Functional Medicine Bitesized | Gut Health and The Severity of Covid

Can Covid-19 severity be improved by using pre and probiotics and Phtyochemicals from plant foods?

‍

Functional Medicine Bite Sized is the podcast where Functional Medicine Practitioner Pete chats to experts in the field of functional medicine and health, giving you the listener pearls of wisdom to apply on a daily basis.

In this episode of Functional Medicine Bitesized, Pete chats with Professor Rob Thomas, Consultant Oncologist across the Bedford and Cambridgeshire NHS Trust. Rob is also Professor of Exercise and Nutritional Science at  the University of Bedfordshire.  

‍

Pete and Rob talk about the study that Rob and his team carried out during the COVID 19 pandemic investigating the links between gut health and severity of COVID outcomes. 

‍

Listen to the podcast episode here or find the written transcript below.

‍

Pete Williams: 0:19 Welcome, everyone. Welcome to this new podcast. Really exciting one because I'm interviewing today, Professor Rob Thomas. I'm going to briefly introduce him in a minute, Rob. It's been a while, hasn't it? 

Prof. Rob Thomas: 0:32 Yes. Well, nice to see you again, looking so well

Pete Williams: 0:34 Well, certainly better than the COVID pictures that were out on the internet, that's for sure. And mate, we've, we've known each other actually, we were introduced by your wife, weren't we? I mean, we must be 20 years ago now. So it does, it does fly. I think even at that stage, we had a bit of similarities in the fact that we were we were sort of thinking about health and fitness. And that was when you were starting off in the oncology world. But you were definitely a systems thinker, weren't you? And so let me formally introduce you. And then I would love you to just give us your background story on that. So Professor Rob Thomas, he is a consultant oncologist across the Bedford and Cambridge NHS Trusts. Now, that's right, isn't it, Rob? Yes. So just for anyone doesn't know what oncology is. He's a cancer guy. Now, not only is he that again, because he's a systems thinker. And I have to say, probably ageing well, and with more experience, and with a systems thinking approach, Rob is also a professor of Exercise and Nutritional Science at the University of Bedfordshire. So, it's a pretty solid couple of titles there, Rob.

Prof. Rob Thomas: 1:42 Yeah. Keeps me busy.

Pete Williams: 1:43 Yeah, absolutely. So why don't you give us your story, because I'm interested in you know, your sort of rise as a systems thinker in something as difficult as cancer care. So why don't you just give us a brief before we move on to what we're going to be talking about today. And that's your, your brilliant phyto V study that is actually looking at looking at outcomes of how we can potentially help COVID Let's give you your introduction.

Prof. Rob Thomas: 2:13 Thank you Pete. I think when we knew each other better, about 20 years ago, I was more interested in finding ways that patients could empower themselves after their diagnosis. And in those days, it was largely due to patient information and giving them different ways they could understand the treatment options. Now, that seems pretty routine. But over the, over the years, it came clear that patients quite rightly wanted ways to sort of, you know, what can they do to help themselves so you know, should they be exercising, should they not be exercising, they were told and still are often told, many conflicting stories of what's good or bad for them. They read conflicting stories on the Internet, etc, or over the garden fence metaphorically. And it's not about just, you know, my opinion or the opinion of others, we need to find, find the evidence, both we are explaining to people that they need to exercise during chemotherapy or during radiotherapy, for example, you know, we really need to do the studies to get the meat on the bones, not only to make sure we give the right advice, but also to persuade our colleagues to give the right advice. So that's when I became interested in sort of lifestyle medicine, exercise nutrition, I was very fortunate to get some attachments initially to Coventry, then more recently to to Bedford University. And it's just got more interesting as the years have gone on, because we're now realising that, you know, the response to cancer treatments. Now, the response to COVID is influenced very much by what we can do to ourselves what we do to our bodies and we've developed a series of studies to support the evidence for that. So that's where I am now is designing studies, working with patients to get the data out there so we can persuade other people to do the right thing.

Pete Williams: 4:07 Sure. And you've got a couple of books out, haven't you Rob if I remember, a couple of books. Well, we'll put those in the notes. I think one of the first books that I can remember on the bigger picture with regards to how you can help yourself with cancer care, and I can't remember what it was called.

Prof. Rob Thomas: 4:24 Yeah, well, thank you for the plug, one is keep healthy after cancer, which is very much you know, we do lots of evidence reviews, we summarise our studies, we publish them in medical journals. But you know, at the end of the day, we need to get the information out to the public. And that's why we wrote the book. So that's quite well, that's very cancer specific. And more recently, I was asked to write for a hatchet and major published on title Not really, you know, that. It's called how to how to live. And it was meant to be a not a sort of a paternalistic approach, telling people what to do and what not to do. but it was more about because there's a very famous book out there called How Not to Die. We felt actually it was more important. It's how to live with enthusiasm with Vitality. And we felt that title was better suited. So but that that's done quite well, that was number one on Amazon for a couple of days. So I was quite proud of that

Pete Williams: 5:16 Well done mate. So I think as you say, I would love to go through where we are with the cancer at a later one. But when you bring people on, like you with such a wealth of knowledge, I want to bring this specific and topical to where we are, because you have just gone through a study that was looking at well, let me let me entitle it, and I'll let you introduce it. It's the UK phyto V study. And this was a study that you wanted to look at from a point of view of potentially reducing the risk of severe outcomes from COVID. This study was designed in a particular way, why don't you introduce it, Rob? And if we can try and keep these terms as laypersons terms as possible.

