Just As Well, The Women's Health Podcast - Nine Simple Habits for Good Gut Health

Episode Date: April 23, 2020

Lockdown life (spending 99% of your time in the house with snacks on tap; tweaked workout schedule; pandemic-induced worry) is causing unprecedented levels of digestive disruption to women right now. But, if you're currently bloated, gassy, or seriously blocked up, we have good news: getting your gut health back on track can actually be pretty simple. Joining host Roisín Dervish-O'Kane to show you how is Dr Megan Rossi AKA the Gut Health Doctor, a registered dietician who investigates nutrition-based therapies in gut health at King's College London. She's also author of the bestselling book Eat Yourself Healthy: An Easy-to-Digest Guide to Health and Happiness From the Inside Out. In this episode, Dr Rossi explains why a well-functioning gut is essential for everything from good mental health to strong immunity, and how you can get yours in a good place - through lockdown, and beyond. Topics:  Why lockdown life can make us bloated and gassy How to create a gut-stimulating morning routine The fundamentals of gut-healthy nutrition Why tweaking diet and lifestyle is better than taking probiotic supplements A constipation-relieving workout switch Follow Dr Megan Rossi on Instagram @theguthealthdoctor Follow Roisín on Instagram @roisin.dervishokane Follow Women's Health on Instagram @womenshealthuk Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

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responsibly. Now streaming on Paramount Plus. It's the epic return of Mayor of Kingstown. Warden? You know who I am? Starring Academy Award nominee Jeremy Rennner. I swear in these walls. Emmy Award winner Eidie Falco. You're an ex-con who ran this place for years.

And now, now you can't do that. And Bafto Award winner Lenny James. You're about to have a plague of outsiders descend on your town. Let me tell you this. It's got to be consequences. Mayor of Kingstown. New season now streaming on Paramount Plus. Hi everyone, you're listening to Going for Goal,

the weekly women's health podcast that's here to help you make good on the health and happiness goals you want to achieve. I'm your host, journalist and women's health senior editor, Roshin Derbyshokane. Our mission right now is to help you stay healthy and sane while staying home. So let us know what you could use our help with. No goal is too big or too small.

So get in touch, and we could dedicate a whole episode to helping you achieve that. Nicole did just that last week, messaging me personally on Instagram to say that she wanted to achieve better gut health and understand more about the role of probiotics. But she's not the only one. My guest today has been inundated with messages and calls from hundreds of women who are experiencing unprecedented digestive disruption during the lockdown. She's Dr. Megan Rossi, aka the gut health doctor, as a research fellow at King's College London,

she investigates nutrition-based therapies in gut health and puts this knowledge into practice as a registered dietitian at the gut health clinic in Harley Street. As an avid healthy home cook, she very much practices what she preaches. And all this insight is crammed into her first book, the bestselling, eat yourself healthy and easy to digest guide to health and happiness from the inside out, which is published by Penguin and out now. Welcome, Megan. Thanks so much for having me. Together, we're going to be spending the next 30 minutes talking all things digestive health and the simple ways that all of you listening can get your gut health back on track. So Megan, gut health, it's ostensibly not the sexiest of topics.

Why is it important for us to be getting ours in a good place right now? Yeah, well, I think the first thing we should definitely do is actually look at what gut health is because although the word is spoken about a lot, you know, what it is exactly is rarely actually communicated fondly enough. So gut health actually relates the functioning of our entire digestive tract. This is this nine-meter-long tube that essentially delivers food from entry all the way to exit. And then if I, I guess, had to summarize why good gut health is just so important, there are really two key things. The first one is that 70% of our immune system actually lays along that nine-meter digestive tract. So studies have shown that if you want things like,

you know, less risk of allergies and sick days, we need to have good gut health. And then the second element, which is really, I guess, what's got the fame to this concept of gut health over the last couple of years, and that is that we contain trillions of microorganisms. Now, I say microorganisms, most of them are actually bacteria. But interestingly enough, we also include things like, you know, viruses and parasites and even fungi like yeast, which actually synergistically worked to look after us. So it's really that community of those trillions of microorganisms that's been linked to the health of, you know, pretty much every other organ in the human body, things like better heart health. even better mental health has been linked to health of our gut health. So it is obviously incredibly

