00:00:17
Speaker 1: Pushkin.
00:00:24
Speaker 2: This show is not a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes. Please consult your healthcare professional with any medical questions. Also in this show, we use women as shorthand for people with XX chromosomes. We understand sex and gender are more complex and acknowledge the experiences we describe reach beyond that word.
00:00:54
Speaker 3: We hear a.
00:00:54
Speaker 4: Lot these days about our microbiome and the importance of gut health, but I find that far too often the conversations around these topics can feel pretty abstract, leaving people with lots of buzzwords but little actual guidance on how to apply the science to your everyday life. So I wanted to speak with an expert who makes this topic very tangible.
00:01:20
Speaker 1: Meat doctor Megan Rossi.
00:01:22
Speaker 3: It's this nine meter long tube that we've all got cooled up in each and every one of us that essentially delivers food from entry all the way to exit. So that is gut health. That nine meat is of digestive track.
00:01:32
Speaker 4: Rat Doctor Rossi has dedicated her career to the extraordinary complexity of the human gastriinetestinal track. That nine meter tube, as she calls it. Doctor Rossi has become one of the most trusted and recognizable voices in gut health science, and for a really good reason. She is both a researcher and clinician, which means she's advancing the science while also delivering care day to day. Doctor Rossi is a research fellow a King's College in London. She's also the author of two best selling books about gut health and is the founder of the Gut Health. Doctor Rossi's mission is to transform how we understand and treat the gut from the inside out. She's super knowledgeable and brings a ton of actionable advice to the table about what foods our gut will love and what we need to prioritize to protect our gut health long term. Plus, she's tapped into the latest science we're now discovering about the crucial role that our digestive track plays in nearly every aspect of our health. Here's our conversation. The term gut health gets used a lot right now on food labels and in wellness culture. For example, it seems to mean something different depending on who's saying it. When a medical professional, physician, gastroentrologist, nutritionist, dietician uses the phrase gut health, what are they actually referring to?
00:03:08
Speaker 3: That is a brilliant question. Who has the term right? That nine meters is incredibly important for three particular reasons. Obvious one is digestion. Right, So no matter what you put into your body is if you don't have good gut health, go gut lining. The food can't get from that hollow tube into your blood to feed all your organs, right, And that's nothing new. We've known gut health and digestion go hand in hand. The second one is it's seventy percent seven h percent of our immune system lives along that nine meter digestive track, right. So again, people who have better gut health have more resilient immune systems. But it's this third element and certainly what I did my PhD in and I work as a research hollow kings where we investigate those trillions of gut bacteria, right, that's gut microbiome that lives along that nine meter digestive trap. And I think that's why when people say gut health, it means different things, because this new community needs bacteria, right, literally talking to every organ in the body. So for some people in the here gut health. They think, yeah, look it's having a bad impact on my hormones, or maybe it's my mental health, or maybe it's my weight. Because our gut microbes are connected to all of those areas, so.
00:04:12
Speaker 1: Let's talk about that.
00:04:13
Speaker 4: So we grow up thinking that bacteria is something to fight off with antibiotics or even hand sanitizer, but over time we've learned that those trillions of bacteria living in our gut are essential to our survival. So what exactly is the gut microbiome, why do we need it? And how do you know if you have a healthy gut?
00:04:32
Speaker 3: Our gut microbiome. Essentially, it's this community of these trillions of microorganisms. Right. So you mentioned about the bacteria, and they do predominate. But for those who want a little bit more of a deeper level understanding about gut microbiome. Right, we've got a virus component called the virom, We've got a fungal component called the microbiome. So what we're understanding is that all these different niche microorganisms we call the microbes, yes, mostly bacteria, but they all kind of work together, right, and they're doing so much in the human body that historically we thought it was just down to human cells, And I think that's quite humbling to the human ego, where we were like, oh, no, we're totally in control of our mental health and what vitamins and hormones are produced and regulated. But actually we're now like, oh oh, we're missing a piece of the puzzle. These microabes, including the bacteria, are actually doing a lot of that for us. And I think, you know, that really has opened up this whole new world of understanding of how we can enhance our health, reduce chronic conditions via targeting this new kind of found or appreciated organism or community of organisms.
00:05:36
Speaker 4: What does it feel like to have a healthy gut or healthy gut microbiome?
00:05:40
Speaker 3: Yeah? Back, you know, twenty years ago when I was at UNI, we got told very much that it was just about not having gut symptoms. Right, So if you didn't have altered stools, you know, you're pooping regularly, you weren't bloaded so you won't getting refluxed, then obviously that meant you had good gut health, right, But actually, flast forward, you know today's day, we're now appreciating that actually just because you don't have gut symptoms. It doesn't necessarily mean you've got good gut health. So yes, obviously, not having digestive system issues is once that you might have good gut health. But there's other things. If you feel like you've got low mood, or your hormones are all over the place, or maybe you're not sleeping well, or you've got all these different food in tolerances, they can all be different signs that you've got poor gut health. And actually, when I was writing my first book, I came up with this tank question assessments and you get a score from zero to twenty to get a bit of a better idea of where your gut health is at. And then I get people in clinical to make a few changes, you know, eat different plants, all that sort of stuff, and then retest themselves every month. And that is a quantitative measure of your gut health. Because let's be honest, I'm sure you're seeing clinical as well. People want a tangible number, but when it comes to gut health, it's so complex. It's not necessarily, you know, as straightforward as as people would want it to be. Like with kidney disease, you've got a marker of you know, you know what you renal function is, you know, cardiovascular, You've got your cholester all that sort of stuff. With gut health, it's so complex. We don't really have this kind of one medical test at the moment.
00:07:08
Speaker 4: It's kind of like perimenopas. Actually there's not one number that you can look at.
00:07:12
Speaker 1: So interesting.
00:07:13
Speaker 4: Yeah, what do we know about gut health differences between midlife men and midlife women? And are those differences significant enough that women should seek gender specific gut health care.
00:07:27
Speaker 3: Yeah, so we definitely do see some differences. So women tend to have slower colonic transit, which essentially means that food kind of moves slower through their digestive trap, which ultimately the outcome of that is that it feeds different types of got bacteria. Right, So if you've got food in there for longer, they overth meant certain foods. That's also why women tend to struggle with things like constipation more than males. That we look at the statistics, we also know that obviously the hormone element to things where if we're having a lot of esgen being dumped into our gut, which happens after our body uses estrogen, it gets dumped into our gut, and therefore we know that certain bacteria really feed on that estrogen, and therefore that can change the profiling as well. But ultimately, what I would say in terms of, you know, in clinical practice, there's not enough evidence at the moment for me to be like, Okay, women should be having more of you know, chickpeas, but not butter beans, having more strawberries but not raspberries that were not at that level to really identify how different the dietary intervention should be. So to speak, I would say that anyone going through perimenopause, there is some fascinating research coming through. A lot of it is at the observational level, right, so they're just looking at people, for example, who go through menopause earlier than others, and they show that this one I think it was in nine hundred women, showing that women who had willifish on the daily and fresh legumes they didn't go into menopause until for years later compared to those who didn't have those gut loving foods. And then there's other more interventional studies where they've shown that women going through perimenopause if they have things like I think it was like half a cup of soy beans on the daily, they had lower symptom reporting of things like hot flushes. So there's little kind of bits coming through of you know, maybe it's more important for women to eat more plant diversity to feed those microbes because they have a role in regulating estrogen and oily fish again another really important one for our anti influmatry cup bacteria. But whether there's a certain female of a male diet, we're not there yet in terms of research.
00:09:26
Speaker 4: So many women in midlife start noticing digestive issues in their thirties, for example, bloating, changes in bowel habits. We talked about constipation a little bit, food and sensitivities or sensitivities like as you just mentioned, what's actually happening here?
00:09:40
Speaker 1: Why are these symptoms occurring?
