Feel Better, Live More with Dr Rangan Chatterjee - #1 Gut Health and why we need to throw out the rule-book with Professor Tim Spector

Episode Date: January 19, 2018

In this episode, Dr Chatterjee meets Tim Spector, Professor of Genetics and author of The Diet Myth, to discuss gut health, microbes and food diversity. We hear about the Hadza community in Tanzania and how they are, surprisingly, in good health by default.  Show notes available at: drchatterjee.com/timspector Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk Hosted on Acast. See acast.com/privacy for more information.

Hi, my name is Dr. Rangan Chatterjee, medical doctor, author of The Four Pillar Plan and BBC television presenter. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people both within as well as outside the health space to hopefully inspire you as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier because when we feel better, we live more. We live more. I'm really pleased to welcome onto the podcast today someone whose work I have looked at for the last few years.

He's written an absolutely brilliant book called The Diet Myth. He's Professor of Genetic Epidemiology at King's College London. He's also a medical doctor. It's Professor Tim Spector. Welcome to the podcast, Tim. Hello. Hi. So Tim, one thing that strikes me from reading your bio is how does a professor of genetic epidemiology get into talking about gut health? It's a very good question and there's a number of ways of answering it. One is that I have a short attention span and I like to go where I think some exciting science is taking me. But my career has actually been quite diverse. So I started life doing medicine. I got interested in epidemiology at an early stage as a medical student,

but I decided there wasn't a real career in that, so I trained as a rheumatologist and became a consultant in the NHS in rheumatology, which is bones and joints, and looking after lots of people with pain and chronic diseases. But I was always interested in research. And so the early years was me trying to find the causes of those arthritis, etc. And then I, in about 1993, I wanted to have a change of direction. And I decided to study twins.

I built up the UK Twin Registry myself with a small grant and that became amazingly successful. And I realized that not just studying bones and joints, but I could actually study anything interesting that's common. It grew and we got thousands of twins from all over the country volunteering and that was 25 years ago. The first 10 years was actually working out which diseases and problems and personality traits were more due to genes and how much were due to the environment. So I, in a way, taught myself

genetics. Then that got into the genetic revolution. We started finding genes for things. into the genetic revolution. We started finding genes for things. And my interest got broader and broader. And so I was interested in obesity and metabolic disorders as much, anything really that was common and of major public health importance. And the twins were just a fantastic tool to study anything, really. And after the genes, I then got into epigenetics and was looking to see why one twin would get one disease and the other not, or one was happy, one sad, one gay, one straight, etc. Then about six years ago, I made a conscious decision to really move full time into the gut health, microbes and nutrition because of my own health. It was actually quite a selfish motive i got ill at the

top of a mountain uh while i was ski touring and uh got double vision and had a sort of very mild mini stroke if you like in the vessels of an eye and got some problems which went away after three months but i was left with high blood pressure and i took some time off i said well i must be able to study what the best diet is and nutrition for myself. With all this training, I'm an expert in genetics of obesity and a lot of nutrition work. And I went out and I found that it was far from easy. Actually, it was pretty impossible from the stuff on the web to actually work out yourself what really is helpful and what is myth. work out yourself what really is helpful and what is myth. And that was really the birth of the book, The Diet Myth. And my focusing, you know, the rest of my career really around this whole idea of nutrition and gut health and actually trying to put the two together, because the reason we got

it so wrong is that really no one really envisaged how important this new organ in our bodies is, the microbiome. So that's a very long answer to a short question, but some of it's a short attention span. Others, I think this is the most exciting bit of science today. It's the most relevant for public health. It's changing every week. And so that's what I love about it. Yeah. Well, Tim, thank you for sharing that. I mean, I very much share your enthusiasm for gut health, having really been reading about it and reading the research on it for, I'd say, about six years now. And I think even within that time, certainly from what I have read, our understanding seems to be evolving and changing

all the time. And I think we probably are right at the start of understanding the incredible complexity of the gut microbiome and how influencing the gut microbiome can influence our own health. Obviously, a lot of people these days are talking about gut health, and I think it's gone from being in the initial research stages to now lots of journalists, lots of health commentators are now commenting on the importance of gut health. Are there certain things that you think are being currently overplayed? Are people sort of overstating some of the benefits potentially, you know, in terms of what gut health can help with?

