Fix Your Gut, Fix Your Hormones: Dr. Megan Rossi Reveals the Hidden Connection

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You saw this need for real information that was easily accessible because I think more than any other field gut health is so overwhelming and there's so much bad information. So you have a PhD, you have written so many books, eat yourself healthy, love your gut, how to eat more plants which will dive into that. You have won the Dean's Award for Outstanding Research. You back up this knowledge with real science and real medicine and I am so excited to get into this conversation with you today so welcome to GMD. Thank you you're making me blush but yeah no I'm incredibly passionate not just obviously to develop the science as a as a researcher but to to share it because like you've said there is just so much kind of confusion in this space and as well as a research on my clinician right so I see you know patients and clients who are really intelligent and they want to make the most of gut health but often they fall down these traps of misinformation and they go on these you know crazy diets that we're learning actually can do more harm than good for their microbiome so hopefully that's what we'll tackle today. We are definitely going to tackle that. So let's just start with the fact that 75% of women have gastrointestinal issues compared to 57% of men. Now I'd love to know why you think that is. Yeah look there's so many factors to play I think one of the big ones definitely comes down to the facts that our hormones are different so we obviously have you know more estrogen and progesterone which is not only important for you know out you know sexual organs but actually we've got receptors in our gut which the estrogen and progesterone can attach to and therefore it changes the movement of our gut and therefore how we absorb and digest different foods but also the sensitivity of our gut lining so you know as we go through the menstrual cycle some women find them more sensitive to certain foods at different stages based on where the hormones are fluxing then also we know that women tend to have slower gastrointestinal trans at times which is essentially a fancy word just to mean slower gut movement of the food from entry all the way to exit and therefore that can create extra fermentation more bloating and constipation and things like that and I think women often are multitasking a lot right so there is that level of the gut brain acts is more stress up here which then sends these hundreds of millions of nerves into the gut and like literally strangles them how do you know when you don't have a healthy gut yeah I mean that is a brilliant question and one that I tried to tackle somewhat in it my first book where you know it is such a complex thing historically we were like okay well if you don't have bloating constipation or gut issues you must have good gut health right but because we've now appreciate this landmark scientific discovery of this gut microbiome these trillions of microorganisms and how they impact pretty much every organ in the body it becomes so much more complex to determine if you've got healthy gut so I've got this 10 question assessment that I get people to complete and we can send the link you know free to clear all that sort of stuff. Yes please please. Well it gets people to think about their gut health so yes about digestive symptoms but also how stressed do they are they on medications how are they sleeping are they in restrictive diets all of these things which kind of you know the literature shows is impacting our overall gut health so just because you don't have got symptoms doesn't mean you've got brilliant gut health we're learning essentially because there's other elements like our gut impacting our mental health so perhaps it could be a sign that you've got really low mood and therefore intervening on your gut microbiome through you know various gut loving foods might actually help lift you know that as an outcome or perhaps you're the one who's always getting sick right we know that 70% of the immune system lives in the gut and people with better gut health also have more resilient immune system so there's you know a lot of factors to consider there but that kind of 10 question assessment gives you a scale from zero to 20 and it gives you that little bit more indicator until we get more of a better validated tool of where your gut health might be at and you know in clinic I get people to complete that at baseline before they change anything of their diet and lifestyle to improve their gut health and then after four weeks and ongoing I get them to repeat it just so they can see tangible outcomes because I think that's another thing with gut health is it you know it can be really hard to know you're doing the right thing like you need to have these you know subjective or objective markers where you start to see you know the changes occurring so you have somebody that comes in says I want to improve my gut health you know I think I have IVS I have no idea different you know and we can get into the different forms of gut I want to improve my microbrain what are some of those things that you look at and how do you start somebody who wants to improve their gut health yeah look so the first thing is to check do they have symptoms right so is it symptom approach where they have an actual issue in terms of they've got bloating or they've got constipation or if they really want to target their mental health so it's really focusing on what area is their main issue and if it is the gastrointestinal symptoms then it's okay well we've got to clear things like celiac disease right so we know that there is you know still millions of people in the world with undiagnosed celiac disease and that's an auto immune condition to gluten and they have historically just been told oh look it's probably just IVS and they haven't got properly tested so it's really important that I think anyone who's experiencing these digestive symptoms just as a port of call right just to make sure you're not undiagnosed you go to your physician your GP depending what country you're in and you just get the blood test now for that blood test to be valid it's so important you don't already cut out gluten otherwise you could get a false negative result right because you need the gluten in you for them to measure the antibodies etc so I would you know check in terms of the different tests needed obviously you know things like checking for inflammatory bowel disease if they have really quite severe pain and those sorts of more medical conditions and then if they they don't have them but they're still having got issues and we look at do they have what we call these functional gut disorders or I think it's been reclassified as a disorder of the gut brain interaction and essentially that's just this again a fancy scientific well that you know scientists and clinicians like to use that's this umbrella term for things like functional bloating and functional constipation and IVS as well which is probably the most common least spoken about type of these functional gut disorders so that's that side of things whereas you know other people might be look I've just I've got low mood and you know maybe it's you know in their family history but they think look I've heard about this got brain access let's try intervene and you know we can talk more about that if that's an area you're interested in but there's been some really convincing research that's changed my confidence you know as a as a a dietician to actually really focus on people's gut microbiome diet to improve that then mental health in a very clinically validated way and I think that's so interesting we're gonna hear so much more about this and this is just you know the it's paper after paper after paper coming out about this but if somebody's coming in they're saying oh I have anxiety and depression I really want to like you said I know there's a direct correlation between the gut and the brain is that person's protocol different than somebody coming in and saying I think I have IBS I can't you know like I poop once a week and then I have diarrhea you know whatever it is is it the same protocol to fix your microbiome and heal your gut or are they different levers that you push yeah no no they would absolutely be very different right so for IBS we would look at because essentially that is this very sensitive gut so if you think about your gut says no one made