important at the moment. It's pretty foundational then and it sounds like at the moment, women that have been in contact with you are struggling in a few ways with their digestive health and they're getting all these symptoms. Would you mind telling me a bit more about that? Yeah, you know, I think if we think about our gut health, there's many different aspects that we know can impact it. So things like changes in our diet, stress, exercise. and sleep. And at the moment in lockdown, you know, all four of those areas actually could be affected. So I know my clinic, the gut health clinic is in undated at the moment, all our appointments have formed online, but still, they're like, damn, full of people saying that now

they didn't really have any digestive symptoms before, but now they've really ramped up. And when I kind of get down to the personal level, a lot of it comes back to things like, yes, it completely changed their diet, their stresses through the roof. The exercise regime and the timing of it has also changed, which can impact the kind of our pooping cycle, which I'm sure we'll go into. First and then, yeah, exactly. Actually, it's really important that we try and maintain that regular pooping habit because that can then go on and affect other things like, you know, if we get bloated and

things like that. So we've talked there about people are getting constipated, people are bloating, people are farting, And often people have got this, well, I know anecdotally, and I don't know whether this is boredom or whatever, but people have got this constant desire to snack. Yeah, absolutely. And, you know, anyone who's working or who has worked from home before all this will know that, you know, when you're kind of doing a project and the fridge is so close and you're a food lover, it can be tempting to kind of visit it every 30 minutes or so just to procrastinate to some extent.

So absolutely people's dietary, not only what the foods are eating, but also the frequency of them eating can have an impact. Interesting. So it sounds like a lot of this is about the timing. Yeah, look, it is both the timing and the types of foods because as I'm sure you've seen in your own grocery stores, there aren't probably the regular foods we normally eat as kind of prevalent, as well as we're not shopping as frequently. So maybe we're not having as many fresh fruit and veggies because we're only going to jobs once every two weeks. Whereas before, maybe we went every couple of days. And I guess if we think about one of the mechanisms of the timing of eating, because there's a lot of myths around whether snacking is good or bad for your gut health.

And I think it very much comes down to the individual. So we do know that if you are struggling with constipation, we find that a lot of people actually, if they reduce the fruit, frequency of their snacking, that can actually help them with the constipation. And why that is that when we are in the fasted state, after about 90 minutes, there is this big movement that kind of pushes through. It's called the migrating motor complex, a little bit fancy there, MMC, and it pushes kind of all the leftover food through that nine meters. It gives a big shove. Now, if we're not getting into that 90 minutes of fasting because we're frequently snacking,

then that could delay the pushing. And there's a bit of that. And there's a bit of a shock. And there's, Therefore, it can be an issue in people have constipation. However, actually, if you don't have an issue with constipation, snacking might actually be more beneficial for you because you're not putting as much pressure and stress on your gut at any one period in time. So it is very much an individualised approach. And I guess that's one of evolves with my book, Eat Yourself, Healthy, is looking at the individual and finding what strategies work to your individual case, because everyone's gut is different. And you touched on there about movement.

exercise, what do you think are some of the adjustments that maybe people are doing now that they're working out from home and they're not commuting or maybe they've just got this one walk a day? How do you think that could be affecting people, the mechanism of what's going on in with their gut? Yeah, so we do know that exercise independent of diet actually is beneficial for a gut health. And I guess the reason why I highlight the independent nature is because people who exercise also typically have, you know, more different types of plant-based food, which is also good for gut health. But they've actually controlled for the diet and just look that people, you know, independent of that, exercising did have a benefit. Now, we don't know the exact mechanism.

