Feel Better, Live More with Dr Rangan Chatterjee - #175 Gut Health: Everything You Need to Know

Episode Date: April 20, 2021

Gut health is a hot topic these days, with more and more research showing that our gut health impacts so much more than simply our digestive system. The gut is now being implicated in a host of different conditions, including joint pain, brain fog, insomnia and depression. Over the past few years on the podcast, I have had the pleasure of speaking about the importance of gut health with some incredible experts, including neuroscientists, immunologists, nutritionists, and clinical researchers and in this week’s special episode, I have pulled together some of the very best clips from these conversations to give you a detailed overview on the science of gut health as well as practical steps you can take to improve it. On this week's show, I speak to my guests about a variety of different gut-related topics. We discuss how the health of our guts is closely related to our physical health, our mental health, our immune systems and can impact how we respond to stress. We delve into what we should eat to improve our gut health and how restricting when we eat can also play a significant role as well. We talk about the role probiotics may play in improving our response to stressful events as well as their potential role in improving a variety of different health conditions. You will also hear advice for Irritable Bowel Syndrome and we discuss the low FODMAP diet and so much more. This episode really is full of actionable tips that you can put into practice straight away. I've seen time and time again with my patients that taking simple steps to improve their gut health can have a profound impact on their overall health. I hope this episode helps you improve yours. Show notes available at https://drchatterjee.com/175 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Hi, my name is Rangan Chatterjee. Welcome to Feel Better Live More. This week's episode is something a little bit different. Over the past few months, I've been experimenting with releasing the odd compilation episode where my team and I clip some of the best bits of previous conversations all around a single topic. Now the feedback to these episodes so far has been really fantastic and so we have decided to work on a few more of them. So far we've covered topics such as brain health and mindset, but the topic for today's special compilation episode is the health of our guts. Now over the past few years on the podcast, I have had the pleasure of speaking about the importance of gut health with some incredible experts, including

neuroscientists, immunologists, nutritionists, and clinical clinical researchers and in today's episode we have pulled together some of the very best clips and modern research is clearly demonstrating that the health of our guts is closely related to our physical health our mental health our immune systems how we respond to stress and so much more. And I've seen time and time again with my patients that taking simple steps to improve their gut health can have a profound impact on their overall health. My team and I really enjoyed putting this episode together and hope you enjoy listening. We begin this episode with the clinical researcher, gut expert and author, Dr. Michael Ruscio. In this clip from episode 63 of the podcast, he spoke about his own personal

experience of ill health and the eventual unexpected diagnosis that gave him a very valuable learning experience. I was in college and my focus was exercise kinesiology and pre-medical. And so I was pretty ensconced in kind of health and medicine and nutrition. And because of that, I had all the dietary and lifestyle factors pretty dialed in. And I had always felt well throughout my entire life. I was also a college athlete. Yet, all of a sudden, I started having insomnia, brain fog, fatigue, depression. I was having all these symptoms for a reason I could not determine.

And it was very disheartening to not feel well, because it was the first time in my life I hadn't felt well. But I figured, well, I want to be a doctor. This is what doctors do. So I'll go see a doctor and they'll figure this out. And I saw three different doctors and they all said, you're really healthy. Your tests look normal. You've got a good body composition, good blood sugar, good cholesterol. And I remarked, well, okay, that's, that's great. But can, can you offer me any reason why I'm having this insomnia, why I'm waking up multiple times per night, unable to fall back to sleep? Why I am tired during the day, why I have these bouts of brain fog and low mood that I've never had before. And none of them had an answer. And so that led me to look for other options.

And I found a clinician who later kind of became my mentor. And he suggested the idea that I may have had an intestinal infection. And I remember thinking, this guy has to be crazy, because I didn't have diarrhea, I didn't have abdominal pain because I didn't have diarrhea I didn't have abdominal pain I didn't have any of those symptoms but at that point I didn't have anything to lose so I said okay you know I'll look into this and you know I'll do the stool test that you're recommending I did the test I had an infection in my intestines an amoeba actually and it was treating that infection that led to a resolution of my symptoms before i got that diagnosis i went on the internet i read about adrenal fatigue about hypothyroidism about metal toxicity and i kind of self-diagnosed myself with all these conditions and i tried different protocols for adrenal support for thyroid thyroid support, for metal detox.