Prof. Rob Thomas: 5:59 Good. Well, just just on a background, you could ask why an oncologist is getting involved in a COVID study? Well, that's a good question. We had, we had to, we had to stop all our oncology studies. So and as COVID was having such a devastating effect on, you know, people presenting late with cancer treatments were able to give, and we were have a lot of experience on nutrition and diet, it was, you know, we felt morally obliged to proceed. We had lots of patients with COVID. And we had the experience so and what we were trying to find out really was could a nutritional intervention, alter the severity of COVID and improve the rate of recovery, and prevent people going into this horrible long COVID situation, which we're seeing more and more. So in short, we looked at the dietary measures, which were largely learned already from flu epidemics, the previous SARS epidemics. And we looked at, you know, gapped health, we looked at the intake of what we call phyto chemicals, these are the chemicals in foods, which have enormous health benefits, which give it its colour, it's taste, and its smell, which we can go on to in a minute. Yeah, that would be good. But could we do though could we intervene in a proper robust scientific design and improve outcomes? And that was the sort of background that's the hypothesis.

Pete Williams: 7:22 So can we define why you work and why you were so interested in gut health? Because, obviously, I think we've gone on to learn that most of your immune system is probably at that barrier, that frontier where, you know, your body is talking to the outside world. So you know, it's a key player, isn't it with regards to immunity and COVID? So can you sort of explain and expand on just your fundamental thinking around this as well? And because I think that's quite important, you know, what, why are phytochemicals important? Why do we think the gut is important? And you know, what happens when things go wrong? And, you know, what do phyto chemicals do? What does prebiotic fibres do? You know, what does probiotics do? And how are they helpful? And of course, as you said, I think this is where your, your, your, your systems thinking is coming into this. And I think if you look at the Institute for Functional Medicine, they've done exactly the same. They've said, Look, we don't have any research on COVID, because it's brand new. But let's go and have a look at what we've learnt with other viruses like flu viruses and the ones that you've mentioned. And let's see whether there has been any research that has shown positive outcomes from that. So can you amalgamate all of that, so people get an understanding of why the hell we'll be looking at the gut? Why is that important? And why are you know, these things called phytochemicals? I mean, what are they where they come from? And, you know, where can we get them before we actually go into the design study?

Prof. Rob Thomas: 8:47 Well, certainly, you know, in my day job in oncology, gut health is becoming very obviously significant in the response to these biological treatments. So in our, in our mindset, we are realising it's so important, we know that people live with, lead a lifestyle, which creates a poor gut health, they're more likely to get chronic diseases, their immune, they have low immune surveillance, they're less likely to recognise things as foreign. They have abnormal immunity, so the more likely to get allergies and all sorts of things. So it is really important for all of us every single day. And, you know, it's it's not really that obvious that when you're dealing with a pandemic, that people with good gut health are more likely to do better. So I've worked first of all wanted to find out if that was true. And and yes, it is true. There's a number of studies to show that people with a better profile of bacteria in their gut and on their skin and other parts of their body, in their airways. They have, you know, an increased ability to fight viral infections.

Pete Williams: 9:52 So Rob, you're absolutely right. And again, we can relate this to oral health as well you know, oral bacteria and You know, some of those potentially causing super infections in the lung fields. I you know that there was a group in London who wrote about that as well. So again, interest in sort of integrative Systems Thinking dentistry also getting involved on this as well. But this fundamentally comes down to doesn't it is that the better lifestyle choices that you have or move on to, statistically we are reducing our risk of severe effects from COVID. Across the board.

Prof. Rob Thomas: 10:27 Yeah, I mean, that's a very good point, Pete, where, you know, I've been doing COVID ward rounds three times a week for the last 18 months, mainly to recruit people into the study. And, you know, I've seen fit young people suffering. And I've also seen, you know, 80 year olds who are obese, walking around not suffering. So it's all about reducing the odds, you know, the fact of the matter is, if you are, if you have, you know, if you're overweight diabetic, if you're male, if you have poor gut health you are more likely to get a more severe version of COVID. So it's about reducing the odds. We know from the data already published, that the majority of people after COVID get changes in their gut health. So they get worse gut health some of that is because they've already had bad gut health before they caught it. And that's one of the reasons why the more severe, the other thing is, of course, the virus we know does go into the gut lining, and damages the gut and causes an inflammation. And then some of the treatments we give are making it worse, like dexamethasone and anti-biotics.

Pete Williams: 11:31 So, so Rob, that's absolutely a point that I wanted to bring up, because I think that is there's not going to be a huge amount of system thinkers on and I look back to the sort of the antibiotic treatment and,look, you know, when people are really, really sick, we probably need to have more intensive interventions, because they're going to die. So you'd need to give them, you know, probably, you know, corticosteroids to help them, otherwise, they're going to die. But I think what we're thinking about, as you just alluded to are many people just don't think on that system point of view. It's a cost risk benefit, isn't it at the time, is that at the time it is if we don't, if we don't give this steroid Now, chances are that it's only going to go one way, and therefore we need to give it now. But what you're saying is that we but we also, we need to think about the longer term consequences of using pharmaceuticals, that may have side effects that influence a patient on a longer term basis, which is exactly what you've done. I don't know how many people are thinking that way. But that's absolutely the way we need to think.

