Feel Better, Live More with Dr Rangan Chatterjee - #5 IBS and Gut Health with Dr Megan Rossi

Episode Date: February 14, 2018

In this episode Dr Rangan Chatterjee meets The Gut Health Doctor - Megan Rossi, dietician and researcher at Kings College London, to discuss IBS, SIBO, the role of pre and pro-biotics and simple steps to improve the health of your gut. Show notes available at: drchatterjee.com/meganrossi 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. I'm really excited to introduce my guest today. It's somebody who I've been following on social media for a good little while now and I'm very, very impressed with the content that she puts out. It's Dr. Megan Rossi. Welcome to my podcast, Megan. Thank you so much for having me.

My pleasure. So just, I'm going to give you a little bit of an intro, just so people know who you are. You are a registered dietitian with an award-winning PhD in the area of gut health, and you work as a research associate at King's College London. You're a consultant dietitian across the food industry and media, and you lead a gut health clinic on Harley Street in London. You've also recently joined forces with Leon Restaurants to launch a nationwide gut health campaign in the UK. Well, it sounds like you are very busy, Megan. Yeah, I am actually struggling to juggle my time at the minute, but absolutely love what I do, so I wouldn't change a thing. Well, I can definitely resonate with that.

And it's great to do something that you love, right, that can help so many people. You never feel like you're working when you actually enjoy it. It's passion that comes through. Absolutely. Smeagol, I think the obvious question for me is how does somebody who is from Queensland in Australia end up as a registered dietitian here in London? Well, where do I start?

I guess probably firstly why I became a dietitian and nutritionist. So I'm both of them. And it comes down to my love of food. I've always had such a passion around food. And I came from a big Italian family where food brought people together. So it was always such a happy thing. And my mum was a science teacher. So the science element stuck with me from a young age where my mum kind of instilled inquisitive

mindset, always asking questions. Now, when I think about a dietitian, it really is about the science of food. So it brings those aspects together. So I think I was always destined to be a dietitian. So I did my nutrition and dietetics degree for four years. And then I worked as a clinical dietitian in a hospital setting. And in there, I felt like I really wasn't doing a lot to help these patients. I thought there was a lot more I could be doing. So I embarked on a PhD and that was in the area of gut health.

So looking specifically at people with chronic kidney disease. And as a clinician, I was noticing that a lot of my patients were actually complaining of gut symptoms, although they had kidney disease. And as a clinician, I was noticing that a lot of my patients were actually complaining of gut symptoms, although they had kidney disease. I was like, what's going on? So I did some reading up on that. And that's kind of what brought about this concept of gut health and kidney disease. So I did my PhD there looking at giving kidney disease patients pre and probiotics, the types of the prebiotic is a food for the good bacteria and probiotics is good bacteria. So I gave them together and that's called a synbiotic. And what we found is we could actually help reduce some of these toxins circulating in the blood of people with kidney disease, which has been associated with improvement in overall outcomes

and stopping the fast progression of kidney disease. So, yeah, really exciting stuff. Finished the PhD and then I thought, geez, what do I want to do? And I knew that, you know, for me gut health was such a powerful way to improve the nations or not the nations, the globe's health. So I thought, yes, this is exactly the area I want to focus in, but I want to, I guess, help more people. And that would be in something that, a condition that affects probably more people and that's such as irritable bowel syndrome. So I applied for a postdoc

in London at King's College and I got it and I've never looked back. It's been such an amazing journey from Australia to the UK. Well, Megan, thank you for sharing that. It's incredibly exciting to hear how you've got here. Now, I do want to talk about Irritable Bowel Syndrome today because I think it's a condition that affects so many people and some stats suggest that maybe up to 20% of the UK population may have symptoms consistent with Irritable Bowel Syndrome. But your story has actually just lit a light bulb in my head because when I started out as a medical doctor, I was training to be a physician, a hospital specialist. So I did my

exams for the Royal College of Physicians and I was practising within kidney medicine. So that's what I was doing in the past. And actually, I moved to becoming a GP and a generalist because I felt that medicine was becoming a little bit too specialised for me. And I wanted to see the whole picture and how various things in the body connect and how they all impact each other. And your PhD sounds incredibly fascinating, both from a professional perspective, but a personal one. So my father, who I used to care for, he died about four and a half, five years ago now. And, you know, dad was ill for about 15 years with a condition called SLE or lupus. And he had chronic kidney failure for 15 years and was on dialysis