And I'd see a little flicker of improvement, but nothing really long-lasting. Not until I addressed the true cause of the symptoms, which was this infectious inflammatory issue in my intestines. And it was only by treating that that I saw a long-lasting and permanent resolution of my intestines. And it was only by treating that, that I saw a long lasting, you know, a permanent resolution of my symptoms. And that really taught me that when someone's not feeling well, you want to make sure to look at their gut first. It's not a guarantee. But if we were to have an order of operations in terms of what should we do first, after diet and lifestyle, I think it's a very tenable recommendation to say, do a check for your gut, make sure everything there is squared away.

Because for many people, and my clinical experience has definitely reinforced this as true, the issue that's causing their symptoms, even if they're not digestive symptoms, even if it's only joint pain or fatigue or insomnia, could be a problem in their gut. Modern research is now really establishing this connection. We know of the gut-brain connection, the gut-skin connection, the gut-joint connection, the gut-thyroid connection. So you can have a digestive problem that is not manifesting digestively and is only manifesting in other

symptoms outside of the gut. Our food choices affect not only our gut health, but also the health of our brains. And my next guest, the nutritionist and clinical neuroscientist, Miguel Mateus, has worked on multiple clinical trials to assess the impact of consuming fermented foods like kefir and sauerkraut on our guts as well as our brains. In this clip from episode 33, we explored the gut-brain connection and why diversity is key. What is the link then between the gut and our brain? The gut is connected with the brain through this cable. I like to call it like an internet cable, like a LAN cable. So you've got

your Wi-Fi and you've got your LAN cable. You've got this LAN cable that's giving you very powerful connectivity with the brain that's not dependent on the modem going off or anything. You've got that physical cable connecting the gut and the brain. And the cable is called the vagus nerve. It's a physical cable that if you actually split somebody open, it's there. And it ends up in a part of the brain called the amygdala. And the amygdala processes emotions like fear, stress, anxiety, these kind of like primal emotions. So this having a gut feeling, what we talk about having a gut feeling or having

a hunch or having an intuition that starts with butterflies in the stomach, it's actually your gut telling you that you've picked up a signal that something is going to happen. When you have a gut that is happier because there's more diversity of the bacteria that live there, the bugs are more varied, the gut wall is working better, there's less permeability, there's less leaky gut, that actually leads to better health in the rest of the body, including the brain.

We all know that a poor diet negatively impacts our physical health, but the effects on our mental health can also be devastating. Professor Felice Jacquet is a world-leading expert in the field of nutritional psychiatry, and in episode 74, she told me about her groundbreaking research into the link between food and our moods. The SMILES trial that you did literally, I think, will go down as being one of the most game-changing trials in terms of research on diet and mental health. I think it's incredible and it's helping to give real weight globally to the notion that our diet can improve our mood and our mental health. I think it's incredible and it's helping to give real weight globally to the notion that our diet can improve our mood and our mental health. I designed it when I was a very early post-doc, the SMILES trial. We recruited people with major

clinical depression and we randomly assigned them to get either social support or dietary support. Now, the social support, we already know that that's helpful for people with depression. And then the other groups are a clinical dietitian for three months. And that dietitian just worked with those people to help them to gradually make positive changes to their diet, to set some goals, to do it in a way that was feasible and achievable for them, swapping out their refined carbs, their white flour, white bread, et cetera, for whole grain versions, increasing the amount of vegetables and fruit in their diet, starting to eat more legumes, so your lentils and chickpeas, et cetera,

having some nuts and seeds, eating fish, getting some olive oil into their diet, but also really importantly, reducing the intake of the junk and processed foods. And at the end of the study, there was just this massive difference in the depression scores. And we were just completely blown away. How big a difference? Well, to put it into, I guess, a meaningful context, more than 30% of the people in the

dietary group achieved what we would call full remission, where they just weren't depressed at all anymore. And that was compared to about 8% in the social support group. So hold on, we just got to pause there because that is absolutely remarkable. You were talking about people who have got moderate or severe depression. If you change your diet, within 12 weeks, you got above a 30% remission rate in symptoms of depression. That is absolutely staggering. We've already heard about how the health of our guts can impact our brain health and mental health. But could there also be an impact on stress? My next guest, John Cryan, is a world-leading researcher on the gut-brain axis

and a professor of anatomy and neuroscience. In episode 20, he described how the connection between our gut and our brains affects all aspects of our health, including our stress levels. I think humans have intuitively known for many years how various things affect us, you know, the word gut feeling says it already. What have you seen so far that actually makes you feel actually maybe a healthy gut is going to buffer us against stress? You know, what are some of those clues in the research so far? Some of the key things that we found is that when we look at how in animal