a long tube right and I mentioned before there's these hundreds of millions of nerves which feed into them and when you've got IBS that that feeding system can be hyperactive right so no matter what people eat often they find it can trigger whether it is the bloating or the pain and they've got quite a vulnerable gut so again there's different lines of therapy so first line therapy we'd be looking at okay they're are they getting an even fiber distribution are they having too many fatty foods is it spicy foods is it caffeine alcohol hydration those sorts of things which actually the research suggests it works you know focusing on this first line category in around 50% of people they'll find relief if they've got IBS focusing on those more I would say basic strategies right so it's things like fiber so we know fiber come from all your plant base food so we want to make sure that you're getting an even distribution of fiber across the day you're not having like no fiber at lunch no fiber at breakfast and then you have this big meal of fiber right because fiber is food for I've got microbiome so human cells can't break down fiber. So just to rewind, because actually fiber will be one that I think is a common theme, right? So if you think of the 9-meter digestive tripe, most of our nutrients, things like your fats, most of your carbs and protein, obs, or biorep that 9-metres, right? So we have the enzymes in the intestine. We break them down. They get from that hollow tube, i.e. I've got into our blood system to feed our brain, our skin, etc. But it comes to fiber. Humans also just don't have the enzymes, right? So we've always been like, "Oh, what's a use of fiber?" Maybe it makes you poop better and that's why people feel better. And, you know, live log, we never really understood until the discovery of the microbiome, right? Well, we've been like, "Uh-huh, that's a light-by-moment. That's why fiber has been associated with so many health outcomes." Because the microbes uniquely have the enzymes to break it down. And when they do that, they produce all these amazing different chemicals. People heard things like short-chain fatty acids, such as puterate, and you know, that's some of the messenger molecules that are thought to potentially impact things like their mental health, but also appetite regulation, etc. So that's kind of what's happening with fiber. Now, the thing about fiber, when our microbes break it down, yes, they produce amazing chemicals, but they also produce a little bit of gas. It's just a completely natural thing. However, if you've got those, you know, live wires in your gut, i.e. i.e. i.e. gas, having too much gas pockets being produced can create symptoms like pain and bloating. So actually, it's important that if you've got the sensitive gut, you don't just dump a whole lot of fiber at once, where the microbes go nuts on it, have this big feast and produce big pockets of gas, right? So you kind of want to go even distribution of fiber. So like us, most people want to be fed at least three times a day, the microbes also want that kind of even distribution instead of being starved and then they binge it and produce extra gas. So that's what I mean about the fiber. So you can't make just every meal, you make sure every meal has fiber. How much fiber should you be eating? Again, it really depends on the individual, you know, most of the recommendations are on 30 grams a day, but I say that most people probably with gut issues probably have cut that down because they find that, oh, fiber doesn't agree with them because it, you know, can exacerbate symptoms. So they might start on 20 grams. You know, ultimately we would want to get through gut training them up to the 30 grams because fiber's got all of those amazing benefits. But if we do that too fast, that's going to create a lot of gut upset. So, you know, fiber getting that even distribution, then we look at fruit, right? So we know that fruit, obviously really beneficial, but fruit is high in fructose, which is the fruit sugar. And our body, particularly when you've got more sensitive gut, you can only absorb a certain amount per sitting. So if you go and eat a whole pan of, you know, blueberries or cherries, some of that can get malabsorbed, higher up, dumps in your large intestine where those microbes live and they feast on it produce extra gas. So again, when it comes to fruit, we want people to have your fruit, but we say typically around 80 grams spread three times a day instead of just having, you know, 200 grams all at once. So you talk about fiber, then fruit, then what? Then we go through things like polyols. So sugar alcohols that are often found in things like protein, supplements, we know they're now found in like, you know, chewing gum. A lot of these sugar-free foods actually contain these polyols. In fact, if you look at chewing gum, you'll often see it says may have a laxative effect. And that's because again, higher up our intestines is not very good at absorbing the the xylitol. And therefore, that can get dumped and again create that extra activity. So it's just looking that you're not having excess polyol, you know, through these different sweet and products in your diet. We look at alcohol, you know, making sure you're not having too much alcohol because that again, you know, not only can speed up and slow down different parts of your digestive tract, but actually alcohol in the short term makes you got more leaky. So if you think if you've got lining, being quite strong and, you know, quite protective of your body, only letting certain nutrients, you know, from your gut into your blood system, alcohol makes things a bit more loose and leaky. And therefore, things that, you know, can cause inflammation your blood system might get through. Then we think about things like spicy food and caffeine. Both of them again can stimulate the gut and exacerbate it for those with sensitive guts. And then of course, fluid. We want to make sure people are having, you know, sufficient fluid, you know, the two or so leaders a day to make sure that the fibers got that water, that hydration to work. It's kind of motility movement effects in the gut. So that's kind of part of the first line dietary therapy, right? For IBS. And then we would look if that doesn't work, like I said, research suggests might work around 50% of people with IBS. We would then move on to second line, which is typically a low-fod map diet. Have you heard of a low-fod map diet before? Yes. I thought that was for SIBO. So the main research is around IBS, right? And when it comes to SIBO, so small intestinal bacterial overgrowth, essentially what happens there is that microbes that normally are just in that last 1.5 meters of your 9-meter-digestitripe get a bit here and they like to crawl up into the small intestine. Now, unlike the lower part called the large intestine, which can handle that gas being produced and the acid being produced and everything, the small intestine is much more sensitive. So that can really, you know, create extra bloating and altered stools. This show is sponsored by Midi Health. Are you in midlife feeling dismissed, unheard or just plain tired of the old healthcare system? You are not alone. For too long, women's serious midlife health issues have been trivialized, ignored or met with a just deal with an attitude. Many of us have been made to feel ashamed or forgotten. In fact, even today, 75% of women seeking care for midipause and paramedicause issues are left entirely untreated. And honestly, that's exhausting. When you know something's off with your body, but no one takes you seriously, it's beyond frustrating. And here's the good news. It's time for a change. It's time for midi. Midi isn't just another healthcare provider. 