00:09:42
Speaker 3: Yeah, I mean there's so many things that play right, and a lot of it comes down to our hormones and the hormone changes that are occurring, so particularly when we're going through perimenopause, but even before that, I think a lot of women will experiencing like period poops. Right, so around your period you get looser stools, and that I think is the perfect sign that these changes in our sex. Hormones around our ovulation, etc. Don't just impact our ovaries, they're also impacting our guns. So we've got estrogen receptors along our gup, which is you know, again changes in the hormones throughout the month can dictate how fast our food moves through and why you might get looser stills in certain parts. And then the other things like crossuglandins hormone like chemicals, they can not only you know, make the urus contracted, we shed our lining, right, they make the gut contract. We see it earlier on. But then I think in perimenopause, you know, certainly clinic are seeing a lot more women coming. Things like with reflux right really are highly reported through that period as well as a bloating and that's because of those receptors in our GI tract, right, the estrogen and progesterone receptors, where the hormones are changing, and therefore that changes how our gut function works, not only with how food moves through the speed of that. And if we are having food move through certain parts that got really fast, we get malabsorption, the bacteria over fermented overeat it release excess gas. We can get bloated that way. And then we also know that things like issues are really important, things like our gut lining sensitivity, so scientific we call it visceral hypersensitivity, where again each is having a role in dictating how sensitive our gut lining is. When we talk about you know, gut sensitivities, we see it in things like irrital bowl syndrome. Right where our gut and brain are constantly speaking, there's literally hundreds of millions of nerves that are connecting the two. So what happens is often when the hormones are imbalance, those receptors are kind of you know, firing off other messages, and those millions of you know, one hundred millions of nerves by the enteric nervous system. Scientifically speaking, they're kind of like live wires. So no matter what you eat, if your gut stretches a little bit more or moves in a certain way, that can exacerbate those feelings and that pain perception, and that can trigger things more like you know, uncomfortable bloating feelings like the reflux and how the gut moves. Ultimately, so a lot of it, yeah, essentially is coming down to changes in the hormones and how that impacts our gut physiology.
00:12:08
Speaker 4: So what is the relationship between estrogen and the gut is it more estrogen equals more visceral sensitivity, more reflux, more progesterone. Let's talk about reflux and motility issues. Progesterone good or bad? Estrogen good or bad? Or is it a balance or yeah?
00:12:25
Speaker 3: Is that really boring balance question? Right? Where it is is fine balance because you know, we know that actually estrogen has a positive role in the strength of our gut lining, right, so it actually keeps our gut from being too leaky, so permeable, so to speak. So if you think of that nine meters right, it's quite good at only allowing things like good nutrients from your gut into your blood system. Right, But actually there's various things we know like if it's really stressed or too much alcohol makes that gut lining a little bit more permeable, so things can get across that creates low grade inflammation. So estrogen's thought to have a role in kind of protecting that gut lining and making it not too permeable to leaky. And therefore, you know, we see that some people going through perimenopause might actually start to have more of a permeable, leaky gut where you know that decline in the esogen is occurring. But then other people we see where they've got really high estrin levels. And obviously there's complexities because they're not just one type of easture and there's three remain types, so they're all kind of in balance, they're all changing and they're all doing different things. And I would say there is still so much we don't understand, you know, because it's a new area. But also, let's face it, women's research has been certainly underfunded in the past. It's a really exciting time to understand more. But it's certainly not as clear cut to say if your eastern levels are high, your gut will be more permeable, or you'll have less gut issues. There's a lot to unpack.
00:13:47
Speaker 4: Let's talk about progesterone in the gut. How does progesterone impact the female gut.
00:13:52
Speaker 3: It's quite similar in terms of that synergistic effect with esrogen, so we haven't necessarily isolated because they you know, typically changed together. What exactly esogen versus progesterone is doing separately, But again we know that progesterone has a role in regulating things like our gut movements and how it's changing from day to day, as well as impacting I've got microbiome and how you know progesterone is feeding certain types of microabes. What again that means in clinical practice, it's still like we don't quite know, but it is having effect.
00:14:26
Speaker 1: So I'm going to ask you a question.
00:14:27
Speaker 4: When I put somebody on estrogen for perimenopause and menopause and progesterone, a very common complaint is bloating.
00:14:35
Speaker 1: What are we seeing there?
00:14:36
Speaker 4: Why are people complaining and bloating when they first start on hormone support?
00:14:40
Speaker 3: Yeah, again, it's that imbalance or that change in the hormone. So in terms of the mechanisms of bloating, right, So, there's you know, like over twenty different common triggers of bloating. For some people it could be the lactos. Other people that could be things like the high fat foods. Other people it's things like you know, tight pants that trigger bloating. There's so many different lifestyle factors, right, but it comes down to, I guess three key mechanisms of what's typically happening, right, so one of the mechanisms is that you are malabsorbing nutrients high up that nine meters right. So something is being malabsorbed, whether you don't have the enzymes with lactosein tolerance, or the gut movement is having too fast and therefore your gut doesn't have time to absorb that nutrition. But essentially what's happening there when you malabsorb things, it gets dumped into that last one point five meters of that nine meter gut right where most of our gut microbime live. And when they are faced with a whole lot of nutrition that they're not usually subject to, they ferment it. And you know, so often, like when it's dietary five, they produce beneficial chemicals, right, So it's good chort chain fatty acids help and strengthen our gut linings a mental health, et cetera. But one of the waste products bacteria produce is gas, right, So if you have a lot of food dumping into your gut, you're going to get excess gas being produced, and therefore that's one of the triggers of floating, right, So that's one reason. Another reason is your gut microbiome can be changing, right, So we know that estrogen feeds a certain group of gut bacteria called the estrabolome that turns the inactiveatrogen into of esogen, and that not only kind of nourishes them a little bit, but that allows that issue you can get from your gut into your blood system, so that has a role in actually helping recirculate and increasing is driden levels as well, so that it can change the types of bacteria in our gut, and we know that certain types of bacteria actually can help eat that excess gas. So for some people, if they have a change in their gut microbiome, it can be more towards kind of diffusing or getting rid of some of that gas, and other types of microbiomes can be more of not diffusing that gas, and therefore it gets more trapped in your gut. And then the third element is around kind of that stressing of the gut lining, where we know that if you have a really stressed gut, instead of that gas getting from your gut into your blood and then actually we breathe a lot of our gas out that bacteria produce that's how breath tests work. It gets trapped in the gut because the gut is too stress to allow that gas to effectively diffuse, so it's getting trapped in the gut and that then creates those sensations of bloating. So I know a lot of science happed in there, but those three mechanisms that you're getting dumping of nutrients into your gutnets creating more foods, producing more gas. One is that your bacteria aren't eating as much gas as they should, and the third one is more gas is getting trapped in the garp.
00:17:28
Speaker 4: So let's talk about the role of the estrobolome in hormonally based symptoms such as PMS, PMDD women who are navigating any type of hormonal transition in perimenopause. How does the astrobolome impact those hormonal actions.
00:17:46
Speaker 3: So a very good question, and you know, I'll highlight that we don't have a whole lot of research. I mean, this whole name of the estruble owner is only relatively new and understanding that different bacteria are recycling esogen. So you know a lot of people you know will come in and be like, oh, I need to activate my estroubolone because I need to like recycle my esogen and we're like, yeah, well, we do quite know exactly what's going on other than that mechanism of bacteria have the enzymatic capacity to turn that inactive estrogen back to active estrogen. And then we've got those clinical trials where it shows that women who eat more plant based foods and have more gut loving foods, and we know that, you know, the key group of nutrients our bacteria love is fiber, rather close to one hundred different types of fiber, and they feed the different microbes. So what we see in these studies is that women who have more fiber in their diet from that diverse range of plants seem to have less of those types symptoms like the hot flushes and night sweat and those sorts of symptoms. So that's kind of ultimately as much as we know in this point in time. I am really excited about the research, you know, starting to look at, okay, well, which specific types of bacteria do we need to activate and therefore feed to make sure they're helping regulate that more. And then you know a lot of you know, people who've got cut issues, we've got too much estrogen and they're still having these gut issues and bloating, So it's not as clear cut, unfortunately as we would like.
00:19:19
Speaker 4: Still to come questions about small intestinal bacterial overgrowth also known as CEBO, one of the more underdiagnosed conditions in digestive medicine. Plus, we'll explore the growing body of science connecting your gut to your mental health, skin performance, immunity, and more. Back in a minute. You're the founder of a gut health clinic which is based in the UK. What are some of the reasons why people come to your clinic and what are the more common issues or concerns that women have that approach you for care.
00:20:06
Speaker 3: Historically, when I first started, it was very much just digestive issues, right, so people with IBS or bloating, you know, they were just coming to me and being like, fix my gut, my physician, my GPS said go away, it's just IBS. There's nothing organically wrong with you. There's no celiac disease, you know, don't have coll and kains, all that sort of stuff. So it was really setting up a space for those women to help with the dietary management of that, because we know that relief can occur through different dietary strategies For that, But what I would say, as the science has really evolved over the last couple of years, there's actually a lot more research coming out around things like you know, mental health, hormone regulation, and even different autoimmune conditions such as you know, inflammatory bound disease were actually dietary interventions can have quite a significant impact. More people are coming without gut issues. They'd be like, no, my bows are opening regularly, not getting bloated, but actually my mood is really low. And historically, you know, as a dietitian, I was very much you know, told we should not touch anyone with diagnosed depression. But there was amazing study I won't go into the details of, but any nerves out there like myself check out the Smiles trial. And that was the first time I had real strong confidence as a clinician to be like, you know what, Yes, you are struggling with your mental health and often medications are needed, but as an adjunct therapy, diet can have a clinically meaningful impact in how people are feeling, and certainly in these clinical trials, has reduced their depression to a level where they would no longer be clinically depressed. Right, So there's some pretty impressive clinical data out there.
