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Holly Lucille:
Yeah, I mean, I think we know from the research now that a good diversity index is correlated with better health outcomes period, you know. So I think for the most part, there’s always the option, right, of addressing first unwanted organisms, right, that might have become opportunistic because of an imbalance or they might become pathogenic. So we need to remove those. But as far as really the diversity, my recommendation, usually, is manipulating the microflora. Through the use of prebiotics and probiotics is an option, you know, using those supplements when needed. But dietary interventions, I think, are really key here, because what I see clinically is a lot of people eating the same thing over and over and over and over again. This does not allow for a great diversity in bacteria. So this, I feel like, is where that eat locally, right, and also seasonally comes in. And get a variety of foods. Variety in our diet will then offer a variety of different, get this bacteria here, the bacteria here. That is the best, I think. We’ve got those tools as far as pre- and probiotics and being able to alter the microbiome, but that dietary intervention of eating more foods and a variety of them is going to have a variety of bacteria, therefore, better diversity. 

Kalea Wattles:
Absolutely. I think the way you just described that was super approachable, because I think we can fall into this trap where we think about, oh, we have to eat these, you know, expensive fermented foods, you know, from this specialty grocery store, but really, just broadening this lens of the types of foods that we eat can be so helpful on its own. 

Holly Lucille:
Yeah, you know, it’s funny, especially lately in the last couple years, my mantra of ‘dirt don’t hurt’ is huge. And I have this beautiful garden that I just spend so much time in, but it’s my favorite, I call it my dirt day. It’s my favorite day where I don’t have to worry about putting on hair, makeup, what have you. It’s like, I just go outside and fuss around and get dirt underneath my fingernails. And sometimes, I’m just like, I’ll just, you know, we’ve been so hyper-clean, right? And worried about being so sanitized for the last couple years. And I’m just like, “Dirt don’t hurt.” And that’s just another thing, you know, it’s like, I really treat my garden soil really well. There’s a lot of diverse bacteria in there, you know, to help those vegetables and such that I grow. And so I feel it’s the same way for us. 

Kalea Wattles:
Well, as a farmer, someone who grows food and eats from the ground, I can absolutely relate. So Holly, you talked about how you’ll really dive into gut health with patients who may be dealing with some mental health concerns—depression, anxiety, mood changes. So let’s talk about this gut-brain axis for a few minutes, because this really describes a bidirectional communication between the gut and the brain, which really occurs through multiple pathways that include hormonal, neural, and immune mediators. And then interestingly, the signals along this axis can originate in the gut, in the brain, both. What can you tell us about the gut-brain axis and its role in health and disease? How are you talking about this with patients? 

Holly Lucille:
Well, I mean, the conversations are really robust right now, especially as, you know, as it parallels with the research in the gut-brain axis. I mean, we’ve heard about, you know, the gut-brain, the second brain, et cetera. But yeah, there’s these efferent pathways that are sending signals down from the brain to the gut, and then afferent pathways, sending signals up to the brain. But I just think it’s huge because the other thing that I’ve been thinking about lately and diving into a lot of this research is our organs, right? The brain is an organ, right? Our liver is an organ, but I feel like I’ve come to sort of see our gut microbiota as an organ in and of itself. So it does interact with our central nervous system, regulates brain chemistry, influencing the neuroendocrine system, stress response, anxiety, memory function, and so much more.  

And the other thing, you know, that I think plays a big part in the relationship between the gut and the brain is the vagus nerve. So I’m going to bring out my vagal nerve tuner right now. [Audible tone] I hope that helped everybody. I start every little working session that I have with this, and I end it with this as well. It’s called Lovetuner, but it’s supposedly helping to tune and sort of settle down that vagus nerve. And I think so many people need it, but that is another big part of this. 

Kalea Wattles:
Huh, I feel better already, I have to say. 