for 15 years. So I know very well from both a medical angle, but also a patient and a carer's perspective, how severe that can be and what sort of strain it can put on patients. And so I often wonder if I knew what I know now about the human body back then, how much I could have potentially helped my dad. But have you done anything with your PhD about people with end-stage kidney disease, such as people who are on dialysis? No. So we were looking at pre-dialysis. So giving kidney disease patients these supplements,

the pre- and probiotics, or the symbiotic in pre-dialysis. But there definitely is a potential for treating patients on dialysis, so end-stage kidney disease. And in fact, from my PhD, because it was a positive trial and very exciting, we'd gotten funding to do a second-phase study. Now, that study is still in earlier-stage kidney disease, so not in the dialysis, because I think where the government's heading is they want to do more of preventing for people to getting on to the really expensive hemodialysis, as well as it being extremely debilitating, as you've experienced through your father's journey. For those who don't know, yeah, dialysis, particularly hemodialysis, involves going to the hospital three days a week and sitting with your arm attached to this special machine, which acts like your kidney for four hours each session. And, you know, it's so debilitating. That's four hours when you're there.

My dad would leave the house, he'd be back seven hours later. He did that three times a week for 15 years. And I can't imagine how he copes. But yeah, I get it. You know, end stage renal disease when you need dialysis, that may potentially be more challenging. But I guess we don't know until we do more research but yeah a good place to start is how can we prevent people getting there and really what I've become aware of in the last five six years

and my immunology degree which I did at university has been incredibly helpful for this is that 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 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 given people, they've randomized people to having a probiotics, remember 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 in 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. Absolutely. I remember a paper from Nature a couple of years

ago where I think the scientists, it was a review paper, and they called all these gut bacteria, these trillions of microbes that live inside us, they call them the brain's peacekeepers. And I thought that was such an apt term. And I think, you know, we're just scratching at the surface, aren't we, about what we're going to learn here? We truly are, yeah. So before we get on to IBS, Megan, what I have found is that many people tend to get a little bit confused about prebiotics and probiotics, but also whether they need to take supplements or whether they can get them from food. I wonder if you could share your perspective here. Yeah, so prebiotics are found in a wide range of plant-based foods. So I think for the general public, there's no need to be taking a prebiotic supplement if you just aim to have a wide range

of plant-based foods in your diet. So I often get people to aim for around 20 in their diet, then they're going to be getting sufficient amounts of prebiotics. So having whole grains, nuts, seeds, fruit, and veggies, different types will contain different types of prebiotics, which are going to feed different types of gut bacteria. So I don't think you need to take a special supplement when it comes to prebiotics. When it comes to probiotics, again, for the general public, there's not enough evidence to suggest everyone should be having one. But instead, we can get probiotics from a range of different foods. They can be found in things like live yogurt. Unfortunately, not all yogurt on the market actually contains probiotics. So you have to actually make sure that it's not, say,

live culture on the yogurt, but things like kefir, kombucha, and things like kimchi, sauerkraut. They're different types of fermented cabbages also contain probiotics. So it's good to include some fermented foods in your diet. If you're really adverse to that and don't like the taste, it's not essential to have good gut health. I think you tend to pick up a lot of good bacteria from the environment and from little things like a little bit of dirt that we accidentally ingest actually gives us some good bacteria. So as long as we're feeding them with plenty of prebiotics. Now, in certain conditions, there is some evidence to suggest

maybe a probiotic, a capsule may actually be beneficial. For example, if you're travelling overseas and you're at risk of getting traveller's diarrhoea, there's good evidence to suggest that taking a specific type of probiotic could actually reduce your risk of getting traveller's diarrhoea, there's good evidence to suggest that taking a specific type of probiotic could actually reduce your risk of getting traveller's diarrhoea. And similar in IBS, there is a small amount of evidence suggesting that some probiotics may be able to reduce your risk, but certainly not enough for me to recommend all IBS patients take a probiotic, but it is an option. Yeah, thanks for that, Megan. I think you've touched on a really key point there, which is we don't know what we should be recommending for every single patient, because I think what's likely to help one patient may be different from another patient. Because IBS, yes, it's a term, irritable bowel syndrome, but

