Irritable bowel, bloating and digestive health with The Gut Experts

Consultant Gastroenterologist Professor Barbara Ryan and Clinical Dietitian Elaine McGowan are The Gut Experts, passionate about digestive health and helping women with debilitating bloating and irritable bowel symptoms.

In this episode, the experts discuss why more women are troubled by gut related symptoms compared to men, how gut and bowel problems have a very real impact on women’s lives, and why eating the right type, amount and variety of foods is so important for your gut health and overall wellbeing. The Gut Experts also talk about their new book written for women of all reproductive ages experiencing gut and bowel related symptoms.

Barbara’s tips for improving your future digestive health:

1. If you’re having digestive symptoms seek a correct diagnosis rather than self-diagnosing
2. Don’t look at your gut and digestive health in isolation, take a whole-body approach. Remember TEAMS: Total gut and body health, Exercise, Alcohol (reduce/cut out), Mental health, Sleep.

Elaine’s tips for improving your diet:

1. Fibre is a superfood for your gut microbiome – find the right amount of fibre intake for your own gut as everyone is different
2. Variety and diversity of foods is crucial, eat the rainbow, following a Mediterranean style diet.

Visit the Gut Experts website at https://thegutexperts.com/

The Gut Experts book, ‘What every woman needs to know about her gut’, contains solutions for bloating, IBS, and digestive symptoms and is out now, published by Sheldon Press.

Follow Barbara and Elaine on Instagram @thegutexperts

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr. Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence, based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] So this morning I’m very delighted to have two people on the podcast today who I’ve recently met and really enjoyed following so far. And there’s going to be a lot more we’ll hear about them going forwards. So there’s Professor Barbara Ryan and Elaine McGowan, who are both friends and co-authors actually of a book that we will talk about. So welcome both, to the podcast today.

Professor Barbara Ryan [00:01:07] Thanks very much, Louise.

Dr Elaine McGowan [00:01:08] Thank you, Louise.

Dr Louise Newson [00:01:09] So let’s start with you, Barbara. I think you reached out to me a few months ago and it’s been absolutely stimulating, having a conversation with you, not just about gut health, but about medicine and all sorts of things as well. So talk through, if you don’t mind a bit about your background and what you do.

Professor Barbara Ryan [00:01:25] Yes. So I’m a gastroenterologist and I’m a professor of gastroenterology at Trinity College, Dublin. So I did most of my training in Ireland, and then I worked in the Netherlands for a couple of years. I worked in Germany, and I worked in Manchester in the UK as well, furthering my training as a consultant in the UK for a while and then I returned to Ireland. So I guess over the years of my gastroenterology work, while I do a lot of interventional endoscopy, I’ve actually found over the years that more and more of my work involves sort of listening to people and while I have technical skills, you can actually glean such a huge amount from just listening to patients. And we see a lot of women in particular with problems like irritable bowel syndrome, which, we might talk about that, but that’s much more common in women and why men and women have lots of digestive problems in common. The vast majority of people, 70% of people with irritable bowel syndrome are female. So I suppose that really stimulated my interest in and what’s different about women. And eventually that culminated in myself and Elaine, you know, talking about this and deciding that there was a need for a book specifically directed at women, because there are very particular problems and challenges that a woman faces in her life that men don’t face, obviously hormonal, pregnancy, etc., and our bodies go through a lot. And that was really what sort of spurred me on to write this book with Elaine.

Dr Louise Newson [00:02:49] So Elaine, tell us a bit about you.

Dr Elaine McGowan [00:02:51] So I’m a registered dietician, Louise, and I am working over 35 years as a dietician, giving my age away here. And I started off working in hospital clinical practice first for many, many years, and then I went on to do a masters in actual sports nutrition. And while I was doing that, I set up my first dietetic clinic in 1992. And at that time there was a surgeon and a gastroenterologist that had a huge interest in nutrition and particularly the role that it played in gut health. So I’ve been working in the area of gut nutrition, and digestive complaints that women often suffer with, for over 30 years. So I had gone on to set up other practices as well, and in the time I actually also had worked a lot in sports nutrition for about 12 years. So I had an interest in the area of exercise and its role that it plays on gut health as well. And I love helping women find solutions to difficult and problematic gut symptoms that can often affect their daily quality of life.