Or do you think that line of thinking is actually quite reasonable at the moment to sort of extend out that we think that actually, yes, improving our gut health can actually improve not only our digestive health, you know, what's in our guts, but also things like our mood, maybe joints. Well, any new area, and I've seen, you know, the genetic revolution, I saw epigenetics, I've seen a number of other technological advances leading to areas in medicine that are either seen as massive breakthroughs or by cynics as hypes. And this is absolutely no different. And the number of publications is doubling every year in this field from a very low base. So suddenly you've got very

few people who could claim to be experts to suddenly, you know, it's in the newspapers every day and everyone's writing books on it and there's TV programs and suddenly it's mainstream from nothing. So when that happens, you always get some hype and people will push it to limits. And then the medical community tend to have a backlash against that. And if they're not in that area themselves, they'll say it's all hype because if they don't, then they feel they're going to lose funding for their more traditional approaches. So it's getting that balance right. And in a fast-moving field, you don't know for a few years how much was hype and how much was real. And there is a portion of the stuff out there that you read that is wildly exaggerated hype. And it comes from this moving from animals to humans mainly.

You can do a very tightly controlled experiment in a few lab mice that are genetically identical. Humans are not like that. And so we've got to realize the limitations. So it's one thing to say that theoretically these things can affect, for example, mood. And we know that's true now, that the microbes do influence mood. It's another thing to say, I know how to improve your gut microbes to make you happier, and by how much. So this is where we just need to be a bit self-critical before we jump into this. And there's always downsides. If it's so important in every disease, the converse is that if you get it wrong, you can mess it up. Yeah, sure. And so there's no such thing as a probiotic that does everything

because if it did, it would have terrible side effects if you got it wrong in one person or one person's panacea could be another one's poison. So I think we've got to temper this whilst still realising that it's moving on apace and the progress just in three to five years has been amazing and we're now suddenly starting to see this the microbiome is becoming part of mainstream medicine it's all the fringes but it's definitely there and it's starting to be licensed and people are talking about the problems of how we get it into mainstream medicine so yeah i think you know

got to keep your eyes open. Don't read everything on the internet. Don't these people who advocate one particular microbe as solving all our problems or that all diseases can be sorted out by it or obesity is only due to the microbes are clearly overstating it. But I think it's a bit like, you know,

us discovering the pancreas yeah if you didn't know anything about diabetes and you just thought where's all this sugar and insulin coming from suddenly we've discovered this new organ and it's much more complicated than the pancreas it's like a thousand pancreases or with you know with a thousand times more hormones etc and so it's going to take us much longer to work this out but i think what is really fascinating is how the discovery of this new organ is going to change our whole mindset about many diseases the way we address nutrition and hopefully destroy these out-of-date myths and dogmas that have really particularly held back nutrition moving in any meaningful way

in the last hundred years yeah and i think this is the opportunity to really tear up all the textbooks everyone who you know who's had these old-fashioned ideas just to say you need to restart again you know prove it now not just because it's been stated as fact for the last 50 years. One thing I talk about in my book is about the importance of nutrition and lifestyle and how it can influence our health which I don't think is a hard sell for anyone really in terms of I think that's quite intuitive for most of us but I do talk about gut health and one of the things that I've become a little bit frustrated about over the last few years is what I call the social media macronutrient wars. This whole, is fat the villain or is it carbs? As if one of them has to necessarily be the villain.

I thought, well, why is it that what people are calling a low-carb approach, so I don't tend to use that term. I prefer the term a diet low in refined and processed carbohydrates. How is it that those are seemingly having quite a good impact with certain elements of the population? I don't tend to use that term. I prefer the term a diet low in refined and processed carbohydrates. How is it that those are seemingly having quite a good impact with certain elements of the population, particularly insulin resistance patients? Some of them seem to do quite well on that approach. But then you've also going to have people saying, well, yeah, what about these blue zones like in Okinawa, this Japanese population that have high rates of longevity are seemingly having, or they have typically had a 70-80% carbohydrate diet primarily made up of purple sweet potatoes. And I think, well, they don't seem to have type 2 diabetes or insulin resistance. So clearly,

there's something beyond fat and carbs. What is the unifying factor between all these different populations? And I think the populations that I've looked at that seem to do well across the world tend to be eating largely unprocessed food or minimally processed food that we would call real food that's local, that's seasonal, that I think actually nurtures and feeds their microbiome and actually optimises their gut health for their environment. I think that might be the commonality. Could it be that in the modern Western world where the majority of the junk food we're having, a huge part of that is refined and processed carbohydrates? Could it be that when we cut those out, we're removing the junk out of our diets? Is that part of the picture? I wonder if you could comment on some of those thoughts, Tim. Well, I absolutely agree about macronutrient wars.