it's quite a heterogeneous term. There's so many patients I see who I feel have got different drivers. So the way I would treat one patient with IBS will be very different from another one. Yeah, absolutely agree with that. You know, the causes of IBS are so varied and we're only just starting to get to the bottom of it. But I think this is probably a good point to actually, you know, let people know what irritable bowel syndrome actually is by definition or how we diagnose it as such. And there's this set of criteria that would determine whether someone has IBS. So the first thing is you have to have tummy pain at least one day a week

for six months. And the second criteria is that you have to have funny stools in some way, whether the form is a little bit funny, whether it's really hard or really soft or mixes between them, or whether the pain that you get is related to when you pass your stool. So they're the two main criteria for irritable bowel syndrome. But of course, you know, before, of course, you as a GP would diagnose someone with irritable bowel syndrome, you rule out things like celiac disease and inflammatory bowel disease because a lot of those symptoms can overlap.

So we like to make sure we rule out those other factors because things like celiac disease, there's actually thought to be over half a million people in the UK who are undiagnosed and still having gluten in their diet, which is actually doing quite a lot of damage. Yes, it's very important for people to try and get an accurate diagnosis and exclude some very, I'm not going to say more serious conditions. I probably would have done five, six years ago. But actually, I've realised that IBS is a very debilitating condition. I think often the public

and even healthcare professionals sometimes, I don't think realise the impact it has on people's lives. I mean, you know, a lot of women who I see in my practice, you know, they feel very social, they feel quite socially isolated. They don't go to various events because they're scared of what their gut's going to do. It impacts them at work. It impacts relationships. So I think it's a condition that actually has a serious impact on people. And I think we can probably do better than we have done because certainly from a medical perspective, I feel that a lot of the treatment that we have conventionally given for IBS has really been symptom suppression. also the treatment that we have conventionally given for IBS has really been symptom suppression.

And whilst that has value, I think if we can delve a bit deeper to get to the root cause of what's causing those symptoms in that particular patient, I think we can actually make quite a big impact. Is that what you found? Yeah, I completely agree. In fact, there's been some 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. Wow. Showing just how debilitating the condition truly is. And when we think about irritable bowel syndrome, like you said, it's very heterogeneous. There's a number of different types and different causes.

And there's four main actual types of IBS. So we've got constipation predominant IBS. So that's when your stools are really quite hard. We've got a diarrhea predominant IBS. We've got a mixed predominant IBS, where that's kind of your stools can get hard and then soft other times. And then we've got unspecified type of IBS. So it's those four different categories. And often my therapy would, you know, in some way depend on the type of IBS that they have as well as other factors. So, you know, we know that stress is a huge cause or huge trigger, should I say, of IBS. And, you know, 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.

Yeah, I absolutely agree, Megan. And I think the way that we get people better from IBS or certainly improve their symptoms and their quality of life is very much the approach that I take to a lot of chronic conditions, which is a multi-pronged approach. conditions, which is a multi-pronged approach, i.e. maybe there isn't just one causative agent, maybe there are two or three things which in combination are resulting in that patient. I talk about a personal threshold. I feel that we've all got an individual threshold and we can deal with multiple insults up to a certain point. And then if we have enough insults, we cross our threshold and we can exhibit symptoms and problems. And I have found in nearly 17 years now seeing tens of thousands of patients, I found that when I go for this multi-pronged approach, so 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. Yeah, no, I would completely agree. Although sometimes when a patient does come to me and they're in really quite a state, so they're opening their bowels like 10 times a day and they're in so much pain, we really do look for not a cure but something that's going to really work. And what we see is that a diet called a low FODMAP diet.

Have you heard of that before? I was just about to come on to that, so I'm glad you brought that up. So it actually, it's an acronym which stands for fermentable oligosaccharides, disaccharides and polyols, which is a mouthful. And really it is, it's just a group of fermentable types of carbohydrates, which are thought in some people with IBS can kind of, you know, trigger their symptoms. Not core symptoms, but more of trigger them.