studies, for example, when we look at how we stratify animals based on different composition of the microbiome, we were able to correlate the changes that we see with specific stress-related responses. So we were interested in how the respiratory system responds to a stressor. And we found that correlated very well with certain microbial species. We also were interested in how the cortisol response, the equivalent in animals, how that responds to a stressor. And we were able to make direct correlations there. But some of the best data is emerging now also in human studies where we've, for example, given healthy volunteers a specific bifidobacterium. And we put them through a stressful laboratory testing scenario. We showed that a bifidobacterium, if it was given beforehand, was able to blunt the stress response. This is in healthy volunteers. So that was quite remarkable finding. That's very exciting. And there's a number of studies now emerging with

different strains of probiotics or combinations of probiotics that are showing this. So we've heard about probiotics, but what other benefits could they have? So we've heard about probiotics, but what other benefits could they have? And how can we include them in our diets? We'll hear again from Michael Ruscio as he explains the multiple potential health benefits of probiotics. And then Miguel talks about misconceptions that we may have read in the papers and how it's possible to get the benefits of probiotics from certain foods. and how it's possible to get the benefits of probiotics from certain foods. But first, back in episode five, Dr. Megan Rossi,

dietician and researcher at King's College London and founder of the Gut Health Doctor, taught to me about further research into the role probiotics can play in our response to stresses. When we get our gut working well, it is amazing how many different organs in the body have beneficial effects. It's incredible. It really is. And the research coming out in a minute is so exciting, connecting our gut with our brain. So they've randomized people to having a probiotic, they're the good bacteria, versus a placebo. So that's kind of like a fake supplement. And after four weeks having that every day, they found that those who had the actual probiotic, actually they scanned their brain with an MRI machine and they could see that their brain responded quite differently to negative stimuli if they had the probiotic versus the placebo, suggesting they're actually able to cope

better with some negative things. So, you know, it's such an exciting time, I think, really connecting mental health with gut health. It's fairly safe to say that probiotics have multiple potential health benefits. Two meta-analyses of clinical trials have concluded that probiotics can improve mood. There's a number of meta-analyses showing benefits for irritable bowel syndrome. There's also some evidence showing that probiotics can improve neurological conditions. There's other evidence showing that probiotics may improve skin. There's some evidence showing that probiotics can improve skin. There's some evidence showing that probiotics can improve cholesterol and blood pressure. And of course, we know that probiotics can decrease inflammation in

the gut. And that may be why we see probiotics having benefit in a number of different systems. Because if the root cause or one of the root causes of many ailments is inflammation in the gut, and by treating the cause, you can see anything from skin to neurological conditions improve. There's just been a big study talking about probiotics. Don't take them. They don't do anything. They don't stain the gut. Well, it's not big news.

We always know that probiotics, whether you call them probiotics or live bacteria or whatever from a yogurt or kefir or a supplement, they go through you and they come out the other end is what they do while they are there. What those probiotics may be doing is whether they are in a food like sauerkraut or kimchi or kefir or yogurt or in a supplement capsule, they may be going through you, but they may be increasing that diversity. They may be facilitating that diversity. I think it's a brilliant point you make, Miguel. And I saw that big newspaper report when it came out, the media were reporting that the probiotics don't work. And it's just not

true. Yes, they don't stay in the guts. But many of us who've been studying this for a while, we know that. They exert their effects as they go through and they change the terrain, they change the environment. And I certainly still do for some patients use probiotics with patients. So it's now for practitioners and scientists to start communicating to lay people who are interested in this kind of stuff, what kind of supplements or foods may be reaching the ones that are good for depression or for better mood or cognition or attention or IBS, that kind of stuff. We're only touching the tip of the iceberg. We know that people can increase their well-being. They can feel better after drinking kefir or eating yogurt, for example. So we don't need to get very fancy. It can be very easy.

Have a bit of yogurt every day. If you've never had it before because it was a novel food for you, you'll benefit from it. If you're on the yogurt already and want to be a bit more fancy, have some kefir that is super loaded with bacteria. You want to be super hipster, have kombucha. Our gut bugs play a vital role in keeping our immune system healthy. And in this next clip from episode 125, the immunologist Dr. Jenna Michoki explains how our diet can affect our gut bugs and our immune system.