That's so last century. Yeah. Anyone talking about fats and carbs and protein now, you know, it's like calorie counting. It's impossible. Every time you eat anything, it's a mixture of all of these things. You know, you take a banana and, of course, you know, you've got fats in a banana, you've got fats in a banana you've got proteins in a banana you've got you know everything in small quantities

as well as the deadly carbs and of all different faults so to view these in this babyish way is really totally missing the point and we don't understand you know all good things have some bad things in it and other you know and some good things have some bad things in it and other, you know, and some bad things have some good things in it, you know, according to our old fashioned view. So absolutely, let's get rid of that off the table and start working out with a different viewpoint why these populations, as you've said, are healthier than others. And it could be that they've just adapted their diet over the years to be healthy that fits their gut microbiome. So we've evolved with our gut microbes for millions of years. And we know, for example, the Japanese, when they started eating seaweed, actually brought a microbe from the sea from some of the fish eating the algae.

And they didn't have it before then. And then once they started eating some of the fish eating the algae and they didn't have it before then and then this once they started eating some of this fish this algae microbe was kept in their guts and then was able to digest the seaweed so they can now get nutrients from the seaweed so it's very much an evolving process with your environment but that's only going to happen if you blitz it and pasteurize it and it comes out of a plastic microwave packet. You're not going to have that contact with your food. So real food is important. I think diversity is important. And there's not many examples of really healthy populations that just have four or five ingredients every single day, which is what people who are living existing mainly on supermarket cheap ready meals and processed foods are having, because that's what the companies have all these cheap

ingredients. It's the soy. It's the wheat. It's the sugar. These products are very limiting in terms of their diversity. The cheaper it is, the less diverse it is. So I think you've got people who have a culture also of food. So in Britain, we've lost that idea that we've got nothing to connect us with the past.

So we will just go on whichever fad, whatever TV program we read last, you know, people will change their diets overnight. Whereas they'll never do that in Japan. They wouldn't do that in Italy. There's that mentality of consistency of these foods. I think you're right about seasonal variation, which also goes with tradition, though. So you can't separate those two. But I think it's diversity. Yes, the foods are local as much as possible. People aren't flying in iceberg lettuce from Brazil every day. Or blueberries in December. you know where yes but

we'll come on some blueberries because they do have lots of health properties no i'm a big fan of blueberries as well i think you're right let's have another look at these these groups and see what else they do but it is also you know you can't separate food from um environment as well i was recently in tanzania visiting this hunter-gatherer tribe, the Hadza. And during the time I was there, they didn't have a huge variety of food in that particular time. But every time you had a berry or a bit of meat, it had everyone's microbes on it. So actually, you were getting a lot of dust and dogs and, you know, babies. And it was also living in this sort of community that far from spraying surfaces with, you know, and wet wipes and all this kind of alcohol spray

that we're now in a petrified, sterile environment, they're spraying their microbes around all the place. And it could be that close families and things like that also contribute in that way as well. I mean, Tim, I mean, I think you did a podcast and I saw some of the things on Twitter about you having spent some time with the Hadza tribe. And the Hadza tribe is a tribe I've been reading about for the last few years. And certainly what I've been reading is that they're a modern hunter-gatherer tribe who, if we compare very simplistically their microbiomes to our Western microbiomes. Some studies are suggesting we may have lost

about 50% of the diversity. Is that fair to say? Is that what you found? Yeah, it's around 40%, but it's substantial numbers. And they have many microbes that we just don't see at all in the West. They can be extinct. Wow. And so what are the key lessons that you learned from visiting the Hatsa tribe and seeing how they eat? Obviously, you've studied their microbiomes compared to, when I say our, I'm talking about a Western microbiome, which again is a very general term, so I'm sure we've all got different microbiomes. But are there some key lessons that people can learn from what the Hadza have done and what you have found there?

Yeah, you don't have to be rich to have a good gut health. I think that's sort of the other point. These guys have no money. They basically just forage for a few hours a day and they're happy to eat what their ancestors have been eating for tens of thousands of years. And for them, their environment is a bit like a supermarket. They just get out there and take their berries in the morning, eat the animals.

