The Food Medic - S1 E8 - Gut Health + IBS

Episode Date: July 30, 2018

This week Dr Megan Rossi is on the show to discuss fibre, probiotics, irritable bowel syndrome, and also food intolerance testing. Dr.Megan can be on twitter and instagram @theguthealthdoctor and her website is https://www.drmeganrossi.com/ The link mentioned in the episode: http://usprobioticguide.com/ The Smile trial: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

What's better than a well-marbled ribeye sizzling on the barbecue? A well-marbled ribeye sizzling on the barbecue that was carefully selected by an Instacart shopper and delivered to your door. A well-marbled ribeye you ordered without even leaving the kiddie pool. Whatever groceries your summer calls for, Instacart has you covered. Download the Instacart app and enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart. Grocer $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart, groceries that over-deliver. Hello and welcome to the Food Medic podcast. I'm Dr. Hazel Wallace, founder of the Food Medic.

I'm a qualified doctor, personal trainer, blogger, and best-selling author of the books The Food Medic and The Food Medic for Life. I'm passionate about maximising our health through how we live our lives, including the food that we eat, physical activity and stress management. We will hear from leading experts in their field who will be sharing evidence-based advice on how we can live healthier lives. And we will cut through the confusing information that we find online. I like to think of myself as one of the first of a new generation of doctors. Hello, everyone, and welcome back to the Food Medic podcast. I'm Dr Hazel Wallace and today I have a very good friend of mine and a very clever lady on the podcast. It's Dr Megan Rossi. Megan is a registered dietitian with a PhD in gut health from the Faculty of Medicine and

Biomedical Sciences at the University of Queensland, Australia. She now leads research at King's College London investigating nutrition-based therapies in gut health including pre and probiotics, dietary fibres, the low FODMAP diet and food additives. Megan also leads a gut health clinic on Harley Street, works with food industry and is currently writing an evidence-based guide to your gut health to be published by Penguin Life in 2019, which is very exciting. And I'm also going to throw in there that you have your own snack on the Leon menu, Megan's Sundae. So first of all, welcome to the show. And second of all, before you introduce yourself, tell us what's in this sundae that's good for our gut health. I'm so excited to be collaborating with Leon.

And for me, it's like the first taste of really translating some of my research that I'm doing into the actual food industry so people can actually enjoy tasty food, but also food that does their gut good. So some of the ingredients is the special type of dietary fiber known as inulin, and that's a specific type that feeds our good bacteria. So hopefully we'll be talking more about the good bacteria that lives in all of our guts. And we also have live yoghurt

that contains potentially beneficial microorganisms like the bacteria. And our ancestors have been having that in their diet for thousands of years with benefits. So it's got some granola, some really delicious dark chocolate. And yeah, I think it's quite a treat. Yeah, and it tastes good.

Importantly, number one thing about food is that it tastes good. I was hoping you'd bring some for me, but... Oh my God, I'm so bad. I should have. No, don't worry. So first of all, welcome. It's so nice to have you here. Likewise, I'm so happy you have your own podcast. Yeah, it's exciting. There's so much potential for this. Well, I know you really well, but can you introduce yourself to everyone and

just kind of tell us why you got interested in gut health, really? Yeah, so as you mentioned, I'm from Australia, hence the slightly bogan accent, and I graduated in nutrition dietetics nearly 10 years ago, which is quite scary. And I first started working in a clinical position as a dietitian in a hospital. And my main patients were actually patients with kidney disease. And I got really interested in that. But one thing I noticed is that a lot of my patients were coming to me with gut issues. And I was thinking, you know, they're diseased in their kidneys, yet they're constantly complaining of the gut, like what's going on? I looked at the literature, there really wasn't much in that space at the time. And I thought there has to be something more to this. So the more

patients kept coming, I was like, you know what, I need to do something. And it was about the time where they started to look more into what we know as a gut microbiota. So that's a community of trillions of microorganisms that live inside every one of us, includes bacteria, yeast, parasites, all of them. And they're really beneficial. So they work together. So it's nothing to be scared of. There was some of that literature coming out about our gut microbiota, but nothing really

connecting it with our kidneys. So I got on board my fantastic supervisor, Associate Professor Katrina Campbell, and we undertook a clinical trial looking at whether we could target the gut through dietary modification and whether that could therefore improve patients' kidney disease. So that was a three-year PhD, and it was a successful trial, which was pretty mind-blowing that the fact we could target the gut and therefore have some benefit on the kidney function with the dietary implications. But I think I need to disclose there that it wasn't