Dr Louise Newson [00:03:47] Yeah. And it’s so important, isn’t it? Because when you think about the gastrointestinal system, as – in isolation almost – and you know, I remember listening and to very learned professors and lecturers when I was a medical student and it’s very much about, you know, it starts in the mouth, ends in the anus, and it’s very much sort of isolated. And you’ve got the liver and the pancreas just attached to it. And food is just for fuel, really. And so this was in the eighties and nineties and things have changed, but there’s still a lot we don’t know. And actually it’s not in isolation, is it, the gut?

Professor Barbara Ryan [00:04:20] No. And I think it’s been a really interesting time to be working as a gastroenterologist, because you’re absolutely right. When I started out, it was sort of seen as this, you know, a tube and things could go wrong within the tube. And now we realised that the 50 plus trillion bacteria in our gut are talking to all the other parts of our body. So, you know, they produce serotonin. You know, 70% of serotonin in our body is produced within the gut. And serotonin has such a profound effect on our mood. We produce dopamine. The gut bacteria produce so many important factors that are important for our overall body health. We know now about the gut brain axis. So, you know, the sort of information superhighway that’s going between your brain and your gut, and that the vagus nerve and the sympathetic nerve and all the connections, so that’s what’s going on in your brain, obviously, you know, like if you go and do a big presentation, a bit nervous, that affects your gut. But we also know that what’s going on in our gut, that mix of bacteria, our diet, etc., that also has a profound effect on our mood as well, and every other part of our body. I mean, and now, you know, there’s evidence that the gut bacteria can affect your risk of rheumatoid arthritis, of lots of autoimmune conditions, of MS there are changes. If you look at pretty much any medical condition and you look at the gut bacteria of the people with that condition, you will find that it is different. So it has been really fascinating area to be involved in because, you know, now we can say, ‘well, that’s what we thought – these gastroenterologists, we’re really looking after the most important organ in the body’. But yeah, it’s really and I think we don’t know everything yet either, which is really.

Dr Louise Newson [00:05:56] No, there’s so much we don’t know and we don’t know how individuals – we’re all different, aren’t we? So our gut microbes are all very different and react very differently as well. And the way we eat can affect different people in different ways. Which makes medicine interesting because I think so much, it is a science, but it’s an art as well and everyone’s different. And certainly, in my clinical practice I really like to try and individualise, because even if symptoms are the same, they affect people in different ways. And I know when I was in Manchester actually, they have a very big irritable bowel syndrome unit there in Manchester. And you know, I wish I could go back in time because I remember sitting in clinics and they just started to give antidepressants to people with irritable bowel syndrome in the eighties and nineties. And if I could go back in time and look at these women, I’m saying women because they were women in the clinic. I bet they were all perimenopausal and menopausal women. And so they were giving the antidepressants for their gut symptoms. So this is not – as a lot of women sadly are offered or given antidepressants for their mood symptoms related to the menopause, which we know don’t help. And antidepressants might help some of the symptoms, but you’re not really treating the underlying cause. And certainly, in the eighties and nineties, I didn’t know we had any bugs in our bowel. We just started talking about Helicobacter pylori and that was the only bug I think I knew was in. Yeah, we were trying to get rid of it. So things have really changed, haven’t they?

Professor Barbara Ryan [00:07:21] Absolutely. I mean in Manchester, Professor Whorwell in Manchester, he was really at the forefront of this and really, you know, quite groundbreaking research that he was doing at the time. And he was one of the really early people to look at hypnotherapy in the treatment of IBS as well. And I think if what it really goes to show you is that it is all connected. I mean, obviously irritable bowel syndrome, for example, tends to start in younger women in their late teens and twenties at a time when there are very marked monthly fluctuations in hormone levels and any person with irritable bowel, in fact, most women will tell you during their fertile years that their bowel function is sensitive to their hormones. And I think when you have a monthly cycle that’s quite predictable because you get the same changes every month. I think when you go into menopause transition, it’s a bit of a wilderness because the changes are much less predictable. And there are fluctuations. It differs so much from woman to woman. So I think that’s really great about, you know, the work you’re doing is recognising that menopause transition is a very, very particular phase of a woman’s life and it affects every other system. And I think we’re really only beginning to look at and find out how it affects all these other symptoms. And I mean, you take a very holistic approach sometimes in speciality areas, we look at things in isolation, but I think we have to look at the whole person. We really do. But it is fascinating the research that has been done in the last 30 years.