They don't waste anything and uh they also did little things like when you killed an animal whereas we'd go for the lean meat they'd go for the fatty meat and they give the dogs the uh the lean meat so little things like that make you think oh yes we've forgotten a few tricks on the way here they have four or five times the amount of fiber we do yeah and that fills you up a lot so i noticed with a high fiber breakfast i just wasn't particularly hungry at lunchtime i think fibers are really important thing because yeah we we're eating a lot less fiber than these than these tribes are eating and that particular types of fiber are the best food

for these gut bugs that live inside us right so can you maybe expand on fiber and why fiber is so important and what are those types of fiber that we should be focusing on sure the reason fiber hasn't got any attention is you know it's not commercially interesting so your supermarkets only got low fat and low sugar because that's how they make all the money on these products by adding chemicals but no one's investing money in extra fiber foods really there's a little bit in baby food and stuff starting to happen and we don't really know enough about all the fibers at the moment about how they work but what's clear is that you want a diversity of fiber because not all microbes feed off the same fiber or if they, they're doing it in sequence.

So one of them would eat it first, and the byproduct would go to the second one, and the third one would eat off those ones. There are some fibers we know about are useful. There's one called inulin, often confused with insulin, but it's definitely inulin. And the microbes use that as a massive energy source to produce other products that are useful like these short chain fatty acids and so choosing foods that are high in inulin in terms of the fiber we definitely know that's useful these are things like jerusalem artichokes leeks onions garlic a little bit in bananas particularly the the less ripe bananas right yes, you don't want them too mushy and soggy. You do lose some of that fibre as you get on.

Did you find that the Hatsa tribe were, just by default, eating high levels of inulin, eating high levels of the foods that you just mentioned, obviously foods that I think we could get here in the UK, leeks, onions, garlic, artichokes, bananas. That's something that would be applicable to us and where we live. What kind of equivalent foods were they eating out there that would also give them those benefits? The standard staple is, particularly when there's no game around, would be the tubers. And so the women dig these up.

They're like little roots. And they're sort of roughly related to this sort of potato, somewhere between a celery and a potato. Underground roots. And you basically, or they just dig it up and throw it on the fire. And it's a bit chewy, but it's packed with nutrients and fiber.

So that's what all the kids very early on get to chew on after their breakfast of baobab. So they've had these baobab husks lying around, which you can't get in the UK. Interesting. It's seen as a dangerous product. So you'd have to get a special license costing you millions to import it. This is the craziness because it wasn't sold before 1991. But they also have lots of berries. And so the equivalent of those berries have now been cultivated. So they have these wild berries.

They're tiny, but they have probably five times the fibre and five times the polyphenols, or 10, 20 times the polyphenols that we do. So they're naturally getting fibre from pretty much everything they eat, just naturally because it tastes good to them. They don't know it's fibre. That's what they've always eaten. And the berries, they will vary seasonally.

But literally, as they're walking, they are, without even thinking, just grabbing them from the trees and putting a handful in their mouth. And it was so abundant. It's almost as if good health is happening for them by default of the way they're living lives rather than thinking we need to do this to be healthy the way that they live and the way that they eat which has been passed down from generation to generation as a natural consequence of that they're in good health. Yeah absolutely there's no concept really of health it's what it is and that's what they do.

These people have been there for at least 50,000 years without moving because they know that around the baobab tree will produce the pods for 11 months a year. The berries grow. It's an easy life. And actually, in a way, by chance, it's providing them with this perfect balance of food that we perhaps need to emulate. And now we understand that fiber is more than just bulking us up in the 1980s you know f plan diet some of the older listeners might remember that it was a huge thing about if you ate lots of fiber it made you less hungry and by some magical reason sort of prevented heart disease and cancer but they had no clue why it was doing that other than it was a purely mechanical thing. And the idea was it was just flushed out toxins and filled you up like eating cotton wool or something.

