, I walk the dog four times a week. I have the view that every day we need to be hitting 8, to 10,000 steps. That's not our exercise. We need to be doing weight resistant exercise three, four times a week, 45 minutes. And you might be thinking, 8 to 10,000 steps a day, like myself, I'm in front of the computer, 10 hours a day. You know what I have under my desk? A walking pad. And so on average, I walk a marathon a week purely by, I mean, I won't be doing it during a podcast, but whenever I'm prepping for anything or writing up treatment plans, I'm walking. When I'm walking, I have greater ideas. I come up with good philosophies and ideas on how to teach a particular subject because my body's moving.

So in my mind, I've always strongly associated with dysbiosis with leaky gut. I've always considered it to be a fait accompli. If you have dysbiosis, you're going to have a leaky gut. Is it always the case?

No. And just with, let's say, inflammation as well. A lot of people think inflammation, leaky gut. Not always. There's a few things to consider here. How we go about assessing. leaky gut or intestinal permeability, it has its limitations. Thereby when it comes around to the research, you've got particular research articles quoting these exact links, but the marker that they've used to identify leaky gut isn't actually validated. And so, well, I actually exclude those research because it's not utilizing A validated method. Now, when we think about the microbiome, We have a microbiome in our gut, on our skin, in our mouth. We have a vaginal microbiome, a penile microbiome. There's all these different types of microbiome. But collectively, what most people are referring to is the microbiome in the large intestine. More specifically, that last 10 centimeters of the large intestine. That is where we can sample it, and that is where we're making a lot of these links with health and disease. Intestinal permeability is occurring in the small intestines. So it's, we're about a meter away from one another mechanically. Are there links between the two? 100%. But can somebody have dyspiosis without leaky gut? Yes. Can someone have leaky gut without dyspiosis? Yes. And that's why we need to assess both of those together or individually to determine what the client is presenting with.

To determine whether someone has dysbiosis initially come to you with a certain set of symptoms, what would those common symptoms look like?

And it's an interesting one. Most individuals, whether it's dad down at the local shop or whether or not it's a trained practitioner, most people will think digestive health symptoms, like bloating, constipation, loose stools. But I would argue that, it's not about the symptom presentation, because I have seen some cases where they've got extreme bloating and loose stools. We measure their microbiome perfectly fine. And it's more of a neurological based presentation, so that visceral hypersensitivity within the gut. So I actually, within my own practice, about 95% of clients will actually do a microbiome test before they actually come and see me. So we sit down at that initial appointment with that latest data to determine, and yes, I focus on the microbiome, so I attract clients who are wanting to measure the microbiome. But there are times where I'll go, the microbiome is not part of your focus. We need to focus on other areas or yes, it is a focus. So what are those symptoms? It could be anything. It could be hormonal presentations, autoimmune presentations. skin presentations, there isn't a set of if they have these symptoms, we need to measure the microbiome.

No, I get that. My concern has always been, and please tell me where things have changed, there were no big data sets available to try to understand or interpret adequately a microbiome test. So you'd go off and you'd come back with a reading and it would have various parameters for different types of bugs. And you go, okay, that's great. And at the end of it, the conclusion was eat more fruit and vegetables in just about every test I've ever seen. And, you know, what are we relatively comparing it to? Because I've read studies over the decades that talk about the different microbiome of Indian people who eat curcumin in their diet. live in different sanitary conditions, potentially Chinese people that have different diets at home, Australian people, English people, we all have such different diets. We're born with different starting microbiome and subsequently, you know, what are we actually testing for? What are we comparing to? How do we know what's right and what's wrong?

Yeah. So And without saying your age, okay, back when you were, can I say in your prime? No, that's mean. Back when you were maybe looking at a microbiome test, okay, many, many, many, many years ago, the test that was available was terrible. I wouldn't use it. Clients would still bring me those results from 15 years ago, 20 years ago, and I go, this is actually going to cause more confusion. In the last, let's say 8 years, microbiome testing has drastically changed. Now I want to give you a really good understanding of the reference ranges. The first thing to consider is how many people do we need to have to determine a healthy cohort? What does the scientific literature state? They state the golden number is about 120. 120, and that is to account for the bell curve to determine, well, what's healthy and what's not. And that's what's widely regarded as the gold standard for forming a reference range. Think about some reference labs and some reference ranges. They are basing this on five individuals, 10. The lab that I use has a reference range of over 500 healthy Australians. They have screened over, I think it's about 14,000 Australians determining any ******** medication, any disease, any antibiotics and ruling all these people out to have a...