curing kidney disease. It was just an added thing, which we're now doing a secondary trial to look at whether we could roll that out and repeat the results. So yeah. Amazing. And now you're working in London. I am indeed. Yeah. So I guess during my PhD, I was very fortunate to work with the Australian Olympic synchronized swimming team and then some quite high profile corporates. And what I noticed in those people is that, you know, they obviously had no issues with their kidneys, but if they were really, really stressed, they also had a lot of gut issues. So again, that came back to maybe it's not just this connection between our gut and our kidneys, but also our gut and our brain. So there was an underlying theme that maybe our gut was really what we should be targeting. And the number one impactor of our gut

health is, of course, our diet. It's just so fascinating. And I know that one of the big areas of your research is fiber. And everyone's talking about fiber now. It's very, very trendy, especially in the world of nutrition. Here in the UK, though, we don't get enough fiber. We get about 18 grams and we should be getting about 30 grams. But I always feel a bit weird using numbers because he's weighing their fiber, none of us. So let's strip it back to basics. What is fiber?

Where can we find it? And how do we know that we're getting enough? Yeah. So fiber is actually it back to basics. What is fiber? Where can we find it? And how do we know that we're getting enough? Yeah. So fiber is actually quite a generic term because there's so many different types of fibers. And a lot of people don't realize is that dietary fiber is actually a type of carbohydrate. But unlike the other types of carbohydrates, fiber is really unique because it's not there to feed the human cells like we do with digestible starches. But the sole purpose of fiber is really to feed our gut microorganisms. So humans can't digest fiber. We don't have the enzymes need to break it apart. So we think a bit

of gut physiology. We have our food pipes, the food when we swallow, it goes down the food pipe into our stomach for a couple of hours. It then makes its way into this long tube called our small intestine, which is a funny name because it's about six or seven meters long. And our small intestine is where most of our carbohydrates, our fats and proteins get absorbed into our actual body. And then the things that don't get absorbed, they make their way into the last part, which is called our large intestine. And the large intestine is where the bulk of the microorganisms live.

So dietary fiber gets malabsorbed in our small intestine and makes its way into the large intestine where microbes like to feast on it. Yeah. And by microbes, you mean the little gut bugs. Yeah, yeah, yeah. Okay. Amazing. The bacteria, the yeast, parasites, all those sorts of things. Okay. So where do we find fiber? So all our plant-based foods contain fiber. And like I said, fiber is a pretty generic term because there's so many different types. So that's one of the really important concepts comes true about why we should have a range of different plant-based foods and not get all our fiber from two types of vegetables, because each veggie has different types and combinations of fiber, which can feed and do different things to our gut microbes.

Yeah. So variety is key there. Yeah, absolutely. Okay. There's a lot of talk about probiotics lately, which are essentially live bacteria, which sounds pretty off-putting for some people because we're kind of conditioned to think bacteria is bad for us, then we shouldn't be ingesting it. Although you can get probiotic supplements and a lot of people are taking them, but should we take them or do we need them? Yeah. So when it comes to probiotic supplements, the evidence suggests that average healthy person certainly does not need a probiotic to have a healthy gut. There are certain scenarios where a probiotic capsule can be beneficial. For example, if you go abroad to a third world country and you get traveler's diarrhea,

we know that taking a specific type of probiotic can actually reduce your risk of getting that traveler's diarrhea or gut infection. Similarly, if you're having a course of antibiotics and your GP said this is really important, you have to do it, it's also recommended taking a probiotic during your antibiotic course to decrease your risk of getting antibiotic-associated diarrhea, something that affects around 30% of people when they take antibiotics. Yeah, it's all over the hospital all the time. So yeah, when it comes to the capsules, there's only a limited number of scenarios

where it's clinically indicated or recommended that people take them. Now, in terms of probiotics found in food, legally we can't actually call the microorganisms or bacteria in food probiotics in the EU. So there's legislation. So we call them live cultures. And you'll notice in all your yogurts it won't say probiotic, it will say live culture.