But we now know that actually this fiber is an amazing fertilizer for trillions of microbes and lots of different ones in different communities. And so it's not just having the same fibre. So if everybody just had an artificial bowl of, say, inulin, you'd get a much more limited set of microbes than you would if you actually had lots of different real foods, all of which with subtle differences in their fibres. Yeah, absolutely. And I think some of the things that I talk about in my book is about how can we eat in a way that hopefully improves our gut health. And one of the interventions I talk about

is for people to try and eat five different vegetables if possible per day. Now, clearly, I don't have a trial showing that eating five different vegetables per day does X, but I know from experience with patients that it's just a simple way of thinking about increasing their diversity, increasing their polyphenolic content by increasing the colours. And it's certainly a game that we implement at home with my kids. My kids are seven years old and four years old, and we have on the fridge a colour chart. And every day we try and tick off, you know, what different colours have we all had per day. And often what will happen at dinner time is if we haven't hit

sort of bluey purple, the kids will jump into the fridge, get the blueberries out and add them and then with joy tick on their chart. And I just think that's quite a practical, simple concept for people to get their heads around that may improve their diversity and also the amount of polyphenols in their diets. You mentioned polyphenols. We're obviously both sitting here drinking our black Earl Grey tea. And I talk about polyphenols in the book, as you do in great detail in The Diet Myth. Could you perhaps expand on why polyphenols or why you think polyphenols are so important for health? Okay, so first I'll say what polyphenols are because I think there are lots of different names for them. So they can be called phytonutrients, which means just a nutrient that

comes from a plant. They can be called flavonoids. And a lot of doctors call them antioxidants. And up to now, really no one's had a clue what they do, or most doctors haven't got a clue what an antioxidant is. It's all made up, really. The idea that this antioxidant used to just mop up stray electrons and things like this and detoxify our bodies was far too simplistic. But we now know that the key chemicals these plants produce, these polyphenols, there's hundreds of them. We understand only a fraction of them so far. But we now start to measure them for the first time properly. And we know that they are released when, say, you eat a berry. That will have hundreds of different

polyphenols in it that get released as you digest it and your microbes interact with them. And the microbes use those polyphenols as energy sources. Humans can't use them. So they're no use to humans without the microbes. Microbes then convert that polyphenol into a very useful chemical, which can then do lots of things like help our immune systems. It can relax the vessel walls for your heart. It can send signals to your brain, all kinds of stuff. But if you don't give them the food, they're not going to produce these generally helpful chemicals, and the rest follows. So I think we've always had this understanding that vegetables and some

fruits were good for us, and we knew that the greater the color, generally, not always, but generally there's more polyphenols. But if we start linking this, particularly for educating kids, into say you have this one, oh, these friendly microbes, they particularly like those purple variety of veg or fruit. It's much better because it's much more direct. It's a bit like this is what your garden needs to produce this kind of rose. If we can get this message across, the dismal failures of the five-a-day,

which have failed in pretty much every country they've been tried, because people just think a five-a-day is a can of tango or something. Yeah, or a pizza, I think, are one definition it's allowed in. It's remarkable. And we change it to say, okay, well, let's educate everybody about not just feeding themselves, but feeding them particular microbes with these different species. And you can grow different ones if you have a wider variety. And I think if we start with kids, as you're doing,

that's an extremely exciting way to start changing our whole attitude to food. And naturally, people will then get to a diversity of foods and want to keep their garden as bountiful as possible. I think what you said about kids is key. Kids get it actually quite intuitively. Kids kind of understand this and I think the problem with many of us adults is that we have to unlearn the sort of preconceptions that we already have about food to actually get some of these basic principles. I think doctors are some of the worst at relearning so you know they're often the last to grasp some of the worst at relearning. So, you know, they're often

the last to grasp some of these changes in understanding because, you know, spend all your time just learning facts and not questioning them. Yeah, absolutely. I think one of the biggest skills we have, or certainly the ability we need most of now in this information era where, you know, we're certainly not short of conflicting advice is we need to be able to think for ourselves and actually go back to some sort of base level research and actually really try and form our own opinions rather than necessarily rely on all the opinions that we're given. And it's incredibly hard because we're all time poor, we're pressured, we want what's the solution and what do I do? I don't think anybody would argue that increasing the amount of polyphenols in your diet

is a bad thing. I think it'd be very hard to make that case. And of course, we well know that yes, brightly coloured vegetables and some brightly coloured fruits are excellent ways to do this, but tea, coffee, dark chocolate, red wine, these are all... Peanuts. Yeah, these are all foods that also are high in polyphenols. Yes. So if you look back 20 years, some of the foods that were sort of banned or told as high fat or bad for your heart, so black coffee, chocolate, all peanuts, seeds, red wine, the common theme there is actually they are now turning out to be good for you from the larger studies that are coming out, on average, although those studies don't give you a real estimate of what it really means. diet is better than a low-fat medically approved diet, is due to the high polyphenols in the base