Holly Lucille:
I have a friend sometimes, she’s lovely. She and I will sometimes just video text each other, and all it is is the vagus nerve tuner sound. And it’s like, it’s exactly what I needed. 

Kalea Wattles:
Friendship goals. That’s awesome. Will you talk to us a little bit about, you know, do you have patients who maybe present with anxiety or depression as a chief concern, you really focus your treatment plan on improving their gut health, and the mental health aspect gets better without medication? Maybe they don’t even have access to counseling. Is that something you see in the real world? 

Holly Lucille:
100%, I mean, you know, I think that there are obviously many different modalities, many different approaches to a clinical condition, but I have to tell you, and in the last at least three or four years with, once again, the research being so robust in the gut-brain axis and these disorders, like, I mean, and we’re talking anxiety, depression, but I would also go into bipolar disorder, obsessive compulsive disorder, sort of higher upstream and then lower downstream. Well, also, other cognitive things, Alzheimer’s disease, dementia, Parkinson’s disease, MS. And then, yeah, we see concomitantly IBS, IBD, right? And other things, but 100%. And I’ve got incredible cases, especially with some younger folks that are coming out of the pandemic and presenting with a little post-traumatic stress and also OCD, it’s been wonderful to work on their gut and to see their behaviors change in a positive way. 

Kalea Wattles:
Hmm, yeah, that’s so exciting to hear. And I think oftentimes when we do our gut healing, we just feel better. And so all of a sudden, all of the other behavior changes that are so helpful as part of our, you know, complete, whole-person care become more approachable because we just have more energy. We feel better. 

Holly Lucille:
Yeah, and that’s a tricky one too, right? Because there’s so many things sometimes going on at the same time, but I do track and have my patients track, you know, throughout time, as far as, because when we’re working on the gut, right, for short and long-term goals, especially when people are presenting with more depression, anxiety, OCD, it’s important to celebrate milestones, but also to see what’s working. And so I have them keep a symptom journal, and we see over time as their gut heals. And then we can measure that through testing, but also, I think the best measurement is exactly what you said. You start feeling better. And without that tracking, you know, people are like, they’re like, “Oh, yeah.” It’s almost like it just dawns on them that they’re not counting as much, right? Or they’re not engaging in those behaviors that were getting their attention or getting their parent’s attention so much. And so it’s really lovely to see. 

Kalea Wattles:
Well, I think we’ve highlighted here how, you know, as you said, there’s often a lot going on, it’s the gut, but there’s all these other external variables as well. And we know that some GI-related pathologies are deeply connected to stress, autonomic nervous system. And stress, for example, may precede the presentation of symptoms or really mediate their severity, I think. So how is emotional and mental health connected to gut health? You know, in the functional medicine matrix model that we have, the center of our matrix is the mental, emotional, spiritual component. So when you’re working with patients on their gut health, is there that piece where you’re checking in on their mental, emotional, spiritual health as well? 

Holly Lucille:
That’s a great question. And I would say, always. You know, I think sometimes what you’re talking about, it’s almost that chicken or the egg story, in a sense. 

Kalea Wattles:
Exactly. 

Holly Lucille:
Right, because a troubled intestine can send signals to the brain, just as a troubled brain can send signals down to the gut. And therefore, a person’s stomach or intestinal distress can be the cause or the product, you know, of anxiety, stress, depression. And we know that because we know this axis, this gut-brain axis that we talk about. But I think without the research that’s out there right now, we also know it because we can feel it. You know, I remember running track in high school, and I ran the mile, right? So it was a pretty long race. And it was also just like, there was a lot of time to get nervous about, right? It’s not like a 440 or a 220, as we used to call them. It was the mile run. And up to the time when that starting gun went off, I’d be in the bathroom, right? My nerves of running that race would, and so we know that, we feel it, we feel what are butterflies in our stomach, right? We know that the only organ system that’s directly innervated from our nervous system is our intestines and our gut, and we can feel it.  