There are many hypotheses out there. We think that perhaps, you know, the physical movement of the gut muscles helps, you know, push the gut muscles through, which then, in turn, changes the gut bacteria. Also, there is another thought that people who exercise, often you're exercising in an outdoors environment and therefore you're actually exposed to different microbes from things like, you know, the grass and the dirt and all that sort of stuff. There's millions of microbes in those sorts of environments. So we think they could be some of the mechanisms. Now, that's kind of looking at how exercise affects the diversity of the different but bacteria. And what we see is diversity of different gut bacteria inside you is kind of

associated with better gut health. But also what I'm noticing in terms of actual but symptoms is that if people are changing their routine too much in the morning, it may actually be exacerbating some of their gut symptoms. An example of this is with, again, constipation because it actually is really common. We don't often like talking about constipation, but it does affect a lot of people. So what we know is if you exercise really intensely, so like you do a hit session in the morning, that can delay your body kind of feeling safe to do a poo. So the why that is is because essentially what helps us poo and why most people actually

poo in the morning is because we've got this movement called another movement, the mass movement. So I spoke about that migrating motor complex, which helps me. moves food through all that nine-meter trapped and kicks in when you're fasting after about 90 minutes. Yeah. The mass movement is the one essentially that's just in the law part of the intestine and really does help us poop. So what we see is when we go to sleep, that mass movement is downregulated.

But when we wake up first in the morning, that mass movement is actually high. So if you're on top of in the morning going straight hard and doing a hit session, that kind of down regulates that mass movement and kind of any proof that was kind of ready to come out kind of sucks back up so to speak. So what I do recommend if people are struggling with constipation, that actually they delay any intense exercise to a bit later in the morning. And actually what we see is helping support that mass movement. So making the most of that mass movement is this kind of gut stimulating morning routine. And it involves things like, We know a little bit of fat, complex carbohydrates, a little bit of caffeine and gentle exercise are four elements which really do kind of increase the mass movement.

So I recommend people starting the day with those four elements, at least for the first, you know, hour or so after waking. And then hopefully I get people, you know, just to sit on the toilet after that morning routine, just literally for five minutes, not straining or anything, but really just helping their body know that this is their habit. but if they want to go to the toilet now, they can. But our pals are very stubborn to some extent. They don't like being cold what to do. So if you sit on the toilet and strain really hard, it will probably be like, no, I'm not doing what you're saying. You have to kind of play its bang.

You know what, if you want to go now, you can. And actually what I find in my clinic is that following this kind of morning routine, after about, you know, two to three weeks, even though people aren't straining, they actually, their body starts to go, okay, they naturally go when they sit on the toilet for that five minutes because it's being trained that this is a safe and comfortable time to go. Do you know what? Something that is coming through so much doing these podcasts basically about how people can stay healthy and sane and feel normal while they're staying at home is the importance of routine. Yeah.

Would you say in general routine is important for good gut health? I think routine, probably the key importance of routine, um, is also with our mental health. And because of this gut-brain connection, we call this our gut-brain access, you know, indirectly through our mental health, that is really going to help with our gut health as well. So I do say that routine, you know,

it just helps people, I think, feel more in control, which is really helping the mental health. And therefore, if they're not stressed in their head as much, it's less likely to be stressful when they're gut. Because the messages going from the brain to the gut are more relaxed. and that's all by this vagus nerve. I think this new understanding of our gut bacteria has really added a new key player to this gut brain axis and that we're starting to see that actually some of the chemicals

of bacteria are produced based on what we eat, particularly like things like dietary fiber, they produce beneficial chemicals, which then affect this gut brain axis and can change things like our mental health. So, yeah, it's such an incredibly exciting area. Totally. And it's, am I correct in thinking that there's been like this spike in interest at the moment, but we are just scratching the surface in terms of what we know. Yeah, no, that's so true. And a good example of that is, you know, they're all up on the market. There are heaps of different kind of gut bacteria tests you can get done. And people often say,

well, should I spend this 300 pounds getting, you know, my bacteria analyzed. And I think it's really important that people appreciate that it's not at the moment. it's really not worth your money. Now, if you have heaps of money, fine, go get it done out of interest, but actually it's not going to come. And if you come to me in clinic, it's not going to change my clinical practice, so to speak. Would you say it's almost more important, rather than naming things and thinking, okay, this does this, it's more about listening to your body and going with what we know how, like what kind of basic fundamental habit? Exactly. That's spot on because we can get all wrapped up.