And the reason for that is there's a lot of strict regulations around the amount of clinical evidence needed it will say live culture. And the reason for that is there's a lot of strict regulations around the amount of clinical evidence needed to actually prove a specific strain of bacteria actually has a benefit. If we look at the anecdotal evidence, that's more of, you know, there's no hardcore clinical trial, but looking at what our ancestors did, they included these fermented foods, which contain live microorganisms, things like specific types of yoghurt, like I mentioned about the Leon yoghurt having live yoghurt. So that contains live microorganisms, things like kefir, which is the fermented milk, kombucha, fermented tea, sauerkraut,

kimchi, those fermented veggies. All of them contain live microorganisms, which our ancestors used for so long and they've always associated them with a health benefit. So I guess I personally think there's a lot of potential there and I always include them every day in my diet. But in terms of that recommendation for curing anything, I wouldn't say that the food at the minute is going to cure your IBS or cure your antibiotic associated diarrhea because we

just don't have the clinical evidence. Yeah. So if people are choosing to supplement with a probiotic in a capsule or a liquid, how do we know which ones work? And also, how do we know which strain to go for? Absolutely. There really is a big gap in our understanding of probiotics. When people go to buy them, it can be so confusing. And for example, lactobacillus, I'm sure you've heard of that, it's in yogurts and often in probiotics. Now there's hundreds of different types of those lactobacillus strains and each strain actually potentially can do different things. So that's why we really do need to make sure that if you are looking

at taking a probiotic for a particular purpose, for example, for something like irritable bowel syndrome, something that affects many, many people, then it's recommended you use the exact probiotic that was used in a clinical trial that's shown benefit. So there's a great website, which I can give you, Hazel, it's usprobioticguide.com. And on there, it's got a list of all of the different probiotic studies, good quality clinical trials. And it lists there the actual probiotic strain that has shown benefit. So it's not just looking at what probiotic strain, but also how long they took the probiotics for.

Some studies suggest for a particular strain, you need to take it for two weeks. Others say you need for three months. And also the dose you need to take it at as well. Because if you need for three months. And also the dose you need to take it at as well. Because if you're taking it at a really low dose, it might not have that benefit that's seen in clinical trials. So if you are taking a probiotic for a particular reason, I definitely recommend visiting that website and making sure you're using the exact probiotics, which that study has used and shown benefit. Otherwise, potentially you could be taking the wrong strain and then wasting your money. Yeah, absolutely. And I can pop that

website into the show notes so people can have a look up after this. So we chatted a little bit about probiotics, but let's talk about prebiotics because I know it's really confusing for a lot of people. So what's the difference? Yeah, so one letter, probiotics versus prebiotics. So P-R-E, biotics, is the food for the good bacteria. So it's mostly certain types of dietary fiber, but also some other things like specific types of antioxidants known as polyphenols. We know that some of them can actually grow specific types of bacteria. Another type of prebiotic, like I said in the Leon yogurt, is the inulin, and that has got the prebiotic status, I would say, because it's been shown in many clinical trials

to specifically increase the growth of bifidobacteria, which is a type of bacteria in our gut that has been associated with many health benefits. Yeah. So, you know, dietary fiber is a very broad term, but within that there's specific types of dietary fibers which have that prebiotic label, I would say. And are there any certain foods that are particularly rich in prebiotics?

Yeah, so there's many foods that contain these prebiotics, things like garlic, onions, legumes, mushrooms, asparagus, so many. But I think people shouldn't necessarily get fixated on just eating these prebiotics. If you're having a wide variety of fruit and veggies and whole grains, legumes, nuts and seeds, you're actually going to be getting quite a lot of prebiotics. Yeah, okay, I think that's a good rule of thumb.

And I'm also seeing a couple of prebiotic supplements coming onto the market, and you can get inulin and things like that in health food stores. Is it necessary to supplement on top of a well-balanced diet? Yeah, certainly not. We have extracted the inulin out of certain foods and that's how we get it and we kind of condense it down. But if you're having those foods in your everyday diet, then you're going to be getting enough of that. And in fact, in some scenarios, for example, irritable bowel syndrome, if you have a whole lot of a supplement of inulin, you can actually exacerbate some gut symptoms. So where possible, we always say food first, don't worry about the supplements. Yeah, absolutely. Now you talked

about irritable bowel syndrome, that kind of brings me on to my next point, or IBS, as a lot of people refer to it. And it's a super common condition. You know, it affects 10 to 20 percent of us. And I think, you know, majority of my patients you'll see like on their past medical history will be written down because at some point in our life, it does affect us. And usually I personally have suffered from it. And like I said, I know a lot of my patients have or do. But just for a bit of background for everyone, it is a functional gut disorder. And functional means there's no physical structural problem, but there's something not quite right with how it functions.