So the research is amazing. And I mean, I just, who can keep up? I just keep scratching the surface, I feel like, and just getting deeper and deeper into these rabbit holes about these precision probiotics that are coming out. You know, Kalea, when I graduated from school, I don’t even think we were talking about probiotics. They were new on the scene, and it wasn’t until, like, the Human Microbiome Project and all of that that we’re starting to get. And so it’s been so fun for me in my career to keep up and to apply this knowledge and get good clinical outcomes. I’m having a blast because of it. 

Kalea Wattles:
Well, it is so fun to watch how this field is deveoping and changing and emerging. And this is the perfect lead in to my next line of questioning, because you mentioned probiotics. That was the hot off the press cool thing. And now I think most of us are familiar with probiotics, but now we’ve introduced in the intro of this episode to this new term, which is psychobiotics. And I think that term is relatively new to many of us. Will you give us a sound bite? What is a psychobiotic?

Holly Lucille:
Isn’t it crazy? Like, I know it’s psychobiotic, but I’ve also read that there’s like ghostbiotics and postbiotics and pseudobiotics. And I’m like, this is what I said, who can keep up, right? But yeah, I think this term was defined in, like, 2013, right? So relatively new. But these are basically probiotics that control the functioning or action of the central nervous system, conciliated of course by the gut-brain axis through, like you mentioned, neural, humoral, metabolic pathways to help, yes, ameliorate GI concerns, but they also have antidepressant and anxiolytic properties as well. I don’t think we really are fully clear on the mechanisms of action, right, of these psychobiotics, but they induce metabolites and hormones and immune factors, like you mentioned, and can modulate neurotransmitters. So it’s absolutely fascinating research. 

Kalea Wattles:
That is fascinating. And I’m very excited to learn more about this. So, okay, psychobiotics, this is our new hot term that we are all going to be searching furiously after this episode. So can we talk a little bit about the bacterial strains that may have been studied for their role as psychobiotics? Is this something that we can access? Do we know? 

Holly Lucille:
Yeah, I mean, there’s quite a few that have been mentioned in the literature. I mean, how much time do we have? I can go through a couple of them, but like, so Lactobacillus rhamnosus, right? We’re pretty familiar with that. 

Kalea Wattles:
Crowd favorite. 

Holly Lucille:
Yep, so preliminary research suggests supplementing with this can lower anxiety in humans. So there’s been some human studies, and this is mostly GABA is that main inhibitory and relaxing neurotransmitter, right, in the central nervous system. And the Lactobacillus rhamnosus may reduce anxiety by changing the expression of the GABA receptors one, two, and four. And so there’s a lot of studies on Lactobacillus rhamnosus, especially for reducing anxiety. 

Kalea Wattles:
Wow, this is so awesome, because these products have benefit across multiple body systems. So it just makes sense that we would add this type of intervention to a treatment plan. Are there any food sources that contain psychobiotics? Is this something we can get from our diet too? 

Holly Lucille:
Oh, 100%. You know, as I mentioned before, I think food is foundational for all of us when it comes to a modality, right? Nutrition, nutrients, you know, I always say to folks, like, these nutrients that we’re talking about, you know, even in the evidence-based supplement world that we’re in, they’re not just, you know, an online dispensary or a couple aisles in your local health food store. These have come from plant to pill, and they are things that drive our biochemistry, right? We need them. And so food is extremely important.  

There’s actually like a psychobiotic food pyramid out there, believe it or not. And it’s not going to surprise you, Kalea, that the recommendation is basically those whole foods, right? Vegetables, fruit with each meal. So this would be the foundation. And then it goes up to, like, seeds, nuts, herbs, clean oils. Quality of food, I’ve been talking about so much lately. I’m just finishing up the oncology nutrition consultant certificate. And I mean, we know a lot about food and nutrition, but the quality of our food, it’s not the food sometimes that we’re asking people to avoid. We’re asking people to avoid the food because of what we’ve done to it over the years, right? And so those qualities are so important when I talk about seeds, nuts, and oils. And then four, I would say, fermented foods are going to get you there. And then fish and seafood, poultry and eggs maybe two times a week. And then sweets and red meat maybe once a week. But you can get these in good, plant-based, nutritional high-quality foods for sure. 