Prof. Rob Thomas: 12:32 Yeah, I mean, well, right from the start, we know that people really, the fatal consequences of COVID is the cytokine storm, where your body, it's such a sort of insult to the body, it releases this massive inflammatory response against it. And a side product of this inflammatory response is exudates, and inflammation and that actually what causes the pulmonary failure. So even even right, today, we're using Chloroquine. hydroxychloroquine, a 30 year old malaria drug, which has anti inflammatory properties, which turned out to be negative, by the way, that trial, that was what we were, that was the early trials 18 months ago. We know that still does help, but it's at a price. And if you can come in what the hypothesis of our trial is, instead of having to give steroids or things like that, which of course, we do need to do, in some cases, absolutely. But in the early days, maybe we should look at foods or changing other parts of our body, which also improves our inflammatory processes and oxidative processes. So the body responds with an inappropriate inflammation, rather than excessive Inflammation.

Pete Williams: 13:41 Yeah, and this is the point, isn't it? You know, and I think this is why you can see I've talked about this is that, you know, I've had a pretty significant gene profile done. And unfortunately, I am a very pro inflammatory genotype, which means, as you say, is that you know, and when we're talking about immune systems, we're talking about trying to modulate them, some people are going to need to boost them, but people like me actually need to try and calm things down because mine is more has a more of a tendency to run away with itself and really likes a good scrap and doesn't want to turn off unfortunately. And that's where the sort of more serious consequences come from that. Mate, let's bring this into to the actual study and, you know, your thought process and how that study was, was designed because obviously, it was around randomised double blind, placebo controlled trial. So again, even just giving our audience an indication about, you know, the quality of the the study design, I think it's quite important, isn't it? We we tend to get most of our research off social media or off the press and they tend to not really understand and look as a clinician, unless you're a consistent reader of science, it's very difficult to really take a study and break it down and get an understanding of whether that study design has been really well designed, but you're pretty much using the highest level of study design. So can you just basically talk through that and then and then jump on to the just the basics of the summary what you guys did and why you did it?

Prof. Rob Thomas: 15:13 Yeah, as you say, a double blind randomised study is to try and make sure the results are as robust as possible. And to reduce the risk of an event could have happened by chance. Yeah, so you need reasonable numbers, you need to get a statistician to say, you know how many patients you should get in as a minimum. Patients shouldn't know what they're on. The doctors shouldn't know what the patient's been given. And even the statistician doesn't know when he's doing the analysis. So it will exclude bias. Yeah. Saying that there was there were two parts of the study. One was we gave based on the previous evidence we talked about one was to give an intervention to improve gut health. So that was your probiotic, and prebiotic capsule. It was Lactobacillus.

Pete Williams: 16:02 Can you define prebiotic and probiotic?

Prof. Rob Thomas: 16:06 Okay, so in our gut, we have unhealthy and healthy bacteria to put it very simply, the healthy bacteria support gut health and support the integrity of the gut, they reduce inflammation, the unhealthy bacteria are ones we want less of and they promote inflammation, they damage the inflammatory patches, which create immunity. So the probiotic bacteria are basically the good bacteria. They're the things in food such as lactobacillus. They are in food like kefir, kimchi, kombucha, fermented foods. Now they also need to be fed. And their growth is enhanced by things called prebiotics. And the prebiotics are just as important. These are the things you find in mushrooms, artichokes, beans, many, you know, fibres, fruit, and vegetable, all the healthy things most of us are aware of. So any capsule needs to have a prebiotic any worth it's worth its weight should have a prebiotic built in. And the one we chose was was actually inulin, which is derived from chicory. It's a very good prebiotic and the probiotics we chose after four months research and looking at the data was mainly five different strains of lactobacillus. We weren't trying to replicate the whole gut microbiome with hundreds of different bacteria. That's not possible. We just wanted to give people a bit of a head start, we know that lactobacillus are very good at breaking down previously, undigestible carbohydrates and forming these small components such as butyrate. And we know that butyrate feeds our gut cells and improves gut integrity. So that was the basis. Could we intervene after COVID and improve gut health at that point, which was previously unproven.

Pete Williams: 18:03 And so just just to sort of summarise, everything that you're saying is that humans really speak to the outside world don't we through the GI tract. And this is where, why most of our immune system sits there because it's trying to defend against it. And you know, you want your pro if you like, your probiotics, your beneficial bacteria to be like your defence force, if you like, and you want, you know, sometimes it's a numbers game, you want more good guys than bad guys. And, and in the sense, we've just, there's a lot of immigration control isn't there you know, they're trying to decide and, and talk and talk in signal to decide who's good to come into the body and who we don't want. And in many ways, there's a sort of war going on at such infinite numbers that we'd never be able to sort of grasp what is going on from this perspective. So you also talked about butyrate, because we're also in the world now, where we have prebiotics, probiotics, and post biotics and, and butyrate, as you said, is a fatty acid that your good bacteria produce, and it's a metabolite of them there it sort of gives us an idea of in many ways, how healthy their the gut is, and how happy the bacteria are of course, that the short chain fatty acids now on the science show, not only do they help to defend the GI tract, it helped to calm the immune system, but they are helping to sort of travel around the body, particularly the brain and help calm immune responses. There are inflammatory responses there as well. That would be correct, wouldn't it?