A lot of people talk about gut health these days, but I don't think people understand the immune system's link to it. They think the gut is something separate, but I often teach doctors about this triad between our diet, our gut bugs, and our immune system, and how they all sort of cross talk. Oh, definitely. Yeah. There's bi-directional communication between, you know, diet and gut bugs, diet and immune system, and gut bugs and immune system together. It's like this. So, you know, if you make certain dietary choices, you're going to improve the health of your gut bugs, you're going to improve the health of your gut bugs, which is going to improve the health of your immune system.

Yes, exactly. Which is empowering, right? Because we can do something about that. Yes. Your gut bugs, the microbiota, at the interface of your digestion and the rest of your body are one of the key educators of the immune system. And again, this is something that's probably

exploded in the field of immunology in the last 10-15 years so if you take an experimental animal model where the animals have a reduced or a minimal collection of good bacteria in their gut their immune system doesn't develop and they're very impaired in how they can respond and heal and even things like you know protection from cancer because our immune system is the main cancer surveillance system so these bugs are helping to educate and teach and mature our immune system and this happens potentially in utero before we're born, but predominantly when we enter the world, because we go from a relatively sterile, there is some evidence that there may be some bugs in the placenta. But we go into this hugely germy world and suddenly our immune system has to cope with that because it's got all these receptors on it to detect pathogens as being problematic. So it has to learn to tolerate those because, you know, most of the bugs around us are safe and harmless and we need them because they're helping us.

And that's actually how the immune system develops, isn't it? It is by exposure to the environment around it, the bugs around it to sort of give it that sort of ongoing education so it starts to learn oh i respond to this i don't need to respond to that exactly i often say that you know the immune system's made it's not born there's maybe a percentage in the genetics that we inherit but then it's made it's built throughout our life and it changes throughout our life so that's a lovely idea it's made not born we can we can build and we can sort of develop it the way we want to if we give it the right inputs yeah Yeah. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show.

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And these packs are perfect for keeping in your backpack, office or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. That's drinkag1.com forward slash live more. These bacteria, they help protect the gut barrier to keep it very nice and tight and stop any bacteria going into the body because they're only good bacteria if they're in the right location. So they're not meant to cross over the gut and enter our body because then they become a problem. But one of the biggest things that they're doing to help our immune system is they're eating our food. And I often think your diet's only as good as your microbiota in your gut because they are the interface. They're eating eating your food they're helping you to produce these vitamins and minerals from your diet but they're also producing these post

biotics um and people might have heard of prebiotics and probiotics but post biotics are basically the metabolic waste of the bugs in your gut so they're producing stuff that is their kind of you know waste product of eating your food. Like short-chain fatty acids. Short-chain fatty acids is the classic one. I used to work on these when I lived in Switzerland and looking at how they influence inflammation in the gut and beyond. So short-chain fatty acids are kind of a metabolic byproduct of the the bugs in your gut and they directly bind to the immune cells at that site and they help educate them and teach them to tolerate anything that you're throwing

down your mouth because we're not supposed to react to that because it should be you know benign things that are going in there but they have to help strike that balance that if you did get some kind of food poisoning they also can identify the bad bugs so they help create an environment that's what we call tolerogenic so it's encouraging tolerance of the food that you're eating and there's a very kind of dynamic interaction between these bugs and the immune cells and i'd say what happens in the gut is not just staying there this um influence this sort of tolerogenic influence of things like short-chain fatty acids is also being absorbed into your bloodstream and helping regulate the immune system one of the key things that is often not linked to your immune system but i'd say it's like massive for the

resilience of your immune system is fiber. So pills and potions and whatever are not full of fiber, but the fresh produce is full of fiber. And people might be thinking, why is fiber important for your immune system? Different bugs need different forms of fiber. And we find it in all the plant-based foods so it's not just the fruits and vegetables nuts and seeds legumes beans pulses and and whole grains and it's about trying to bring in the diversity i think in the last few years there's a publication about the sort of trying to get 30 different plant-based foods into your diet because it's per week yeah because it's about the diversity but also it's that includes i think lentils and nuts yeah you know and you know i think it's very achievable

yeah once people have it in their mind exactly yeah to do it and they're very common in in traditional diets i remember growing up you know my mom would would add lots of different um grains and beans and pulses to spin things out as she put it so that you could make a dish go a lot further and so now that's something that i do as well lots of different colors lots of different diversity of plants is going to help your gut microbiome it's going to help your immune system so have we lost touch with where our food actually comes from? Well coming up next Felice Jackett explains why eating a wide variety of plant foods is important for gut health