Absolutely. And I think we've got some pretty good research showing that from a symptom perspective, a low FODMAP diet can help a lot of people. What's interesting about it for me, and I'd love to hear your thoughts on it, is that I try not to make that suggestion as a long-term thing because a lot of the foods and maybe we can go into those that people would cut out on a low FODMAP diet are actually conversely those foods that actually are very good for our gut health but it's in that moment the state that that person's is in, they can't tolerate those foods at that particular time. I wonder if you could share some of your thoughts on that.

Yeah, no, look, I would completely agree with that. And that the low FODMAP diet, like I said, it's not a cure to your IBS. It's more of giving your gut a little bit of a rest while it heals what's going on. And I think one of the really, really important things, and you've touched on it, is that the low FODMAP diet is not what we would call first-line therapy. First-line therapy, so if a patient was first to come to me, I would actually look at so many other aspects before I would touch on the low FODMAP diet. So I would look at things like, firstly, their eating pattern. Are they just having one big meal a day and putting a lot of pressure on their intestine? Are they having too much caffeine, which can stimulate intestinal motility?

Alcohol, looking at dietary fiber and fluid, as well as things like just chewing, how many times you chew your food. And it's really quite interesting. Most of us only chew each mouthful about five times. So we're actually not helping our body digest it very well. So another recommendation is try and aim for around 20 chews per mouthful next time you're having it. Let me know how you go with that. But I personally find that quite difficult to do. Me too. I have tried that. And like many

people, if I'm in a rush, I suspect three to four, maybe five times is the max. But the odd time that I have tried it when I've been sitting at home with my family and actually think, hey, I'm going to try and chew this. It's amazing. You actually get more flavor from the foods when you actually chew it properly. You do really appreciate it. Absolutely. So that's, like I said, is what we would call first-line dietary therapy. So we'd look at whether those factors can really help. And also, sorry, in there, I'd look at dairy. So lactose intolerance, and lactose is a milk sugar, and often lactose intolerance is quite a prevalent condition, particularly if you've got Asian heritage. So I'd make sure that your symptoms

aren't just related to when you're having milk. So like I said, that's first-line therapy, and the studies have shown works around 50% of people. And it's only when that first-line therapy doesn't work would we move on to the low FODMAP diet. And still in clinical practice, I see a lot of my patients who are quite anxious people, and I think the low FODMAP diet could actually worsen their IBS because it creates so much anxiety around food. So it's definitely not something that should be widely recommended and certainly not a fad diet that I think it has a risk of becoming. I'm so glad to hear you say that because it's something that I see a lot of with my patients. And if they're really trying to go hard on a particular diet, it can cause a lot of anxiety and that stress in itself

can drive problems in their guts because we know the whole body's connected and we know that increased stress levels does change the composition of our gut microbiome, which is that collection of bugs in our guts. And we think about food and clearly food has a huge role to play, but we shouldn't neglect those other things like stress and how damaging they can be in some cases.

So yeah, I would absolutely agree with that. And I think the reality is a low FODMAP diet is pretty tricky to follow. And you probably do need that specialist support to actually help you manage it if you need to do it. Yeah. And also, I think it's important to remember, it's actually only a four to six week, you know, strict reduction in FODMAPs. So what we're doing, it's actually a three phase process. So the first four to six weeks, we'd cut out the FODMAPs and you'd go to lower FODMAPs. So what we were doing, it's actually a three-phase process. So the first four to six weeks, we'd cut out the FODMAPs and you'd go to lower FODMAP foods. And then we'd see how your symptoms are. And if you do respond, then we would systematically reintroduce different groups and

different categories of FODMAPs to look at what your tolerance level is like. And we do that, like I said, systematically over three days, looking at a dose escalation type of regime. And then, sorry, you'd move on to the third phase, which is personalization. So it's certainly not low FODMAP. It might be moderate FODMAP. And you kind of know and adjust according to your tolerance. But that's really important because we know, we've seen in all the studies, that if you're having a low FODMAP diet, you actually do have a negative impact on your gut microbiota.