Dr Louise Newson [00:08:47] Yes. Yes. So, Elaine, when you started as a nutritionist, how when we talk about gut health, it’s very broad. But if we think about the microbiome, was that something that was on your radar many years ago or how has it developed as an interest for you?

Dr Elaine McGowan [00:09:01] Yeah. So certainly when I started 30 years ago, Louise, the gut microbiome wasn’t on the radar at that time, and it’s really only in the last decade that we’ve seen so much about the gut microbiome. What I would have seen 30 years ago was people presenting with gut symptoms when they eat, particularly brassica vegetables. One of the ones common at the time was certainly cabbage. And certainly people, if they put an awful lot of onion in their stew, they could get symptoms of bloating and wind. We weren’t seeing as much of these functional gut symptoms where people’s tests were all coming up normal, but they were still suffering with bloating and wind and discomfort. And we know now that diet has a huge role to play in the gut microbiome. And as you said, everybody has their own set of gut microbiome. So the amount of fibre that you give one person could affect them differently to another. So some people are able to eat 50 grams of fibre and not suffer with any gut symptoms or uncomfortable symptoms. And then other people can only tolerate about 20 grams of fibre. So it’s very individual as to how your gut microbiome actually digest certain foods.

Professor Barbara Ryan [00:10:07] But I chime in there for a second as well. I mean, I think I mean, there have been, you know, 40,000 publications on the gut microbiome in different conditions in the last few years. I mean, it’s absolutely exploded. But I came across a term a few years ago that I absolutely love. And it’s the ‘mysteriome’ to describe the gut bacteria, because while we you know, we’re now great at identifying all the different families of bacteria, firstly, there’s no one signature in any one person that indicates this is the optimal. We know that having plenty of gut bacteria and having a huge amount of diversity is really beneficial, and most people will have somewhere between 2- to 400 different types of bacteria predominating. And in general, the more the merrier. But we still don’t know the function of all those. We don’t understand the cross-talk between all the bacteria. And I find it sometimes a little a little bit disconcerting, because obviously there are commercial gut microbiota tests done now. And while they’re very interesting, I think our understanding of the science lags behind our ability to test these things. Because if somebody comes to me and shows me a printout of this and it looks so impressive, it’s ten pages of print out and this bacteria is a little bit, it’s red because it’s a little bit low, and this one’s green. We don’t really know what to do with that information at this point. I suppose if you’ve got very little diversity, okay, eat more fibre and plant-based foods, fine, increase your diversity. But I think it’s a little bit cynical for people to be offering these tests when we don’t absolutely understand the therapeutic implication of it at this point.

