The Dr Louise Newson Podcast - 047 - Fermented Foods & Gut Health - Emma Ellice-Flint & Dr Louise Newson

Episode Date: May 12, 2020

In this podcast, Dr Louise Newson talks to Emma Ellice-Flint, a very knowledgeable nutritionist, all about fermented foods. Emma takes it right back to basics and explains the importance of good gut health and how eating and drinking fermented products can be beneficial for our gut microbes as well as our overall health. Emma and Dr Newson also discuss sauerkraut, kefir and the variety of different ways we can boost our gut microbes - as well as the ways our gut health can worsen due to our diets.  Emma's Three Take Home Tips for better gut health: Buy some kefir, try having two tablespoons a day. It's a great place to start! Bring as much fibre-rich food as you can into your diet - but introduce it slowly. Don't be put off by how overwhelming it can seem! Simple, small changes can vastly improve your gut health. https://emmasnutrition.com/  https://www.instagram.com/emmas_nutrition/   

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today, by popular request, I have invited Emma Ellis-Flynn, who is a nutritionist I work closely with. So I've invited her back into my clinic. I'm very grateful because she's often here in the clinic, seeing some of my patients. So today we wanted to talk about fermented food. So welcome, Emma. Yeah, hey, hi, Louise. There's been so much about gut health, about how it can link with hormones, about our mental health there. There's a huge amount of information out there. But often I'm getting messages to say that people are still quite confused. So we thought we would do a meal sort of noddy,

very basic guide, if that's all right, Emma. So before we start talking about fermented foods, What I wanted to do was just talk about our gut because it's a massive organ, isn't it? Yes. And very important. And when I was at medical school, I just was really taught, it started with the mouse, ended with the anus. And we know all about digestion. You know, my children at school know about the main food groups about digestion and what's important to eat and not. But they don't know anything about gut microbes or gut health or how it connects with various other organs like our brain and our body.

So can you just explain a bit more about this amazing organ that we have in our body? Yes, yes, I'm real. Okay, absolutely. And you're right, it starts in the mouth and ends in the anus, definitely. And there's actually beneficial microorganisms throughout, in your mouth, and right the way through, and they're different depending on the environment in the gastrointestinal tract. The main one we hear a lot about is the microorganisms in the large intestine. It's called the large intestine for reason. it's the largest surface area of the digestive system.

It's all kind of around your belly and that sort of area. It's very long, isn't it? If you took it out and stretched it. Right. There's a lot of people saying how far it would stretch. I don't know about that. It's trudges an awful long way. Yeah.

The surface area. Yes, it's absolutely enormous. And living in there is billions of beneficial microorganisms and some microorganisms that are not so beneficial for us. And they live there in this environment, in this soupy gloopy sort of gel-like environment, kind of like a swamp, happily so, in most people, and not so in others.

And this is where the food that we have finished doing the digesting of, the kind of classic things we think of of sugars and proteins and some minerals and vitamins and things like that. And this is where that's sort of leftover food, only it's not at all, but this is where this leftover food goes through. and in this sort of state they call the bolus, but you can imagine it's kind of a little, still a bit mushy often,

and it's sort of churned around and moved through this very, very long tube of the large intestine. But in fact, now we know that there's so much more going on than just moving it through. And it's all about what goes on in that large intestine, especially, and how does it affect our mood and how does it affect our kind of well-being and our inflammation say in our body and just, you know, how happy do we feel?

And this large intestine affects that. Which is so interesting because certainly at medical school I was taught and it's quite right that as the sort of fecal matter passes down, the large intestine, water gets absorbed back into the body and that's the most important part of the large intestine, which, you know, it is important because obviously we don't want to just have diarrhea every day. But actually, you know, all these bugs, I didn't even know there were bugs in it. We just know about if someone's got an infection, if they've got traveller's diarrhoea or they've picked up gastroenteritis. That's bugs that cause disease. But we didn't know that there were

bugs that cause health. Yes. So it's quite weird, isn't it? And we've been brought up, or I've certainly been brought up in an era where we used to give a lot of antibiotics to try and to reduce antibiotic prescribing. And obviously we want to eliminate bad bugs, but we don't want to eliminate the good ones, do we? No, that's it exactly. Well, an antibiotic, although profoundly important when someone is very sick and needs it, it doesn't discriminate necessarily between the good and the bad bacteria and the large intestine. So it reduces them all down. And, you know, there are, I mean there are antibiotics which are more specific to certain strains.