And IBS is characterized by the presence of intermittent abdominal pain. So pain in the stomach that kind of comes and goes and is also associated with diarrhea, constipation or alternating episodes of both. It's important to point out that these symptoms are non-specific and they also overlap with various other conditions such as inflammatory bowel disease and also celiac disease. So it's really important that if you do think that you've got IBS, you go to your doctor to rule out these more sinister problems. So that's IBS in a tiny little nutshell. Megan, you obviously know a lot more than I do about this area. So let's talk a little bit about what causes it and what are the main triggers? Yeah, it's such an interesting area. And I guess the way we're currently viewing irritable bowel syndrome is a disorder of the

gut-brain communication. And all of us have got this constant communication going on between our gut and our brain. That's how things work and how things move. But when you've got irritable bowel syndrome, that communication is not working very well. And it's often overstimulated. So for example, things like eating, stress, caffeine as well overstimulate that connection and therefore you can get extra motility going on. You can get those things like the pain and the cramping and things like that. So there's a number of triggers that we're aware of. And in terms of what actually causes irritable bowel syndrome, there's certainly no single cause that we're aware of at the minute.

But if you get something like food poisoning or traveler's diarrhea, you actually have a fourfold increased risk of developing irritable bowel syndrome in the following year. So we do think there is some sort of issue with the gut bacteria, again, relating to that gut-brain axis. Something's gone wrong there. Other things, for example, if you're subjected to some sort of trauma, whether it's physical or emotional abuse, you're also at an increased risk of getting irritable bowel syndrome. And there's some genetic component as well. Not mean that, you know, if you've got the gene, you're also at increased risk of getting irritable bowel syndrome. And there's some genetic component as well.

Not mean that, you know, if you've got the gene, you're definitely going to get IBS, but you're more susceptible to getting irritable bowel syndrome. Yeah. And, you know, obviously we just said stress is a big component. I think everyone can relate to that when you're really nervous for something, you get like butterflies in your tummy or you've got an exam and you're kind of running back and forth. Yeah, and that's like brain access. Yeah.

And in terms of food, we know that food does not cause IBS, but it can trigger symptoms. What are the kind of foods, the red flag foods that tend to cause problems for patients with IBS? Yeah. So it's a source of foods that can potentially, if we have heaps of it, trigger symptoms in everyone. But remembering what I said about with the IBS, you're kind of hypersensitive to certain things. So things like alcohol, caffeine, having a really high fat meal, having a really large meal, things like chili can also

trigger some symptoms in IBS people. And then having a large load of fermentable fibres, some specific types of fermentable fibres all at once. So if you binge eat on something like cherries, have like a kilo of cherries or something like that, most people will get symptoms. But in IBS, if you have maybe 300 grams of cherries, you're going to get those symptoms. So having large portions of these fermentable fibres can also trigger symptoms. Yeah. But then obviously there's a lot of people who have specific triggers for

them. So what are the treatments for IBS? What's available to people? Yeah. So I guess one of the main pathways for management is diet because we know that not that diet's causing, like you said, but it's actually a trigger. So we look at take out some of those triggers. But there's many other things. For example, mindfulness is actually a really powerful way to help re-jig that gut-brain axis. So we don't necessarily need to focus on diet. But if we are specifically looking at diet, like I said, those key things we would address, like whether it's caffeine, alcohol, large meals, eating when you're really stressed is another one. That we would categorize as first-line dietary management. And a dietitian would take you through that, or any healthcare

professional actually take you through that first-line dietary management. Now, if you don't respond to that, we would then recommend you see a specialist dietitian who's trained in a low FODMAP diet. And that dietitian would then evaluate whether you're appropriate for this special low FODMAP diet, which is actually an acronym, which stands for fermentable oligosaccharides, disaccharides, and polyols, which is a huge mouthful and not something you need to remember. Yeah, don't worry about remembering that. But that diet is very complex. So it's something certainly that you couldn't do alone and it could actually be quite dangerous for your gut bacteria. It's a very short-term diet, so it's something we shouldn't be doing for any more than four to six weeks. But like I said, that should be something

that a dietitian who's trained in the area should be administering, so to speak, because it's certainly not for everyone. It can trigger things like disordered eating in some people if it's given to the wrong types of people. And yeah, there's so many negative consequences if it's not given appropriately with that. So just to recap, like we said, there's no kind of one food that really causes IBS, but there are certain triggers for people. Like Megan said, alcohol, caffeine, really fatty foods or a lot of fiber in one go can trigger symptoms. But the best thing to do is to keep a food diary first and foremost and really take it from there. But there are certain medications that can help. They're not super effective, but they can help relax your gut.