Kalea Wattles:
Well, lucky for us, that list sounds delicious. And it’s some of our favorite foods anyway. So that’s— 

Holly Lucille:
Kind of like that Mediterranean diet type thing that’s going to get you there. 

Kalea Wattles:
Things we would recommend anyway. So it sounds to me, when you’re putting together a treatment plan, let’s say you want to make sure your patient is getting some exposure to these psychobiotics that there’s a dietary component, that there’s potentially a supplemental component, that really, we can create this, a very well-rounded treatment plan utilizing all kinds of interventions. 

Holly Lucille:
You bet, you know, what I’ve seen so far for me clinically in using psychobiotics is that the food part, we have a lot to do, because cleaning up people’s diet and them engaging in behavioral change is a big deal, right? And I know that that’s going to take a longer time and more intense intervention as far as touchpoints. You know, I have to understand their ability to adhere, their motivation to change. All of those things, which I think are really important. Their health literacy, like, why are they doing it? But there are, I think, some really high-quality products with the research that manufacturers have blended these synergistic psychobiotics that I can put on board as a recommendation to get the job done just a little bit quicker, right? And so we’re concomitantly working on that food piece as well. 

Kalea Wattles:
I think that is a very important point. And I say this all the time, it’s not an either/or. We’re not going to do the food or the supplement, you know, it can be an also/and, and really, that’s to the benefit. Well, so many benefits. We’ve talked about the food. It’s not only the psychobiotic action, but it’s improving the diversity. So really, we can utilize so many tools in our toolbox. 

Holly Lucille:
Yeah, and there’s such great testing out there now, too, where yeah, you certainly, you know, having good clinical acumen, understanding the clinical presentation, marrying that with the history of the person, doing good investigational interviewing and such, but then having that clinical hypothesis and confirming it with the testing that’s available, especially when the microbiome is concerned, that’s where I think the sweet spot is. Because then we can get, there’s these precision probiotics that are amazing, right? I mean, to lower LDL cholesterol for depression, for obesity, for OCD even. So we can get super specific with folks and really walk our talk when it comes to individualized treatment. And so I think that’s exciting too. 

Kalea Wattles:
You read my mind. You must have known I would ask about testing next. That’s just the natural line of thinking. So you mentioned precision probiotics, which I think is so fascinating. Are those treatments that we can only utilize if we have testing? Or we can utilize those products based on the clinical, you know, our history collection, our physical exam, our other labs. Can we call upon those products without, you know, a comprehensive stool analysis? 

Holly Lucille:
I think that’s a great question. And I would say, yes. Like, so for example, let’s say I’m working and caring for somebody who really wants to change their lipid profile, right? We need to swap some things up, like get that protective HDL up and the LDL down, you know, maybe get some more antioxidants on board as far as that’s concerned. But I think it’s Lactobacillus plantarum CECT 7527, which is the bacteria that has been shown to help reduce LDL cholesterol. So with all the good dietary recommendations, exercise, lifestyle interventions as well, that’s a perfect part of a synergistic comprehensive program. You could do the same thing with, I mean, bone mineral density, right? So Lactobacillus casei 393 has been shown to help with bone mineral density, which is another synergistic, great little tip that you can put on board along with other things that we know, right? Number one in the research is weight-bearing exercise for women postmenopausally that are struggling with bone issues and osteopenia/osteoporosis. So precision probiotics, I mean, it’s fascinating. The research is fascinating. And like I said, from a kid that graduated in 2001, we barely were talking about probiotics, and now where I’m just like, oh, I can’t get enough. It’s like, it’s crazy town. 