and the benefits of real whole grains. But first all the way back in episode one my guest was Tim Spector, Professor of genetic epidemiology at King's College London, a medical doctor and author of the fantastic books, The Diet Myth and Spoonfed. Tim told me about the time he spent with the Hatsa tribe in Tanzania. Are there some key lessons that people can learn from what the Hadza have done and what you have found there? You don't have to be rich to have a good gut health. 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. They have four or five times the amount of fiber we do. They're naturally getting fiber from pretty much everything they eat. They also have lots of berries. And so they have these wild berries. They're tiny, but they have probably five times the fiber and five times the polyphenols, or 10, 20 times the polyphenols that we do. 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. 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. balance of food that we perhaps need to emulate. If we compare, you know, very simply 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. I think fibres are really important thing because, yeah, we're eating a lot less fibre than these tribes are eating.

And that particular types of fibre are the best food for these gut bugs that live inside us, right? We don't really know enough about all the fibres at the moment about how they work. But what's clear is that you want a diversity of fibre because not all microbes feed off the same fiber. There are some fibers we know about are useful. There's one called inulin, and the microbes use that as a massive energy source. 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. So 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? If you blitz it and pasteurise 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. We already know what sort of diet is consistently linked to longevity and that's a diet that is

high in plant foods and high in a diversity of plant foods, because the more diverse your diet, the more diverse your gut microbiome, and that seems to be a marker of gut health. The bacteria in your gut in particular, very, very simply speaking, they break down the fibrous foods that our human enzymes can't break down. So fiber is found in plant foods, things such as vegetables, fruits, whole grain cereals, legumes, beans and lentils, etc. So all sorts of different types of plant foods have dietary fiber. The gut microbes break that down by a process of fermentation. And in that process of fermentation, they produce many, many, many

metabolites. And it's the production of these metabolites that seems to be so important. And we know that they, for example, interact with every cell in the body. Whole grains have become quite a controversial area in the diet wars. And I think that's because often what we consider to be whole grains are not whole grains so I think it's quite clear that there's pretty good research suggesting that real whole grains can have beneficial impacts on your gut microbiome and consequently on your overall health including your moods what do you see the problem with whole grains is it that interpretation is it that when the food industry and marketing refined grains as whole grains?

Yes, basically, yes. And I think people in the US where their food system is just so broken and has been for decades to the point where nobody alive today in the US remembers what normal food looks like. I mean, it really is. It's a rarity. And for them, whole grain might be a brown bread that's still highly refined and full of all sorts of things. But if you look at, certainly the epidemiological data, whole grain intake is, out of all of the food groups, the most strongly associated with improved health outcomes. If you look at the gut and what we know

so far, whole grains, and here we're talking about things like oats and barley and frica and spelt and buckwheat and brown rice. So things that are true whole grains are just a really valuable source of fiber for that fermentation process of the gut. But they're also anti-inflammatory. My recommendation is just try and avoid the ultra processed foods and have as much diversity of whole foods as you can. And so what we call a plant predominant diet. As we've already heard, the health of our gut microbiome is key to our overall health. gut microbiome is key to our overall health. We'll now hear once again from John,

who gives his thoughts on the importance of our relationship with our microbes. It's very hard not to feel that once we understand the gut microbiome more and more, we'll see that that is really the intersection point for many different conditions. Absolutely. But you know, you could have a cynical view on that too. And people have often addressed this to me, like, is there anything that the microbiome is not involved in? But my response is always this, is that we have to remember that the microbes were there first. And there has never been a time where our brain or body has existed without signals coming from microbes. So if we understand and can step back and not be so human cell centric and try and think

of it from an evolutionary perspective, we have co-evolved with these microbial friends and they have helped us benefit from many, many things. I guess in the last 50 years, because of modern living and a lot of modern practices, we're starting to decimate the populations of those microbes. So arguably, we're now entering a time where maybe for the first time in our evolutionary history, we might be living without the presence of certain microbes. Professor Sachin Panda of the Salk Institute in California is one of my most popular previous guests on the podcast. He's a world leading expert in the field of circadian rhythms and in episode 81 he explained how time-restricted eating can help reduce

inflammation in our guts and improve many other aspects of our health. In this clip, he describes some of the incredible findings of his research. Nearly 50% of adults in Western countries eat for 15 hours or longer. So that means if the first cup of tea with milk and sugar happens at 6 o'clock in the morning, then the last sip of wine or last sip of milk might happen at 9 o'clock at night or later. Almost one-tenth of our stomach lining is repaired and replaced every night. Wow. And just like you cannot repair a highway when the cars and trucks are moving, we cannot repair our gut if we eat at night. The most obvious circadian rhythm that we all experience is the daily sleep-wake cycle. But that's just the tip of the iceberg. And there are many other rhythms that go on inside our body. We wanted to test