What about age group, weight, pregnancy.

So they've ruled out anyone of underweight or overweight in accordance to BMI. Pregnancy is discontinued. An age range is between 18 and 80. Okay, so a much larger, a very large range, so it's not applicable to pediatrics. And so that healthy cohort is the reference range that I go off because it's for Australian healthy individuals where it is above that 120 mark.

But doesn't the microbiome change with age in any way?

Birth until age, it's debatable, maybe age 6 to age 12, there's a lot of change. It really, really does fluctuate. From about the age of 65, there's a slight decline in the number of markers and maybe an increase in pro-inflammatory markers. But the microbiome from an adult population stays relatively stable if undisturbed. And when I say undisturbed, that's medical conditions, very strong medications, infections. If there are those events, it's drastically going to change.

Yeah. But even if you're testing for 500 healthy subjects between 18 and 80, and Australia is quite multicultural, there are significant differences in the way people live and eat. Does that not impact the outcome?

That's a great point in the sense of, because it's such a large data set, the inclusion exclusion criteria was meeting sufficient fruits and vegetable intake. Okay, so there is that understanding that they're not on, let's say, a carnivore style diet, so with alcohol. I actually welcome the multicultural demographic that we have in Australia. So these reference ranges can actually be applied to populations within the UK and the US. Can they be applied to Papua New Guinea and China and India? Absolutely not. That's a completely different reference range. And so I wouldn't actually be advising it for that population.

Yeah, well, that's great because back in the day, which wasn't that long ago, Thank you, Brett. 90% of the published data that came out on the microbiome overall came from China or India. And so I never quite understood or appreciated the relevance to the Australian standard. Yeah, I'm glad we're onto it here. But just getting back to what I mean conditions, because that is essentially our topic today. Patient comes in to see you, you've assessed that there's potentially some sort of, they've come in with rheumatoid arthritis, let's say. They've also come in probably with some sort of gut change, often, like not always. What's your next step?

So when a patient books in, they get emailed a series of intake forms to fill out. One of them is I refer to it as my autoimmune root cause questionnaire. 27 questions that I ask trying to identify different root causes for their autoimmune disease. We go through mold, history of mold exposure, renovations. We look at sodium intake. We look at genetics for vitamin D. We look at early life events. We look at dietary patterns, past infections. And so I get them to fill out this very detailed questionnaire and I go through it and I find those key potential driving factors that could be linked up with their presentation. I'll give you an example. Have you ever heard of the ACE study, the adverse childhood event study, right? It was an incredible set of research articles which are being produced by this very large data set. So basically, Over in Europe, they followed children from birth up until the age of 18. And they looked at any adverse childhood events. And I'm talking about very serious consequences, including sexual abuse, imprisonment, an alcoholic parent, any form of traumatic event before the age of 18. And what these studies are actually indicating is those who are exposed to one or more of these events have a 100% fold increased risk of developing an inflammatory autoimmune disease. Now, I know when I first graduated, was I going to be asking my patients about traumatic events in their childhood? It wasn't top of my radar. But ever since utilizing a questionnaire like this, ever since asking the questions, wow, the prevalence of these these horrible and adverse events and the links up with autoimmunity is huge. To the point of I have a number of theories and those who have been exposed, their ability, their improvements are less. than those who haven't had an adverse event. And that's just something I've been seeing in my clinical practice and recently actually referring on to actually some form of hypnotherapy when it comes around to those events. And so, yes, that's just one example of when someone comes in trying to identify the cause. Another example is going to be mould. If they say, oh, yes, lots of black mould in the bathroom, had a bathroom renovation, symptoms flared up thereafter. I may do mold testing. I may send in a building biologist to actually do a sample of the air to understand, are they constantly being exposed to that mold? Everyone's presentation or everyone's driving cause could be different. And we can't just be narrow vision to go, okay, it's only going to be the microbiome. It's only going to be vitamin D. We've got to be open to all the possibilities. And I think asking the questions gathering that information, it really does help to direct me in the direction that's going to have the most profound impact for the individual.