But antibiotic use can generally reduce down both the variety and the numbers of the bacteria. Which is really important, isn't it? I know in Germany they give probiotics as well as giving antibiotics the doctors do, which is fantastic. Whereas over here, I mean, I always recommend them, as you know, but there's lots of doctors that wouldn't even know what probiotic is. So how can we improve our gut health? Because we can always improve it, can't we? Even when we think we've got the best diet in the world, there's always ways. But sadly, there's, like you say, antibiotics can change the gut flora, but also some food can as well.

So talk us through the good ways of improving our gut health. And then we'll maybe talk about what we're doing wrong as well to ruin our gut health. That's okay. So those gut microbiota, they feed on generally, the ones we're trying to promote, feed on plant food. Right. And then plant-based food is vegetables and fruits and nuts and seeds and grains and legumes and pulses. That's all the plants kingdom that we eat. Lots of colour.

Lots of colour, but not just colour because we are talking about whole grains and we're talking about legumes and pulses and nuts and seeds. But it's all the... kind of the wholeness of it or it's that plant kingdom. So yes, when we've talked about lots of colour being beneficial and it is massively beneficial to us, we're talking about really a person trying to have a big variety in their diet of plant foods. So variety is really important. Variety. And by talking about the colour, it kind of pushes people, you know, have lots of colour on your plate. Well, that means have lots of variety of plant foods on your plate. And what about organic food? Is that better for our gut health if we try and have organic vegetables or does that

Okay, so this is the icing on the cake. This is the tweaking if you want more perfection. Yes, organic food is better than non-organic because those pesticides, for instance, that linger on, more so on the non-organic foods. They also disturb that lovely balance of the gut microbiota in our large intestine and can upset them. And also you can imagine things like fungicides that linger on plant food

have a fungocidal effect in our large intestine. Now this is at a very small level. It's also very price dependent. If someone can't afford necessarily to buy organics, well, they're still doing themselves an enormous amount of good. Really? Eating lots of plant food. Washing it.

Yeah, washing it before. But if you can afford it, try and step it up a bit and wherever you can buy organics. I mean, I mainly eat organic food, but I try and eat in season. And that's often good as well, isn't it? Yes. So seasonal food is just generally higher in the beneficial vitamins like vitamin C, but also higher in the phytonutrients. The phytonutrients are these chemicals in all plant food. And there's all different beneficial chemicals, phyter nutrients, in plant food.

And many of those phytonutrients are beneficial for us, human beings, in our body, but also beneficial for the microbiota. They also love it. For instance, you take dark berries. like blueberries or black currents. And the microbiota love that dark colour. That dark colour is a phytonutrient. And they love it. They thrive from it just as much as we do as our human body.

And so that's also beneficial because there's more phyton nutrients as well as vitamins in seasonally fresh food. Right. That's partly why. So that's really key, isn't it? Yeah. I mean, obviously it's not always possible. No. But if we can, then that's definitely a good thing, isn't it?

Yeah. But just talking about those, say, dark berries, when they become expensive and they're not in season and winter, buying frozen is actually still really good. Yeah, I mean, certainly I bulk freeze everything because that's the way I use my life because I'm so busy and I often will freeze berries when they're in season and then they're there. But I think there is a bit of stigma, isn't there, about frozen food. But it's fine. It can actually be fresher sometimes than buying in the supermarket and far better than tinned. So if you're having sweet corn, for example, it's far better to have frozen sweet corn than tinned sweet corn is. it?

Yes, as far as I'm aware. Yes, but especially those dark berry colors and things like that don't get destroyed with the freezing effect. So that's great. But going back to the plant food, being food for our beneficial gut microbiota, it's particularly about different types of what they call starches in the food. So starches or fibres or the carbohydrate basically. So we're not talking about sugar here, that simple carbohydrate.