Dr Louise Newson [00:11:36] Yeah, and I think that’s very, very interesting because I do see a lot of women as well, like you with printouts and it worries me because actually they’re very expensive and I really worry about people spending money unnecessarily. And it can be interesting, but actually because we don’t know what we’re aiming for, it’s not like if we do a blood test for iron level, you know, it’s quite useful then sometimes and we know, you know, if they improve with iron replacement, we can see that in a blood test. But this – we don’t know what we’re aiming for. And so it is about individualisation, but it’s also about taking a step back and thinking what else is going on and thinking beyond the gut. Isn’t it? Because I didn’t actually realise until probably five years ago, I’ve been running my menopause clinic for more than that but over the first few months I started to ask people more about their other symptoms and bowel symptoms came up a lot, and a lot of heartburn, lots of indigestion, a lot of bloating, a lot of irritable bowel type syndrome. And it was only because I treated so many women and when I see them, when their hormones are balanced a lot of them said, ‘Oh, my heartburn’s improved, my bloating’s improved’, and some of it is because they feel better, their diet’s improved. I understand that. But a lot of it is because of their hormones. And we’re starting to do a little bit of work about estrogen in the gut. But as you know, testosterone is another hormone that we produce four or five times (or three or four times, depending on what you read) more than estrogen before the menopause, and there are receptors for all our hormones out there in our guts. So I’m very interested in thinking, well, how does estrogen have a direct effect on the gut? By stimulating various cells, but also how does it have an effect on the gut microbes, but also testosterone as well? You know, men aren’t getting the symptoms as much as women. And we’ve always thought, or I’ve always been taught because women are more stressed, and women have a bit more chaotic with their food. And actually I’m not sure that we are. I think we cope with stress well and actually most of us – I’m not saying all but a lot of us – control what the whole household eats you know. I don’t think it’s because we all go to a sweet cupboard and eat rubbish food. We actually are quite sensible, but people don’t believe us. And I’ve sort of known other healthcare professionals and I’ve done it a bit myself with women. When women sit there and say, ‘Oh, I haven’t changed my diet, I haven’t changed my exercise, but I’ve changed my body shape, and I got this bloating and I’ve got these symptoms’, and you can sit there in a ten minute consultation really, ‘are you really telling me the truth?’ Because this isn’t very helpful, you know what I mean, and then and then I’ve rebalanced the hormones because they’ve had other symptoms and they’re menopausal and they come back and go ‘Oh Dr Newson, this is the best I’ve felt in ten years’ and I’m thinking, ‘Oh my goodness, why didn’t I think about this before?’ And so it’s really interesting the work that you’re doing and the connections, because people don’t think about hormonal health and gut health as being something that is together really. And I think it is more than we think.

Professor Barbara Ryan [00:14:34] Absolutely. It is all connected. I think particularly what you say about reflux symptoms is really interesting. I mean, there is some research showing that reflux symptoms are about three times more common in women, particularly in that sort of early menopause transition phase. And they do seem to improve afterwards. Now, I think the research doesn’t tell us is that because those women go on HRT? Is it because even if you’ve got stabley, low levels of hormones, that’s kind of an easier situation to deal with?

Dr Louise Newson [00:15:00] I think you’re right there. And I think we all talk about the menopause, and I sort of really battled for my book to have perimenopause on the title because perimenopause, I didn’t know even existed, ten, twenty years ago because no one talked about it. But it’s a great state of flux in the body. And people have very high hormone levels and then very low. And I think it’s that we know the change in hormone levels often trigger the vasomotor symptoms and the psychological symptoms. The brain’s very unstable with this flux. So it’s got to affect the gut. And the gut microbiome as well hasn’t it.

Professor Barbara Ryan [00:15:33] Yeah. It does and the rate of hormones. So as you said, we’ve got estrogen and progesterone receptors and testosterone and cortisol receptors, all these really important hormones that play such an important role during perimenopause, we’ve got all those receptors on our gut. And actually it’s been shown that people with irritable bowel syndrome actually have an increased density of estrogen receptors on their gut, so may leave them more sensitive to these changes. But it’s not just the actual hormone levels. It’s the rate of change that’s also affected, if your hormone level changes very slowly, as you know, your receptors increase to kind of…

Dr Louise Newson [00:16:09] accommodate don’t they?

Professor Barbara Ryan [00:16:11] But if they change very quickly, the receptors don’t change. So that’s an important thing. We know that estrogen increases mast cell activity within the gut as well. And we now have this big interest in mast cells and its role and sort of in many, many different symptoms, allergic type symptoms, increased pain sensitivity. So it’s thought that changing estrogen levels also changes pain receptors. Estrogen also affects our pain receptors in our brain so that all the pain pathways are affected by it as well. So and there’s certainly, you know, research showing that sort of widespread body pain increases in people, again, particularly, I think in early menopause transition and maybe improves later during the perimenopause. So it’s an incredibly interesting area. Progesterone also increases or has a big effect on gut, many women would identify with when they’re pregnant and progesterone levels are really high, tend to get a bit of constipation, they may get more reflux because progesterone kind of slows everything down. And these changes and the fluctuations, they really do vary from person to person. So I think we’ve got to whether we’re going to, in a gastroenterology clinic and just speaking to somebody only about their gastro problems, or if they’re in your menopause clinic, we need to talk to the individual person and find out what are your individual predominant symptoms and try to address those. Because, as you said, it isn’t a one size fits all and it isn’t a simple story.