Prof. Rob Thomas: 19:34 Yeah, I mean, I think the key thing is gut integrity. There's many things which damage gut integrity, it could be radiotherapy, chemotherapy, etc. But I mean, the profile of bacteria is key to this. So if you're producing butyrate, through the healthy bacteria, it's feeding the gut cells, it's making them healthy and grow. If you're eating too much sugar, too much processed meat, not exercising, smoking, you get a proliferation of the unhealthy colonies which then cause inflammation in the gut and damage it. Once you have reduced intake, you get toxins leaking into your bloodstream, you get nutrients leaking out, those toxins in the bloodstream, the rest of the body recognises them as foreign issues an immune reaction. And it's that which causes chronic inflammation. And as a byproduct of that, we then get swelling in the joints, we get, you'll get the inflammatory markers going into the brain causing reduced thought process cognitive function, depression, later alzheimers and dementia. So it's like the key to many many chronic diseases and you know, with COVID, acute diseases as well,

Pete Williams: 20:40 Yeah, and this is absolutely the thing that we look at and have been in our practice for the last five years is number one, we think more about the health of our bacteria, or at least at least we think 50 50, about the health of our bacteria and the health of our cells. But also we're very concerned about, as you said, barrier integrity. Because if they're if that barrier is more permeable than it should be, then things slip through. And as you know your immune system has to respond to that. And unfortunately, its response is a big inflammatory response, and it's a big oxidative stress response as well. And unfortunately, that's not switched off pretty quickly, it can become really damaging. And as you said, Rob, I just want to just want to note a couple of those Alzheimers, and depression has a very strong component of in chronic inflammation, the chronic immune activation. And I think that's the beauty of, again, reason why I wanted to get you on today, because this is real, your studies, real systems thinking to COVID, we can look at COVID. And again, if I quote, Dr. Joe Pizzarno, he said, you know, vaccinated or not, we have to do our absolute best to try and look after ourselves. And this is the first sort of real COVID Systems Thinking study I think I've seen so we're sort of setting the scene, we're talking about probiotics, we're talking about your study, from the point of view of, can we help COVID patients, maybe reduce the severity of their symptoms by their probiotics, and phytochemicals that you're giving them? Can we talk about, you've talked about the potential downsides to gut integrity that is poor, you know, influencing this increased cytokine storm? Can you just sort of talk about that briefly? Because I think that's the reason why you're looking at the phytochemicals as well.

Prof. Rob Thomas: 22:27 Yeah. We know, as I said, before, we know that majority people get poor gut health after COVID, we know that people with poor gut health are more likely to get widespread symptoms like GI symptoms, diarrhoea, nausea, they're also more likely to get these other weird symptoms you get with COVID, such as poor smell, tinnitus, headaches, and reduced cognitive function and fatigue. But what we don't know is intervening, after you've had COVID would change those things. You know, it could be that the damage is already done, and there's not a lot you can do also, so many people will have to go they've got a poor appetite, it's hard to get them to change their lifestyle, or diet, you know, to have a protective effect. And that's why we felt we needed to intervene with a supplement. Because you know, you're able to deliver a high quantity of healthy bacteria, and prebiotic built in quite quickly. An we know, also from previous studies that, you know, people's gut can change quite, quite rapidly over two or three days. It's possible. And, and the hypothesis, could that change result in better outcomes? And, you know, that's what needs to be proven, because, you know, there's a lot of people out there trying to sell a probiotic or something, just saying these things, but we need to know for sure.

Pete Williams: 23:46 So can we go on to the study then? And what happened? How was it how it was delivered? I think you've just published haven't you, Rob,

Prof. Rob Thomas: 23:57 The trial's in two phases really. We also as well as the probiotics, we're also investigating a capsule which was had lots of phyto chemicals in it, and things such as poly phenols. And we know that polyphenols help with reducing inflammation improve oxidative stress, they have direct antiviral properties, which is largely not known as last SARS epidemic. And they work very well with probiotics because what the probiotics do is they help the breakdown of these phytochemicals into smaller units which are then more rapidly absorbed into the bloodstream which also help the reduce inflammation etc. So it's a great partnership in theory. So what we did with the trial is we recruited people either in hospital or in the community who had symptomatic COVID. We gave them a probiotic, it was called Your Gut Plus, one which is made for us which was supplied free by the company. And that was basically on our design, which is mainly lactobacillus, and then we randomised them 50/50 whether to have this phytochemical rich caps, which are the number of foods including pomegranate, and resveratrol, and citrus bioflavonoids, where we won't go into there's a whole panel of foods which had the best, we felt the best, like most likely improvement. And then we measured outcomes. So we measured the duration of pyrexia, the duration of cough, fatigue, probably the most important and then overall quality of life subject is a thing called subjective well being as a questionnaire was just basically ask people, how, you know, how they're enjoying life, how much they're getting out of life. And we we then compare the two groups to see if there was a difference.