We're talking about more complex carbohydrates. and we're talking about different fibres. So we're not just talking about really branny type fibres necessarily because there are different fibres that beneficially feed the gut microbiota. Different fibres. Some fibres, if you've noticed when you might be cooking up oats, for instance, making porridge. Porridge goes quite gloopy, doesn't it? And that gloopiness is called soluble fibre.

And that makes it sort of a lovely gel gloopiness. And other foods do the same, like cheer seeds and things like that. And our gut microbiota love those just as much as, for instance, going back to those oats. There's the insoluble fibre, which is actually the fibre you still see in, say, in the porridge or in the oats, which is hard for our body to digest, but the gut microbes love that type of fibre. So it loves both types. It's having a combination. Yes, very much.

So there's things called resistant starch as well, which is another form of food for your gut microbiota. and where might that might be found resistant starches in potatoes, which we used to all think was so bad for you because it potentially raised your insulin levels too fast when you ate it and it was kind of thought to perhaps not be so good for us. Well, actually, research is talking about the resistant starch and potatoes being so good for us and our gut microbiota. And if we cook them and cool them and then eat them,

or even cool them and reheat them, you've got plenty of resistant starch and the gut microbes I love those as well. So plant kingdom generally is just wonderful. Really interesting. So let's move on to fermenting. Yes. Fermenting was never really spoken about much decades ago and now there's been a huge amount of fermenting foods

and we can buy stuff and we hear about it, loads of recipe books and I'm still a bit scared and I think a lot of people are, what does it mean, how do you do it? Talks through. What is fermenting? Well, yeah, so fermented foods are foods that have been fermented, allowed to go off, but they go off in such a way that they produce beneficial bacteria.

It's not about having mouldy food in you. No, no, that's right. And through centuries, in fact, humans have found that these types of fermented foods work really well with our gut and people feel better after eating them. And it's very interesting. So traditionally, if you think about preserving milk with yoghurt, yogurt doesn't actually last that long. So actually it's really, it was done because that was a much better way for an adult human to eat and digest dairy.

Because that beneficial bacteria has actually predigested the lactose in the dairy. So that's great. Plus, there's these live bacteria in them like acidophilus and bifidus and stuff, which work beautifully in our gut. And our own host gut bacteria that's already in there. Love the acidophis. It's like a party. So when the yoghurt gets in there and that acidophilus bifthus get in there, the others who are already in the gut say, oh, hey, mate, you know,

and they have a bit of a shin dig together and a bit of a party. And it kind of benefits everybody, including, you know, our feelings of gut health and well-being. I mean, digressing, there are some people who can't tolerate dairy foods, and that's fair enough. There's many other fomented foods. I just pick yogurt because it's so common because of that reason. So fermented foods, let's name. some others so people become familiar with what I'm talking about. Yoga being, I think in this

country anyway, in the UK, one of the most familiar fermented foods people know about. But there's sourcrowt, which is fermented cabbage. And then there's, from more of the Asian countries, there's another fermented cabbage dish called kimchi, often has chili with it. And then there is drinks as well where you've got things like kombucha, which is actually a tea, just simply tea and sugar, fermented with other microorganisms. Actually, I'll come back to that because it's quite a lot of fun that one. If you've ever seen it, and I'll try and describe it on the podcast, people. And alongside the yogurt, we've got something called kaffir,

which brilliantly now is available in most supermarkets in the dairy section. And kaffir are different microorganisms from yogurt, and they're also really beneficial. In fact, kaffir has many more beneficial microorganisms in them than yoghurt. So like, say, 20 beneficial microorganisms, whereas yoghurt has maybe two or three. So when you say yoghurt,

does that mean low-fat, strawberry yogurt that I buy from the supermarket? Which has got a lot of sugar in it. Not usually. Usually that's pasteurised. Yes. No, I'm just talking about natural yoghuget. So this is really important, isn't it?

So full fat usually, anything that's enabled low-fat probably shouldn't be? It depends, yeah, but yes. This is a general role. Yes, absolutely. And there's sort of Greek-style unpasteurised. yoghurt would be best. Yeah so the milk itself of course is pasteurised because that's the legislation in the UK but then when they've made the yoghurt they don't pasteurise it to then kill the

beneficial bacteria. So there it is it's fabulous. A natural unsweetened yogurt absolutely fantastic and then you can go and sweeten it yourself or add your own food or do what you like with it rather than buy it ready sweetened and sugared up and that's a good start. That's a great start Lots of people are probably having fermented food and don't even realise that... They're probably having yoghurt and then they've seen this kaffir on the shelf next to yoga and what the heck's that.