And then, like we said, the next step is the FODMAP diet or the low FODMAP diet. But that's not something that you should really be doing by yourself because it can be quite restricted. And you're cutting out a lot of fiber, which we just spoke about is super healthy for your gut as well. So I guess that's IBS in a nutshell. But in your clinic, you don't just see IBS, you see a range of gut issues. How much does stress have to play in a role of these issues? Yeah, it's huge. It is definitely one of the things I target with most of my patients, whether they've got irritable bowel syndrome, whether they've got other functional gut symptoms

like functional constipation or functional bloating, even things like people with inflammatory bowel disease and if they've got some functional symptoms as well, looking at stress management is also hugely important. And actually, there's been some really cool research which had in irritable bowel syndrome and they compared, they went head to head. So they divided up people, they randomized them to either getting a low FODMAP diet or getting yoga therapy for 12 weeks. And they measured their symptoms at baseline and at the end of that 12-week intervention. So one just looking at diet, one looking at yoga and mindfulness. And what they found is that both had

equal efficacy, so equal effectiveness at helping patients manage their IBS symptoms. So, you know, for me, that's just such a huge and powerful example of why stress management and things like yoga, mindfulness, can be so therapeutic. And diet's not always the answer. No, and that's something that people can do at home. You know, you don't need a doctor prescription to do mindfulness or yoga or whatever relaxes you is going to relax your gut right so I think that's really exciting as well to think it showed equal efficacy as well. Yeah and now it's

evidence-based because we've always known that things like mindfulness and yoga worked but it's nice to have that clinical charge but yes you know we are on track. Yeah and it definitely gets the more the kind of scientific community engaged in something that can often be considered a bit hippy-dippy and woo-woo. Absolutely, yeah. So a lot of people are really big into food intolerance testing now, and there are various methods of doing so. What are your thoughts on this? Yeah, look, this is something, again, I see quite frequently in my clinic, and it's quite

disappointing because a lot of people have spent so much money on these tests. And, you know, there is currently no valid test for a food intolerance other than lactose intolerance. Yeah. So things like gluten intolerance, fructose intolerance, there's no single validated test. The way, the gold standard, so the best way to do it is doing a food diary. So you record for seven days seven days everything that you eat along with your symptoms. And then if there's nothing that overly stands out, you would take it to a dietician or a nutritionist who specializes in tolerances. And they can kind of

put their investigator hat on and identify the different components in different foods. And then what they would do is take that suspected component out of your diet for a couple of weeks, see where the symptoms resolve, and then they would reintroduce it. So it is important to re-challenge because then you know it's definitely that component. Okay, so we have probably overloaded people with a lot of information. And just to summarize, what foods would you encourage people to include in their diet to help support good gut health? Yeah. So generally speaking, I would say maximizing out on your plant-based diversity. So trying to get as many different types of plant-based foods per week. I think I always say aim for about 30 different types is really

important. That sounds like a lot for people. Yeah, look, I guess it depends where you start. But if you think about it, whole grains, so whether you have brown rice, whole grain pasta, quinoa, herbs and spices also count to that 30, nuts, seeds, all of those sorts of things. So if you start to count it up, I guess the average person may have about 12. So it might be over a year you end up getting to your 30. So each week you might increase one or two. So you don't need to go straight away to the 30. It's that slow, gradual increase I think is really quite helpful for gut health. And we keep referring to gut

health and fiber is good for gut health, but we know that supporting good gut health isn't just important for our digestive system. It's important for other systems and organs in our body. Can you talk a little bit about that? The evidence has exploded over the last couple of years showing that, you know, like I mentioned, my PhD is about the gut-kidney axis. But there's also the gut-brain axis. So there's been some really fantastic studies, a SMILE trial, I'm sure you're aware of that one there, where they showed it was in Australia

and they looked at the benefit of a really high-fibre diet. It was a Mediterranean diet but it had 50 grams of fibre per day in the diet and they gave that to people with depression and they compared it to a placebo where they didn't touch their diet. It was a counseling therapy. And what they found that those who had that really high fiber Mediterranean diet actually had a much greater benefit on their mental health than that placebo counseling style. So that was such a powerful study to show the power of food, including through gut, feeding your gut that extra fiber, an example of the gut-brain