In how many cases that you have seen with autoimmune conditions, do you think the microbiome has come up as something that you need to deal with as a percentage?

50 to 65%. And there are some cases where I look at the microbiome report and go, your microbiome's fine. But they've had this, maybe they've read online or they've watched a Netflix documentary and they go, it's about my microbiome, it's about my microbiome. And I'll be frank, I'll be honest, I'm looking at it, I'm like, this is great, okay? It's something else. But there's other cases, oh, where you look at their microbiome results and I will actually say, I'll say, Your focus for the next two years should be optimizing and supporting your microbiome. And we wouldn't know this purely based on symptoms. We need to use the right form of testing to.

How long on average would it take, and I know this is an impossible question, I'm putting you on the spot here, for someone to start to see improvement with a significant autoimmune condition. How long does it take to change somebody's microbiome if that's what's needed? Because I just know from my clinical experience, You could give somebody some supplements and probiotic supplements and if you don't change their diet and you stop the supplements, they're back to where they were within a week or two. If you change their diet significantly, from my experience anyway, about 50% of people revert to where they were and some not quite as bad. How do you get, you know, we don't want people to be on any sort of medicine for the rest of their lives. So how do we get the How do we get the significant profound change that we're looking for?

All right, so you've got a couple of questions there. One is, how do we get that effect? But 2, how long will it take? How long will it take to see a change in autoimmunity? And how long will it take to see a change in the microbiome? So I'm going to answer those three questions. With the microbiome, I usually have the number of species as an indicator to determine how long it's going to take. On average, and this is just my own interpretation of the results, on average, I can add in about 25 species to the microbiome each year. So if someone comes in and their microbiome has 150 species and we're aiming for 200, I would say that there's two years worth of work. Is that two years worth of supplements? Absolutely not. Is that two years of considering and focusing on what you're eating and what you're doing, what you're thinking and feeling and moving? 100%. So it kind of gives them an arbitrary length of time for how long it's going to take to address their gut. When it comes around to the length of time for an autoimmune presentation, it really does depend on which autoimmune. I find one of the hardest to get quick improvements will be alopecia. So that's hair loss. Sometimes, if we do a very restricted diet, you can see some slight improvement. But alopecia, it's harder to get the initial treatment and a smaller that longer term change that I see. Whereas you take something like inflammatory bowel disease, Crohn's disease, ulcerative colitis, where we've got an increase in inflammation in the bowel. we can see a change in clinical symptoms within weeks. And that is working in an integrated fashion with conventional medication while also doing modified dietary changes and targeted interventions to bring down that disease activity and inflammation. So to answer that question, how long? For some, yeah, two weeks, others two years. Unfortunately, there's no... one number that fits all 100 autoimmune conditions.

It reminds me of a very funny, it's not really funny, but I think it's funny now, study I read from Mayo Clinic going back, I don't know, it must be 25, 30 years, where they said ulcerative colitis is a disease of non-smokers.

Because of the research to show that smoking actually supports with ulcerative colitis. It's an interesting one that keeps on coming up, but I wonder whether or not it has, yes, there's the nicotine component, but I wonder if there's something to do with stress. So stress, when it comes around to inflammatory bowel disease, it is the biggest driving factor. And it's so common, and I'm probably going to categorize middle-aged men, When I say middle age, I got a watch here. I don't want to be classed as middle age just yet. I want to say 40 plus in that category of they have the financial stress potentially of a family in some situations, the work stress and so forth. And then how that translates is when they get stressed, they flare up. And it's one thing that, and I'm at that forefront of, and I don't give that diagnosis that's not within my scope, but I can count. 10, 15 times in the last couple of years where I've measured someone's microbiome and said and looked at it and said, the odds of you having an inflammatory bowel disease is 95%. Send them off to the gastroenterologist and they get that diagnosis. But I'm at that forefront to say, yes, you've got this presentation. Once that diagnosis comes along, it's educating to say, From my experience, stress is a major factor. We've got to keep stress low. Initially they go, oh yeah, and then a flare comes on due to stress and then they listen a little bit more.

Sure, we're talking about mental health stress because there's also physical stresses and physiological stresses through diet and exercise we talked about earlier. What do you prescribe for mental health stress? Is it meditation? Is it that walk with the dog?