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They're the only compression socks I can keep on all day and actually forget I'm wearing them. For a limited time, Halo Sox is having a buy 3 get 3 free sale. Head to HaloSox.com today to check it out. Now there's a lot of overlap between IBS and CBO, which is kind of what the research is suggesting at the moment. Our team at Kings has done a lot of the randomized control trials on the low-form map diet, and it's shown that it can be really clinically effective in those with IBS. But it's often done probably not that effectively in terms of people see it as this long term restrictive diet. But essentially what it does is give your gut a lot of rest. So it's not a healthy diet, because it cuts out a lot of really helpful fibers. In fact it cuts out a lot of foods which people have heard of being pre-bionic. So pre-bionic is this fancy term, which essentially is fertiliser for I got microbiome. So the diet cuts out a lot of these, so things like your chickpeas, your garlic, your rung in, your mushrooms, those sorts of things, which we know are really beneficial. But the reason for that, it's just about a 4 to 6 week period of cutting them out. And I like to think of it kind of giving the gut some rest, so that large intestine doesn't get overly activated. And then during that time we like to focus on the gut brain access, like doing gut directed yoga flow, or diaphragmic breathing, those sorts of things to try to relax that gut brain connection, like the interic nervous system. Because if you just got a low-form map diet and then just have a bit of a period of rest and then reintroduce them, often people just get symptoms back, right? Because they haven't fixed the underlying issue of this gut brain dysfunctional connection. You have to introduce it slowly to see what is affecting you, right? Is that the whole point of it? Absolutely, that's the second stage as a reintroduction. And the third stage is the personalisation. So you should always be getting and building in terms of ultimately getting back to a decently high-fod-map diet. Right? But it's to your personal tolerance. Because I like to think of the gut. I mean, you know, it's this big muscle, right? It's like any other muscle in the body you need to train it. Now that gut training is even more important for those with sensitive guts. And that's the way that I think people need to think about their gut if they have these sensitivities, which as you've highlighted, is really going to really common in women. And also it does affect quite a lot of men. I think it's under-reported a bit in men as well. You know, it's often, IBS has claimed to be a female condition, and I think there's a bit of stigma around that. So it's about thinking you don't necessarily have an intolerance to these fod maps or these pre-biotics. Your gut is just quite sensitive and you need to train them. So, you know, when we go through the reintroduction period, you know, and then go to the personalisation stage, typically it's like having one tablespoon of chickpeas every day for the first week. Second week, it's two tablespoons. Okay. Obviously that sounds incredibly painful and slow and frustrating, but that's the way, you know, in clinical practice, we kind of treat it. And it's really successful. It just takes a while to achieve, and therefore a lot of people get frustrated by it. But ultimately I say, you know, a year of this kind of frustrating teaching training the gut will lead to what we know has been linked with so many positive outcomes in terms of all the different pre-botic fibers. People can access my Fodmap Light approach, you know, on the website free. Just it reduces down the really high format foods. And obviously it's much safer, much easier to follow because it's not super restrictive. Of course, you still need to go through the reintroduction. We can add the link. Yeah, it's something we're going to do that. Can you just tell us the difference between SIBO and IBS? Because there's so much confusion about that and do treat them the same. Yeah, very, very good questions. So in terms of IBS, there is this diagnostic criteria, right? So the first thing obviously we want to rule out inflammatory bowel disease and silly activities. So there is this criteria of what if people have it, then we, you know, would say you have IBS. So you have to have tummy pain at least one day a week. And that tummy pain has to have persisted for at least three months and that onset at least six months. Now that tummy pain also needs to be associated with your pooping habits in some way, whether it gets better with pooping or worse with pooping. So that's kind of the, you know, the diagnostic criteria for IBS. And then there's different types of IBS. So you've got diarrhea, predominant IBS where your poop's mostly loose. Then you've got constipation where you poop's mostly hard. Then you've got the mix where you alternate between the hard and the, and the loose. And then you've got unspecified. And then you've got unspecified where actually you still don't kind of look quite normal, but you still fulfill that criteria. So that's IBS and there's that nice clear diagnostic, you know, definition for it. And for that, like I said, first line strategy, we discussed second line low-fod map. And then there is some medical treatments if that's not working as well in terms of like neuromodulators, which is very no dose of antidepressants, which often medics will prescribe for those who just are not, you know, getting successory dietary strategies. In terms of SIBO, so as we said, it's those microbes falling up higher. And there is, it's quite difficult to get a clear diagnosis. So, you know, there is these, you know, validated tools of these breath tests. But they're not as clear-cut. They're not as black and white just because you've got, you know, high hydrogen after having the glucose or the lactolose tests. And the only thing that's not as clear-cut is that you have to be able to get a clear diagnosis. And then there's a lot of things that you can do to get a clear diagnosis. They'll crawl back up, right? So, you know, we've also looked at, in addition, can we do a low-fod map diet? And that's kind of where, you know, the dietitians role is quite similar between IBS and the SIBO. But I would say there's a few tweaks. So, for example, there's some research suggesting that alongside the refaxmen, then trying some hydrolyzed guagum might give you a better response. And then also thinking about prevention. So, if you have a longer, slightly longer fast period, what happens is you get this migrating motor complex come through your gut, which essentially cleans and pushes the food and it'll lift over bits from your small intestine higher up down to your large intestine, including some of your microbes. So, often with SIBO, you know, that migrating motor complex might not be working very well. So, it might be a case of, you know, in saying to them, particularly if you're a frequent snacker, let's try and move to just your three main meals and give yourself a solid four-hour period for that cleaning to occur and push the microbes. Then it's also looking at, you know, are you on different medications, like protein pump inhibitors? And if you obviously medically indicated need them and they're effective for things like reflux, and obviously we can't change that, but a lot of people kind of get stuck on these proton pump inhibitors, and they kind of aren't really helping with every flux, but they think they should take them. So, it's always worth, you know, chatting to your medic to determine, is it helping you? And if it's not get off it, because it's been associated again with changes in your microbiome, which might mean your microbes can call up, you know, and create SIBO. So, there's many different, like, slight tweaks, but I would say SIBO is very much a new phenomenon. And we haven't really established all of the details of the most effective therapy. And you mentioned alcohol, which everyone asks about, how much is too much, and does it matter what kind of alcohol is wine? Is tequila better than wine? Is beer better than vodka? Yeah, look, I'm not going to be a party, people, and say you can't have any alcohol. And in fact, there are studies out there showing obviously things that red wine have been associated, potentially, with some gut health benefits. And the reason for that is that red wine contains these polyphenols. So people probably are starting to hear polyphenols a little bit more of these agencies, quite beneficial types of plant chemicals that, you know, the red wine, but also things like dark chocolate are associated with health benefits, cause they contain these, right? Now, like fiber, a lot of these polyphenols, human cells can't digest, right? So we need to, they get, you know, melabsorb through most of the small intestine, and that's where those microbes are having the role that they break down those polyphenols into smaller chemicals, some of them become bioactive. And that's when they're thought to be associated with all these benefits. So I know it was a bit of a ramble, but in terms of alcohol, what I typically say is that having like one glass of red