Well, it kind of actually tastes a little bit like yoghurt, and it's a little bit more sour and it's actually even more beneficial for the gut and many more beneficial microorganisms of that. So what is kaffir then? So kaffir is, it looks like this spongy white grain. It's sort of like pudding in it. Yeah, a bit right, yes, absolutely.

Like cooked rice. And it's that cooked, ricy, spongy, sort of grain thing is just a collection of the microorganisms living in their own little kind of house and they when you add milk to it they feed off the lactose in the milk and they digest it which is fabulous because it's their food for them and they're having their own little life going on and they're happy as anything but what they produce is this lovely kind of dairy yogurty type drink all and that is really beneficial you strain away the grains and you eat it or drink it or drink it and it's great the bacteria in that the kaffir bacteria are great working with your gut

and then how do you choose because there's loads now aren't there and actually as you know i make my own and i hate the taste of the ones that you buy from the supermarket but they vary a lot don't they and actually they can be quite pricey if you're having them all the time yes they can so what would you recommend you know if you go you're new to kefu you want to try it and then you go to a supermarket and there's six, eight different choices. Yeah, I'd choose one that's not been flavoured up or sweetened, number one. Preferably if you can afford it, choose one that's organic. Right.

I'd really like that if it was, the dairy was organic. And beyond that, try one and use it gradually. Just when you're starting out, have two heap tablespoons of it each day at whatever point. Because I think to drink it is quite sharp. Yes, so if you're not used to it. Absolutely. If you wanted to use it and a drink, it's best to make up a smoothie with some frozen berries. I mean, I mix the yoghers.

and with granola and fruits so the taste is diluted right from the start anyway. There you go. Yes. I think, but you can't make kefair from bought. No, you need to have the grains or a kefir starter. How do you get the grains? You kindly gave me, but not everyone can. I know, most people give them away.

It's a bit hard at the moment. You want to ask around if anyone has some kefaheer grains or you want to go to a health food store and ask them if they have them or can supply kaffir grains or you go online and you Google it. And one, because I know you're changing your website, but when it's live, will you have any links or suggestions? Absolutely right. I'm going to be suggesting links, most definitely, in the UK,

to people to be able to buy kaffir grains, both dairy and water kaffir grains. That's the water kaffir I bought today. Yes, so you brought this every drink. And the water kaffir grains, they're a little bit more opaque than the dairy kaffir grains, but they're still in this kind of, they look like tiny little jelly pieces.

And you literally ferment them with, water and sugar. And they feed off the sugar and they gradually digest it so it goes away. And you ferment it, it's slower than dairy catheter, but you ferment it, say, for a week. And you've got a faintly sweet drink and then you flavour it up with grated fresh ginger or a few sort of slices of lemon zest. Excellent. Yeah. So that's be good for people that can't tolerate dairy. Yes. And it's fabulous as well. You must say it tastes delicious. It does taste great, doesn't it? Yeah. And so that's another good one. And of course that doesn't have caffeine in it, which kombucha, another fermented, good fermented drink does, that's made with black

tea. And so it therefore has caffeine. And some people can't tolerate the caffeine. As you know, I don't drink any caffeine at all, so I wouldn't have kombucha. But this is great if you don't want a milky product. Yes, it is great. So water, caffeine is good. You've got things like live apple cider vinegar, which has got them, what they call the mother in it, which is the actual live bacteria. And there's some great companies in the UK that produce that. And then you can make a drink with that. A dash of apple cider vinegar with some say fizzy water is a lovely drink. So that's still fermented. Also a fermented drink. Interesting. Okay. Can I make a lot of salad dressings with apple cider vinegar? Perfect. Good. Yeah, that's very good. I think about it being

fermented food. Yeah. I'm fermenting without even realizing that's great. And so going back to sourcrow. Yeah. All sauerkraut is is actually fermented cabbage. It's very simple. Very simple. Cabbage itself has its own microbes naturally on it. All plants have their own natural microcos of living on them. And so what you do is you very finely shred or chop