Dr Louise Newson [00:17:35] Yeah, absolutely. And so that brings me onto your brilliant book that I’ve just heard is a number one bestseller in Ireland. You humbly said it’s very small, but there are a lot of books in Ireland, so I’m still going to give you credit for that. I know on personal experience it’s a huge amount of work, especially when you’re working full time and have a busy clinical practice to find time to dedicate to a book. And I know you’re like me and that you want more people to learn from you and to share your knowledge, which is just amazing. So tell me about the book Elaine, why you decided to do it?

Dr Elaine McGowan [00:18:10] Well, I think Barbara actually approached me about two years ago, and I’ve always had an interest in sharing some of our knowledge to impact more women. And I jumped at the opportunity. So it took us about two years, a lot of work, as you said, but COVID allowed us time during the evenings and at the weekends to concentrate on it. And for the first three months of COVID, my practice was closed, so I was able to give it a lot of attention. But the main reason why we wrote it is we wanted to share our combined experience of medicine and certainly nutrition – which is over 50 years – experience of working with people and women with problems, not only women, but men as well. And we wanted to impact more lives and help women who are suffering with uncomfortable gut symptoms like bloating, pain and discomfort. So that’s what we actually wanted to attain. And I think we’ve achieved that in our book because it’s definitely a book that includes medicine, diet and lifestyle, and it’s got a whole-body approach to managing uncomfortable gut symptoms.

Dr Louise Newson [00:19:05] Barbara, what’s the feedback been like so far?

Professor Barbara Ryan [00:19:07] It’s been really great. So our book, Louise, it’s called What Every Woman Needs To Know About Her Gut. And we’re hoping that it does exactly as it says on the tin. The feedback has been great. We’ve had some lovely feedback on Instagram. I’ve had patients bringing the book in to be signed. I had a lovely letter from an older woman because we want the book to speak to women of all ages. You know, it’s not just for people during the fertile years. It’s also for women to understand what’s happening, to their body after menopause and the sort of pelvic floor problems people can get, etc., and also to try and reduce the stigma of talking about these things. But I had a lovely, lovely letter from a lady, I don’t know. And she didn’t put her name on it, but she’d read an article in the paper and she’d got the book and she sent me two miraculous medals just to thank us for talking about these issues. So we’ve had really lovely feedback and we’re hoping that more people will hear about the book because we’re both really passionate about, like yourself, I mean, sharing our knowledge and our information. And one of the things we wanted, we feel that if you have knowledge, you have power. So we’re trying to empower people to take control of their problems and understand what’s going on. Because I think it would be very trite of us to say, ‘oh, look, there’s an easy solution for every problem’. There isn’t, and there isn’t an easy solution for the women you see. It can be very complex. Hormone replacement therapy is part of that, but it’s all the other things you said as well as diet, lifestyle, sleep, looking after mental health. And we’re really passionate about trying to give women the power to try and gain some control on things. And, you know, the whole area of irritable bowel syndrome, it’s really like the whole area of menopause transition because for years women were told, ‘it’s in your head’ because they have all really uncomfortable symptoms. They’re bloating, they’ve, you know, having to dash to the toilet because they’re getting terrible cramps and diarrhoea. It’s held people back professionally because they don’t want to go for an interview because they’re afraid in the middle of the meeting they’ll have to dash or their tummy’ll let them down. And so women have been told, ‘look, all the investigations are normal, everything is fine. You’re absolutely fine. Nothing serious, go on and get on about things’, and are very similar to what’s happening women during menopause. So we wanted to say this is not in your head. These are real physical conditions. Oh, yes. Standard tests are normal, but this is not normal to be experiencing these symptoms. And one in six women has IBS and one in two women will have bloating, a little bit of constipation, maybe not enough [unclear]. So these are really common symptoms.