wine probably has more, you know, potentially anti-inflammatory effects because of the polyphenols. But if you have any more than one glass, those anti-inflammatory benefits become more pro-inflammatory because of the alcohol. Of course, if you don't drink, go have some grapes, have some dark chocolate, like you're gonna get the polyphenols. So you don't need to start drinking. But yeah, in terms of, I guess, the alcohols, we know that the dark beers and the red wines are probably the best, but ultimately, in terms of that negative impact of inflammation, the gut leakiness that occurs with alcohol comes down to the percentage of alcohol. Right, so there's no escaping that element to it. So let's talk about the gut brain access. And so you have someone that comes to you and says, I have anxiety, depression. I want to work with it. I've heard about the correlation between the gut brain access. What kind of protocol would you do with them? Yeah, so IBS receivo. Yeah, absolutely. So if someone had come to me, you know, when I just graduated 15 or so years ago, I would have been like, maybe just, you know, try have some more free and veg and something like that. I wouldn't have felt confident, right? But there was this landmarks, Lensstrial was called the Smilesstrial. Lensstrial study called the Smilesstrial. And it was the first one where, you know, as a dietitian, I was like, wow, we have the, you know, quite robust evidence. So what they did, some researchers in Australia from the Food and Moody Institute, took people with moderate severe depression and they randomized half of them to this gut boosting diet. Now this gut boosting diet is kind of the protocol, right? So it's very much Mediterranean loads of different, you know, fruits, veg, but legumes, whole grains, extra virgin olive oil, menta dairy, some oily fish in there. And the other half got a befriending type of counseling just to make sure any benefit in the diet group wasn't because they were like seeing a dietitian, right? So it was nicely controlled to avoid the placebo effect, which is a very real phenomenon. And they followed them and gave them the either of the interventions for 12 weeks, seeing the researchers the same number of times. And those in the diet group had a significant improvement in their depression scores of, you know, I think it was over 30% of them that would have classified them as no longer clinically depressed. In the control group, that was only 8%. Now, you know, for me as a clinician, I'm like, wow, that is so empowering for people. But of course, I make the scores of everyone stayed on the antidepressant medications. You know, I think it's just so so important that you would never throw out your medications for a new diet plan, right? But certainly as an additional therapy. And again, if you want to talk to your prescribing doctor, some people have, you know, slowly titrated off if they're feeling good about the diet and that, you know, it's in a very controlled setting. Or perhaps before they go on medications, if you just start to feel low, you know, thinking about how you can fertilize your microbiome through that Mediterranean diet. To improve your mental health is, you know, clearly a very valid approach to what we're now seeing from the research. So is anyone listening that wants to just improve their gut microbiome? They know that this is real, that there's a lot of science right now. Is that the first thing? So start the Mediterranean diet? Pretty much. I mean, there's, I guess, two pillars. So if it's general gut health, I would say where the researchers are is thinking about the plant diversity. So there is six different plant-based food groups. Your whole grain of things, like your quinoa and your oats, you got your fruit, you got your vegetables, you got your legumes, things like your chickpeas, your butter beans, you've got your herbs and spices and your nuts and your seeds. Now, each different category of plant provides both your body but also your microbiome with different types of plant chemicals, which feed different ones. And that's essentially what the ultimate goal at the moment we believe around gut health. People who have more diverse types of microbes in their gut because they've been fed a more diverse range of fertilizers seem to have lower risk of over 70 different chronic conditions. So feeding them that different diverse range has been associated with how you achieve that. And actually, my team at Kings has just been awarded a grant from the government actually led by Dr. Arunitimedi and it's to look at this exact factor of this concept of diversity. So we're looking at, you know, in a randomized way if people have the same amount of fiber, remember, fiber feeds are microbes, but different levels of diversity, how important is that? Because most of the industry guidelines at the moment are quite old school. They're just like eat more fruit and badge and they don't realize or they don't incorporate the fact that actually the legume, you know, families got loads more pre-bottles and other types of plant chemicals, which feed certain types of inflammatory bacteria. So the first concept is that plant diversity. So I said people try eat across the super six most days if you can. So think, you know, have I had my legumes at the end of the day, if you haven't just got a can of mixed beans and add them to whatever you're eating, the soverse tile. Then the second element too, I guess, what I would recommend, pillar, would be fermented foods. And this was based on a study from Stanford University where they showed people who went on a high-fmetafood diet, not only had increased microbial diversity, but also they seemed to have lower markers of inflammation in their blood as well, so seeing kind of more of a translation of why it's important to have more different microbes. So they're kind of the two elements. And then obviously you add some oily fish in there as well, because again, independent of the other elements has been to show associated with, you know, better gut health. Of course, if you don't eat animal products, you know, thinking about just taking an amiga three supplement is probably a good shot. Okay, so in terms of fermented foods, how many times a day do you need to eat fermented foods? Yeah, so the study I refer to actually, the intervention include like six serves a day, which a lot of people like, whoa, there's not no way. - There's not no way. There's no way. - Yeah, yeah. How do you do that? Yeah, but they, I mean, they're quite small of it. And it includes things like, you know, your chemchings, like your kombucha, I think it was probably, don't quote me on the portion size, but they're actually quite small portions. And things like, you know, fermented and live cottage cheese. So actually you start to realize an age cheeses. There's quite a lot of fermented foods that we probably naturally have live yogurt as well that, you know, we don't necessarily associate as being fermented foods. It's more of the wacky and new ones where people like, oh, I have to have NATO or, you know, miso and those sorts of things to get them in. So you do, do you believe that you should get all of your supplements or prebiotics, probiotics with food? If you're eating across the super six, most people are going to get in, like, plenty of these prebiotics in, so you don't need to supplement. So I'd very rarely recommend someone have to take a prebiotic supplement. When it comes to probiotics, you know, this is one of the areas I do my PhD in. Probiotics and fermented foods are actually very different things by definition. So, you know, if you look at the international society of pre- and probiotics, you know, they all, you know, there's really strong consensus around this. But I think in terms of the public translation, it's really lacked in terms of what is the definition of probiotics. It needs to be very much be strange-specific and do-specific. So in fact, the world gastro-organization have these guidelines around probiotics, kind of taking any random supplement, even if the individual strains of sharing health benefits, if you chuck them all together, often they can cancel each other out. So we need to get very specific, not using them like medication, right? You're not gonna go and take blood pressure medication for your type to diabetes, you know, they're different things. Or if someone comes to me with an iron deficiency, I'm not gonna give them a vitamin D supplement. They're different, you know, nutrients