Pete Williams: 25:48 And shall we talk about what we what you found?

Prof. Rob Thomas: 25:52 Yeah, good. So the, the open aspect, the probiotic aspect is was published this week, right? And then we're going on ITV News tomorrow, actually, and I've to wear my thermals because it's going to be filmed outside. You could argue why it was that bit was not randomised. Well, the reason why it wasn't randomised, it was such an overwhelming evidence of likely response, that when we started counselling people for the study, nobody would go into the study receiving a blinded probiotic. So we had to change, to do a protocol amendment and give everyone an open everyone the probiotic otherwise, they just would have taken it themselves that what we had in the study we had, we had about 30% of people had acute COVID. So they had symptoms within 14 days. And the rest of the people had chronic symptoms, most of them over 100 days. So we were attracting people from all over the country with these horrible chronic symptoms of cough, intermittent pyrexia, headaches, intermittent diarrhoea, and fatigue, obviously, all symptoms of long COVID. So with what we found is within literally within about 10/14 days after the probiotic, symptoms quite dramatically and significantly improved. And obviously, the statistician report that is highly statistically significant is very unlikely to have happened by chance. So our hypothesis that you can intervene with a intervention, which improves gut health within the time frame. And when you do start having criteria of improving gut health, so in other words, their GI symptoms, improved the nausea improved, the rest of the symptoms also improved, particularly fatigue, because it's not randomised you can't say it's not 100% proven, but you can say it's highly suggestive that this particular probiotic, and other interventions to improve gut health will improve the outcome if you have long COVID symptoms, or even acute COVID.

Pete Williams: 28:06 So pretty damn cool.

Prof. Rob Thomas: 28:10 Yeah, I mean, we were very pleased with the outcome. It must be it must be remembered. However, you know, it wasn't that every single patient who went in the studies. Within a week, were doing backflips down the corridor and smiling, you know, it was it was a significant change, you know, the majority of people improved. But some, particularly the ones who'd have really horrible symptoms for a long period of time, you know, didn't improve much. And it also sort of what we learn from it is really, when you get COVID, or even before hopefully, that's when you should be intervening, because the earlier you intervene and improve your gut health, the less likely you are then to go on and develop these horrible chronic symptoms. So it's the earlier the better, like like most things you can imagine in life.

Pete Williams: 29:00 Yeah, so I think there's a couple of things to take take away from this is that, again, without being 100%, we're pretty clear that probiotic and some phytochemicals are going to enhance the way that the gut microbiome works and defends for us. I think there's a couple of other things to take in. How did you? Was there any resistance to this study? Because this is, you know, this is systems thinking here, this is probably not a how a conventional medic and that's you know, don't want to say that in a horrible way it is but it's probably not how a conventional medic would would look at this. And would look at if you like COVID outcomes. Did you have any resistance to going to the ethics board and say, look, we think we should do this. We think this is something that we should look at. Any resistance there?

Prof. Rob Thomas: 29:53 Very much so but don't forget the, fortunately over the last 18 months because this this study we put this study in in March 2020. And despite the rapid pathways they were they were making out happened. It still took four months to get through ethics and the MHRA committees and I had to go back to the MHRA, four times pleading them, they have this loop that estrogenic foods or phyto chemicals and probiotics aren't actually drugs. And they're an organisation to control drugs. So they will say, well, it's not a drug, I say, that's fine. So let me deal with the trial. And then they say, No, you can't do the trial, because it's not a drug. So you have all these bureaucratic loops you have to fight with. And also, the trials committee, most of them had never heard of a probiotic. They never heard of gut health. So of course, they had to get it peer reviewed from people around the country, who could reassure them that giving bacteria to people with COVID is a good thing. You know, they instantly thought it was a bad thing to give bacteria to people who were ill. But we had to pull out all the data from, you know, probiotic interventions from the past, including, you know, babies on intensive care, people on ventilators, all showing it's completely, well not completely safe, but it's very safe.

Pete Williams: 31:16 A bit like your area. I mean, there's been plenty of studies done with probiotics helping Cancer Care.

Prof. Rob Thomas: 31:23 Absolutely. And now, you know, the president of ASCO stood up in the last meeting in Chicago in front of 44,000 people. And said we need to be finding ways to improve gut health before we give oncology treatments. Absolutely. That that's a game changer. But you're right. It's many people are not on board, that you have to help the whole body it's not just focusing on one thing. There is an intervention in oncology called prehabilitation, which is becoming more and more accepted. And part of preparing people for treatments is also to look at gut health as well as exercise levels, obviously. But nevertheless, yes. So in answer your question, it was very difficult to get through.

Pete Williams: 32:07 So do you do? Do you think that it? I mean, you've you've been systems thinking since I mean, we were doing it 20 years ago, they were sort of the start of our conversations, weren't they? We were talking about exercise, and, you know, whether that could help oncology patients, but do you think there is a there is a change? And because you can't really ignore the science? Can you? I think this is the key on this is that, you know, there's just so much literature scientifically out there to show that this sort of makes sense. You know, and I think we have to upset that humans are slightly more bacteria than they are human cells. And, you know, I think even even on that first bit, it's like, well, you know, you are a super organism of human cells and bacterial cells. And if you don't look after your bacterial cells, or, you know, the composition of them is is not great, ie, you've got more bad guys than good guys, then that's going to be problematic. But as I said to you, I mean, I was gonna say, it does seem crazy that people, medics just don't have any awareness of this at all. I say that sounds incredible. But as we discussed didn't we before came on is that I suppose humans and how they interact with with the outside world is so infinitely complex is that maybe it's just as you say, you spend your whole career with your blinkers on in an area that you would you would never look outside, has it changed for you? Is it changing for you? I mean, it must.