00:21:39
Speaker 4: I just want to touch on SIBO for one brief moment. Do women at perimenopause and menopause have more sebow.
00:21:46
Speaker 3: It is a good question, I mean, SIBOW is this whole other can of worms? Right? We obviously know small intestinal bacterial overgrowth is a very real thing. I remember we spoke about that nine meter long digestive tract, and there's four main parts of that. You've got your sophagus, your food pipe, You've got your stomach. Then you've got this thing called the small intestine, which is not small. It's literally six meters in length. And in the small intestine is where most of your food gets from your gut into your blood system. Right, and then we have that final part called the large intestine. And what happens is with small intestinal bacterial overgrowth, often because your gut movement isn't as effective or you've had gut surgery, those microbes that are normally in the bacteria that are normally in that large intestine where they do all these cool things, eat the fiber, produce gas, They sneakily start to crawl up a little bit high into your small intestine. Now, Unlike your large intestine, which can handle the gas being produced, you know, the acids being produced when the bacteria eat fiber and beneficial things. The small intestine is much more sensitive and therefore the bacteria of crawled up and aren't being pushed back down to where they should live. That can create more gut issues and gut sensity, so people might experience more lucive stools, a lot of pain in their gut, bloating, et cetera. So a lot of the symptoms very much overlap with IBS. But when we look through the studies, I think it often gets confused with irrital bowl syndrome, and the diagnostic profiling of breath test isn't as clear cut. It's not like I'll send someone for a breath test and it's like, yes, you definitely have CIBO, you definitely don't. It needs to align with symptoms there, and I think overall it's probably has been over diagnosed. Of course, we know that if you're on PPIs or you've had gut surgery, yes you're a higher risk of ciboat, but I would say that it's probably not the true definition if we actually looked at the smaller test and then took a sample of cebo. It's probably not as common as people have been led to believe. It's probably more a case they've got my BS. It's interesting some people who you've struggled with IBS or their life goes through perimenopause and they're like, oh my god, actually all the other symptoms are recurring, but my IBS is cleared up. I'm not getting any stomach pain anymore. But yes I'm getting hot flushes and you know, brain fog and all the rest of it, whereas other people it starts to trigger that. And I think it comes down to that level of there is clearly a role of the gut brain access occurring. When it comes to whether it is IBS or these gut lining sensitivities, we're still trying to under downd what exactly is is the cause. I wouldn't say it's significantly higher in terms of prevalence of CEBO or IBS and perimenopause. It's very individualized.
00:24:21
Speaker 4: I like to refer to this as like this the gut everything access. Right, we know about the gut brain axis, the gut cardiac axis, the gut muscle axis. Can you explain just the different organ systems for our listeners that the gut does impact. You talked about mental health a little bit, but what are those organ systems that the gut impacts And I'm going to say it's probably everything it is.
00:24:43
Speaker 3: And you know, look, we look at the mechanisms, right, So there's this gut metabolism access, So we know that our gout microbes play a really important role in stimulating our body's own production of the GOPI one hormone. Right, So the target almond for a zambig and weight loss drugs. So certainly we see people with better gut health also have lower body weights or more healthier body weights because of that axis there where they're feeding the gut microbiomes and microbes are you know, helping switch on GPI one hormone, and that's helping with appetite regulation. So that's the gut metabolism app says. We've obviously got a gut skin access where we don't just have these bacteria living in the gut, right, We've got billions on our skin, which acts as this second skin, and we see a lot of correlations where the gut microabe seem to be talking to the skin and vice versa, so things like you know zorias is an exma. There is a lot more research coming to the forefront around whether it's how we can prevent it by targeting the gut. I would say treatment so far are not overly impressive in terms of targeting the gut to treat exma and eroisata as well and zoriasis, but prevention there is a little bit more, and it's interesting in terms of when women are pregnant having specific types of bacteria. This one called lectozyls Ramness neat to know one is a really cool space where it's reduced at risk bubbs of XMA byry like fifty percent and one of the clinical trials, so really cool research going around the gut skin axis, despite obviously me dedicating my career to gut hull and I think it's important because there's so many connections. But still I don't want people to be misled and think that all of their solutions lay in the gut because a lot of the research is very observational at this time. It's kind of like we don't know what came versus the chicken or the egg sort of scenario.
00:26:22
Speaker 1: Let's talk a little bit about the gut and the immune system.
00:26:24
Speaker 4: What is the link between the gut and the immune system and autoimmune disease, especially for women.
00:26:29
Speaker 3: And it's striking how much higher the rates of autoimmune conditions are in women, right, which highlights that our hormones are having a really big role in our immune regulation and how they are essentially upregulating in women. Obviously with the automune conditions, how overprotective the immune system is, right, So that's what the automune conditions are, where the body's immune system is too protective of the body and start to kind of attack itself where you know, in states where it shouldn't normally. So we know that the bacteria and the gut immune system are living together so that they have this marriage. And I think the really important thing is kind of early doors, not that you can't do anything about it, but I think what we're seeing through the research is like the first you know, thousand days of life is when the microbes are training the immune system. We see it through a lot of the studies where you know, infants who grow up on farms are exposed to more different, diverse ranges of microbes, aren't on antibiotics and PPIs and things like that. They have more diverse ranges of microbes from the get go, and that seems to be able to more effectively train the immune system what it should actually react to so you can protect you, but what it shouldn't react to, you know, things like different allergies and that can you know, the protein and peanuts. The microbe seem to be having that really important role in training that immune system.
00:27:59
Speaker 4: Coming up, doctor Rassi breaks down the specific foods, lifestyle habits, and daily practices that directly shape your microbiome, including some simple changes that could have a big impact.
00:28:28
Speaker 1: Let's get into some action points.
00:28:30
Speaker 4: How can a woman get a healthy microbiome? Is it through foods, probiotics, lifestyle factors, sleep, stress management? How do we impact our microbiome?
00:28:40
Speaker 3: A lot of it will come down to some of the basics that people have heard before, but I think it's important that we now appreciate why things are Eating more plants and eating more fiber is important because essentially the firebar doesn't feed human cells, it feeds that microbiome, right, So if we think of the diet element, obviously that's my errow expertise. I often talk about the super six, so it's just a catchy name to remember. The different categories of plants. And we've got your whole grains, so things like your your buckwheat and your oats and your quinoa. You've got your nuts and your seeds, your herbs and your spices, your free obviously, your veg and your legumes and things like your chickpeas and your butter beans. Now, each different plant category provides your gut bacteria with different types of fiber slash fertilizer. So if we want to feed a really diverse range of got bacteria, which essentially means you've got more skills within you because more different bacteria do all different things, like each train is capable of different functions, then you need to feed it something from the super six most days. And if we look at the average diet, you know, maybe people are hitting you know, three or four of those categories, but they're probably missing out in one of those categories, which means even if they're having loads of vegetables, if they're not having any legumes, they're not feeding the legume loving bacteria and a turn reducing down kind of that functionality. So I think one of the most basic strategies is to think have I had something from the Super six today? So it's a mental note that I get a lot of clients to think, like at three pm, like have I ticked something off? If I haven't tonight, whatever I'm having, even if it's like takeaway Indian, I'm just going to get can of mixed beans if that's a category you've missed and put that in there, or maybe it's the nuts and seeds category and you're like, okay, just you know, goog get a couple of walnuts just to feed the microbiome in there. There's obviously the fermentative food elements are having things like kafir and kimchim. Those sorts of memental foods has been shown and have studied from Sevic University actually to increase your microbiome diversity and also reduce some inflammatory markers in the body. So fermental foods oiling fish. Again with those Amiga threes in their plant diversity, we didn't touch on food additives and actually our team at Kings have just finished a well versed clinical trial looking at emulsifiers in people with inflammatory bout disease, specifically Crone's disease. We did show that those people who went on the lower mulsifier diet than those who had a mulcipi containing diet actually had a significant reduction in their symptoms and disease severity. And it feeds into ultra process foods right like most older process foods. Actually we're seeing have a multipliers in it. I think the mechanisms around that were starting to piece together. So having something from the super six and watching how much of these ultra processed foods were having, which you know, we're starting to look in a lot of these like protein supplements and these drinks that people think are healthy, Actually they're full of a multipliers and may have that negative impact. Stress management. Right, if you are stressed in your head, that strangles your gut through those hundreds of millions of nerves, and that changes the balance. No matter what you feed your gut, it can have a negative impact on that diversity. Sleep again, biodirectional relationship. We know our microbes can impact sleep, but our poor sleep can impact our microbes. Physical activity independent of diet can increase your gut microbial diversity as well. But I would say focus on one thing and I would say it's around the super six that probably is going to give you the biggest bang for your buck.