axis, but also things like the gut-heart axis is also coming out. So having fiber in your diet and polyphenols and all those sorts of good gut-boosting foods has also been shown to decrease your risk of heart disease. Yeah, and they're linking, there's many hypotheses around the microbiome and like diabetes and also obesity and kind of metabolic diseases. Yeah, absolutely. One of the most well-known mechanisms for that now is that when we eat the fiber, the bacteria break it down into what we know as short-chain fatty acids. Now, these short-chain fatty acids can do so many different things. You may have heard of things like butyrate, acetate, propionate. So they're what we call communication molecules, and they can go all throughout our body. And we know that they can actually get into our brain

and communicate messages to our brain. They can also help talk to our liver and our pancreas and all that sort of thing. So that's the communication molecules which we think in part may have a benefit in diabetes. Finally, can you leave us with three small healthy habits that you do that you think could add to everyone's life? Yeah, so I already touched on one about the plant-based diet diversity. And again, it's something like, you know, if you're going to buy peppers in the supermarket, don't just get the red ones. Buy the variety pack where it's got the red, the yellow and the green because each of them contain different types of polyphenols, slightly different types of fibers even, which all feed different gut bacteria. And what we see is that the more diverse your gut bacteria, the lower your risk of a lot of chronic diseases are.

So that's my number one. Just to add to that, I think that's something I recommend in my book as well. I say have a veg of the week or a fruit of the week. And I think if you have kids, it can be really cool to allow them to choose it so that they're kind of getting involved in it and just, you know, say, right, this week you choose what our veg of the week can be. And it kind of, I think, gets kids a little bit more excited about vegetables. Yeah, absolutely. And also knowing different types. Because, you know, growing up, I was quite fortunate because I grew up a little bit on a farm, so I had a wide range of different fruit and veggies available to me. But the average kid doesn't know, you know, these different types,

like what a squash is and, you know, aubergines. A lot of kids don't know what that is. No, I think a lot of adults don't know what an aubergine is. That is a good point. Apart from the emoji. Which is helpful. A lot of people are becoming more aware of it thanks to the emoji. Which is helpful. A lot of people are becoming more aware of it thanks to the emoji. So, yeah, and the second top tip,

something that I've probably been doing in the past three or so months is doing some sort of mindfulness every day for about 10 minutes. I like to do stretching and yoga first thing when I get up in the morning, but it can be a mindful app. It can be going for a gentle walk and then not listening to music, but just being very mindful, listening to your surroundings and feeling the air on your skin, all that sort of stuff. And then the third thing will be something which I'm struggling to do, but I'm making more of a conscious effort. And that's

when I'm eating, to not have my phone on me and not eat at my computer. So when I'm eating, I need to be really with my food. And I noticed when I do that, I actually chew my food more. So again, that's another great strategy to help people with digestion issues. Yeah, that's so important. What I always say is to people, when you're digesting your food, like a lot of people think, well, that happens in my tummy. Like that's true. But digestion starts in your meds. So like chewing is actually the first step of digestion. So if you're not chewing your food, you're actually not fully digesting your food either or getting all of the nutrients. So I like that one. And I do think it's really hard for a lot of us. But if you just try for like 15,

20 minutes while you sit and have your meal, lock your phone in like a drawer, just put the TV away, the Kindle, whatever it is, and just try and enjoy it. I think now that the weather's getting better, it's almost nicer because you can take your meal outside and just kind of embrace the natural environment as well. So I love them. But before you go, can you tell us where we can find you on social or website, X, Y, and Z?

So I'm at The Gut Health Doctor across Facebook, Instagram, and Twitter. And my website is www.drmeganrossi.com. Amazing. And I briefly mentioned your book at the start. So that's newly announced? Yeah, yeah. No, that's very exciting. It's still kind of not overly official um but you guys can know

because you're friends of hazel all those listeners out there well thank you so much for joining us today that was really fun i'm really informative and i'm sure we've answered a lot of questions for people around gut health and ibs thank you everyone for listening and make sure to subscribe if you haven't already please do leave me a review and rating and I'll see you again next time. Thank you so much for tuning into the Food Medic podcast please do subscribe so that you are the first to hear about any new episodes and if you you are enjoying them, please leave us a five-star rating and a review so that we can reach as many people as possible.

Check out my website, thefoodmedic.co.uk, where you can find tons of recipes and articles. Follow me on social media, Instagram, Twitter, and Facebook at The Food Medic. And my new book, The Food Medic for Life, is out now, which is packed full of loads of recipes, nutritional advice, myth busting and feature pages on topics such as sleep and mindfulness. You can grab both my books on Amazon or in any good bookstore. Thanks for listening and I'll see you next time. Thank you.