this very simple idea. If our liver, if our gut is better primed to digest and use these nutrients at certain time, is it better if we align eating time to that time? And we know that when we sleep, our gut is not functioning well. It's not primed for digestion. We did a simple experiment where we divided the mice to two groups. One group got to eat this high-fat, high-sucrose diet whenever they want. And the other group got the same unhealthy diet, but that was aligned to their circadian rhythm. So they ate all that food within eight hours in the first experiment and then later in 10 to 11 hours. So these two groups of mice were eating the same number of calories

from the same food. But to our surprise, the mice that ate within eight to 10 hours were completely protected from all these diseases, obesity, type 2 diabetes, fatty liver disease, high cholesterol, type 2 diabetes fatty liver disease high cholesterol and cardiovascular disease if you align your eating time with your circadian rhythm when your liver when your gut is primed to digest that food has this huge health benefits. Sachin that's just incredible just just to highlight that you're saying that the mice had the same diet, the same amount of calories, simply the time that they had them was restricted. We repeated this experiment three, four times before I could really believe it, because this goes right against what we know in nutrition research for the last 150 years. Clinicians and nutritionists are already putting this research into action. And in episode 40, the author and nutritional therapist Jeanette Hyde

explained the benefits that she is already seeing in her patients. The microbiome will flourish and have more diversity just being by not having food sort of charging through it you know all day long yeah so what happens it's like i say to people it's like think of it like a lawn you need to not walk over it for a few hours let it to have time to flourish and thrive that's a great analogy for the big cases like inflammatory bowel disorder and stuff like that, and also diverticulitis and some of the really bad IBS cases, I start by saying do a 16-hour fast with an eight-hour window. So that's eight hours in the daytime where they would eat food within.

Yeah, and do that for the first month. So for instance, let's say somebody tells me they hate breakfast. I leap on that. I leap on that fact. That's one of my key entry points. I'm like, oh, you don't like breakfast. Well, you don't have to eat breakfast. And they're like, really?

I've always been told I've had to eat breakfast, so they don't. So suddenly, instantly, those kind of people might be very happy to start eating at 12 to late. Generally, time-restricted eating and time-restricted feeding is a very safe recommendation that can impact weight, blood sugar, immune system, inflammation levels, all kinds of things in the body. So it makes sense that when you make that recommendation with a patient, Jeanette, all kinds of different diseases or conditions may start to improve. I've had several of these cases and I thought I was just doing it, you know, to regularise the microbiome and put that in better shape. So that is going to have a knock-on impact.

I wasn't expecting the results as fast as they're coming. Because of our modern lifestyles, problems in the gut are becoming more and more common. If you're suffering with irritable bowel syndrome, Megan and Jeanette offer some practical advice. There's been some, you know, really powerful studies that have shown, they've surveyed quite a large number of people with IBS and shown that on average, they'd be happy to give up 25% of their remaining life to be symptom free, showing just how debilitating the condition truly is. We know that stress is a huge cause or huge trigger, should I say, of IBS. In my clinical practice, often I not only look at things like diet, but I also look at levels

of stress and how they can manage that in order to manage their IBS. I have found in you know nearly 17 years now seeing tens of thousands of patients I found that when I go for this multi-pronged approach so you know for an IBS patient maybe making some food suggestions talking to them about some gentle movement talking to them about things that they can do to de-stress I find it's much more effective than actually just going for that magic bullet approach people can be just sort of focusing really hard on the diet and I'd have a conversation with somebody and you know they're actually seated 12 hours of the day, these IBS patients, you know, driving to work, then being in very sort of demanding jobs and driving home. And it's only as we're talking and they're explaining it to me, I might feed it back and go, do you realise you're seated for 12

hours a day? And they go, really? I've not really thought about it like that. Do you know what I mean? And I said, you're not having a lunch break either, are you? And they're like, no, I haven't got time for lunch you know they're eating at the desk and all that stuff as well but physical activity is important right for our guts yes totally because you know when you're moving your gut bacteria improves and you produce short chain fatty acids which help with the gut lining and to keep that repaired and in good shape so again moving around if you have IBS is really important. Are there some common themes that you see that people are

either not telling you about or that they're doing wrong? Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of

happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making and reduce symptoms of anxiety and depression.

It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal. And as with most things, it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three question journal.