if function different. The same goes with prebiotics. We have to, you know, give the right strain at the right time in the right way. So how do you know which strain you need? As a wide sweeping area, I would say that we want to make sure, like, for example, the world gastro-organization or the international society of pre-improbiotics have recommended, so they've looked at the research, the body of research and said that there are several, you know, clinical randomized control trials showing that this specific strain has this outcome and therefore we should have it at this dose. If there has been at least one placebo controlled trial, whether it's shown a health outcome using a strain, you know, maybe it's in mental health, then I would say to the person, look, there is some convincing evidence. So why don't we trial this strain? So if someone's sitting at home listening and they are saying, okay, I don't know what kind of strain, because there's a million of them out there. Should they be refrigerated? Or do they not have to be? - So it depends on the strain, which all comes back to the same concept, right? Like, each strain has different conditions, right? But most of the ones where there is a good scientific evidence like LGG and BB12, actually, as long as it's a below 25 degrees, it doesn't need to be refrigerated, right? It's stable at room temperature, but there are certain types of strains which actually, you know, might need to be refrigerated. So you just need to check the label and obviously getting them from a reputable company where they will tell you that information is also obviously key. What I would say is there is the strongest scientific evidence is if you go on antibiotics to take that specific type of bacteria and people can all have, you know, easily access the world gastroguid lines where you can see it says, strain, the dose for antibiotics, right? So you can head over to their website and, you know, it's free to access. Collick as well. So the world gastroorganization guidelines have that for the BB12 strain of bacteria at one billion units for babies with collic and actually the clinical trials, as a mom and as, you know, growing third baby in my tummy now, you know, we've, the research is really convincing. So they randomized half of the babies to fake intervention and the other half got the BB12 strain of bacteria and the parents, and everyone was blind and they didn't know which group their baby was in. And those who had the live bacteria had this significant, like, you know, huge reduction in their fossa and crank compared to placebo and actually from baseline increased the daily situation by like 60 minutes. So like quite, quite impressive. The other one is cold and flu. So there's a cochlear review and again, it's quite scientific, but cochlear review is something somewhere where it's an independent body where they come together and look at all the individual studies and they give a consensus. on something on a topic. So the consensus there was should you take a probiotic for upper respiratory tract infections like cold and flu? And they showed that actually yes specific strains could reduce duration of cold and flu and the study the strains of the baby 12 and LGG combined. And then the other one that's really fascinating and I think can really help women is around the vagina microbiome. So you know we hear and we know the stats at 75% of women are likely to get thrush at any one point. And what the clinical trial has shown or one of the placebo controlled trials showed that they everyone went on their antifungals because they had thrush. Half of them got a placebo. The other half got the specific strains of LA14 and hate and I know one with lactoferin combined and they took it up to six months after their treatment. And they showed that those who had the specific formulation had about a three-fold reduced risk of getting relapse of thrush which again for any woman in that vicious cycle of relapse is huge. And as a dietitian I was kind of like this you should just be medication. Yeah. Now we have this additional tool because things like the anti-antique indeed a diet there's just no science behind that and doesn't work. It can be too restrictive all of that sort of stuff. So it's great to have extra tools. Would you have them take it just for a short amount of time or would you have them take that strain long term? So it depends what the indication is right. So for antibiotics I would take it during antibiotics and for a week after for you know cold and flu obviously through cold and flu season or if you're traveling or a bit stressed and you feel like you know you're likely to get picks up makeup you're kind of that vulnerable person or kids at nursery. My kids have been on them and knock on wood with good effect but you know what it's like they're just germs everywhere. In terms of the colloquine I would just do it you know in the first couple of months of a baby's life if they are colloquine and then for the gyneomicrobion if you are someone who is wonderful to ongoing relapse then it would continue for like at least six months but if it's just a once-off then kind of just seeing because I don't like people to take things where they don't need to right because you know you want your body to be functioning on its own. These are kind of just supportive sources. And are there any other ones like for the brain, the gut brain, anxiety, depression? So the brain is a really interesting one as so is IBS right but when it comes to mental health and anxiety so overall the studies have suggested that yes particularly you've got quite severe or like high-level mental health issues you seem to do respond to specific strains of probiotics but the issue is that each different study has used a different strain so it's really hard and a different community so what I as you know as a clinician I kind of like there to be at least two placebo controlled studies using the same strain showing same benefit to make sure it's not a chance finding so that's the way I often would determine whether I would recommend something. So when it comes to mental health I think there's loads of potential in this it's this whole world of called the psychobiotic but yeah like there was one that I used to recommend because I had positive study, a positive study and then actually they did a bigger study and now it's negative so it's kind of a tricky watch this space and the same with IBS and I think with IBS again everyone's used a different strain some benefits some non-benefit which tries to guide people a little bit more towards a clinical trials I would say that it's not feel proof and I've seen some indications on there such as weight loss where when I reviewed the research and other clinicians and other researchers we're like there's not good evidence to take a probiotic for weight loss right we know dietary interventions are much more effective. So what about acrimancia? Acrimancia that's sort of like that big one right now everybody's like. Acrimancia, yeah, mousseophila is a really interesting one and again it comes down to perhaps we haven't discovered the right strain so acrimancia, mousseophila that's at the species level but there's many different strains underneath that. So in terms of the acrimancia, mousseophila a lot of the researchers just been observational actually just did see there was a study which was the you know one of the first interventions studies to look at a strain of the acrimancia, mousseophila I'm probably pronouncing that wrong but you know everyone can appreciate what that one is and it actually compared to the SIBO didn't overall show a benefit for weight loss. It did have the subset analysis where they suggested people who the microbes kind of landed more in their gut IE kind of had more of a penetrating effect and actually at baseline their lower amounts might see more weight loss but again it was kind of like not that convincing. So I think that's why we just need more of these studies and I know people get so excited they just want to jump the gun but what I would say unless there's good evidence for a strain. So what I would actually say to a person who's like I've heard this probiotic is really good because you know marketing is quite convincing. I would say to the company can you send me a placebo controlled trial using that exact formulation showing the benefit that you claim or that I want to achieve if they can't send you that I would not waste you know your time or your gut health