We reduce things like bifidobacteria that we all know is really quite beneficial to harvest in our gut, as it certainly should not be a long-term diet. Yeah, thanks for that. I think one thing I just want to clarify for people listening is that we talk about these prebiotic foods, and many of you have heard me talk before about things like leeks and onions and garlic and artichokes and how fantastic they are at providing fibre to feed those gut microbes so that they can flourish. Some of my patients with IBS don't do so well with those foods and I just want to make it clear that it's not that those foods are inherently bad,

they are fantastic for your gut, but it may be that at this particular time, they're not agreeing with you. So maybe a period of exclusion with help from someone like Megan can be incredibly useful and give your gut a chance to rest, work on stress management, work on your eating habits, and maybe in a few weeks, your gut will be in a better place to receive some of those foods. Yeah, absolutely. We think that it is really important that you do reintroduce so no one should ever be cutting out these really beneficial foods. And I guess the other thing, the elephant in the room, is that most FODMAPs are actually prebiotics. So essentially, a low FODMAP diet is a low prebiotic diet, which everyone knows, or everyone should know, is not

going to be good for your gut in the long term. it is just giving your i guess your large intestine a bit of a rest um while you you know amend other things in your life and then reintroducing i read one study i can't remember where it was from now that suggested that in this cohort that maybe 78 of those patients who had ibs type symptoms had a condition called SIBO, small intestinal bacterial overgrowth. Now, I wonder whether you have seen that study or whether you can sort of share some insights on that. Yeah, look, so SIBO is a bit of a new concept and we're not quite sure the overlap between SIBO and irritable bowel syndrome. And what we see is with some people who kind of report symptoms of SIBO is that the low

FOMAP diet also gives them a bit of a rest because it's more of the bacteria moving up in their small intestine. So if you're not having these fermentable carbohydrates, then that's kind of not feeding those bacteria. So I think the treatment therapy is fairly similar. I know that a lot of GPs give out quite large doses of antibiotics and repeated antibiotics. Now, you know, it is obviously up to their own discretion, but, you know, there is obviously comes a risk of repeated antibiotic use. And what's interesting though, there has been a study

in people with IBS slash suspected of SIBO. And what they found is that giving a prebiotic along with the antibiotic therapy actually resulted in a decreased risk of relapsing for their gut symptoms with the SIBO. So, you know, I think this is such a new area and there's a lot of potential in there. That's incredible. I didn't know about that, actually, that you can give antibiotics with a prebiotic supplement. Yeah. Yeah, with a prebiotic supplement to help reduce their risk of relapse. Because, you know, for those patients who have suspected SIBO, you know, there's a huge rate of recurrence and relapse. And I wonder, are we getting to the root of the root sometimes? And the other thing I find is that if I'm treating a patient with Irritable Bowel Syndrome,

it's very rare that I don't find stress to be a play in some way. And often the patient isn't aware of it. And, you know, because stress is quite a subjective thing at times. But I always find stress reduction practices useful, no matter how small. Absolutely. And in fact, I'll share another, a bit of a nerd when it comes to studies, but another really, really cool study, which was undertaken in IBS patients. And what they did is they randomised IBS patients to either get in the low FODMAP diet or getting hypnotherapy that was

targeted for people with IBS. And what they found after, I think it was a four-week intervention, is that both groups had significant improvements in their gut symptoms. So around 70% of people responded in both groups. So one therapy only focusing on diet, the other only focusing on your head, both had the same efficacy, which blows my mind to think that. So in my practice, I always do a combination. That's absolutely remarkable and really is aligned with where I'm going with on my health journey in terms of trying to help transform the lives of people is that the body is interconnected and there are actually many ways to actually get the same

results and different people will adopt different approaches and often you can get similar results and it's one thing that I get frustrated with sometimes is the kind of social media wars over you know what is the right way to eat what is the right way to treat this condition because I feel that actually we're learning more about personalization as the days go by we're learning more about the gut we're learning more about personalisation as the days go by. We're learning more about the gut. We're learning more about how the gut affects the brain and how the brain affects the gut. And, you know, you really can't look at these things in isolation. And that's one of the reasons I moved from, you know, being in the specialist world to the generalist world,

because I feel that actually that's where I want to go. And that's why I feel I can help more people by having that overall view of health. So Megan, a lot of people would have heard us talk about this term SIBO, and they're probably wondering what it is. I wonder if you could give an explanation for them about what we think it is. Yeah. So if you think of our digestive tract, it's this big long tube, which is the tube that delivers food from entry all the way? Yeah. So if you think of our digestive tract, it's this big long tube, which is the tube that delivers food from entry all the way to exit. So that's our digestive tract and that's about nine metres long. And we can break that down into four different sections.