and how much bacteria or leicilis do you have. But actually, when it comes down to it, it doesn't seem to work that way. And I know one of the listeners who actually, you know, requested a gut health topic asked about probiotics. And I think it speeds in really, really nicely here because probiotics are essentially for those who aren't aware of it, they're the good microbes. So most of the bacteria, but you can also get some probiotics that are types of use. And I think that they've been very much misunderstood.

and as a result, a lot of people are skeptical around probiotics and, you know, with good reason. But the thing we need to start thinking about in terms of probiotics is that each different type of bacteria or yeast actually has different functions, and there's thousands of different types. So I have listed the seven key areas where the science supports a probiotic in my book alongside those probiotic restrictions, like the dose, the duration, and this specific in a way now we're thinking of lockdown life obviously because of the way it's come about as quite a negative thing we've already spoken about how it's pretty disruptive for people's gut health but actually could we make a virtue of the fact that because now most days are playing out

pretty similarly is it actually a pretty good chance to get in touch with your gut and have a bit of a reset when, as you say, improving your gut health isn't just improving your digestive health. It's improving pretty much everything. Yeah. You know, I believe that to all this, the silver lining is that we, not all of us, because obviously, you know, frontline workers and things like that don't, and might be even more stressed. A lot of us actually have that little bit of extra time to, you know, nurture our health. And also, because we're having a disruption of our normal habit, we have the opportunity.

opportunity essentially to create a new healthier habit. So once we go back to our chaotic lives, actually we've got a really strong new habit formed foundation that we can carry on, which will really support our gut health. So yeah, I absolutely think that that is a positive to all of this craziness. Cool. So let's talk tactics then. Where should someone start? So if someone's like all jeed up and now they're like, right, I'm going to improve my mental and my physical health, all in one by sorting out my gut health. Where do they start? So I think it's worth thinking about what area of their gut health is kind of more vulnerable at the moment. And I can link you guys to my 10 question about health assessment. So it goes through the different areas which really do

impact our gut health. So it looks at things like, are you apparently have any gut symptoms? are you really stressed how much sleep are you getting, how diverse is your diet, are you on medications, etc. And what that does is really helps kind of indicate which area you should be focusing on at the moment. Because like I said, diet is clearly a huge, you know, importantly, has a hugely important role to play in terms of our gut health because our gut microbes solely are reliant on what we feed it, but also things like your stress, your exercise and your sleep. So I think it's about personalizing it to what your lifestyle is like at the moment and what area you're more vulnerable to and then really focusing on that. If people are just have no clue and they're in a really bad way with their gut, what I recommend is actually they start a gut diary.

And again, those who have my book will have access to the My Gut diary, which actually gives people, you know, a seven-day plan of recording things like what are they eating? what are their stress levels like? What time are they going to bed? What time are they waking? What are they exercising? Are they having gut symptoms? And really getting, I guess, the data from a more objective viewpoint and printing all that for seven days.

So then people have an understanding of if there's any correlations and, oh, look, on the days where I do that hit session first thing, actually the next day I feel terrible because my guts all over the job. Or actually on the days where I, you know, sleep in, you know, buy an extra two hours. I'm feeling really rotten in that afternoon. So it helps kind of people more objectively pinpoint. But I guess if we want to think about some, you know, very generalized recommendations that I think a lot of people can benefit from, one of the key things we see is people

who have more different types of plant-based foods in their diet actually can have better gut health. Now, the study which I referred to actually showed that people who have 30 different types of plant-based foods in their diet can better gut health than those who only have better gut health and those who only had 10. Now, the thing about these plant-based food, it's not just your fruit and veg. It actually comes from all six plant-based food groups. Things like your whole grains, your nuts, your seeds, your fruit, your veg,

and your legumes, your beans, and your pulses. Now, obviously, at the moment, we don't have access to everything, so people probably think, oh, look, there's no way I can get 30, but actually there's many simple things you can do. So things like, instead of just getting the steam broccoli, get the steam multi-pack if it exists at your jobs. The same with the legumes instead of just getting your chickenies, get your four bean mix, and whatever you're having for breakfast, add a teaspoon of mix seeds on,

and you get four points from each different types of seeds. So those sorts of little switches in your diet, I think, will help people achieve those diverse range of plant-based foods. And I guess the mechanism behind that is that each different type of plant-based food contains different types of fibres and plant chemicals, which essentially feeds different types of gut bacteria. And, you know, like a sporting team, you want a really diverse range of skills on that sporting team.