potentially because it's one actually do a negative thing if you're getting the wrong ones. So you think so. So everybody I know is on a probiotic so what you're saying is and they have no idea what's in it they have no idea the strain some of them are refrigerated some are not. So what would you say to those people that that probiotic might actually be hurting your gut that you need to be very specific so how do you figure out which one you're supposed to take. Yeah so for most people don't take a probiotic for their general gut health there's no evidence for it right? Okay but there's those specific indications where we now have more evidence that okay if you get thrush maybe it's good idea if you've got a colickey baby if you get cold and flu if you go on antibiotics I think in the future there'll be more clarity around you know IBS and the strain for mental health you know and various other conditions but it's still remember the microbiome research is so early right with there's still so many things we haven't you know there's still microbes in our gut that we don't even know the name of right now in terms of I guess the damage of it so this is just based on a small study and but I guess mechanistically it does highlight that actually we probably shouldn't just take any old one as an insurance policy so what the researchers looked at is after antibiotics these people were all on antibiotics some of them went on this kind of you know generic probiotics where it was told to be really good the others didn't have any probiotic and they showed those who didn't have any probiotic actually their microbiome recovered faster than those who took that multi you know strain probiotic so again it was a small study but it think it highlights a principle that we shouldn't just take it because we think it might have an additional benefit right so for general gut health the mental foods plant diversity for specific indications you know if there is a randomized control trial it might be worth considering for your specific outcome so you know things so what so what we've learned today is do not take it probiotic just randomly but there are some that have studies so there's one that for and after antibiotics you should take it's the LGG during antibiotics during during to got a lot of you make that mistake right because it you actually want to protect it while the damage is being done in a way and then you stop after you take it for a week off and then you stop and then you stop so I think this is so important because I honestly I you have no idea I think everybody's just on a probiotic they see the marketing and they're just like okay great I'm just going to take it and there really isn't a lot of evidence right now that it's even you know that it's even working so it's really about food and diet and then what are the other things that you think that you need to do for your gut my there are there are supplements that you give everyone to take that will be beneficial for your microbiome yeah so I would say you know depending on where you live but we know vitamin D I know that's throwing around a lot for things like mental health but also it's quite important for our gut health our gut lining if we have vitamin D deficiency we should be on vitamin D supplement I would say omega-3 if you're not getting it too seriously fish in a week I would recommend everyone take your omega-3 for example if you struggle with constipation I would recommend helium husk fiber there's you know good clinical evidence for for taking that for that lactating effect you know IBS there's some research around peppermint oil capsules which are kind of these antispaths monics kind of relaxes your gut so again it kind of comes down to your specific issues but I think this whole approach which I get people get excited and they want to like just take everything but I think we need to think about stripping it back keeping it to the basics and only when there is evidence for what you need should you consider taking it okay and then so I obviously because of this amazing podcast I get to try lots of different things I get you know I have meetings with people that are creating this and this and this and I I have recently tried I've tried several of these gut tests that test your gut and they're the poop test I'm just gonna say you have to poop and they have sticking in the thing and then you put it in the mailbox and it goes off so there's one that recently that I did where they say that they can map your microbiome and that when they map it they can tell you oh you have no acrimansia you need acrimansia or you have no like what are your thoughts on these tests look so I I totally understand where they're coming from and certainly you know at kings we do these microbiome tests right so we are looking at what your microbiome changes are pre and post different dietary interventions and mechanistically how that can impact the fact we did a study a while back looking at people with iBS looking at could we use a microbiome to predict response to different dietary interventions on iBS and what we showed actually the microbiome wasn't the predictor of response it was the chemicals the bacterial were producing so essentially when it when it comes to these microbiome tests. The own Any kind of time I would use them in clinic is for motivating people who want to see physical tangible changes in their microbiome. Like I said at the very start, sometimes it can be like, "Well, I'm doing all this stuff, maybe I feel a little bit better, but because often it can take like three months to start to feel changes." So at baseline, they could do these microbiome tests and check their microbial diversity. And then after we intervened and added all the different plants in, check it again and often, that score is increased. But at the moment, there is not any tests that I've seen. I've kind of, I also get sent, everyone trying to convince me, "This is the latest thing, where I would look at that test and it would change my dietary recommendations for that individual." I think we will get there. I really believe we will get there. But there's kind of three things. One is the fact that there's still hundreds of microbes, which you don't even know the name of, in our gut. And there's also, that's the bacterial component, which, you know, lobees tests are assessing. There's also the viral component, the virus component, the microbiome component, which is the fungal component, which actually is synergistically probably intervening and working with the bacteria. So that kind of component, we're not really getting the full picture. And there's also the point that even if you and I have the same bacteria in our gut, they could act very different depending on what we feed them and their environment. Right? So there's just so much more at play than being like, "You're missing a commency." And remember, there's like many different types that are the genus level, then you have the species level and then you've got the stray level. There's a whole lot of levels. So unless they're going to have like, you know, hundreds of different strains available for you to take, these tests kind of are flawed in that way. Okay. So we're getting there, but we're not there yet. That's right now. Your protocol really is food. You have to eat all kinds of different fruits, investibles, different fibers throughout the day. Would you give different protocols to a woman who is pregnant versus a woman who's parryminopausal and menopausal in terms of what she eats and how she takes care of her gut microbiome? Yeah. I mean, it probably would differ slightly based on things like protein needs, energy needs, and that sort of thing. But fundamentally, a lot of the same principles apply. I would say, you know, going through parryminopaus, and again, there's this whole area, which is so fascinating around, there's a group of microbes that I got called the astrabalome, right? So these microbes, what they do is they turn inactive estrogen to active estrogen. So when our body uses the estrogen, it gets old, it gets dumped into the gut, and then typically we would poop it out. But there is this category of bacteria called the astrabalome, which turn it from inactive back to active. And obviously going through the menopause where your body's production of the estrogen is lower, the astrabalome is thought to probably be even more important. So, you know, there's studies looking at things like adding in, you know, soybeans for the finer