00:31:56
Speaker 1: So let's talk about fiber.
00:31:57
Speaker 4: Fiber as well as the gut microbioma is having a moment. But I think the recommendation now is twenty five to thirty five grams of fiber every day, Am I correct?
00:32:06
Speaker 3: Yeah? Exactly.
00:32:07
Speaker 4: Fiber supplements, yes or no? Or just get the city of fiber through the super six.
00:32:14
Speaker 3: I would say in a clinical practice, as certain scenarios where like, for example, cilium husk fiber it's a unique type of fiber where there's loads of evidence for things like constipation, then I would recommend that specific fiber supplement. But generally speaking, I don't recommend people take a fiber supplement because it's not going to have that diversity that needs to feed that broad variety.
00:32:34
Speaker 4: We haven't talked about. My favorite topic and which it probably is a great topic for you. Also would imagine is probiotics and live bacterial supplements. So there are tons of probiotics on the market. What is the efficacy of probiotics? What should we be looking for when we look for a probiotic? What should I be recommending as a physician to my patients for probiotics. Are we at a spot now where we can say, Okay, you're concerned about brain health, so we're going to recommend this probiotic for you. Or you're concerned about metabolic health, so we're going to recommend this probiotic for you. Can you impact that for us a little bit?
00:33:07
Speaker 3: I think when we talk about probics, it is so important that we understand that there is literally, you know, thousands of different types of bacteria, and each different bacteria is actually doing different things in the human body. You know, someone comes to see me with iron deficiency, I don't go and say, hey, take a vitamin D supplement. I would say take your iron supplement, right, because that's the one that you need. The same goes to probotics. I think telling anyone to just take a probiotic is absolutely useless. So, for example, we know that the LA fourteen and h and ie strains along with lactofera and clinical trials have shown to reduce recurrent thrush compared to PACEBO. So you know, that's the exact formulation you should be recommending to women who you know are struggling with recurrence of thrush. Similarly, you know, we spoke about the LGGNBB twelve strains where they've shown to reduce the duration and severity of cold and flu. So we need to get very specific, and I would say there's some really fascinating research coming to the forefront highlight that there is some promise there. But actually the exact strains have yet to be really identified. There's only been you know, one study WI look at one strain. There's not been a duplication where at least, you know, two different clinical trials have both shown the exact same formulation. Have this outcome. But to your question, should we all take a probatic? Absolutely not. I think for general gut health, there's never been a clinical trial showing that a probatic will help with your general microbial diversity, right that is where the plant diversity comes in. But for specific need states, you know, college is another one that as a mom with a four month or at the moment, my little girl's taking the BB twelve strain because actually there's these randomized control trials showing that bobbs who have that specific BB twelve strain at one billion dose per day, actually they have nearly a two fold reduction in things like colleague symptoms, and there's international guidelines. Spagan's guidelines actually have that in their recommendations. They say that bubbs with colleague symptoms should have the BB twelve strain. So I think this is a really exciting space where we're learning more about specific strains doing specific things, and we have these clinical and medical guidelines starting to recommend them. But I would say for the vast majority of cases like perimenopause and things like bloating even and mental health, we don't know the formulation yet. So for now, go with diet, and I think in the next couple of years, as a number of clinical trials underway, we'll have more specificity around those different indications.
00:35:43
Speaker 4: Sodium Buterrate is a very buzzy kind of topic right now for gut health. Should anybody be taking sodium butyrate? And also what about calcium D glucrate. That's another supplement that's really recommended a lot too that we see.
00:35:56
Speaker 3: Yeah. Look, I mean what I would say as a scientist and as a clinician, I wait until there has been the two randomized control trials showing with placebo right that taking that specific supplement at that specific dose can lead to a clinical kind of outcome. But again, as a research unfolds, I might change my mind. And if someone wants to trial it, what I typically say, because there's so many do things that mechanistically make sense and could have a benefit, I say, but maybe trial it for four weeks see if you feel any benefit. If you do, then you might want to keep going. Although I would be cautious of the Pacibo effect, right, So Paceibo effect. Essentially, if you think something's doing good for you, that often subconsciously change things a little bit more that gout brain access at play, and actually we see it in our Etechlin controls. The Perceibo effect works around thirty percent of people where you start to feel better if you think you're doing something good. To just be conscious of that.
00:36:51
Speaker 4: Fermented foods such as yogurt, sauer kraut, kambucha, morning afternoon, evening, dinner, throughout the day. When should we eat fermented foods?
00:37:02
Speaker 3: Yeah, it's a good question. I mean, there's not a whole lot of research that suggests that your microbime is more primed to absorbing different fighter chemicals which we can get or bioactive peptiz that we can gat from these fermented foods at certain times of the day. What I would say is there are some interesting research showing that not eating or not having loads of food after like five PM they have a beneficial impact on I got microbiome. But I'd say anything beyond that, we don't really have the research to suggest you should be having it this time. I think it comes down to habit. You know, if you're having it on the daily, do it when you're going to remember to habit and when it's going to fit into your lifestyle. Yeah.
00:37:39
Speaker 4: I love that habits are important. Microbiome test stool test, Is it useful? Are we at a point where we can use them now?
00:37:47
Speaker 3: Yeah? That is a very hot topic. And you know in our clinical trials at Kings we absolutely do these microbiome tests right we are investigating what's happening there. We go a step further to look at the metabolome, so not just what bacteria are there, but what the bacteri are actually producing. In terms of my clinical practice, I think if you've got loads of money and you're just interested sometimes in clinically use it as a motivational tool where someone will baseline get their microbiome tests if we look at the microbial diversity and then do all the general recommendations not actually informed by their microbiome test, and they get them to repeat it and they'll see their diversity intechs improved. Right, And as we mentioned, you know, it comes down to the different strain specificity. Each bacteria is doing a different thing, and most of these microbiome tests aren't even at that strain level. They're looking at the species level, which is essentially a much higher up in kind of the animal kingdom. And we know that even you know, two bacteria within the same species can actually have very different effects. So just talking about bacteria in that species level doesn't tell us the functionality.
00:38:54
Speaker 4: So if you could give one single evidence based recommendation for every woman entering midlife to maintain and improve and have her optimal gut health, what would that be?
00:39:06
Speaker 3: Think of the Super Sex? Have you had something from the Super six today? Add a nuance to that, right, because we know all about this fiber maxing and everyone being obsessed with dumping fiber is like any other muscle you know in your body. You know you're not going to just go run a marathon and expect you know you'll do amazing or you won't be crippled with pain the next day if you don't train your muscles. The same with your gut. If you go from little plants a little fiber to loads, you are going to get altered stools, extra bloating, etc. So you need to train your gut and you've got microbiomes essentially that is small, steady increases in these super six across three or so months will then mean that you're getting the benefit of the fiber without those gut symptoms.
00:39:50
Speaker 4: The pillars of solid gut help start with what's on your plate. Doctor Rassie's Super six recommendation gives us a great framework. Make sure you're regularly incorporating all six. That's all grains, vegetables, fruits, lea, gooms, nuts and seed, and herbs and spices. The target is thirty different plant varieties per week, and every single one counts towards feeding the trillions of microorganisms working inside you around the clock. But good gut health doesn't stop at the dinner table. The gut brain axis runs both ways, meaning chronic anxiety, stress and overwhelm can wreak havoc on your digestive ecosystem. Also, since your microbiome follows a circadian rhythm, sleep is essential to maintaining a healthy gut. Consistently, poor sleep disrupts the delicate microbial balance your body depends on. Move your body regularly and stay well hydrated.
00:40:56
Speaker 1: And remember this.
00:40:58
Speaker 4: Probiotics have their place, but they are never a substitute for a diverse, plant rich diet. And as doctor Rossi explained, even two bacteria within the same species can and have completely opposite effects on your health, making precision absolutely critical when it comes to interpreting your gut health data. Your gut is arguably the most underrated system in your entire body. Take care of it with the same intention you'd give any other aspect of your health. Decoding Women's Health is a production of Pushkin Industries and the Atria Health and Research Institute. This episode was produced by Kalaliah. It was edited by Amy Gaines McQuaid, mastering by Sarah Bugaier. Our associate producer is Sonia Gerwit. Our executive producer is Alexander Garreton. Our theme song was composed by Hannas Brown. Concept and creative development by Shavan O'Connor. Special thanks to Vicki Marrick, Alan Tish, David Saltzman, doctor David Dodick, Sarah Nix, Jacob Goldstein, Leah Rose, Jordan McMillan, Morgan Ratner, Owen Miller, Eric Sandler, and Greta Cohne. I'm doctor Elizabeth Pointer. Thanks for listening and until next time,
Speaker 1: Pushkin.