You don't want just all stellar forwards. You want, you know, the good backs, etc. And the same with have got bacteria. We want a diverse range of all the different types to get those skills up, to have a really strong kind of inner team within us. So we do that by feeding it a diverse range of fibers. When you support Movember, you're not just fundraising.

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And what about, because people can have probiotic and, prebiotic foods, can't they as well? Can you explain a little bit about why those are beneficial and where people can find those properties? Yeah, so the two P-Biotic, so prebiotic, so P-R-E-biotic, essentially is the food that feeds with bacteria. So most of the pre-bikes are actually types of fibres, dietary fibres, which actually come from all six plant-based food groups. So I actually very rarely prescribe a pre-botic supplement because I say if you're having the 30 different types of plant-based foods, you're actually going to be getting enough prebiotics, so enough food to feed the bacteria.

In terms of probiotics, so if we think about the legal term, the probiotics is more around the capsule form because you need to have the specific strain. However, we do get live culture, so live bacteria in a range of different fermented foods. So things like live yogurt, kaffir, kombucha, kimchi, salkat, etc. Now, in terms of fermented foods, I, firstly, I'm very, very pro it. However, with my scientific hat on, it's important to realize the science is very much in its early stages. One of my favorite things is having my overnight fermented oats. And I think most people listening to this will totally be up to see with overnight oats.

You put them in the fridge after you've added like the oats and the milk, etc. But actually with overnight fermented oats, you add the live cultures. So I usually add some of my kaffir to it. Interesting. And then if people aren't making their own kaffir yet, they can, You can often buy that in supermarkets now, can't you? Yeah, absolutely. You can buy it from most of the supermarkets now.

You can buy some. Though I do encourage people just to give it a shot, though, because it's so, so easy. All you do was get the grains, pop it in some milk, leave it out of the fridge for 24 hours, and literally you have your kaffir ready to go. So it's super, super easy. And if you've got kids, it's such a fun science experiment. So you talk about milk. Can people achieve the same results?

plant milks as well as cow milk? Yeah, really good question. So when it comes to dairy kifia, unfortunately not. It has to be a milk from a mammal. So it can be sheets or goats. And the why that is is because the specific yeast and bacteria that make kufia actually eats the milk sugar called lactose and plant-based milks don't contain lactose. So they don't work on it. Just a touch back on probiotics. We were talking about how it's really important to look to kind of be focused on what you want to achieve out of them when supplementing. Would you say then bottom line, so if we're thinking about the process in which people are going to adopt these habits, is that something that you almost work through the others?

So you work through the dietary changes and you work through maybe experimenting with fermented foods and then some of the movement that we're going to touch on in a sec. Would you say that you focus on that and then if you are still struggling, then you investigate probiotics. Yeah, no, absolutely. Because like I said, there's only like the seven areas where I would say there is good clinical evidence that a probiotic will work. So actually in most scenarios, there's much more evidence for changing your lifestyle and your diet rather than having a probiotic.

It's important. And if you're generally healthy, you know, there is no evidence to suggest that a probiotic adding that into your daily practice will have any benefit at all. Interesting. And I know something that is really common within our readership and our listeners as well is IBS. Yeah. And what's the evidence like for just like mild IBS and probiotics?

Yeah. So there is a little bit of evidence for probiotics, specific probiotics and IBS. However, we do see diet and lifestyle. a much greater benefit. So maybe probiotics might improve your symptoms by 15%, but we know that diet and lifestyle will improve your symptoms by 80%. Right. So that's where we start. Yeah. And I would love there to be a special pill where you take it and all of the IVS symptoms are resolved. But sadly, it's just not as simple as that. What are some good principles for movement then? we spoke about not doing hit first thing. But what are some other things? And what if people do

love hit and those intense workouts? When should they kind of fit those into their day? Yeah. So, you know, if people have no gut issues at all, then absolutely doing hit whenever you want to is completely fine because again, we know the exercise is good for our gut. However, if people do have quite a sensitive gut, we do see that hit can actually exacerbate the sensitivity of the gut. And why that is that exercise, particularly extreme high intensity exercise, draws the blood from the stomach to the muscles, which makes sense to help our muscles move and all those sorts of things. But actually, that kind of deprives the butt of a lot of oxygen.