Kalea Wattles:
Okay, so you graduated, and people were barely talking about probiotics. Now we have probiotics, prebiotics, we mentioned psychobiotics, and now I’m going to introduce another term, which is synbiotics, just as we’re doing our terminology review here. Will you give our listeners just a brief intro? What is synbiotics? 

Holly Lucille:
So I think the idea behind synbiotics, which is great, maybe this podcast should be posted along with a glossary, right? So is that it’s adding prebiotics to a probiotic supplement so it can ensure that the digestion-friendly microorganisms arrive in the gut alive and well. And they’re particularly useful for people with conditions like IBS, for sure, and other bowel disorders, even diabetes. So that synbiotic synergy, it’s like that one plus one equals 10, is adding those prebiotics along with the probiotics to get the job done and make sure that those probiotics are eating the right thing so they stay alive, survive, and thrive. 

Kalea Wattles:
That sounded so nurturing how you said they arrive alive and well. I really liked that. 

Holly Lucille:
Yes, yeah, and you know, it’s so funny, because I think that our conversations around probiotics used to be mostly around delivery form, right? Survivability, how are they going to, you know, get through that stomach acid, the bile acid, how are they going to, you know, and then also dosage, right? Colony-forming units. And I like having these conversations, because I think the consumers sometimes can get confused, right, with all the claims out there and everything. And if maybe more is better, if you’ve got 25,000 colony-forming units or, you know, or five or 10, but there’s just so much more to talk about now with this precision and with synbiotics and psychobiotics and postbiotics and all of those things. So it’s very interesting. 

Kalea Wattles:
It is extremely interesting. And you brought up a question for me, which is, okay, I think we’ve established a clear benefit of using probiotic strains, maybe even very specific probiotic strains to support our patients. Is this something that our patient needs to be on forever? Is there an expected timeline? Does it depend based on what they’re eating and what their lifestyle looks like? I just would love to hear your perspective about the timeline. 

Holly Lucille:
That’s a great question. And I think for everybody, it’s different. So if we’re trying, and for me, if I’m trying to get a specific job done where I’m using a specific probiotic, I think there’s going to be a time based around that. And I usually like to give people a time base around any recommendation. And then there’s this thing called maintenance, right? I have a little saying called supplement your lifestyle, right?  

So I work in this really small town out here on the West Coast called Los Angeles. And we’ve got this really small industry called the entertainment industry. And some of the people that I see, I mean, you know, they’re wined and dined, and their lifestyles are buzzing, right? I mean, and I guess, pun intended. And so if I have somebody who on the regular, right, maybe they’ve come in for something that’s really getting their attention, but on the regular, their lifestyle is running pretty, pretty hard from a stress perspective, right? So adaptogens are going to be on board as a maintenance. And then, yes, if they’re drinking each night, so we’ll do milk thistle to protect, you know, that liver. And then as well, we know that alcohol intake, you know, will disrupt the microbiome, and so there’s going to be a probiotic. It might not be the same probiotic that I chose to get, quote, unquote, “the job done clinically that they came in for.” But there’s going to be a recommendation on covering the bases and supplementing your lifestyle. That’s kind of how I work. There’s a maintenance phase for folks, which is who are you when you’re not suffering from this one condition that actually got your attention enough to come in, and how can we optimize and mitigate the lifestyle influences that people are not willing to change, or can’t change, or don’t have much control over? 

Kalea Wattles:
Supplement your lifestyle. We need that t-shirt. It’s a very important point. 

Holly Lucille:
Call my trademark attorney right now. 

Kalea Wattles:
Exactly, get ’em on the line. I mean, that’s so well taken. I think that is individualized medicine. So thank you for sharing that with our audience. It sounds like you have a very interesting client database and have seen a variety of cases. Are there any cases that come to mind where a probiotic or a psychobiotic intervention helped improve your patient? Anything, really, come to the front of your mind when we talk about that? 