So the first is our food pipe and that's in our esophagus. So if we eat an apple, it'll go down there into our stomach. And in our stomach, that's is kind of mush food up and turn it into kind of like an apple puree consistency. And it's in there for about one to two hours, then moves to the third section of our digestive tract, which is called our small intestine. And there is where most nutrients are absorbed. So they get from our gut into our actual blood system to go and feed all our cells. And the fourth component of our digestive tract is known as our large intestine. And our large intestine is what's home to the trillions of microorganisms you spoke about previously. Now, the bulk of those bacteria, yeast, fungi, all those sorts

of microorganisms which make up our gut microbiota actually predominantly live in our large intestine. gut microbiota actually predominantly live in our large intestine. So the bulk of the bacteria actually live in our large intestine. And what we see in SIBO is that there seems to be some of those microbes which actually move up a little bit higher into the small intestine. Now the small intestine's structure is a little bit different and quite sensitive. So if there's more microbes moving up there, then they can actually cause gut sensitivity and lead to symptoms like bloating, a little bit of gut pain. So that's one of the, I guess, the understandings of what SIBO is. So small intestinal bacterial overgrowth. So the bacteria kind of get from our large intestine up into our small intestine. It's these bacteria really in the wrong place.

The gut is designed to work in a certain way, very finely tuned, and these bugs, for a variety of reasons, are thought to migrate up and basically be in the wrong place, so they're going to have a different effect. And I see patients who tend to have bloating very quickly after eating, maybe within 20, 30 minutes sometimes, or are needing to burp and release that gas from their mouth. And often, you know, we hear about that potentially being symptoms that might be consistent with SIBO, but you're right, it is a very new area.

So probably one of the big points on that is where this gas is coming from. Well, these bacteria actually ferment our food, and one of the waste products is gas. So that's where the gas can kind of build up from. And that gas shouldn't be coming out in the small intestine up, it should be coming out in the large intestine where these bugs are meant to do their job. Exactly. I think the other thing I'd like to talk to you about before we go to my final questions is about fibre. So fibre is clearly very important for our health. I think many

listeners will probably have heard before that they need to eat more fibre, but what does that exactly mean? Yeah, so fibre is actually a type of carbohydrate. But what's really interesting about fibre is that human cells can't digest it because we don't produce the enzymes needed to break it down. So it moves from our stomach into our small intestine. And then, like I said, most nutrients are absorbed in our small intestine, but fiber can't be. So it makes its way down into our large intestine where the bacteria then get to eat it. So dietary fiber is actually not food for human cells. It's food for bacterial cells. And with dietary fiber, there's so many different types of dietary fiber.

And, you know, in the general population, we want to be having all different types of dietary fiber, which comes back to the plant-based diet diversity. But in conditions like irritable bowel syndrome, what we see is that probably some types of fibers may be better than others. In fact, my research group is actually looking at that at the minute, looking at different types of fiber and whether they, you know, contribute or improve gut symptoms in people with irritable bowel syndrome. So watch this space about the best types of fibre we should be giving our IBS patients. Well, that sounds super exciting. I'm looking forward to seeing that research when you guys have completed it. Megan, this has been an absolutely fascinating discussion.

So I'm going to move on to the two questions that I ask every guest I talk about four pillars of health that we have control over food movement sleep and relaxation and how they all play a role in how well that we feel I know which pillar I struggle with the most but I'd love to know out of those four do you struggle with any of those pillars and if you do do, which one is it? Absolutely relaxation. I think, particularly with my jobs, doing so many different things, I find it very hard to switch off and relax. I would absolutely agree with that. That's the same one for me. I'm pretty dialed in with food and movement and I do really prioritise my sleep, but I struggle sometimes. And have you got any things that you try and do when you're really on it?