00:00:24
Speaker 2: This show is not a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes. Please consult your healthcare professional with any medical questions. Also in this show, we use women as shorthand for people with XX chromosomes. We understand sex and gender are more complex and acknowledge the experiences we describe reach beyond that word.
00:00:54
Speaker 3: We hear a.
00:00:54
Speaker 4: Lot these days about our microbiome and the importance of gut health, but I find that far too often the conversations around these topics can feel pretty abstract, leaving people with lots of buzzwords but little actual guidance on how to apply the science to your everyday life. So I wanted to speak with an expert who makes this topic very tangible.
00:01:20
Speaker 1: Meat doctor Megan Rossi.
00:01:22
Speaker 3: It's this nine meter long tube that we've all got cooled up in each and every one of us that essentially delivers food from entry all the way to exit. So that is gut health. That nine meat is of digestive track.
00:01:32
Speaker 4: Rat Doctor Rossi has dedicated her career to the extraordinary complexity of the human gastriinetestinal track. That nine meter tube, as she calls it. Doctor Rossi has become one of the most trusted and recognizable voices in gut health science, and for a really good reason. She is both a researcher and clinician, which means she's advancing the science while also delivering care day to day. Doctor Rossi is a research fellow a King's College in London. She's also the author of two best selling books about gut health and is the founder of the Gut Health. Doctor Rossi's mission is to transform how we understand and treat the gut from the inside out. She's super knowledgeable and brings a ton of actionable advice to the table about what foods our gut will love and what we need to prioritize to protect our gut health long term. Plus, she's tapped into the latest science we're now discovering about the crucial role that our digestive track plays in nearly every aspect of our health. Here's our conversation. The term gut health gets used a lot right now on food labels and in wellness culture. For example, it seems to mean something different depending on who's saying it. When a medical professional, physician, gastroentrologist, nutritionist, dietician uses the phrase gut health, what are they actually referring to?
00:03:08
Speaker 3: That is a brilliant question. Who has the term right? That nine meters is incredibly important for three particular reasons. Obvious one is digestion. Right, So no matter what you put into your body is if you don't have good gut health, go gut lining. The food can't get from that hollow tube into your blood to feed all your organs, right, And that's nothing new. We've known gut health and digestion go hand in hand. The second one is it's seventy percent seven h percent of our immune system lives along that nine meter digestive track, right. So again, people who have better gut health have more resilient immune systems. But it's this third element and certainly what I did my PhD in and I work as a research hollow kings where we investigate those trillions of gut bacteria, right, that's gut microbiome that lives along that nine meter digestive trap. And I think that's why when people say gut health, it means different things, because this new community needs bacteria, right, literally talking to every organ in the body. So for some people in the here gut health. They think, yeah, look it's having a bad impact on my hormones, or maybe it's my mental health, or maybe it's my weight. Because our gut microbes are connected to all of those areas, so.
00:04:12
Speaker 1: Let's talk about that.
00:04:13
Speaker 4: So we grow up thinking that bacteria is something to fight off with antibiotics or even hand sanitizer, but over time we've learned that those trillions of bacteria living in our gut are essential to our survival. So what exactly is the gut microbiome, why do we need it? And how do you know if you have a healthy gut?
00:04:32
Speaker 3: Our gut microbiome. Essentially, it's this community of these trillions of microorganisms. Right. So you mentioned about the bacteria, and they do predominate. But for those who want a little bit more of a deeper level understanding about gut microbiome. Right, we've got a virus component called the virom, We've got a fungal component called the microbiome. So what we're understanding is that all these different niche microorganisms we call the microbes, yes, mostly bacteria, but they all kind of work together, right, and they're doing so much in the human body that historically we thought it was just down to human cells, And I think that's quite humbling to the human ego, where we were like, oh, no, we're totally in control of our mental health and what vitamins and hormones are produced and regulated. But actually we're now like, oh oh, we're missing a piece of the puzzle. These microabes, including the bacteria, are actually doing a lot of that for us. And I think, you know, that really has opened up this whole new world of understanding of how we can enhance our health, reduce chronic conditions via targeting this new kind of found or appreciated organism or community of organisms.
00:05:36
Speaker 4: What does it feel like to have a healthy gut or healthy gut microbiome?
00:05:40
Speaker 3: Yeah? Back, you know, twenty years ago when I was at UNI, we got told very much that it was just about not having gut symptoms. Right, So if you didn't have altered stools, you know, you're pooping regularly, you weren't bloaded so you won't getting refluxed, then obviously that meant you had good gut health, right, But actually, flast forward, you know today's day, we're now appreciating that actually just because you don't have gut symptoms. It doesn't necessarily mean you've got good gut health. So yes, obviously, not having digestive system issues is once that you might have good gut health. But there's other things. If you feel like you've got low mood, or your hormones are all over the place, or maybe you're not sleeping well, or you've got all these different food in tolerances, they can all be different signs that you've got poor gut health. And actually, when I was writing my first book, I came up with this tank question assessments and you get a score from zero to twenty to get a bit of a better idea of where your gut health is at. And then I get people in clinical to make a few changes, you know, eat different plants, all that sort of stuff, and then retest themselves every month. And that is a quantitative measure of your gut health. Because let's be honest, I'm sure you're seeing clinical as well. People want a tangible number, but when it comes to gut health, it's so complex. It's not necessarily, you know, as straightforward as as people would want it to be. Like with kidney disease, you've got a marker of you know, you know what you renal function is, you know, cardiovascular, You've got your cholester all that sort of stuff. With gut health, it's so complex. We don't really have this kind of one medical test at the moment.
00:07:08
Speaker 4: It's kind of like perimenopas. Actually there's not one number that you can look at.
00:07:12
Speaker 1: So interesting.
00:07:13
Speaker 4: Yeah, what do we know about gut health differences between midlife men and midlife women? And are those differences significant enough that women should seek gender specific gut health care.
00:07:27
Speaker 3: Yeah, so we definitely do see some differences. So women tend to have slower colonic transit, which essentially means that food kind of moves slower through their digestive trap, which ultimately the outcome of that is that it feeds different types of got bacteria. Right, So if you've got food in there for longer, they overth meant certain foods. That's also why women tend to struggle with things like constipation more than males. That we look at the statistics, we also know that obviously the hormone element to things where if we're having a lot of esgen being dumped into our gut, which happens after our body uses estrogen, it gets dumped into our gut, and therefore we know that certain bacteria really feed on that estrogen, and therefore that can change the profiling as well. But ultimately, what I would say in terms of, you know, in clinical practice, there's not enough evidence at the moment for me to be like, Okay, women should be having more of you know, chickpeas, but not butter beans, having more strawberries but not raspberries that were not at that level to really identify how different the dietary intervention should be. So to speak, I would say that anyone going through perimenopause, there is some fascinating research coming through. A lot of it is at the observational level, right, so they're just looking at people, for example, who go through menopause earlier than others, and they show that this one I think it was in nine hundred women, showing that women who had willifish on the daily and fresh legumes they didn't go into menopause until for years later compared to those who didn't have those gut loving foods. And then there's other more interventional studies where they've shown that women going through perimenopause if they have things like I think it was like half a cup of soy beans on the daily, they had lower symptom reporting of things like hot flushes. So there's little kind of bits coming through of you know, maybe it's more important for women to eat more plant diversity to feed those microbes because they have a role in regulating estrogen and oily fish again another really important one for our anti influmatry cup bacteria. But whether there's a certain female of a male diet, we're not there yet in terms of research.
00:09:26
Speaker 4: So many women in midlife start noticing digestive issues in their thirties, for example, bloating, changes in bowel habits. We talked about constipation a little bit, food and sensitivities or sensitivities like as you just mentioned, what's actually happening here?
00:09:40
Speaker 1: Why are these symptoms occurring?