I tap in and I ask, what do you enjoy doing? And if you ask them that question of what brings you joy? I've had clients start crying and it's typically the clients who are overworkers and they go, I love going to the beach or I love drawing or I love doing something. And they've almost lost what it's like to actually be human, to actually enjoy life because it's too focused on the grind and working. So I tap into what they like. A few suggestions that I like to give, and it really does depend on the individual. Diaphragmatic breathing is a free intervention that I feel is very effective. There's research around changing brainwave frequency and coloring in. So actually spending 20 minutes of the nights coloring in changes brainwave frequency means that you're able to cope with stress more effectively the following days. I am also. an enjoyer of a float tank. And so I'll often say, go down and book a magnesium float. It's something I personally enjoy doing. And it's a great way to calm and reset the nervous system. In some situations, sure, I'll give some L-theanine and some saffron. But I think those lifestyle interventions and educating around it is more profound long term for actually changing how we respond to stress than just relying on an intervention.

I completely understand that. But as you said, it is quite difficult for a lot of people, especially if they're on the treadmill of work and life and these sort of situations. So do you often bring in spouses or other family for support in these cases?

I'll ask them about what their support network's like. Often that would lead to more crying in the sense of them acknowledging that they actually don't have a support network. Sometimes they'll say, yes, they do, and bring those individuals into the conversation 100%. It's such a diverse mix on whether or not someone has that support network.

Yeah. One of the biggest drivers of dysbiosis, pharmaceutical drugs, a patient comes in, they've got rheumatoid arthritis, they're on some sort of nonsteroidal anti-inflammatory drug, which is For a holistic practitioner, it's great for the patient who can reduce some of the markers of inflammation and make them feel better temporarily. On the other hand, there is a cost and the cost is changes to the microbiome and avail over the true set of symptoms, which makes it hard to get to the root cause. How do you manage those sorts of issues?

So there are targeted interventions that we can give to basically counteract any negative impact of pharmaceutical agents, okay? Yes, we've got antibiotics and NSAIDs. Some typical interventions that I may co-prescribe for that short-term period will be things like SB or Saccharomyelacis boulardii. I may do a colostrum of some form. I may utilize interventions such as HMO, so that's your human milk oligosaccharides to protect the microbiome, to feed up the microbiome. I am very much integrative and I can see in most situations the greatest success occurs when we have this collaborative approach between conventional and complementary. this integrative medicine whereby it's not me saying, no, don't take this medication. It's me supporting the client in their understanding of the importance of that medication and what we can do to potentially reduce any negative consequences that it may be contributing to.

Do you find that generally speaking, working with a patient's GP or specialist is most of the time, or do you get a lot of pushback?

It really does depend on who. I have, and because of my position as an educator, I have a lot of colleagues, a lot of, I'd almost call them friends, who I've met over the years, who are integrative GPs, where we will actually meet up at a conference and we'll go, oh, can we quickly discuss this particular case together? And we'll pop to a corner and we'll discuss a case in that mutual care. In some situations, we'll do those email backwards. Other GPs, less. I won't sugarcoat it. I get dismissed a lot of the times, especially when it comes around to gastroenterologists. I feel like the, I'll categorize them as the old school gastroenterology, they need to retire. The new ones that are coming out, they are open, they're ready to learn, they're wanting to integrate. And as long as I stay within my scope of practice, they're happy. And you create this relationship where they understand your scope of practice. And we actually have a synergistic action where our clients will actually get better because we're working together.

And so Brett, you've created some... support tools such as your questionnaire for autoimmune disease. And it's such a big issue. I think it's a brilliant idea. Can you just run me through what that is about and what you're looking for?

That particular questionnaire?