Holly Lucille:
Oh, again, how much time do we have? Yeah, I mean, so I have been seeing trends out of the pandemic, I have, and they’ve been with younger girls having really some mental health issues. And that is where psychobiotics have really shined for me lately. The results that I’ve been getting have not only blown me away, but you know who’s blown away is that these parents that feel like they’ve gone through so much in the last couple years, and now the result is they’ve got, you know, this troubled individual. And being able to work with them and help that, and then see more promise and more sort of excitement in their future and not so glib, it’s been amazing. So yeah, the psychobiotics and the research around them and how I’ve been using them clinically and the outcomes that I’ve been getting, I’ve been super excited about. 

Kalea Wattles:
Yeah, amazing. And in these outcomes that are unexpected, are you using both food and supplements for the most part in these cases? 

Holly Lucille:
Yeah, great question. Always. Once again, always working on cleaning up somebody’s diet as far as quality, and of course what they’re eating, but the actual products and using psychobiotics that have been studied in the research, getting those on board. And the other thing, I was working remotely with a client in New York, when we could, when the pandemic had opened things. OCD, some of the results that I’ve been getting using psychobiotics for OCD, unbelievable, unbelievable. And once again, this younger population that I think has gone through so much, we all have, but that’s what I’ve been seeing trend, like, from a clinical perspective. 

Kalea Wattles:
Excellent. If we want to prescribe psychobiotics or we’re a patient, and we’re a consumer, and we want to use some psychobiotics, how do we identify… I mean, it doesn’t say on the bottle, right? Or maybe it does, what do we look for? 

Holly Lucille:
Yeah, that is a great question. You know, I think understanding in the research. So just going in and using that search bar. The amount of research that is out there, and people are writing about them all of the time. I just read an article on postbiotics. It was postbiotics. And it had to do with the mental health issues spurred on by COVID-19. And then there’s also, we’re coming to a point in the research as well where there’s so much literature review, because there’s been so much written, so you can find condensed, easy-to-read, and extrapolate articles. And then you can also understand what these studied strains are. And usually, manufacturing companies that have packaged together evidence-based postbiotics will be writing. And you’ll be able to see their product kind of next to the literature, in a sense. So I think it’s easy to navigate and understand where you can actually get some of these for sure. 

Kalea Wattles:
Okay, great. Well, now we know what we’re looking for. So Holly, we could probably talk for five hours about this, but unfortunately, we have time constraints in the real world. So as we’re coming to the close of our episode today, anything else we need to know? I mean, what do you hope our listeners take away from this episode? 

Holly Lucille:
You know, I think one of the most important things is this. When I feel like, Kalea, sometimes when things get introduced in our sort of landscape, they get very commercialized, like the gut-brain axis or, you know, the gut’s the second brain. And it is real, it is real. And the amount… And like I said, that’s why I’ve been thinking about our microbiome as an organ in and of itself. And its ability to communicate to all of these different clinical conditions, especially through, you know, the gut-brain axis and the vagal nerve and the way that these postbiotics and probiotics are working, I just feel like we need to take it seriously and know that it’s real. And that I think people, honestly, consumers and practitioners, we should continue to follow our gut, you know that feeling that we have. I mean, if there’s anything that has driven home more of that intuitive sense for me, it’s been the heady research that I’ve gotten my hands on, and it’s just made me believe more and more how important it is to pay attention to our gut. And like I said, you know, you might look at me like I have six heads if you come in diagnosed with diabetes, and I’m wondering, you know, about your stool and your bowel movements and such, but it’s real. And these precision probiotics and things like postbiotics can make a huge difference. 

Kalea Wattles:
Well, thank you so much for your insight. We’ll take it back. We’ll start and close with Hippocrates, “All disease begins in the gut.” And I think you’ve beautifully highlighted so many ways we can support our gut health today. So thank you so much for being with us. We really appreciate your time. It’s been great chatting with you.

Holly Lucille:
You as well, thanks for having me. 

Kalea Wattles:
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