of the olive oil, plus the onions and the garlic and all the other things that generally go with it. And that's that mix of variety with the polyphenols. So it's not just high polyphenol count, but I think it's the variety of them as well. So I think by understanding polyphenols, if you combine the polyphenols plus with the fiber message, for me, they're my two pillars. I know you've got four, but they're my two legs, if you like, of the nutritional argument that you can't go far wrong if you're getting high fiber, high polyphenol. And actually, a lot of the foods that give us polyphenols will also give us fiber, right?

Yes, they do. And surprisingly, because I've just been researching berries for my new book, and it turns out, you know, you wouldn't think of raspberries, for example, as a high fiber food. It's just packed with sugar and things. But actually, percentage wise, they have an amazing amount of fiber in them. And they also have the highest levels of polyphenols. We've often been shifted away from some of our natural things that grow outside our, you know, all of us can probably go picking for these things once a year. We can store them in our freezer.

Those polyphenols also keep their stability even when frozen and you have them in midwinter. So, you know, we just need to be a bit more savvy about how we do this. We don't have to import this stuff from chile and other things we can we can do a bit more self-sufficiency yeah and on the theme of kids so it's just a few weeks back now we were local to us in the local common all the berries were there growing and we went and we picked them all and took them we had we brought so much back to the house and the kids. It helps them connect with nature. It helps them connect with real food and where it comes from.

And there's all these other benefits from when we can locally source that food and actually engage communities, engage kids. And growing things and picking it themselves, rather than relying on the latest fad trend of getting some Peruvian berries that only get flown in. It's crazy because there's no evidence they're better than the stuff we can get locally. Yeah, absolutely.

And you mentioned, as you will, those sort of two pillars, fibre and polyphenols. The reason I talk about four pillars is I think it's deceptively simple. I think for messages to take off and to really help patients and also to help myself, I find a simplistic framework can be quite useful. And I feel that the power of consciously thinking about food, movement, sleep and relaxation can have a profound impact on our health. I've seen it over 16 years with patients. I've seen it in myself and my family. But if we talk about gut health and if we start with the premise that it's still a new area of science, but we know that

improving our gut health, whatever that means, and we can obviously define that, and I think that is still being written at the moment, what is perfect gut health, if such a concept exists. But if we improve our gut health, I think there's enough evidence so far to suggest that actually multiple different parameters for our overall health can also improve. How much by I don't think we know yet in all the different conditions, but certainly I don't think improving our gut health is a bad thing for anyone. And I think the four pillars that I talk about, because the body is so interconnected, you know, yes, changing our food can impact our microbiome and our gut health, but also we know that movement or excessive movement, I've seen some studies where they have shown a detrimental impact on our gut health and on our gut border and our microbiome.

I have seen fasting, and in my food intervention, I talk about fasting, but not a complex fast, just 12 hours and every 24 hours, which I think is achievable for most of us. And how fasting can improve the growth of a particular species called Accomansium eucinophilia, which has been associated in some studies with some positive health outcomes. Although I think I may have seen something on your Twitter recently where there was a negative association with something, I think. MS, I think it was. Yeah which I found incredibly interesting and really that shows how myopic we might be being by focusing on these individual species but then if we are sleep deprived how that then affects our gut and also how stress and increased stress and increased cortisol can have a negative impact on our gut.

So although we can focus on gut health I believe that actually the body is so interconnected that these four pillars that I talk about can influence our guts, even though I'm guessing you would argue that our diet has the biggest impact on our gut health. It's the easiest way to change it quickly. But I absolutely agree. It's a two-way process. So it's not just fuel goes in and things happen. Your body is interacting also with your gut microbes. So we know that your gut microbes can influence your body's genes, switch them on and off. We also know that the genes in your lining of your gut can actually switch your microbes on and off. It's amazing. And so the whole brain-gut axis is going in two directions.

So absolutely right. If you're stressed out, that's going to, in a way, harm your microbes. And so we have to understand this whole process. It is very much everything you said all interacts your gut microbiome, but it's just like any other organ in the body, you know, just like your brain or whatever. And I'm just saying the fuel and the food and the things that that's easier to control. Sure. Then it is, then it is very easy to say, cut stress out of your life. We'd all love that.