Yes. So I do actually give it away. So it's a free resource that any practitioner can download on my website and they can have full access. to that questionnaire and it's a questionnaire that I send to all of my patients. It is a combination of 27 questions and it took me a very long time to actually collate these questions because I really wanted to have in one spot all of the questions that could be a potential driving factor for an autoimmunity. So rather than me asking these questions in clinical practice and get a yes, no, yes, no, knowing them up front means that during the appointment, I have that information and I can ask those follow-up questions. So these questions, we've mentioned a few of those, before, but others that I haven't mentioned so far will be viral infections. So talking about, well, what's their overall viral load? How many times did you get COVID? Did you get the herpes simplex virus, Epstein-Barran virus? Understanding that total viral load, understanding their exercise. I will actually ask, what type of exercise do you do? What exercise are you able to do? Because we know that link between permeability and autoimmunity. I'll ask questions around sleep and understanding, well, are they getting too much sleep or not enough sleep? And we know the research in and around sleep as one of those core pillars for optimal health. I may ask questions, or I do ask questions around environmental chemicals and pollutants. What did you do for work? Did you work in a mine? Do you have any amalgams? Have they been removed? How were they removed? So a lot of questions to understand the why and the how and what could be driving this autoimmune presentation.

So just getting back to our previous conversation on exercise and finding that limit where intestinal breakdown can start to happen. If somebody is exercising very heavily, two hours at 70% plus and that's a trigger for some sort of permeability event, How long will it take the gut to recover from that?

Okay, that's a really good question. So it depends on whether or not the expression of the zonulin proteins remain upregulated, okay? In some cases, they can stay upregulated and that's when it really causes a problem. in some situations like pregnancy. So you can have pregnancy induced intestinal permeability. And that's where, yes, permeability is natural during pregnancy. But if it stays due to that overexpression of these proteins, that's when it becomes problematic. It can take a couple of hours to a couple of days. So it is a semi-permeable barrier where it opens and closes during different exposures. Alcohol is another one. One standard drink can induce intestinal permeability for a number of hours. Stress, they did this interesting study where they got individuals to jump up on stage, give a 20 minute presentation and measure their permeability before and after. Yes, it increased, but in healthy individuals, that comes back down. And so if I got stressed, permeability would go up, but it would come back down. So it's when it stays high, that's when it's more problematic.

For our listeners, when your gut does become more permeable, meaning that the gap between the gastrointestinal cells opens up, it allows more substances into the bloodstream from the gut. And theoretically. You've got this smile on your face which people can't see, which is going, you are wrong, man.

Okay, how to say this without bursting your bubble. If we had pure substances going into our bloodstream, bacterial substances, that would be sepsis and we would be dead, okay? And that happens, okay? Medical professionals acknowledge acute intestinal permeability within a hospital setting. And that's sepsis and pancreatitis and burn victims and end stage kidney disease.

All I'm talking about more is protein fragments and partially digested substances.

These protein fragmentations, they can stimulate the immune response. They can drive up an inflammatory response. They can drive up total burden on the portal vein, thereby contributing to things like fatty liver. There's a lot of research between intestinal permeability and fatty liver. One that we may not be seeing as much in clinical practice as a nutritionist or a naturopath, but still very, very prevalent is that link with fatty liver. So smaller broken down proteins rather than complete undigested foods or complete bacteria because that would be a much worse situation.

Yeah, and non-alcoholic fatty liver disease, and it's got a new name which I've just forgotten, is on the increase. And that once again is testament to diet, the microbiome changes, the lack of production of short chain fatty acids. And so that is a really interesting topic. I did a lecture tour I don't know, eight years ago with a physiologist from Florida University on the condition. And it was mind blowing to see how many people had come across, but they hadn't hit the medical literature yet. And it was really a significant issue. All right. So I just want to touch a topic which is sensitive for some people, not for you, of course, but around fecal transplant. And the reason I want to touch on is because I had patients that have had it with some success. I've had patients that have had it with absolute disastrous results for inflammatory bowel disease. And I'm trying to understand why it was okay for some patients and not okay for other patients. These are ones that came to see me after the event. So what's your take on that?

Professor Tom Brody, rest his soul, he was a pioneer in this space and of Sydney. And over the years, I've had a number of conversations with him. And he's done thousands of FMT. So that is where we take the fecal matter of somebody who has a healthy microbiome and giving it to somebody who has an unhealthy microbiome. Now, a few interesting concepts here. There was a period of time where he was having amazing success, huge success, because it came down to his super donor, one individual that had an incredible microbiome. So the success of your FMT is only as effective as the health of your donor. And I think the biggest limitation with FMTs now is not selecting the best donors by not analyzing the stool to the greatest degree. So most tests that get done are basically just making sure that there's no pathogens for these donors, whereby I would want to take it to that step further and go, let's actually do a very detailed and expensive test on the donor to make sure that it has an optimal diversity, optimal short chain fatty acids to actually have that clinical effect. Now I've measured the results of clients the day of an FMT. So general protocol is high dose antibiotics to wipe it all out. And the microbiome of the day of the first FMT, there were seven species in the microbiome. So virtually nothing. And then measuring the microbiome over the years, a lot of clients, their FMTs will actually stick, but it comes down to one main factor. And that is whether or not they change their diet and lifestyle. If they go back to what they were eating, back to what they were doing, the microbiome would just revert. We've got to ensure that we provide a healthy, diverse diet.