Dr Louise Newson [00:21:32] One in two is huge, isn’t it? And we know that, for example, one of the symptoms of ovarian cancer, which is not nearly as common, obviously reassuringly, is bloating. So when I was working as a GP, a lot of women would come and say ‘I’ve got bloating’ and they’d be worried about ovarian cancer. And if they had their tests, everyone was so reassured they didn’t have ovarian cancer. That was like ‘you’re fine’. And of course they’re not. And they’ve got symptoms. And I think it’s very difficult and it’s happening more, I think, as people, not just women, but people in general are more aware of their bodies. They’re more aware of symptoms that they might have dismissed before. And I mean, as you know, Barbara, I had pancreatitis a few years ago. And when I had symptoms for about six months after, I kept going to a very eminent gastroenterologist and saying, I’ve got pain, I’ve got discomfort. I just don’t feel myself. I can’t bend down. I feel very nauseated. And he, at the last consultation, I went to him and he’s examined me and said, ‘look, your scan’s fine, your examination is fine. I think you need antidepressants’. And then I burst into tears and said, ‘but I’m not depressed’, which made me look like I was even more depressed. And he said, ‘No, no, you’re not depressed, but antidepressants can work really well for irritable bowel syndrome’. I said, ‘but I don’t have irritable bowel syndrome. It’s all in my upper intestinal tract’. And I came away really sad and I thought, I cannot live like this because it’s really impacting, like I really enjoy yoga. I couldn’t bend down so how could I do a headstand? Of course. And I just thought, this is terrible, actually. And then I saw someone else, had my gallbladder taken out and the rest is history, if you like. But I mean, if I hadn’t been persistent and had the medical knowledge, I would have been labelled as something. And yeah, as women we’re often being labelled because, you know, there’s all sorts of misogyny that goes on out there that’s going to continue and we’re always being suppressed as women. So I think to have something that empowers us and it’s quite unusual actually, isn’t it, to have a book that’s aimed at women as well. Are there any other books out like that on the market?

Professor Barbara Ryan [00:23:35] Well, apart from yours!

Dr Elaine McGowan [00:23:38] And we also wanted to sorry to interrupt. We also wanted to reduce the stigma around talking about these symptoms. So very much like the menopause, we feel like we have some women, Barbara was looking after one woman who couldn’t go on a long haul flight to see her children in Australia because she was suffering with loose bowels, associated with urgency and she had been suffering with that for about 20 years, wasn’t it Barbara?

Professor Barbara Ryan [00:24:00] Yeah, more than that.

Dr Elaine McGowan [00:24:01] And she hadn’t really spoken about this. So very much I think like the menopausal symptoms over the years, a lot of people are embarrassed to talk about the symptoms of the gut because, you know, particularly the loose bowels that can be associated with urgency, the excess of wind and they tend to put up with the symptoms. So we really wanted to reduce the stigma associated with talking about these symptoms.

Professor Barbara Ryan [00:24:20] And one of the things that I, I really hate to hear somebody say, I just have something, I just have IBS or something, it’s just this because, okay, it’s not life threatening, but it can be something like that can be life altering as can you would see a lot of people with pelvic floor problems, you know, particularly older women. So they have their children at a young age. Their muscles are good and strong. They have a big baby. They kind of bounce back. But then when they go through menopause and into postmenopause, those muscles that were damaged 30 years ago are suddenly becoming much weaker. And suddenly they’ve problems with control of I mean, I think it’s just cuts to the core of somebody having a problem controlling wind or bowel motions or urine. It’s just like as an adult human being, they’re things we expect to be able to do. And, you know, I hate when anything is used in terms of it’s just that or, you know, these are absolutely really important things that affect people’s daily lives. We want to talk to people. We want people to be able to go to their – sure I’d say you’ve always been a very approachable person – but I’ve certainly seen patients who’ve gone to their GP a number of times wanting to speak about something, but then they can’t bring themselves to that to say, well, actually I’m having trouble controlling my bowel motions and they talk about something else and they come away and it takes a few visits sometimes to actually, you know, get the courage to talk about what’s really on their mind.