cabbage, add a little bit of salt in a bowl you squeeze and squeeze and squeeze it and mush it and that sort of thing until you get

kind of liquid leaching out of the cabbage and what you do then is you have flavors in maybe some cumin seeds or some caraway seeds or some juniper berries

anyway that's up to you you pack it into a preserving jar which has been sterilised pack it right down and then pour the liquid over the top tap it a bit, get rid of any air bubbles,

then pop a weight or something on the top of that so that the cabbage stays below the liquid line, pop the lid on and forget about it for four weeks and it just foments away. So it doesn't take that long to make. It always, for me, it seems a bit scary, but I know you've been doing some lovely fermenting workshops here in my menopause clinic, instructor, Pornayvon,

and a lot of fun. Oh, it's great. The photos look great. And men and women have come, which is brilliant. Once you've done that, you just leave it for four weeks or so. Leave it for four weeks. Then it's ready. Open it up. Then have about a tablespoon each day is plenty. It's great. So you don't need much? No, you don't need much. And it helps with digestion actually as well. Having that kind of like almost as a condiment on your plate.

And how long will it last once you've made it? Well, I put it in the fridge once I've made it and it'll last six months. Okay. Yeah. So it's long time, isn't it? And it can be made with different types of cabbage? Yes, red or white cabbage, savoy, there are many other varieties. I can't remember the top of my head. Yes, so it doesn't. matter it's just cabbage preferably organic there's more bloom on those and away you go brilliant and you can buy i mean i have bought some sauerkraut there's a company near here isn't there that make very good so i know where it's from and i keep it in the fridge and i often just have a spoon with my salad and my children hate the smell so often want me to go and sit elsewhere because it is an acquired taste

and i think what we're talking about for people that have never had any of these foods they're not going to suddenly part of the place that was fermented foods because they might have some some of my friends say well then I then I don't suit me because I get tummy pain or feel uncomfortable or bloating so how would you get around that? Yeah well you start slowly most definitely you start slowly so you just pick one a fermented food say keffi I think dairy keffi is one of the best to start by it yes because it's there in the supermarkets and have a couple of tablespoons each day get into it you eat it any way you like and then when to used to that, perhaps you might start introducing him to say some sauerkraut. The live

sourcrow is not just off the supermarket shelf in a jar that unfortunately has had to be pasteurised. The live sauerkraut is in the fridge. So that's great and then start with a tablespoon of that. Just do it slowly. And then what other fermented foods are there? They're all cheese. Like the longer, the older the cheese, the more fermented is. So that's a fermented food. There's that fermented food natto. Natto, yes. You've made me try. Yeah. Fermented soy beans. That's a Japanese fermented soy bean. And that you don't need much of at all. No cup of teaspoons of that. Where do you find that? That's in the freezer section usually of say Japanese shops. Someone like that. You could buy

it online. That's a brilliant one. Some people have found that's quite profound for their gut. Okay. Baries with everybody which fermented food suits their gut the most or they like that. Sometimes it's a bit of trial and error, isn't it? Yes. And it's true to say that sometimes people, when you have fermented food, it makes you feel happier, which seems a bit crazy, doesn't it? And often it's very pleasurable if you have a good meal with friends and company. But actually the whole gut microbes can help our serotonin, our happy hormone in our brain conflicts. Well, this is the thing.

So pulling right back to the beginning of our podcast, we want to bring in foods that feed that good beneficial gut microbiota in our large intestine. And partly we want to do that because they themselves produce the kind of chemical components that make up neurotransmitters, which are things like dopamine and serotonin. And those actually are beneficial in the brain for those feelings of happiness and good mood. She's so important. Yes. We live in a time of doom and gloom and anything that can lift our mood naturally.