In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a

journal, that is completely fine. I go through in detail all of the questions within the three question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal, or click on the link in your podcast app. I see the food diaries and often it's like wonderful food diaries, very, very sort of all round diets, eating a good quality breakfast, lunch, dinner, lots of variety. You know, they're doing lots and lots of good things. You want to know what the butt is? The butt is, it's a massive blind spot for a lot of people is the alcohol and binge drinking at the weekend. And these are all walks of life. who are retired some people have you know the high flying jobs and they're drinking a lot of alcohol and they haven't put two and two together

that their IBS is terrible all the time you know like not even knowing if they're going to make it to the loo on time you know the IBS is so bad but they've got this kind of big thing, elephant in the room that's not being acknowledged. Some of you may have heard or used something called a low FODMAP diet. But what on earth is a FODMAP? Well, FODMAPs are a group of fermentable carbohydrates that can aggravate gut symptoms in people who are sensitive, and they are found in a wide range of different foods. Now, for some people, reducing FODMAPs really helps them with their gut symptoms, but it's really important for me to emphasize here

that a low FODMAP diet is not designed to be a long-term diet. Ideally, you would utilize this diet under the guidance of a trained healthcare professional to make sure that you are addressing any underlying issues. And then ideally with time, start to reintroduce some of those foods back into your diet. So what are these high FODMAP foods? And how can eliminating them for a short time potentially help our guts to heal?

The foods that are high FODMAP, we would stereotype as being healthy. Asparagus, broccoli, avocado, apples. Who would have thought that these foods, when eaten in too high of a level, could actually make you feel worse? But they can. The nice thing is that the solution isn't a hard one. If you download a low FODMAP diet list, you can clearly see, okay, here's the vegetables and fruits I want to focus on. Here's the ones I want to be a little bit more careful with. The goal is to use the diet to help the person gain awareness towards what their food triggers are and also allow some healing in the gut to occur. And then you can

broaden your diet and move to the most diverse diet possible. For some people with highly compromised guts, they may always be sensitive to some FODMAPs, and that's okay. There's kind of this nuance, this balance. We don't want to blindly follow the low FODMAP diet forever. We want to use it for a short term, heal, and then reintroduce and try to have the broadest diet possible, but also be okay with the fact that there may be a few high FODMAP foods that you don't tolerate. And don't stress out if you can't introduce some high FODMAP foods without any symptoms. As we've heard, the health of our guts has implications for our overall health and

happiness. Research is finding new links, connecting our gut's health to many different health conditions. But there is still so much more to learn. Felice, John and Tim give us their thoughts on what the future may hold. We know that the gut microbiome is so important for our immune system, for our metabolism and body weight, for our brain health and right across the board. And there's huge amount of research that's being done across the world now in this field, which is wonderful because it means that we're getting advances in our knowledge very quickly. But at this point, what we know is that diet is the

most important thing that affects the gut microbiota and that you can change your gut microbiota and your gut health within a very short space of time, like even within days by changing your diet. And that's such a powerful thing to understand. This knowledge that these bacteria that have co-evolved with us have such an important role in our health is really giving us some new insights that we can act on to, I think, improve a lot of health outcomes. We all have blood tests now. Do you think there will be a

point in the future where we all might have our microbiome tested as a sort of baseline to see what we need to improve on? I really think so. I really think so. And as a GP, I think this will be part of your reality within the next five or so years, because the costs are coming down. The knowledge about what it means is going up. And so we're able to use large data sets like the American Gut Project, which published a huge paper outlining you know what the American microbiome looks like and if you have enough metadata so information about at a population level you can start to ascribe changes and there they were able to look at specific bacteria that were implicated in certain mental diseases and particularly in relation to depression so we're beginning to see more and more of this I think what we're going to have is in the whole field of nutritional psychiatry moving forward is that we will be able to target individuals with specific diets that will A, suit their symptoms, B, suit their microbiomes and hopefully relieve some of their underlying pathology.

The progress just in three to five years has been amazing, and we're now starting to see this, the microbiome, as becoming part of mainstream medicine. 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. for public health. It's changing every week. And so that's what I love about it. We finish off with some great tips from all of my guests to help you improve your gut health for better physical and mental health.