But you and I know how you can't always control that. Whereas what you decide to eat is something that's easier to control. So I think, you know, you put me on a nice holiday for two weeks in the Caribbean. I'm sure my microbes are happier, but I can't do that every day.

So that's- Absolutely. And I think we've all got to see what principles we can apply in the context of our own life and what is easier for us to apply with our cultural expectations, with our cultural beliefs, with what is the norm in the society in which we live. Just finally, Tim, I would like to just touch on something you said at the start. You obviously had a personal experience, which I've actually found that a lot of doctors who have had to refresh their outlook on medicine and look at

things in a different way, it's often come from either a personal health scare or someone with their family. I know for me, that was a big driver to question what I'd been taught. But you mentioned ski touring, and it reminded me of a story I wanted to talk to you about, which is a really good friend of mine is on the UK ski mountaineering team, actually. So he and I ski a lot in Chamonix. He actually lives in Chamonix and he ski tours a lot. In one of our ski trips over the last years, I remember him telling me that actually in their hospital in Solange,

which is a valley near Chamonix, he said, and he said this has been going on in France for many years, that when they give antibiotics to children, and we know that antibiotic usage, although the antibiotics are there to kill, let's say you have a pneumonia, for example, and there is a harmful bug causing that pneumonia, the goal of the doctor giving you that antibiotic is to try and kill that harmful bug so you no longer have that pneumonia. But what we're realising is actually there are some unintended consequences of antibiotic usage which is changing our gut microbiome and he says that in French hospitals when they give antibiotics to children they are also giving a probiotic at the same time to help reduce the likelihood of adverse effects such as diarrhea from giving

that antibiotic. I wonder what you think about that as an approach. And what's also interesting is that that is not an approach that is currently adopted in the UK. And this conversation goes quite some years back now. So, you know, is it that we're a little bit behind or is there questionable research there? There's no doubt we're behind the rest of Europe. We've had a cynical view of yogurts, probiotics, this whole field, and we haven't really had any champions in the UK to drive it forward. So things you don't know about, all doctors dismiss and say, oh, well, that's just some internet rubbish. We don't believe what the French do. We have the best system in the world. But it turns out, and I was quite sceptical four or five years ago about this, I've just completed a review with some colleagues for the BMJ about the value of probiotics across 24 different conditions and disorders. These are all reviews, so I was doing a review of reviews,

and it turns out the evidence is pretty good for about 19 out of 24 of these different conditions. And the ones that it comes out particularly beneficial of, these are semi-randomised trials, is that young kids, the elderly, antibiotics, or someone's really sick, in those cases you can see a positive benefit of probiotics. So there's no doubt that probiotics are massively underused

in hospitals in the UK, particularly in neonatal and paediatrics, but also in geriatrics. And I think now people need to look very carefully about anyone. If you're giving someone a drug like antibiotics, most of which are used in this country unnecessarily as a defence mechanism in case someone gets an infection or in case it turns out to be bacterial, it's a very defensive medicine. They should also now be giving a minimum advice about nutrition.

So you would have yogurt and kefir or have some other natural probiotic or actually take one of these products. At the moment, the review suggests that we don't know which ones to take. And the trials have all been different because they're all run by manufacturers rather than by government. So we don't get a standardized set of what it is. But absolutely, we need to change our mentality, embrace some of these things that other countries have been using for years ahead of us. And particularly, anyone on antibiotics really shouldn't be taking it as lightly as we have in the past. They do have major side effects on our gut health and can take years to recover.

Yeah, and I think some of us are more sensitive than others. Some of us have a blitzes on our microbiome. Some of us can bounce back relatively quickly from what I've seen. I remember speaking to some German doctors a few years back, and they said a lot of them give a probiotic yeast called Saccharomyces boulardii when they prescribe antibiotics. And I found that incredibly interesting that it's such a different practice than what we're doing here. And I would say that, yeah, I think our whole attitude towards

antibiotics has to shift a little bit where I think we thought we were doing our patients a service by, oh, just in case you get an infection, we'll give you this antibiotic. And I think we need to really recognise the real downsides that exist there and work out, well, actually, maybe in some of those instances, we should wait and see evidence that actually you do need this rather than prophylactically giving them. But doctors don't get rewarded for things not happening. No. And that's the problem is that, you know, if you've got a childbirth,