It's got to be good, hasn't it? Yeah, absolutely. So before we finish, what about those foods we mentioned a bit at the beginning, going the other way, there's an anti-fermenting food. So what will really flora gut flora? Flora. I know, yeah. We've talked about antibiotics, which is the obvious.

thing. But what else can we do wrongly to affect our gut? So sugar, just, you know, like table sugar, like cane sugar, that really is quite negative to our gut microbiota and it just doesn't help at all and sort of reduces down the numbers down there in that party they're having down there. So that's not just adding sugar to our porridge in the morning. That's actually sugar that's in food and often it's hidden in food. And you know, during our day, exactly, during the day, it'd be surprising how much sugar some people eat without realising it. So it's not just where something might taste sweet. It might be a processed or a takeaway food or something or something's pre-made

savouries or, you know, a lot of my patients say they eat really healthy and they have a whole plethora of vegetables but then they're putting a ready-made sauce on top. Yeah, that's a really high, very high in. Yeah, so it comes in and you have to kind of be a bit aware of it and just take it out. Yeah, sugar's quite detrimental. So is alcohol. Okay. Alcohol has sugar in it.

It's not beneficial to our those gut microbes. We need to moderate alcohol. Yeah. But generally speaking, eight foods that people eat that are just kind of low in fibre or kind of that sort of Western diet. Yeah. So we're a white bread sandwich with very processed cheese with maybe a bit of mayonnaise which has sugar in it. Yeah.

That's seriously not going to feed them. Right. Yeah. But we know, I mean, people do, don't they? We're a very fast nation. want to eat on the go, a lot of people will grab a sandwich and I guess things like Coca-Cola or Fizzy drinks, they've got lots of sugar in and even the zero-sugar or low-sugar drinks often still have sugars in them, don't they? They do and also the, even the artificial sugars,

they actually are also detrimental to our gut microbiota. And I think that's really important because there's a big move to low-sugar, low-calorie drinks and food as well, but they're sweetened, don't they? Yeah. I mean, I mean, I've also. I mean, I've got to, you. I mean, read that because the gut don't know how to process it, the body doesn't know how to process it. Firstly, well, the body converts it to fat, but also it's quite toxic to the body, isn't it? And I'm sure it has such a negative effect on our gut health. Yeah, so talking about the gut health and those bacteria, the bacteria also think what the heck is, and actually it is a negative chemical with those gut bacteria.

So we're talking about those things. Generally, you know, white rice, white flour, that's the thing. But you're going back to, so if someone wants a sandwich for lunch, can buy multi-grained bread. They can have multi-grown bread. They can try and pile as many veggies as possible. And have a handful of seeds or nuts as well. I have a handful of raw nuts like raw almonds with the skin on that skin.

It's profoundly good for the gut microbiota. It's really great. Perhaps have some hummus in that sandwich. Hummus has chickpeas in. Chick-peas are a lagoon. They're great fibre. So it's just making little changes, isn't it? That can really make a huge difference in our health.

So, oh, that's been brilliant. Thank you ever so much. Before we end, could I just have three take-home tips? So for people out there who are listening, who have never done any fermenting, who just want to have a dabble, want to really improve their gut health, what would you suggest? So number one, I'd say start with buy some kaffir, some sugar-free kaffir. And when you get at home, have perhaps two tablespoons each day in any way you like,

mixing it into another drink or mixing it into your breakfast. And just try that and start with the kaffir, because, that's really good. And secondly, I would say bring in as much kind of fiber-rich foods as you can tolerate. Just slowly. Do that. Not all at once. If you have a whole load

of chip-pee, say, all at once, you are going to get bloated. Yeah. And you're going to get sort of maybe even loose boughs and that's something. So just bring it in slowly, but just increase up the fibre. All plant foods. Just increase them in, just gradually bring in just a bit more into your day.

And then I think the third one is, just not to be put off by feeling all quite overwhelming. Little bits really make a big difference. If you're just bringing in, say, some oats every day, cooked or uncooked, then you're doing a profound goodness for your gut. So I think that's really key, is it? Making very small changes. So thinking about what you can cut down rather than stop

and what you can introduce and then just changing that balance is very important. And I know you've got lots of tips on your website and your Instagram's brilliant. It's very inspiring watching. how you do. Very simple things and that's important. It's not to be scared of trying something new. That's exactly right. And start with a little bit and just build it up. That's been brilliant. So thanks ever so much for your time, Emma. I really appreciate it. Thanks for coming. Thanks, Louise. Thanks.

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