Dr Louise Newson [00:25:40] Absolutely. Because it’s embarrassing, isn’t it? And I think also a lot of people are scared that they are just going to be sent for tests and will have invasive tests and it might not be the right thing to do in the first line. And I think a lot of what I’m trying to do is empower people so that they can make the right choices, not just for their treatment, but maybe their investigations as well. And the more information we can give, the more we can help people direct. And I think this is great. And even just looking at your Instagram account, you know, you’re giving out some very, very simple messages that for a lot of people, it will be the first time they’ve heard it. And actually to have it from a voice of authority is really reassuring because there’s so much noise. I mean, there’s now thankfully more noise about menopause than there used to be. But with diet and nutrition and weight loss and gut health, it’s massive, isn’t it? But then it means that the good evidence or not always evidence for the good clinical practice is drowned out by other sort of things, that it’s just confusing women so they don’t know where to go. And I think also anything that we do that changes our gut doesn’t happen overnight, does it? I’ve listened to people, because I have a very diverse diet and it was ‘I couldn’t eat that, I’d get so much bloating and I would be having so much wind’. Well, yes, they would for the first week or so you’ve got to persist. And I think that’s having the knowledge that you it’s quite safe to have some symptoms short term, but they will improve. And knowing that you can do various things is really reassuring as well, isn’t it, for people? Yeah.

Professor Barbara Ryan [00:27:15] Elaine, you’ve a particular interest in fibre.

Dr Elaine McGowan [00:27:18] Yeah, I think having worked over 30 years in the gut, I can’t actually believe that there’s never been so much information available to people. And yet in our clinics we have so many people that still have so many symptoms and they’re really confused and they’re making very large decisions like taking whole food groups out of their diet and like eliminating wheat and eliminating dairy. And there’s also the very simple, practical tips that you can look at, like the way that you’re eating, whether you’re eating, you know, on the run, all your behaviour around eating to eat more slowly, eat smaller meals, take your time while eating and also eating more fresh food, less processed food, cooking foods that are in season, maybe batch cooking if you’re very busy. So there’s lots of practical tips that people can do that are really easy wins, but people are going from A to Z very quickly and eliminating whole food groups out of their diet. And we see really two sets in our population today. We have a whole lot of people that are eating very processed convenience takeaway foods. And then we have people that are eating healthy, which we sometimes maybe too much fibre for their gut. So it’s very much about finding what suits you and then more of a middle ground. We are very committed to more moderation in certain food groups as well.

Professor Barbara Ryan [00:28:32] And exactly as you said, Louise, if you are going to make some dietary changes, you know, try and do them slowly because fibre is food for gut bacteria. So our gut bacteria fermented produce gas. So if you’re going to increase your fibre, you know, we would say that you kind of start low and go slow, maybe look at increasing it by five grams a week. Don’t go and eat, you know, 15 tablespoons of lentils, if you haven’t been eating them at all, because that will cause bloating, because your gut bacteria are practically having a feast on the fibre within those foods. So it’s normal to get it to produce some wind. It’s normal to be a little bit bloated. But if you do things gradually by making changes to your diet, as Elaine said, you know, you will have fewer symptoms and our gut bacteria will adjust as we change our diet as well. But we are very concerned about the number of patients we see at our clinics who are following overly restrictive diets. And that’s one of the messages in our book. And it’s very strongly our ethos that we want people to follow as much as possible, to follow an inclusive diet and possibly look at how much of certain foods you eat, because lots of foods would cause some wind and bloating in people. And people with IBS are much more sensitive to that. So that’s where our dietary approach has really evolved from, and we feel that some of the approaches are putting people down, sending people down a line of over-restriction. And as Elaine said,  we see so many people who’ve cut out dairy completely and it’s such a wonderful source of calcium, then they cut out gluten, and gluten has really been demonised. I mean, there’s a study from Sheffield a few years ago showing that in 2012, 12% of people in that area were following a gluten free diet – in 2015, 33% of people. And now 1% of people in our part of the world, in the UK and Ireland, are coeliac. So why are 33% of people saying they’re buying gluten free products? And so gluten and wheat is being demonised unnecessarily because it’s a wonderful source of fibre and diversity. And it may be that it’s how much of what you eat that might cause a little bit discomfort as opposed to an all or nothing. So we don’t want people cutting out things. And that’s where we came up with our flat gut diet as well. That was as a result of trying to include certain amounts of most things.