00:09:42
Speaker 3: Yeah, I mean there's so many things that play right, and a lot of it comes down to our hormones and the hormone changes that are occurring, so particularly when we're going through perimenopause, but even before that, I think a lot of women will experiencing like period poops. Right, so around your period you get looser stools, and that I think is the perfect sign that these changes in our sex. Hormones around our ovulation, etc. Don't just impact our ovaries, they're also impacting our guns. So we've got estrogen receptors along our gup, which is you know, again changes in the hormones throughout the month can dictate how fast our food moves through and why you might get looser stills in certain parts. And then the other things like crossuglandins hormone like chemicals, they can not only you know, make the urus contracted, we shed our lining, right, they make the gut contract. We see it earlier on. But then I think in perimenopause, you know, certainly clinic are seeing a lot more women coming. Things like with reflux right really are highly reported through that period as well as a bloating and that's because of those receptors in our GI tract, right, the estrogen and progesterone receptors, where the hormones are changing, and therefore that changes how our gut function works, not only with how food moves through the speed of that. And if we are having food move through certain parts that got really fast, we get malabsorption, the bacteria over fermented overeat it release excess gas. We can get bloated that way. And then we also know that things like issues are really important, things like our gut lining sensitivity, so scientific we call it visceral hypersensitivity, where again each is having a role in dictating how sensitive our gut lining is. When we talk about you know, gut sensitivities, we see it in things like irrital bowl syndrome. Right where our gut and brain are constantly speaking, there's literally hundreds of millions of nerves that are connecting the two. So what happens is often when the hormones are imbalance, those receptors are kind of you know, firing off other messages, and those millions of you know, one hundred millions of nerves by the enteric nervous system. Scientifically speaking, they're kind of like live wires. So no matter what you eat, if your gut stretches a little bit more or moves in a certain way, that can exacerbate those feelings and that pain perception, and that can trigger things more like you know, uncomfortable bloating feelings like the reflux and how the gut moves. Ultimately, so a lot of it, yeah, essentially is coming down to changes in the hormones and how that impacts our gut physiology.
00:12:08
Speaker 4: So what is the relationship between estrogen and the gut is it more estrogen equals more visceral sensitivity, more reflux, more progesterone. Let's talk about reflux and motility issues. Progesterone good or bad? Estrogen good or bad? Or is it a balance or yeah?
00:12:25
Speaker 3: Is that really boring balance question? Right? Where it is is fine balance because you know, we know that actually estrogen has a positive role in the strength of our gut lining, right, so it actually keeps our gut from being too leaky, so permeable, so to speak. So if you think of that nine meters right, it's quite good at only allowing things like good nutrients from your gut into your blood system. Right, But actually there's various things we know like if it's really stressed or too much alcohol makes that gut lining a little bit more permeable, so things can get across that creates low grade inflammation. So estrogen's thought to have a role in kind of protecting that gut lining and making it not too permeable to leaky. And therefore, you know, we see that some people going through perimenopause might actually start to have more of a permeable, leaky gut where you know that decline in the esogen is occurring. But then other people we see where they've got really high estrin levels. And obviously there's complexities because they're not just one type of easture and there's three remain types, so they're all kind of in balance, they're all changing and they're all doing different things. And I would say there is still so much we don't understand, you know, because it's a new area. But also, let's face it, women's research has been certainly underfunded in the past. It's a really exciting time to understand more. But it's certainly not as clear cut to say if your eastern levels are high, your gut will be more permeable, or you'll have less gut issues. There's a lot to unpack.
00:13:47
Speaker 4: Let's talk about progesterone in the gut. How does progesterone impact the female gut.
00:13:52
Speaker 3: It's quite similar in terms of that synergistic effect with esrogen, so we haven't necessarily isolated because they you know, typically changed together. What exactly esogen versus progesterone is doing separately, But again we know that progesterone has a role in regulating things like our gut movements and how it's changing from day to day, as well as impacting I've got microbiome and how you know progesterone is feeding certain types of microabes. What again that means in clinical practice, it's still like we don't quite know, but it is having effect.
00:14:26
Speaker 1: So I'm going to ask you a question.
00:14:27
Speaker 4: When I put somebody on estrogen for perimenopause and menopause and progesterone, a very common complaint is bloating.
00:14:35
Speaker 1: What are we seeing there?
00:14:36
Speaker 4: Why are people complaining and bloating when they first start on hormone support?
00:14:40
Speaker 3: Yeah, again, it's that imbalance or that change in the hormone. So in terms of the mechanisms of bloating, right, So, there's you know, like over twenty different common triggers of bloating. For some people it could be the lactos. Other people that could be things like the high fat foods. Other people it's things like you know, tight pants that trigger bloating. There's so many different lifestyle factors, right, but it comes down to, I guess three key mechanisms of what's typically happening, right, so one of the mechanisms is that you are malabsorbing nutrients high up that nine meters right. So something is being malabsorbed, whether you don't have the enzymes with lactosein tolerance, or the gut movement is having too fast and therefore your gut doesn't have time to absorb that nutrition. But essentially what's happening there when you malabsorb things, it gets dumped into that last one point five meters of that nine meter gut right where most of our gut microbime live. And when they are faced with a whole lot of nutrition that they're not usually subject to, they ferment it. And you know, so often, like when it's dietary five, they produce beneficial chemicals, right, So it's good chort chain fatty acids help and strengthen our gut linings a mental health, et cetera. But one of the waste products bacteria produce is gas, right, So if you have a lot of food dumping into your gut, you're going to get excess gas being produced, and therefore that's one of the triggers of floating, right, So that's one reason. Another reason is your gut microbiome can be changing, right, So we know that estrogen feeds a certain group of gut bacteria called the estrabolome that turns the inactiveatrogen into of esogen, and that not only kind of nourishes them a little bit, but that allows that issue you can get from your gut into your blood system, so that has a role in actually helping recirculate and increasing is driden levels as well, so that it can change the types of bacteria in our gut, and we know that certain types of bacteria actually can help eat that excess gas. So for some people, if they have a change in their gut microbiome, it can be more towards kind of diffusing or getting rid of some of that gas, and other types of microbiomes can be more of not diffusing that gas, and therefore it gets more trapped in your gut. And then the third element is around kind of that stressing of the gut lining, where we know that if you have a really stressed gut, instead of that gas getting from your gut into your blood and then actually we breathe a lot of our gas out that bacteria produce that's how breath tests work. It gets trapped in the gut because the gut is too stress to allow that gas to effectively diffuse, so it's getting trapped in the gut and that then creates those sensations of bloating. So I know a lot of science happed in there, but those three mechanisms that you're getting dumping of nutrients into your gutnets creating more foods, producing more gas. One is that your bacteria aren't eating as much gas as they should, and the third one is more gas is getting trapped in the garp.
00:17:28
Speaker 4: So let's talk about the role of the estrobolome in hormonally based symptoms such as PMS, PMDD women who are navigating any type of hormonal transition in perimenopause. How does the astrobolome impact those hormonal actions.
00:17:46
Speaker 3: So a very good question, and you know, I'll highlight that we don't have a whole lot of research. I mean, this whole name of the estruble owner is only relatively new and understanding that different bacteria are recycling esogen. So you know a lot of people you know will come in and be like, oh, I need to activate my estroubolone because I need to like recycle my esogen and we're like, yeah, well, we do quite know exactly what's going on other than that mechanism of bacteria have the enzymatic capacity to turn that inactive estrogen back to active estrogen. And then we've got those clinical trials where it shows that women who eat more plant based foods and have more gut loving foods, and we know that, you know, the key group of nutrients our bacteria love is fiber, rather close to one hundred different types of fiber, and they feed the different microbes. So what we see in these studies is that women who have more fiber in their diet from that diverse range of plants seem to have less of those types symptoms like the hot flushes and night sweat and those sorts of symptoms. So that's kind of ultimately as much as we know in this point in time. I am really excited about the research, you know, starting to look at, okay, well, which specific types of bacteria do we need to activate and therefore feed to make sure they're helping regulate that more. And then you know a lot of you know, people who've got cut issues, we've got too much estrogen and they're still having these gut issues and bloating, So it's not as clear cut, unfortunately as we would like.
00:19:19
Speaker 4: Still to come questions about small intestinal bacterial overgrowth also known as CEBO, one of the more underdiagnosed conditions in digestive medicine. Plus, we'll explore the growing body of science connecting your gut to your mental health, skin performance, immunity, and more. Back in a minute. You're the founder of a gut health clinic which is based in the UK. What are some of the reasons why people come to your clinic and what are the more common issues or concerns that women have that approach you for care.
00:20:06
Speaker 3: Historically, when I first started, it was very much just digestive issues, right, so people with IBS or bloating, you know, they were just coming to me and being like, fix my gut, my physician, my GPS said go away, it's just IBS. There's nothing organically wrong with you. There's no celiac disease, you know, don't have coll and kains, all that sort of stuff. So it was really setting up a space for those women to help with the dietary management of that, because we know that relief can occur through different dietary strategies For that, But what I would say, as the science has really evolved over the last couple of years, there's actually a lot more research coming out around things like you know, mental health, hormone regulation, and even different autoimmune conditions such as you know, inflammatory bound disease were actually dietary interventions can have quite a significant impact. More people are coming without gut issues. They'd be like, no, my bows are opening regularly, not getting bloated, but actually my mood is really low. And historically, you know, as a dietitian, I was very much you know, told we should not touch anyone with diagnosed depression. But there was amazing study I won't go into the details of, but any nerves out there like myself check out the Smiles trial. And that was the first time I had real strong confidence as a clinician to be like, you know what, Yes, you are struggling with your mental health and often medications are needed, but as an adjunct therapy, diet can have a clinically meaningful impact in how people are feeling, and certainly in these clinical trials, has reduced their depression to a level where they would no longer be clinically depressed. Right, So there's some pretty impressive clinical data out there.