Prof. Rob Thomas: 33:34 It is changing fortunately. It's mainly driven by the fact that in oncology, we're moving over to biological treatments, with and these biological treatments are basically recruiting our immune systems to recognise cancer as foreign and attack it. And if you've got an impaired immune system, these drugs aren't going to work. So, you know, without with my conspiracy hat on when the pharmaceutical companies have realised that they're going to be making billions of dollars over a year by improved getting people to have improved that health, suddenly, you know, we're discussing it in conferences, you know, you see it in journals every day now. Absolutely. And and you know, on the academic side, there's there's an enormous project going on in Cambridge University called the gut signature profile, they're analysing gut health with hundreds of volunteers and people on treatment to find out what is the best profile for responding to different drugs. And it's amazing project and they're finding new bacteria every day. In fact, they've stopped publishing new bacteria, because it's like, going into the ocean and finding new things you never knew existed in your own insides. But the fact is, now it is becoming more mainstream people are, my colleagues and I are beginning to say, you know, look, we need to be doing this we need to be supporting gut health. And the same applies to COVID. It's been a little bit of a surprise, you know, that the government guidelines over The last 18 months, you know, I heard the Welsh Assembly telling people not to exercise after the vaccine the other day. In May last year, there was an announcement from the the three panellists who sort of go up on the news every night, saying there's no evidence for vitamin D, you know, and then a month later there was like, oh, yeah, there is evidence, you know, you should be taking it, but their public message was to stop people taking it. I mean, how many people?

Pete Williams: 35:26 I mean, that, just, as I say, Rob, we've just published our first podcast, actually, just on that subject. And again, unless I'm severe, a lot of people are severely missing something. I mean, number one, you know, a significant proportion of the population in the UK are deficient in vitamin D, your product has some vitamin D in there, because, you know, one of the key things we've learned about vitamin D is its ability to help your immune system modulate itself, particularly on those mucosal surfaces. So I find that incredulous that well, is it because Rob is it because maybe we don't want to overwhelm the population with too many things to do.

Prof. Rob Thomas: 36:06 I think the bottom line is, you know, the danger of saying, you know, you can help yourself, you can look after your gut health, you can take a probiotic and increase your vitamin D is that some people might misinterpret that is they mustn't go out and get vaccinated. They mustn't, you know, socially isolate and obey the rules. So what they were so paranoid about that they were afraid to tell people, you can also help yourself, but we know from the vaccine now that it's not really stopping people catching it, you're just getting a milder version, which is what we're gonna have to live with.

Pete Williams: 36:39 I think this comes down to given that we're probably going to have more and more varying changes, probably new, new variants coming out over the next several years, it brings us back to fundamentally your study, but the principles behind the study and the systems thinking, is that, okay, how do I start to make myself healthier going forward? Why don't we sort of bring that to summarising, you know, that sort of what can be the, you know, the three to five things that that we can take away from your study, that, you know, the person in the street can apply on a daily basis, based on what we're learning about, about what your study results are showing.

Prof. Rob Thomas: 37:22 I will, can I just briefly mention, you mentioned the vitamin D. And and the study, we're just starting, would you mind, if I just tell you about that? Listen mate, the more the more we get out of you, the better. You've hit the the nail on the head that we were going to be living with this for many years. And we need to make the vaccine more effective. And there is lots of data to say that if you exercise prior to your injection, if you don't have low vitamin D, and if you have good gut health, or you take a probiotic it will improve your antibody titers, that's already been proven. This is so true, because Rob, I mean, you can look at you can look at there's been, there's been many studies done on ageing populations that have done a bout of exercise before they've had a vaccine, and it absolutely shows that their immune response is so much better. And I look at this and think, God, you just the amount of money you're going to save from this. I mean,it just beggars belief that no one does anything about it. It's not being shown in COVID, but it's very likely to so this is, this is what we've done. We've reformulated the Your Gut probiotic, we've got the company to add a slightly higher amount of inulin and to add a good quantity of vitamin D. And the reason why it's important to get vitamin D with a probiotic is probiotics help the absorption of vitamin D, so many people are taking very high doses of vitamin D, but what they actually do is need to take it with a probiotic. And that will increase the absorption

Pete Williams: 38:55 Again, systems thinking again. Yeah,

Prof. Rob Thomas: 38:57 Good. So what we've said is now we're doing we're doing, we've just started, we're just putting through ethics now. So we've got this battle ahead of us. But I think we'll get approved that, that we're giving it another double blind randomised trial. So they're having Your Gut Plus, or placebo in a double blind randomization pattern before their vaccination. And we're measuring antibody titers at four weeks, three months and six months. We're also measuring exercise levels. And so that's what we'll get out of the study is, are people who exercise more likely to get high titers, and secondly, could an intervention with a probiotic, vitamin D and inulin also improved Titus, very simple things to do. Very cheap. And just as you can and Roche kindly are sponsoring us with the free antibody tests, which are quite expensive and hard to get hold of. So thank you to them, and wouldn't that be a lovely conclusion. If you could just say that you know, when you go for your vaccination, you need to take some extra probiotics look after your gut health, go for a run, and that will double your response to the Vaccine.