estrogens can help with symptoms like hot flushes, going through the parryminopause, actually, you know, and we think a little bit of a bit of a forward to that. There's another study observational, but it showed that adding oily fish and legumes on the daily seemed to delay the natural menopause by like four years. So there are sort of interventions there. Maybe you want slightly more antioxidants because there is a lot of oxidative stress going in the body, so things like more berries and walnuts and dark chocolate, those thoughts of things might be more helpful during that period. And then probably I would focus on protein, and that's more of a just, you know, our muscle mass degradation is higher as we get older. And we just want to make sure that we're having that protein more regularly spread across the day and probably higher levels of it. So, instead of it being maybe like one gram of protein day, we might want to, again, eat everyone's different, but maybe like 1.2 or 3 grams of protein a day. And having that little bit more protein can help stimulate the muscle mass production as well. When I'm craving a real reset, ProLon is the only nutrition program that actually works for me. It's convenient backed by Nobel winning science and it really works. And here's what I love. ProLon next gen makes it so easy. 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So there's no like convincing scientific evidence other than people who have more wholesome plant-based fees, Mediterranean compared to ultra-processed food seem to have less brain fog symptoms, but there is no like magic pill otherwise, you know, I think we'd all be on it. Totally, totally. And then also, you know, Dr. A and I've talked a lot about this with PCOS and Indomie Trioces. There is a lot of gut issues with women with PCOS and with Indomie Trioces. When you have a patient that has either PCOS or Indomie Trioces, what are some of the [BLANK_AUDIO] that you have them do. Yeah, so I mean endometriosis is a really interesting one where people with endometriosis at a, I think it's like two to three times higher risk of getting IBS or having IBS. And there was a study recently which showed that actually going on a low-fod-map diet, again not forever, but actually helped with some of the pain symptoms. So it might be exploring that I know there's also research around things like making sure you have vitamin D sufficient, you know, you're omega-3 and there was one study in endometriosis which looked at chamomile T and linseeds, combined together, improved things like pelvic pain and pain during sex, which are common symptoms of endometriosis. We might want to explore that. And then when it comes to PCOS, this is, yeah, there seems to be more of the microbiome involved in PCOS. So there was a very cool study. Now it was more mechanistic because what they did is they transplanted the poop sample from someone with PCOS into it and to a mouth model and then someone without PCOS, another mouse got their poop sample. And it showed those who received the poop sample are either microbiome from someone with PCOS, seem to develop more similar symptoms to PCOS. So like changes in hormones, you know, more insulin resistance, those sorts of things. So there seems to be potentially a stronger link and talking about probiotics, there has been a few probiotic studies suggesting a potential benefit, not enough for me to be convinced yet. But again, it might just because we don't have the right strain of bacteria, but they're in murmurs, I think, that that could be a good therapy. With PCOS, we want to look more at blood sugar regulation. So things like if you're having your fruit, which is great anti-inflammatory, all that sort of stuff, but you might want to have protein with it. So have something like Greek yogurt with it to help with your blood sugar regulation. So combining your carbs with your protein and your fat is kind of that combination probably comes a little bit more important in PCOS. When someone comes in and they were asking about anxiety and depression, what would you do different from just somebody coming in and wanting a healthy guy? Yeah, look, I mean, it wouldn't be a whole lot of difference. I would very much focus on particularly depression, I would say there's more evidence for gut modulation and that's through that Mediterranean diet. The really fixating of things like changing all your oils to extra virgin olive oil, having those leafy greens, having the nuts and seeds. But it would be quite similar, I would say, to a general gut health diet. We haven't really spoken about other techniques to help with that gut brain communication. So whether they do 10 minutes of gut-directed yoga flow every day. Got directed yoga flow? Yoga flow. So we know that has been showing to help with IBS. So just flow? Just flow yoga, or is it? Yes, so there's certain types of moves. So there was an intervention study and they put half the people on a low format diet, which we spoke about. The other half got directed to yoga flow. And actually both groups had very similar kind of effectiveness, even though one is like super restrictive and like, you know, impacting the diet and the other was just focusing on kind of that interrac nervous system. And it's so indirect. So indirected yoga flow. Can individuals and listeners find that? Yeah, well, actually in my first book, Love Your Guards, I saw the clinical trial and I took it to a yoga specialist, Richie Norton, and I said, "Can you convert this protocol like the moves into something that is like 10 minutes because people aren't at home going to be spending an hour every day to kind of emulate that clinical trial?" So we've kind of got that 10 minute yoga flow that has followed that. And essentially it's, you know, doing a lot of the same move as like the cat count. And I think it kind of stretches and relaxes and moves that interrac nervous system, which obviously, you know, located across your spinal system. So yeah, I think that can be really helpful. And then also there is gut directed hypnotherapy, which again, there's been another randomized control trial looking at low format versus gut directed hypnotherapy and a shown that again have quite similar effectiveness. So I would assess someone's lifestyle and be like, you know what, maybe you're better towards the gut directed hypnotherapy or gut directed yoga flow. So what are some small daily habits that women can do today that it can be hormone health? So anyone that's just starting, you know, you're not about being like everything has to be restrictive. But if you were going to say, okay, here are three things I would take away and three things I would try to add. And it could be food, it could be yoga, it could be anything. But just what are those, you know, take away, add to your life? Yeah. So I would say mixed berries that can be frozen berries, right? I think they're just such an underrated, accessible source of these different phytochemicals, particularly with blue berries. They've shown it increases blood profusion to the brain. So if you need to let you use your brain, have something stressful going on interview that sort of stuff, then that could be a good good one. So I think frozen berries are just such an accessible one. I'd say mixed legumes, a can of mixed legumes or a jar of mixed legumes that you just can't underestimate that as a source of prebiotics. And it's so versatile, you can add it in anything. And then I would say, frozen cauliflower is actually one of my favourite because it's so easy to add to smoothies. And again, it contains different types of these phytochemicals to feed your microbiome. So obviously the super six is the most important. So it gets something from each of the category. But if you made me pick three easy accessible foods, I would say that. But I would say for leaving top level of that, what I do, and it's very nerdy, but I think it helps, certainly helped a lot of people that I've spoken to, is think every time I have a meal, what is on my plate to feed my microbiome? Because they need to eat like my taste buds need to eat. So it kind of moves away from this whole approach of like, you know, restrictive eating and then you binge, right? Or these cheat meals. Because if you start to have this relationship with your gut, which sounds nerdy, but you start to respect them and be like, you know what? If you need to eat, when I need to eat, if I look after you, you've got my back, all the studies are showing how important