00:21:39
Speaker 4: I just want to touch on SIBO for one brief moment. Do women at perimenopause and menopause have more sebow.
00:21:46
Speaker 3: It is a good question, I mean, SIBOW is this whole other can of worms? Right? We obviously know small intestinal bacterial overgrowth is a very real thing. I remember we spoke about that nine meter long digestive tract, and there's four main parts of that. You've got your sophagus, your food pipe, You've got your stomach. Then you've got this thing called the small intestine, which is not small. It's literally six meters in length. And in the small intestine is where most of your food gets from your gut into your blood system. Right, and then we have that final part called the large intestine. And what happens is with small intestinal bacterial overgrowth, often because your gut movement isn't as effective or you've had gut surgery, those microbes that are normally in the bacteria that are normally in that large intestine where they do all these cool things, eat the fiber, produce gas, They sneakily start to crawl up a little bit high into your small intestine. Now, Unlike your large intestine, which can handle the gas being produced, you know, the acids being produced when the bacteria eat fiber and beneficial things. The small intestine is much more sensitive and therefore the bacteria of crawled up and aren't being pushed back down to where they should live. That can create more gut issues and gut sensity, so people might experience more lucive stools, a lot of pain in their gut, bloating, et cetera. So a lot of the symptoms very much overlap with IBS. But when we look through the studies, I think it often gets confused with irrital bowl syndrome, and the diagnostic profiling of breath test isn't as clear cut. It's not like I'll send someone for a breath test and it's like, yes, you definitely have CIBO, you definitely don't. It needs to align with symptoms there, and I think overall it's probably has been over diagnosed. Of course, we know that if you're on PPIs or you've had gut surgery, yes you're a higher risk of ciboat, but I would say that it's probably not the true definition if we actually looked at the smaller test and then took a sample of cebo. It's probably not as common as people have been led to believe. It's probably more a case they've got my BS. It's interesting some people who you've struggled with IBS or their life goes through perimenopause and they're like, oh my god, actually all the other symptoms are recurring, but my IBS is cleared up. I'm not getting any stomach pain anymore. But yes I'm getting hot flushes and you know, brain fog and all the rest of it, whereas other people it starts to trigger that. And I think it comes down to that level of there is clearly a role of the gut brain access occurring. When it comes to whether it is IBS or these gut lining sensitivities, we're still trying to under downd what exactly is is the cause. I wouldn't say it's significantly higher in terms of prevalence of CEBO or IBS and perimenopause. It's very individualized.
00:24:21
Speaker 4: I like to refer to this as like this the gut everything access. Right, we know about the gut brain axis, the gut cardiac axis, the gut muscle axis. Can you explain just the different organ systems for our listeners that the gut does impact. You talked about mental health a little bit, but what are those organ systems that the gut impacts And I'm going to say it's probably everything it is.
00:24:43
Speaker 3: And you know, look, we look at the mechanisms, right, So there's this gut metabolism access, So we know that our gout microbes play a really important role in stimulating our body's own production of the GOPI one hormone. Right, So the target almond for a zambig and weight loss drugs. So certainly we see people with better gut health also have lower body weights or more healthier body weights because of that axis there where they're feeding the gut microbiomes and microbes are you know, helping switch on GPI one hormone, and that's helping with appetite regulation. So that's the gut metabolism app says. We've obviously got a gut skin access where we don't just have these bacteria living in the gut, right, We've got billions on our skin, which acts as this second skin, and we see a lot of correlations where the gut microabe seem to be talking to the skin and vice versa, so things like you know zorias is an exma. There is a lot more research coming to the forefront around whether it's how we can prevent it by targeting the gut. I would say treatment so far are not overly impressive in terms of targeting the gut to treat exma and eroisata as well and zoriasis, but prevention there is a little bit more, and it's interesting in terms of when women are pregnant having specific types of bacteria. This one called lectozyls Ramness neat to know one is a really cool space where it's reduced at risk bubbs of XMA byry like fifty percent and one of the clinical trials, so really cool research going around the gut skin axis, despite obviously me dedicating my career to gut hull and I think it's important because there's so many connections. But still I don't want people to be misled and think that all of their solutions lay in the gut because a lot of the research is very observational at this time. It's kind of like we don't know what came versus the chicken or the egg sort of scenario.
00:26:22
Speaker 1: Let's talk a little bit about the gut and the immune system.
00:26:24
Speaker 4: What is the link between the gut and the immune system and autoimmune disease, especially for women.
00:26:29
Speaker 3: And it's striking how much higher the rates of autoimmune conditions are in women, right, which highlights that our hormones are having a really big role in our immune regulation and how they are essentially upregulating in women. Obviously with the automune conditions, how overprotective the immune system is, right, So that's what the automune conditions are, where the body's immune system is too protective of the body and start to kind of attack itself where you know, in states where it shouldn't normally. So we know that the bacteria and the gut immune system are living together so that they have this marriage. And I think the really important thing is kind of early doors, not that you can't do anything about it, but I think what we're seeing through the research is like the first you know, thousand days of life is when the microbes are training the immune system. We see it through a lot of the studies where you know, infants who grow up on farms are exposed to more different, diverse ranges of microbes, aren't on antibiotics and PPIs and things like that. They have more diverse ranges of microbes from the get go, and that seems to be able to more effectively train the immune system what it should actually react to so you can protect you, but what it shouldn't react to, you know, things like different allergies and that can you know, the protein and peanuts. The microbe seem to be having that really important role in training that immune system.
00:27:59
Speaker 4: Coming up, doctor Rassi breaks down the specific foods, lifestyle habits, and daily practices that directly shape your microbiome, including some simple changes that could have a big impact.
00:28:28
Speaker 1: Let's get into some action points.
00:28:30
Speaker 4: How can a woman get a healthy microbiome? Is it through foods, probiotics, lifestyle factors, sleep, stress management? How do we impact our microbiome?
00:28:40
Speaker 3: A lot of it will come down to some of the basics that people have heard before, but I think it's important that we now appreciate why things are Eating more plants and eating more fiber is important because essentially the firebar doesn't feed human cells, it feeds that microbiome, right, So if we think of the diet element, obviously that's my errow expertise. I often talk about the super six, so it's just a catchy name to remember. The different categories of plants. And we've got your whole grains, so things like your your buckwheat and your oats and your quinoa. You've got your nuts and your seeds, your herbs and your spices, your free obviously, your veg and your legumes and things like your chickpeas and your butter beans. Now, each different plant category provides your gut bacteria with different types of fiber slash fertilizer. So if we want to feed a really diverse range of got bacteria, which essentially means you've got more skills within you because more different bacteria do all different things, like each train is capable of different functions, then you need to feed it something from the super six most days. And if we look at the average diet, you know, maybe people are hitting you know, three or four of those categories, but they're probably missing out in one of those categories, which means even if they're having loads of vegetables, if they're not having any legumes, they're not feeding the legume loving bacteria and a turn reducing down kind of that functionality. So I think one of the most basic strategies is to think have I had something from the Super six today? So it's a mental note that I get a lot of clients to think, like at three pm, like have I ticked something off? If I haven't tonight, whatever I'm having, even if it's like takeaway Indian, I'm just going to get can of mixed beans if that's a category you've missed and put that in there, or maybe it's the nuts and seeds category and you're like, okay, just you know, goog get a couple of walnuts just to feed the microbiome in there. There's obviously the fermentative food elements are having things like kafir and kimchim. Those sorts of memental foods has been shown and have studied from Sevic University actually to increase your microbiome diversity and also reduce some inflammatory markers in the body. So fermental foods oiling fish. Again with those Amiga threes in their plant diversity, we didn't touch on food additives and actually our team at Kings have just finished a well versed clinical trial looking at emulsifiers in people with inflammatory bout disease, specifically Crone's disease. We did show that those people who went on the lower mulsifier diet than those who had a mulcipi containing diet actually had a significant reduction in their symptoms and disease severity. And it feeds into ultra process foods right like most older process foods. Actually we're seeing have a multipliers in it. I think the mechanisms around that were starting to piece together. So having something from the super six and watching how much of these ultra processed foods were having, which you know, we're starting to look in a lot of these like protein supplements and these drinks that people think are healthy, Actually they're full of a multipliers and may have that negative impact. Stress management. Right, if you are stressed in your head, that strangles your gut through those hundreds of millions of nerves, and that changes the balance. No matter what you feed your gut, it can have a negative impact on that diversity. Sleep again, biodirectional relationship. We know our microbes can impact sleep, but our poor sleep can impact our microbes. Physical activity independent of diet can increase your gut microbial diversity as well. But I would say focus on one thing and I would say it's around the super six that probably is going to give you the biggest bang for your buck.