Pete Williams: 40:06 And isn't that as you say, these are the things that the evidence is out there, you know, and there is no doubt. Again, if you look at the evidence regards to age match, and sex match populations, the people who are more physically active, in some studies are showing an immune system that's 40%, they are 40% less likely to catch respiratory tract infections. And so again, there is something that is, you know, highly statistically significant, but again, comes down to the lifestyle, lifestyle aspects being the, you know, the biggest bang for your bucks. And and again, look at again, it's this is it's not just about being vaccinated or not, it's again, how do we enhance the situation around it? So, so thanks for that mate. And when's that? So that study's been designed? And you're going through ethics now on that?

Prof. Rob Thomas: 40:56 Yeah, that's been submitted two days ago, actually. I mean, you know, hopefully, with all the hurdles that you have to cross to get the Your Gut Plus through ethics the first time, it'll be pretty rapid. I don't think we will run out, the danger is everyone's gonna get vaccinated, there'll be no patients around but the way it's going, I think we'll, there'll be plenty of people having vaccinations. So yeah, that'd be quite an easy study to do, because we'll, you know there'll be a lot of patients and we'll get the answer quickly. And hopefully, we can get that message out to the public, which is already common sense. But you know, we just as he said, we need the proof, we need the proof before the government bodies are going to put that in a public health message.

Pete Williams: 41:35 Mate listen, I know, I know, your your time is very precious, can I just ask a couple of things that we sort of approached earlier on? Because, you know, if I can give my example of having COVID a month ago, you feel pretty shitty with it, well certainly I did as well. And, you know, I did take some painkillers for 48 hours, because I was feeling so rough, as you say, it's a question of cost risk benefit, isn't it? You know, if we, if we look at aspirin and ibuprofen, we know that maybe very short term, they are going to just help you get over feeling so rough. But of course, there could be complications with sort of medications like that on the sort of gastric mucosa. And so these are the ones that really again, it's that I suppose the right medication for the for the right period of time for the right reason.

Prof. Rob Thomas: 42:26 Yeah, I mean, paracetamol is you know, is probably the safest. But when you start taking ibuprofen, again, you sometimes just have to you feel awful. You've got joint pains, headaches. Yeah. But bear in mind, you know, you are going to risk damaging the the gut a little bit. So I would, you know, that's why I would advise taking a probiotic when you have Covid.

Pete Williams: 42:46 Yeah, and I think also with this, as you say, is that in generally, when you when your immune system is gearing up for a viral fight, you're not gonna have really, you're not gonna have an appetite. And I think this is why this is so important. Because, you know, the key to this was, well, you know, you should be getting this from your diet, you should have a diet that's completely high in, you know, in the plant foods of a rainbow of colours, but it's just not what you feel like doing it in those first days. So I think this is why this is even more important for me is that, you know, and again, I've videoed this about, you know, what I was taking, and what I'm sort of tailing off now, but why I was doing that, and that is so important that you know, we are we are understanding that the the gut, and how that gut works and defends is dependent on we've got to, you've got to feed it well. Yeah. And you've got to give these phytochemicals that do a sort of systems wide conversation to the body talks to talk to genes to help them deal with some of the side effects of the immune of how the immune system works, which in general is creates a lot of inflammation, and also it creates a lot of oxidative stress. Rob, have you got just a few minutes to talk about oxidative stress? Because I know that's a big component of why you've formulated what you've formulated in your phytochemical product.

Prof. Rob Thomas: 44:03 Yeah, I mean, oxidative stress. As I said, I've got a whole chapter of this in my book because I mean, to be honest, before I started writing, I was a little bit confused, because it's not actually part of the immunity. Oxidative stress is an intracellular, it's an inside the cell phenomenon. So it's, so basically, if you generate energy, or if you eat carcinogenic foods, you develop these things called free radicals, which we need a certain amount of for normal cell function, but if we have too many free radicals, and we don't control their quantity with antioxidant enzymes, they then go on to damage our tissues, damage our DNA, increase the risk of cancer in the long term, but in the short term trigger, you know, tissue damage, and we know that excess oxidative stress is also a hallmark of COVID. Yeah, and particularly the cytokine storm, which is part of the same picture.

Pete Williams: 44:56 So, can I just clarify that because as you say, is that this is oxidative stress, it's a question of level, isn't it? Because yeah, I can remember the front of the Lancet in probably 2016. And James Watson, who is an incredibly famous scientist, he is Watson and Crick, who found the double helix to the DNA, he actually wrote a paper suggesting that he believed that type two diabetes was a fundamentally a disease of lack of oxidative stress. And what he was, you know, what he was trying to say, there, is that you need your body works, actually, optimally, with a little bit of oxidative stress on a daily basis, it's really important, but of course, too little of it. And too much of it is where the problems start to begin, I think what we get with COVID is way, way too much oxidative stress.