Make sure that if your symptoms are really quite debilitating, you do see your GP and rule out things like celiac disease and inflammatory bowel disease. Then the next thing I think is getting individualised advice. There's so many different therapies out there and each different therapy could actually be beneficial for different types of symptoms. I think for those with IBS with less severe symptoms, one of the big keys is trying to stress less. So look at ways to relax. Make sure when you are eating, you chew your food at least 20 times per mouthful and little simple things like that to kind of go a little bit slower

and let your digestive tract kind of relax and get ready for the food that it's about to receive. Don't forget to slow down. And I think it's it's you know especially in westernized societies it's it's so easy to get swept into always working thinking and doing taking that time for stillness for reflection is so important to help you key in on maybe you're not happy with a certain thing in your life and maybe you're just kind of running from that and distracting yourself in this never-ending litany of stimulation. A little bit of stillness time and a little bit of thankfulness can go a long way in helping to make sure that you don't just get caught up in this runaway

syndrome of trying to have more, be more and do more. syndrome of trying to have more, be more and do more. Diversity actually goes further than just dietary diversities. If you have a life that's more diverse in experiences, that's also playing a role in keeping your brain engaged. It's probably going to play a role in keeping you less stressed. And because you're going to be less stressed and less anxious, it's likely to make you feel happier than if you do the same thing every day. When there is flexibility in the behaviour, we adapt better to whatever may come next because we are more flexible, we are more plastic, we can take things that life throws at us in a more gracious way.

at us in a in a more gracious way maybe keep a diary about your drinking because i think that a lot of us we don't realize till we actually see it in black and white how much we are drinking alcohol yes and i think that you know especially in ibs or if you've got a weight issue it's a big factor so you know it's just worth seeing it in black and white. And sometimes that can, you know, you start to have a conversation with yourself about, well, actually, maybe my partner and I will try and do this, that or the other. It's much easier to drink less if you've got support and, you know, you're supporting each other. Try and increase the diversity of the diet. Fermented foods, they can be quite exotic things like kimchi and kefir and kombucha, but also yogurts and sauerkraut and various things like that.

We know that they're going to have beneficial effects on the bacteria that we want to see thriving in the gut. We know that increasing the prebiotic, the fibers, the inulins, the green vegetables, that's very clear positive things we can do to our microbiome. What you eat really does matter to your mental and brain health in the short term as well as the long term. So pay attention to it. And it doesn't need to be expensive or fussy or difficult. It can just be really basic peasant food, you know, cooked up without much in the way of complex recipes. It really does help.

And getting regular exercise. If I don't exercise, I don't sleep properly and everything falls apart. So finding something that you really like doing, whether it's just big walks in the park or resistance training or whatever it is, just try and move because that has such a flow-on benefit to everything else. Have much more fibre than you're currently having. Forget all brand, talk about diverse fibres. And by getting fibres naturally, it's grains, it's vegetables. It's a variety of fibers that you want. 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. Above all, embrace diversity. Pick different things to eat

and your microbes will love you for it. Really hope you enjoyed that special compilation episode just a quick note to say that i do recognize that some of those tips can be challenging for some people to put into practice those who have had long-term gut issues can sometimes find that adding in some of those foods recommended can be uncomfortable and cause flare ups and symptoms such as bloating and cramps. So if you think that may apply to you, it really can be worth seeking out a trained healthcare professional to help you out. But please do not forget about stress. For me, it is the number one cause of gut problems and there really are so many simple things that you

can do each day that really do make a difference. I've talked about this in previous podcasts, I've also covered them probably in each and every single one of my books. The ones most specific to this area are probably the Stress Solution or Feel Better in 5. They are widely available all over the world in paperback, ebook, and as audiobooks. If that is something you want a bit of help in, they may be a good resource for you to use. If you enjoyed the show today, if you want to support the show, please do share the episode with your friends and family. And please consider leaving a review on whichever podcast platform you listen on. And of course, please do support

the sponsors. You can see a full list with all the special offers at drchatterjee.com forward slash sponsors. Before we finish, I just want to let you know about Friday Five, my weekly newsletter that contains five short doses of positivity. It usually starts off with a practical tip for your health, but also various things such as books, articles, videos that I found inspiring. It could be a recipe that I'm making, a quote that's caused me to stop and reflect. Basically anything that I feel would be helpful and uplifting. I get such wonderful feedback from my readers on this every week. And many of you tell me it is a wonderful way to finish off your week and get you set for the

weekend. That sounds like something you would like to receive each Friday. You can sign up for free at drchastity.com forward slash Friday five. Thank you so much for listening. Have a wonderful week and please do press follow on whichever podcast platform you listen on. Remember, you are the architect of your own health. Making lifestyle changes always worth it because when you feel better, you live more.