Dr Louise Newson [00:30:41] Yes. So it’s very important. So there’s so much to talk about. And I think I’m going to have to get you to come back for a follow up if that’s okay. And hopefully we can start to do some research because I think…

Professor Barbara Ryan [00:30:52] That will be wonderful.

Dr Louise Newson [00:30:52] So important. So we’ll put links to the book and to Instagram and everything else with the notes, because it is really important that people just take time to look for themselves. It’s really important. So this is a book for anyone who’s listening to just have a bit of time to reflect and think about what they’re doing for their diet, not just for today, but for their long term health as well. So I’m very grateful for you coming. But before I end, I need three take home tips. So there’s going to have to be one and a half from each, so maybe, maybe I’ll allow four and you can do two each. So really, I’d like to know maybe from you Barbara, two tips how people can just start to think about what they eat for their future health. And then two tips for you Elaine about what people can eat to improve their gut microbes, if that’s okay.

Professor Barbara Ryan [00:31:40] Okay. So my two tips would be firstly, I think if anybody is having digestive symptoms, I think you should try and get a correct diagnosis to start with. And I think you shouldn’t self-diagnose now. I’m all about empowering people, but I think people should talk to their GP and get some basic tests done and the GP will help them decide whether or not they need to be referred for further investigation. I think this is particularly important around menopause transition, around perimenopause, because while hormonal changes may be causing our gut symptoms, you can’t assume that. So it’s really important to get the diagnosis right to start with. Secondly, my top tip would be Elaine is going to talk to you about diet, but I think that you cannot look at your digestive and gut health in isolation, and you do need to look at your total body health and have a holistic approach. And we’ve come up with a little acronym for total gut health and  we call it Teams: T is for Total body health, E is for Exercise – that has to be part of what we do. A is for alcohol, because people can sometimes be doing all the right things with diet and then maybe overdoing it a little bit on alcohol as well. So it’s really important to stay within safe drinking guidelines. M is for your mental health and S is for your sleep. So we think of looking after your gut health as being a ‘TEAMS’ approach. And they would be my top ten.

Dr Louise Newson [00:33:00] Love it. That’s really great. Thank you so much. So, Elaine, how can we improve? What’s going on?

Dr Elaine McGowan [00:33:06] My top two tips first of all, fibre. Fibre really is a superfood for your gut microbiome. And it’s very important for those that are gut sufferers or that are transitioning through hormonal changes that they find the right amount of fibre for their gut. So certainly not too little and not too much. And in our book, we certainly help people navigate finding their fibre tolerance. And my second one would be variety and diversity of foods, eating the rainbow, lots of colour from basically a Mediterranean style diet, which is lots of vegetables, fruits, salads, herbs, spices, nuts and seeds, and also some animal based proteins such as some poultry, dairy products and also lots of good fats, healthy fats from fish oils, olive oils and also the nuts and seeds.

Dr Louise Newson [00:33:55] Amazing. So much to take in. There’s a lot going on in this podcast, but it’s so, so important. We’ve all got guts and we’ve all got guts that can improve and it’s up to us to make that difference. So thank you so much. I’m really grateful for your time and I’m looking forward to seeing the book a number one bestseller over here as well.

Professor Barbara Ryan [00:34:14] That would be fantastic.

Dr Louise Newson [00:34:15] Thanks ever so much.

Professor Barbara Ryan [00:34:16] Thank you so much, lovely to talk to you.

Dr Elaine McGowan [00:34:18] Thank you.

Dr Louise Newson [00:34:21] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

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