you know, every woman having an you know a childbirth you know every woman having a cesarean section automatically gets antibiotics don't even ask for it yeah and the reason is there's about a you know one in 500 chance of some nasty infection so most people are getting unnecessarily if there was a no blame culture it would be easy to do that i absolutely agree so well thank you for sharing that sim and look i as i say i am a huge fan of your book the diet myth um although it's been out for a few years now maybe two years is that right it's been out for now no it's been yeah it's i think it's still valid today i think it's absolutely valid is there anything significant that's changed do you think since you wrote it uh there are a lot more books now on the subject. But no, I think a lot of the

speculative things I put in there have actually sort of come to fruition. And actually, you know, it's all moving in that pretty much as I planned. Some of them I put some ideas out there as particularly on the brain gut axis and things like this about how microbes might control appetite and things like this. And generally, you know, everything is moving towards it being reality rather than just speculation. But I think also the more we learn, the more we know we know very little. Yeah. And so that's the other thing.

And providing individual advice is always going to be tough because we're all so different. And I think that's the other lesson we've learned since then is that individual responses to everything is quite hard to predict. But I think we're moving towards a point where everybody in the population will have their microbiome screened, just like they get a blood test or a blood pressure taken. Yeah, well, that's incredibly exciting what the future holds there. Tim, one of my favourite books, apart from yours, of course, on the gut is martin blazer's missing microbes have you got a book that you would recommend to the listeners that might help them understand you know this area

in a bit more detail as well as your own i should say marty blazer was the first person who put me onto this subject but um there's a fun book on the web by jeff leach who writes blogs and he's written a couple of self-published books called uhewilding. And just listening to his antics of him giving himself poo transplants in the bush are great fun. But there are lots of books out there. I like to look tangentially. Some of these ones on nutrition are quite fun as well. So I like the one by B. Wilson, called First Bite, how, yeah, yeah. How educating kids in the early stages can be really important. I think if you combine that sort of psychology of early kids

with our new knowledge of the microbiome, you know, you're pretty well. It's a good powerful combo, isn't it? Yes, it's a great combination. Well, Tim, look, thank you for your time. Just to finish off, what I'm trying to give listeners is four key tools that they can maybe think about and apply in their own lives straight away after listening to this podcast. So four tips that you can give the listener about how they can improve their gut health. Yes.

Have much more fiber than you're currently having. Currently have probably half the recommended levels and we probably need twice the recommended levels. Would you mean cereal fiber and things like All Brand? Because that's what people often think about when they think of fibre. Forget All Brand. Talk about diverse fibres. And by getting fibres naturally, it's grains, it's vegetables. They're the main sources of fibre.

It's a variety of fibres that you want. As you've mentioned, polyphenols are crucially important. So learn which foods have high polyphenol contents, teach the rest of the family, go with colors. The rainbow is a nice analogy to think about that. You'll be surprised at what foods do have these polyphenols. I think not snacking and giving your gut a rest is crucial. Listen to your body. Most of the world doesn't have breakfast. If you're the kind of person who can skip breakfast,

that's the easy way to do it. Or even if you just do it once or twice a week, you know, and you just have an early lunch, giving your microbes a break and stop this British habit of having to have a Kit Kat every day without, you know, otherwise you're going to faint. Eleven says afternoon tea. All these are cultural terms now, aren't they? But, you know, we're the odd ones out in the world about this.

Us in America, you know, we stand out as being wrong. And the final one really is a general point is that above all, embrace diversity. Pick different things to eat. Try something different every single week that you haven't eaten before when you go to a menu. So I haven't had that. Let's break my habit and i think that's also an exciting way to start giving your taste buds extra extra excitement and your microbes will love you for it so thank you so much for sharing your expertise thank you for sharing those tips for the listeners and i hope at some point in the

future we get the chance to get you back on the podcast. Thank you. Look forward to it. Thanks. That's the end of this week's Feel Better Live More podcast. Thank you so much for listening. And I really hope you found the conversation useful, but also enjoyable. If you're not already, I'd highly recommend that you subscribe to this podcast so that you can be notified when the latest episode of my podcast comes out. I'd also be incredibly grateful if you consider going onto iTunes and giving this a five-star rating so that I can get this information out and reach more people. It really does make a difference. And if you have any suggestions for people you'd like to see me have conversations with on this podcast,

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