So I guess one of the things I've just recently tried to do is two hours before bed, not to use my phone, to not use social media, which has been a bit of a challenge. And I think that has in some way helped me relax a little bit more, but I guess, you know, that's why I'm struggling with it because I don't have practical tips. Do you have any, or do I have to wait for your book? No, well, look, I'm very happy to share the tips. Look, I talk about something called a no tech 90 in my book, which you're literally illustrating, which is, you know, you do two hours. I try and talk to people about having 90 minutes before bed if they can, where they don't really use electronic media.

And I find it game changing for so many people, such a small, quite difficult intervention these days, but a small one can have a really profound effect. I'm a huge fan of meditation apps. I know there's a slight irony there, given that we're talking about being off our phones, but I often will put my phone in the morning in airplane mode. So I'll wake up, the phone stays in airplane mode and I'll have an app. And often I use the Calm app to just meditate for 10 minutes. And I find I'm much better throughout the day when I do that in the morning. I'm less reactive. I've got more energy. I'm a bit more balanced in my outlook.

Do I do it every day? I wish I could say yes. I struggle with it, you know, probably just as much as you actually. It's probably a good tip, though, for me to start doing that in the morning, whereas I kind of see the evening to relax. But I think starting off the day feeling relaxed is probably more powerful. Yeah, I think it is, actually. I think it's a much more proactive way to start the day. So you've got that little bit of control rather than your emails and your tweets and your Instagram messages. Actually, you're sort of taking control of your mind first thing in the morning. And for me, you know, I'm busy like you, I've sort of got two young kids trying to juggle what I do with work and trying to see my family.

I find incredibly challenging sometimes. So I know for me, if I don't do it first thing in the morning, it doesn't happen. I can persuade myself, I'll find time later. But you know what, doesn't happen. I can persuade myself, I'll find time later. But you know what? Somehow, like many of my patients, you know, I can't find 10 minutes later on to meditate, whereas I can find half an hour to go on Facebook. So, you know, there is a real clash there. The final question, Megan, I'd love to ask you is, with this podcast, my goal really is to give the listeners some practical information that they can put into practice in their lives immediately if possible, because I think it's those small changes that very quickly can improve people's health. And I wonder if you've got three or four top tips for people that you've learned in your career that you think might help the listeners. Yeah, so I think when it comes to gut health, my top tips would be around having plant-based

diversity. So trying to aim for 20 different types of plant-based foods a week. That's kind of my number one tip. And what we're remembering that each different types of food have different types of special nutrients and phytochemicals and antioxidants, which feed different types of gut bacteria and make them flourish. So diversity is really key in that aspect. With my IBS patients, I think one of the big ones is to 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. And it's really simple. You just get a blood test for celiac disease and they get a bit of a stool test for inflammatory bowel disease and they rule them out. And that's really important. Then the next thing I think is getting individualized advice, because like we've heard, there's so many different therapies out there and each different therapy could actually be beneficial for, you know, different types of symptoms. So going to see an expert who, you know, knows probably the best therapies, which are more likely to work for you other than trying the thousands out there. So definitely getting individualized advice. 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. Mika, thank you for sharing that. I think that's going to help a lot of people. In particular, the one that strikes out for me is that try to chew your food 20 times per mouthful. I think that's something I find incredibly challenging and I'd love to know how people get on with that tip.

Megan, I find your work incredibly fascinating and where can listeners sort of keep up to date with what you're doing? Yeah, so I'm across social media at The Gut Health Doctor. Bit of a cheesy name, but I think it's one easy to remember. So if you want updates on all things gut health, that's where you can find me, at The Gut Health Doctor. Megan, I can't thank you enough for making some time to actually come and have this conversation

with me today. I think a lot of our listeners are going to find it incredibly useful, and I hope we get the opportunity to do it again in the future. Absolutely. Thank you so much for having me. Like you know, I'm a huge fan of everything you're doing, so I'm so excited for this book to really have an impact. Thank you, Megan. 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, I'd encourage you to get in touch with me on social media using the hashtag feel better live more you can find me on Facebook and Instagram using the handle at Dr Chatterjee and on Twitter using the handle at Dr Chatterjee UK