00:31:56
Speaker 1: So let's talk about fiber.
00:31:57
Speaker 4: Fiber as well as the gut microbioma is having a moment. But I think the recommendation now is twenty five to thirty five grams of fiber every day, Am I correct?
00:32:06
Speaker 3: Yeah? Exactly.
00:32:07
Speaker 4: Fiber supplements, yes or no? Or just get the city of fiber through the super six.
00:32:14
Speaker 3: I would say in a clinical practice, as certain scenarios where like, for example, cilium husk fiber it's a unique type of fiber where there's loads of evidence for things like constipation, then I would recommend that specific fiber supplement. But generally speaking, I don't recommend people take a fiber supplement because it's not going to have that diversity that needs to feed that broad variety.
00:32:34
Speaker 4: We haven't talked about. My favorite topic and which it probably is a great topic for you. Also would imagine is probiotics and live bacterial supplements. So there are tons of probiotics on the market. What is the efficacy of probiotics? What should we be looking for when we look for a probiotic? What should I be recommending as a physician to my patients for probiotics. Are we at a spot now where we can say, Okay, you're concerned about brain health, so we're going to recommend this probiotic for you. Or you're concerned about metabolic health, so we're going to recommend this probiotic for you. Can you impact that for us a little bit?
00:33:07
Speaker 3: I think when we talk about probics, it is so important that we understand that there is literally, you know, thousands of different types of bacteria, and each different bacteria is actually doing different things in the human body. You know, someone comes to see me with iron deficiency, I don't go and say, hey, take a vitamin D supplement. I would say take your iron supplement, right, because that's the one that you need. The same goes to probotics. I think telling anyone to just take a probiotic is absolutely useless. So, for example, we know that the LA fourteen and h and ie strains along with lactofera and clinical trials have shown to reduce recurrent thrush compared to PACEBO. So you know, that's the exact formulation you should be recommending to women who you know are struggling with recurrence of thrush. Similarly, you know, we spoke about the LGGNBB twelve strains where they've shown to reduce the duration and severity of cold and flu. So we need to get very specific, and I would say there's some really fascinating research coming to the forefront highlight that there is some promise there. But actually the exact strains have yet to be really identified. There's only been you know, one study WI look at one strain. There's not been a duplication where at least, you know, two different clinical trials have both shown the exact same formulation. Have this outcome. But to your question, should we all take a probatic? Absolutely not. I think for general gut health, there's never been a clinical trial showing that a probatic will help with your general microbial diversity, right that is where the plant diversity comes in. But for specific need states, you know, college is another one that as a mom with a four month or at the moment, my little girl's taking the BB twelve strain because actually there's these randomized control trials showing that bobbs who have that specific BB twelve strain at one billion dose per day, actually they have nearly a two fold reduction in things like colleague symptoms, and there's international guidelines. Spagan's guidelines actually have that in their recommendations. They say that bubbs with colleague symptoms should have the BB twelve strain. So I think this is a really exciting space where we're learning more about specific strains doing specific things, and we have these clinical and medical guidelines starting to recommend them. But I would say for the vast majority of cases like perimenopause and things like bloating even and mental health, we don't know the formulation yet. So for now, go with diet, and I think in the next couple of years, as a number of clinical trials underway, we'll have more specificity around those different indications.
00:35:43
Speaker 4: Sodium Buterrate is a very buzzy kind of topic right now for gut health. Should anybody be taking sodium butyrate? And also what about calcium D glucrate. That's another supplement that's really recommended a lot too that we see.
00:35:56
Speaker 3: Yeah. Look, I mean what I would say as a scientist and as a clinician, I wait until there has been the two randomized control trials showing with placebo right that taking that specific supplement at that specific dose can lead to a clinical kind of outcome. But again, as a research unfolds, I might change my mind. And if someone wants to trial it, what I typically say, because there's so many do things that mechanistically make sense and could have a benefit, I say, but maybe trial it for four weeks see if you feel any benefit. If you do, then you might want to keep going. Although I would be cautious of the Pacibo effect, right, So Paceibo effect. Essentially, if you think something's doing good for you, that often subconsciously change things a little bit more that gout brain access at play, and actually we see it in our Etechlin controls. The Perceibo effect works around thirty percent of people where you start to feel better if you think you're doing something good. To just be conscious of that.
00:36:51
Speaker 4: Fermented foods such as yogurt, sauer kraut, kambucha, morning afternoon, evening, dinner, throughout the day. When should we eat fermented foods?
00:37:02
Speaker 3: Yeah, it's a good question. I mean, there's not a whole lot of research that suggests that your microbime is more primed to absorbing different fighter chemicals which we can get or bioactive peptiz that we can gat from these fermented foods at certain times of the day. What I would say is there are some interesting research showing that not eating or not having loads of food after like five PM they have a beneficial impact on I got microbiome. But I'd say anything beyond that, we don't really have the research to suggest you should be having it this time. I think it comes down to habit. You know, if you're having it on the daily, do it when you're going to remember to habit and when it's going to fit into your lifestyle. Yeah.
00:37:39
Speaker 4: I love that habits are important. Microbiome test stool test, Is it useful? Are we at a point where we can use them now?
00:37:47
Speaker 3: Yeah? That is a very hot topic. And you know in our clinical trials at Kings we absolutely do these microbiome tests right we are investigating what's happening there. We go a step further to look at the metabolome, so not just what bacteria are there, but what the bacteri are actually producing. In terms of my clinical practice, I think if you've got loads of money and you're just interested sometimes in clinically use it as a motivational tool where someone will baseline get their microbiome tests if we look at the microbial diversity and then do all the general recommendations not actually informed by their microbiome test, and they get them to repeat it and they'll see their diversity intechs improved. Right, And as we mentioned, you know, it comes down to the different strain specificity. Each bacteria is doing a different thing, and most of these microbiome tests aren't even at that strain level. They're looking at the species level, which is essentially a much higher up in kind of the animal kingdom. And we know that even you know, two bacteria within the same species can actually have very different effects. So just talking about bacteria in that species level doesn't tell us the functionality.
00:38:54
Speaker 4: So if you could give one single evidence based recommendation for every woman entering midlife to maintain and improve and have her optimal gut health, what would that be?
00:39:06
Speaker 3: Think of the Super Sex? Have you had something from the Super six today? Add a nuance to that, right, because we know all about this fiber maxing and everyone being obsessed with dumping fiber is like any other muscle you know in your body. You know you're not going to just go run a marathon and expect you know you'll do amazing or you won't be crippled with pain the next day if you don't train your muscles. The same with your gut. If you go from little plants a little fiber to loads, you are going to get altered stools, extra bloating, etc. So you need to train your gut and you've got microbiomes essentially that is small, steady increases in these super six across three or so months will then mean that you're getting the benefit of the fiber without those gut symptoms.
00:39:50
Speaker 4: The pillars of solid gut help start with what's on your plate. Doctor Rassie's Super six recommendation gives us a great framework. Make sure you're regularly incorporating all six. That's all grains, vegetables, fruits, lea, gooms, nuts and seed, and herbs and spices. The target is thirty different plant varieties per week, and every single one counts towards feeding the trillions of microorganisms working inside you around the clock. But good gut health doesn't stop at the dinner table. The gut brain axis runs both ways, meaning chronic anxiety, stress and overwhelm can wreak havoc on your digestive ecosystem. Also, since your microbiome follows a circadian rhythm, sleep is essential to maintaining a healthy gut. Consistently, poor sleep disrupts the delicate microbial balance your body depends on. Move your body regularly and stay well hydrated.
00:40:56
Speaker 1: And remember this.
00:40:58
Speaker 4: Probiotics have their place, but they are never a substitute for a diverse, plant rich diet. And as doctor Rossi explained, even two bacteria within the same species can and have completely opposite effects on your health, making precision absolutely critical when it comes to interpreting your gut health data. Your gut is arguably the most underrated system in your entire body. Take care of it with the same intention you'd give any other aspect of your health. Decoding Women's Health is a production of Pushkin Industries and the Atria Health and Research Institute. This episode was produced by Kalaliah. It was edited by Amy Gaines McQuaid, mastering by Sarah Bugaier. Our associate producer is Sonia Gerwit. Our executive producer is Alexander Garreton. Our theme song was composed by Hannas Brown. Concept and creative development by Shavan O'Connor. Special thanks to Vicki Marrick, Alan Tish, David Saltzman, doctor David Dodick, Sarah Nix, Jacob Goldstein, Leah Rose, Jordan McMillan, Morgan Ratner, Owen Miller, Eric Sandler, and Greta Cohne. I'm doctor Elizabeth Pointer. Thanks for listening and until next time,