You mentioned in that particular story that there were one patient with seven in the species of the stool sample. And it raises another question for me really, and that is around number of species and the quality of those species versus sheer quantity. And as a previous manufacturer of probiotics, we would often come across products often from the US that just had ridiculously high doses of viable probiotic cells. the substance, you know, hundreds of millions of one particular substance in there. To my naturopathic or holistic way of thinking, we didn't produce anything products like that because I never believed it was the right thing to do for our patients. And I didn't believe that because everything I've read and understood over the years about the microbiome is that the species are interactive. And there was even a an article that came out in the New Scientist magazine a few years ago that talked about a particular group of bacteria that were so low in their molecular weight that they weren't generally detected, but they had worked out that they have a relationship with the larger species. And so there are so many things we don't know, I guess. So I've always been very nervous about giving people extraordinarily high doses of one or two species without because I just don't understand the knock-on effects. Can you comment to that?

So a typical probiotic, drop in the ocean when it comes around to the number of bacterial cells within the intestines. I'll give you an example. I once had a client who was taking an entire bottle of probiotics every single day, 30 capsules every single day.

And we measured her microbiome and we saw those species in the gut, but it was only at 0.01%. It was at the smallest amount possible. So yes, they were detected, but they were nowhere near the overall relative abundance of 1%, 2%, 10% of the microbiome. So it's only a very, very small component. The thing to consider is the vast majority of these bacteria are transient. they're not going to stick, okay? They will come in, they will change the environment in the gut, they will maybe modulate the immune system, maybe reduce inflammation, maybe increase species through cross-feeding, but they're not going to actually stay within the gut. I think probiotics, they very much have their place within therapy. but it's about choosing the right strain at the right dose for the right effect. And sometimes it is about modifying the microbiome. And in other cases, it's about changing clinical symptoms. So there's some probiotics which have got really, really good evidence to illustrate their effectiveness in improving quality of life and clinical symptoms in medically diagnosed IBS. Fantastic. Using those in that particular cohort.

Okay, but you can't do anything long-term with that lifestyle and dietary and meditation practice. So just to finish off, mate, what do you think the potential, if we just talk about autoimmune diseases overall as a category, what do you think the potential success rate in supporting people long-term in a relatively drug-free environment is by adopting a correct approach to microbiome, health, diet and lifestyle.

Oh, that's a very loaded question. There's a few things to consider and that's overall intervention burden. Okay, and when I say intervention burden, I'm not talking about necessarily medication or supplements, but intervention burden of, okay, I've got to make sure I meditate today, I've got to make sure I eat organic, I've got to make sure that, okay, I walk by 8,000 steps. Sometimes to achieve that, it's such a huge burden. people have got other things to think about other than their health. Although, you and I, we think about health day in, day out. It may be, the only thing I think about every day. But for a lot of people, they want to, just do what they need to do to prevent things from getting worse. Success rates, it comes down to compliance. is going to be a big factor. It also comes down to what were those driving causes and have we managed to eliminate those driving causes? So if it was mould, have we eliminated it? Was it an infection in the gut? Have we eliminated it? So the correct identification of the cause greatly governs the overall success that a client may have.

Makes a lot of sense. That's when you become the detective.

Yeah. Now, Brad, how do people get in touch with you?

Yeah. So the best way is to pop to my website, drbradleach.com. And on there, you've got everything from microbiome testing. to working with me as a patient, to also all of my education that I offer. So I've got what I refer to as the Academy by Dr Brad Leach. It's a place for all of my education and I focus on the microbiome, autoimmunity and paediatric care for practitioners to upskill in those areas.

Fantastic, Brad. Look, you do a great job. I've been following you some time. I love what you do. So thank you very much and really appreciate your time.

Thank you and it's been great speaking.