Prof. Rob Thomas: 45:47 Absolutely. And what people don't, it's a misnomer. People sometimes refer to foods like turmeric, citrus bioflavonoids, things as antioxidants, which is actually incorrect. They, they enhance the oxidative process. So they encourage oxidative enzymes to form when they're needed, in other words after exercise, or if we have, you know, too much sun or radiation, etc. But they also encourage the degradation of the antioxidant enzymes when they're not needed. So they prevent anti oxidative problems. However, you got to be careful of things like viatmin, A, vitamin E, which, interestingly, in clinical studies have been shown to increase the cancer risk in excess because they mop up too many free radicals that they are direct antioxidants. So, but you you don't see studies with Whole Foods or phytochemical rich foods causing cancer? And you don't we know that because they don't over anti oxidise the situation.

Pete Williams: 46:49 So mate, maybe we've got another podcast we're particularly this is something that we see with exercise, isn't it is that if you're using antioxidants to offset the oxidative damage from exercise, it actually it can be counterproductive on most of the studies that you're looking at? Yeah.

Prof. Rob Thomas: 47:07 There's lots of data to say athletes who take vitamin A and vitamin D, in excess, for example, do themselves more harm than good? Yet, if you go out and have some blackberries, pomegranate cherries, you enhance your performance? And this, you know, is blatantly obvious why

Pete Williams: 47:24 Do you think that's because these, these phytochemicals just do a better job of signalling, I mean, they are signalling to much more of the body, they are sending messages much more to the body, whereas maybe just the antioxidants are doing a very specific job with that.

Prof. Rob Thomas: 47:39 I mean, you know, the cynics would say, oh, but the biggest creator of free radicals is exercise, because we're using because free radicals are a byproduct of energy production. So the more we exercise, the more energy production we have, the more free radicals. That's why you need to make sure when you exercise, you have a good diet full of phytochemical rich foods, because when you start getting these free radicals, your body adapts by producing more antioxidants. And it's an adaptive process, which is why you need to train, you know, integrate your training. But when you start taking things like a high dose vitamin E and vitamin A, they directly mop up the free radicals, naturally, they reduce the natural adaptive process of free radicals. So that's why, you know, but people it's a very subtle difference. But it's a very important difference.

Pete Williams: 48:26 Yeah, this sort of, in the sense make your body a bit lazy. Yeah, could be Yeah. So Rob, can we summarise up, imagine that we're sat in the pub, which at some stage we'll do, and I've got absolutely no idea of the study that you have just produced. And again, as you say, we'll we'll put the study links on to the, onto the podcast notes, what are going to be the three to five things that you're going to tell the layman in the pub with regards to what we can do on a daily basis to reduce our risk of COVID. But but to be fair, to reduce our risk of infection, right across the board with your study,

Prof. Rob Thomas: 49:07 I think you need to split it up to you know, if you've got COVID You know, if you're already if you're suffering from it right now try to you probably best to just go on and take a good lactobacillus probiotic, such as Your Gut Plus, because you know, your appetite is going to be poor, you're under a lot of strain, phytochemical intake, we're going to get the results of the main part of the study very soon. And you know, I don't want to preempt the results, but phytochemical rich foods do a good job in in boosting your immunity and and helping you fight the disease. But that's, you know, the short term in the longer term. You know, we all should be thinking about our gut when we you know, on a daily basis, I mean, the far east they're much better at it. Absolutely. So, you know, think you know, think of what could be damaging it processed sugar, not exercising, being overweight eating lots of meat. You know it's the same formula for everything really, isn't it? Let's face it, but try to have some some bacteria rich food everyday like they do in you know in Korea and Japan. You know some some pickled foods and fermented food, miso soup, kefir, kimchi, kombucha, just something everyday thing, what have I had anything today get into the habit of having a pot of kimchi, B and having a spoonful with your sandwich at lunchtime. So you're always topping up the healthy bacteria. And then on top of that, think of the foods which help the growth of our healthy bacteria. So, you know, mushroom if you see the menu mushrooms, beans, artichokes, as much fruit and veg as you like. So just you know, just Just have a try to you know, have avoid days where you're not having any of those products would be my sort of golden tips.

Pete Williams: 50:58 So, as unprocessed a diet as possible with high levels of plant foods within that. And in particular, fermented foods love kimchi, by the way, love the the hotness of kimchi and increase our exercise, again is a key for you, isn't it? Because, again, when we're looking at general studies showing that and I'm going to say within reason the fitter you are the better that sort of microbial community seems to be but obviously on the very extremes, it can go the other way as well. They're sort of high endurance athletes. So again, it's always a question of levels on that.

Prof. Rob Thomas: 51:38 And it's just a question of reducing the odds. Nobody's blaming anyone. Yeah, no, absolutely. Or any disease but it you know, the data is strongly out there, that you will reduce your odds of catching it, the more you'll improve the the effectiveness of the vaccine. And if you get COVID You're going to reduce the severity.

Pete Williams: 51:55 Mate, real pleasure, thanks very much.

Prof. Rob Thomas: 51:57 Lovely to talk to you as well.

‍

For more about our services, visit: www.functional-medicine.associates

Follow us on instagram: @fmedassociates

‍

Are you looking to boost your overall health? Interested in how functional medicine can help you? Sign up to our free 5 steps to a healthier you here.