it is to look after these little guys. So I think like, you know, for having some chocolate, like, you know, chocolates allowed, have a handful of nuts or literally get a carrot and munch that and like, that's my microbes chocolate to me. So having that mindset, I think can really help people nourish their microbiome without it feeling like a chore. Our team at King's just finished this. It was well first clinical trial, looking at a food out for more suppliers. And probably people are saying here, murmurs around food additives. And I'd never want to be fear mongering, but there's like, you know, 400 different additives. They've been approved, generally approved to say so grass is kind of the category they're in. But that was all before we understood about the microbiome because we didn't test. We didn't know the existence. We didn't really see how they impacted them. So a lot of the retesting is happening at the moment. And our team looked at the emulsifiers and it was in those with Crohn's disease. So an inflammatory bowel disease based on like pilots, so there's an animal model suggested they would be the most vulnerable group. And what we showed actually is that those on a lower emulsifier diet actually had a significant improvement in not just their symptoms, but also disease severity. What's an emulsifier? Emulsifier. Emulsifier. So it's, it's sort of things like cariguinin and polysorbit 80, which adds to a lot of plant based food. So it's this whole new research. And again, I don't want people to freak out and say, I can't have any emulsifiers, but it's probably worth becoming aware of how many of these food additives that we're having. And I think it's making people realize that actually looking at how much of their diet is ultra processed and even a lot of these like vegan that say all the plant, you know, burgers or yoghurt, all that sort of stuff, you're like, oh, that sounds so good. It's plant based. Actually, a lot of them have got these extra emulsifiers in it. So if you can spend, you know, two hours, once a month, make, you know, veggie burgers in batch, freeze them, that sort of stuff is going to be much better than buying the convenient inversions at the moment. Tell me, if what would you, one day of eating the best gut feeding meal breakfast lunch and dinner look like for you? For me, I pretty much always start my day with overnight fermented oats, where essentially it's kind of like your overnight oats, but I add kefir to it. And what happens is, you know, it's again, there's no other thing that I have where the microbe from the kefir start to kind of ferment down some of the oats and the dates and even carrots so they put in there with some chia seeds and some walnuts. And actually the flavor is so much more rich in the morning than it was in the evening. And it's kind of a batch that takes me like five minutes to whip up. And then I've got no excuses I walk out the door. And then, you know, I might have, I usually have like a handful of nuts kind of, you know, my bag or a piece of fruit or something like that for a snack, for lunch, it's usually just a throw together of left over might be an old stir fry, but then I always try have like a super six one where I'll add in some legumes. And I kind of have in my mind like a little checklist that's now so automatic to me. I make sure there's something from each group of my lunch. And then in the evening, again, it could, I'm quite a lazy cook. It might be like a stir fry or it might be like a wrap. And then I'd add just like, you know, make me a little pizza that takes like, you know, 15 minutes. The boy, my kids love doing that. And it's just such an easy win again to get a lot of those different plans and, you know, frozen peas on that, you know, tomato paste, which is like a pink or a few skin, all of that sort of stuff. And then yeah, I usually have some berries, frozen berries and some kefir in the evening, maybe with some dark chocolate, depending on how I'm feeling. That's me. I could do that. That's something I could do. That was, you know, I think that the point of what you're trying to say is that you don't have to change your entire diet, but it's just adding in these, you know, gut healthy foods is the first line of defense, really. And that with probiotics, less is more and use the ones that have clinical trials and that are very specific to what you're looking to do. You talk about the supersetial. So these are the super six categories to have a healthy gut. Will you tell us one more time? What are the super six categories? - Yeah. - Honestly, write them on your fridge. And like, even when you're learning them, tick them off like, "Okay, Monday, "yes, I had something from the super six." - Yeah. - So you've got your whole grains, things like your buckwheat and your barley. You've got your fruit, you've got your vegetables, you've got your legumes, things like your black beans and your chickpeas, you've got your herbs and your spices and your nuts and your seeds. - So all things people can do, right? It's just having that mental note of ticking off, "Yes, category, yes, category." - And you don't have to have more than one. I mean, like the veggies, should you have way more veggies than you do nuts or way more fruit than you do or just making sure that in your mind you're thinking, just make sure you have one of those six every day. Is that what you're saying? - I love your mind so much. And you're very much like me want the specifics. And I say it depends where people are at, right? So people like, "Oh my God, this is overwhelming." I just want to focus on the super six. Then just don't worry about number of serves, right? - Okay. - If you've moved on from there and like, "Okay, I'm reading up my game." Then yes, you want to have five serves of veg. You want to have maybe three serves of whole grain, which is like half a cup of grain or we know one slice of sourdough bread is one serve. You two pieces of fruit. And again, depends on the energy requirements. If you've got more energy requirements, you might end up going to three pieces, that sort of stuff. You want to have probably one serve of your legumes. So again, about 80, half a cup or if you want to be brave and you've got lobs them. Like I typically try and about a full cup of legumes each day. And then you're not some your seeds around 30 grams of either or or mixed. It's kind of the serving sizes. The fun to do everything, as you said. Do what works. You just focus on one simple thing. And then listen to this in a month's time and take one more note. And then another month to again. And obviously that will only help us by getting the numbers up. And it will just make it more practical in terms of, you know, how about forming as well. So everybody listening or watching this is so much information. I think this is a podcast that you're going to want to listen to. Take one or two things. Come back in a couple of weeks. Listen to it again. And the research is changing, changing, changing. So we're going to keep having you on the podcast as the research grows. You know, I love everything that you're doing because you're science-backed. You're medically backed. And this is such a wild west in the way, you know, all the probiotics, the prebiotics. You've just given me, you know, my PhD in gut health. But no, I thank you so much for joining us. And I think this information is going to be great. Yeah, like it's such an exciting time for, for God help. And I just want everyone to be really empowered with the research without being this led. So it is kind of watched this space for a lot of areas. Where can people find you? So there's the website, guhletalktuk.com or online of the cross-socials at the guhletalktuk.com. Amazing. Thank you so much. That's it. That this has been so much fun. Thank you. Thanks so much for joining us today on GMD. If you want to own your own health, a good place to start is by following us on social media at GMD podcast. And by subscribing to our show on YouTube or wherever you get your podcasts. For takeaways from today's episode, visit our website, she-m-d-podcast.com. We'll see you next time on GMD. This podcast is for educational and entertainment purposes only. It is not intended as a substitute for a physician's medical advice. You should regularly consult your medical provider and matters relating to your own health. Even though we share our honest beliefs on GMD, some of the products and services we discuss may involve sponsorships or paid advertising.