So if we're doing really prolonged sessions, really high intensity, that can aggravate a gut if it's already quite sensitive. Now, if it doesn't affect your gut, then, you know, I don't want people to be like, oh, I can't do hip because of my gut. don't worry about it, but it's just those people who already have an underlying sensitive gut. Again, there has been some clinical trials, particularly in people with sensitive gut,

showing that things like a gut-directed yoga flow can actually have a huge impact on people's gut health. So actually, in my clinic, I do recommend people start their day with a 15-minute back-directed yoga flow. Again, it's only anecdotal evidence because it's just from, you know, the people telling me in clinic that so many people have found that it really helps their diet. stay up, right, to help, you know, have their gut in a very relaxed state before they take on the day. So I think starting with those sorts of dental exercises, you know, can be really helpful for gut.

And so there's often this urge when going after a health goal to want to do everything all at once. How should people be adopting these gut healthy habits? Is it as a wholesale change or is it building up one by one? What would you recommend? It's up to the individual really, but I think it's important people keep in mind that looking after their gut health is a marathon, not a sprint. However, if people find that sprinting at the start really helps build their motivation, then absolutely they can completely, and particularly now where they've got a little bit of extra time, they can completely revamp their diet and their lifestyle to be more supportive of gut health. But if you have kids and you're working and it's all too stressful, then literally just choosing

one five-minute strategy to add to your day to look after your gut health is going to be an amazing feat. So I think remembering we want these strategies to last long term, but whatever the way that works best for you to get there, I think, you know, I'm happy for you to do. But, you know, there's many different motivation techniques. I find that a lot of my clients, if they write, you know, a little note to themselves and keep it on their mirror or, you know, in their bedroom door. And then every morning they'll see that as a reminder.

why they're making these changes, why they're taking that 10 minutes out to do the gut-dropping yoga flow, and actually they want to go and watch Netflix straight away. So just that constant reminder of how it's going to make them feel and drawing on emotions, I think, can help really support the motivation longer term. Megan, thank you. That's been super informative. Nicole, if you're listening, I hope that's helped you understand a little bit more about gut health and also where probiotics fit into the wider picture of looking after your gut health. and with it, as Megan said, your whole health, so your mind and body.

Megan, before you go, what's one thing that you'd like our listeners to take away? One thing is it's quite tricky, but I guess probably the most important principle is the fact that looking after your gut health is more in terms of diet. It's more about what you include rather than what you exclude. So I think we shouldn't have built attached to foods and being like, oh, no, add a trick is bad for my gut. it's more important that if you're having some out of sugars, you're also adding in some plant-based foods that are going to feed the gut bacteria. So include versus exclude, I think, is my key take-home. Fantastic. And I should actually say before we go as well, that there are some gut symptoms that are associated with COVID-19, aren't they?

If someone is experiencing diarrhea or sickness, but then not experiencing any other of the symptoms, what is your recommendation? What should they be doing? That's a really good point. I think you should still, in terms of following the government's guidelines, that the key things are the fever and the persistent cough. But if you are noticing that you have ongoing kind of gut upset and battery and you don't normally have that sort of gut upset, and you have it for, you know, at least a week, then it's worth just having a quick chat to your DP.

And like I said, there's up my husband's a GP, and, you know, they're still all open for teleconferences. So, yeah, have a quick 10-minute chat and just, make sure you don't meet any of the other symptoms. Absolutely. Don't dismiss those symptoms and listen to your body. Right, Dr. Megan Rothby, it's been such a pleasure to have you on the show. Thank you.

Thank you. And cheers to all of you for listening to. If you've enjoyed the show, please share, rate, review and subscribe as it really helps others find us. And if you've got a goal in mind, get in touch on Instagram. Our handles are in the show notes. And together we can help you get there. A reminder before we go that you can order six issues of Women's Health magazine fronted this month by the irrepressibly sunny Alice Living for just £6 straight to your door.

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