Inflammation and your gut: Expert guidance to improve your health

29:40And this is something that you'll find with E. coli, salmonella, basically the pathologic bacteria that are a normal part of our body, they can actually get across and they inflame our immune system. And this is a large part of where chronic inflammation comes from. So our gut microbes play an essential role in maintaining this barrier to protect us. And just to add that when you eat healthy food, like fiber, our beneficial microbes will eat on that fiber and produce chemicals that are then really stimulating our immune system to dampen down any inflammation in the rest of the body. So that's why there's this link between eating good foods and making sure that our immune system is working perfectly, not overreacting, and if anything, can dampen down any of these fires.

30:34But it can't do that if it's not getting the right foods for those particular microbes that are very specialized and need real foods to eat. They can't just exist on burgers because those microbes tend to produce pro-inflammatory substances, things that actually kick up the inflammation more. So that's how our diet starts to play into this delicate balance that Will's talking about. Is it always one way? So is it basically, you start with whether or not your gut bacteria are good, and then it leads to inflammation in the body? Or is there also something coming? Is there also a chicken and egg where, you know, I've got inflammation elsewhere, and that then shapes my gut microbes?

31:23Do we know? It absolutely is a two-way street. So when you have inflammation, the inflammation does affect your gut microbes. So ultimately, though, the part that we have more command and control over are the choices that we make with diet and lifestyle. Those choices ultimately are shaping the environment of the microbes. When you shape the environment of the microbes, then ultimately you are creating a specific microbiome that can create an anti-inflammatory immune system or that is going to promote inflammation in the body. And we've talked about microbiome and bacteria. I'm conscious there'll be some people joining us at the beginning of the year for whom this might be a bit new.

32:05Could you just help to explain a bit what those two terms mean and how that ties back to this idea, I think, of what people are really interested in here, which is, okay, so I want to have the stuff that's going to be reducing my inflammation, but also what's going on with the stuff that's actually increasing my inflammation? So what we mean by microbes are microorganisms. So that means bacteria. It also means parasites. It means fungi and little viruses, but we tend to call them all the same sort of community. And that community is called the microbiome. And there's good and bad guys in there.

32:45And if you're healthy, you'll have a good balance of good guys and relatively small amounts of bad guys. And essentially, they're all like mini pharmacies pumping out generally healthy chemicals, but the bad guys can be sometimes pumping out chemicals that are increasing inflammation, irritating your body. So you want to get that ratio right, and that's where lifestyle comes in. And is it possible to reduce the inflammation in the gut? So I think you were both describing this pattern where you could have this really inflamed gut and some awful things were happening well, which were pretty scary sounding.

33:23So is it possible to reduce the inflammation or is this a sort of like one way street? You can absolutely reduce the inflammation. And, um, you know, the, the exciting and empowering thing about the gut microbiome is that it is constantly evolving and changing, and it is also extremely forgiving. There's research that was done almost 10 years ago that was one of the first major papers in the microbiome where basically they showed that in less than 24 hours after changing your diet, you will start to see those effects take shape within your microbiome. Now, this is not to say that 24 hours is all that it takes to overhaul the microbiome.

34:05That would not be true. But the choices that you make today will start to manifest by tomorrow in your microbiome, and it will be a snowball effect. That snowball starts very small. But if you come back and you double down and you keep following with consistency these same patterns, you start to build that snowball, you start to build momentum, and that momentum can be an anti-inflammatory momentum. And so what happens when the inflammation is reduced? How does that, what happens as a consequence? We've talked a lot about as it's going up? There's two effects. One inside the gut, you'll get a greater number of beneficial microbes rather than pro-inflammatory loving microbes.

34:48And so you get a more helpful set of chemicals being produced and your immune system will then get back into its normal regulation and it'll be able to carry on repairing the body and picking up cancers and dealing with aging and really perfecting metabolism so you're not wasting energy and you're feeling healthier and your chemicals going to your brain or improving your mood and your energy. So it's really getting you back into that perfect scenario before, in a way, this false infection hit the body. So the idea is to use restabilizing things. And because your blood isn't having that inflammation anymore, that also acts two ways and again helps the good microbes overcome the bad microbes in your gut.

35:42So again, this two-way process, just as well as it happens on the bad way when you get a disease or an infection, the same thing happens when you can improve your diet, then all the rest of it falls into place. So I'd love, I guess, having sort of talked about how serious inflammation is, how deeply interlinked it is with our gut microbes, these bacteria, to start to talk about, okay, what's the actionable advice? What can people do? And I think a lot of people listening to this will be saying, okay, that's great. I want to go and make some changes. Tim, maybe you could start by saying, imagine when people are thinking about changing what they want to eat.

36:23what would you be telling them to do in order to really make a difference here? Eating a greater diversity of plants, having more color on your plate, having more fermented foods are particularly important. And the fermented food is very interesting because there are clinical studies showing that people having several portions a day got really big reductions in their inflammatory markers just after a couple of weeks. We don't know the exact mechanisms, but we do know that fermented foods are probiotics. So they're live microbes. And these people, this was a US study where you're having lots of different types of microbes.

37:05So maybe 30 or 40 different species every day. They seem to have a beneficial effect on the resident microbes in the gut. And that meant they were pushing out helpful anti-inflammatory chemicals and actually drove down and suppressed the immune system that was previously high. And this was a remarkable result because no one expected this to be quite so dramatic. And there was a much bigger effect just by from fermented food rather than just fiber alone. So this is a real sign that of all those dietary changes we're talking about, whether it's the multiple plants, whether it's the polyphenols in the different color, fermented food is probably the one that's most specific to inflammation in the immune system.

37:56And it's something I think we haven't really paid nearly enough attention to in the past. So little and often, but I think it's not just having one pot of children's yogurt once a week that's going to do it. You need several portions a day, probably three small portions a day to get these beneficial effects. And at the same time, cutting out some of the negative things in your diet, ultra-processed foods, foods containing bad fats that we've talked about a lot. We know that from our own experiments, people having all these highly processed, saturated fats in ready meals, et cetera, and junk foods, they cause these particular spikes in inflammation.

38:42So cutting them out and then giving your gut a rest so it can't spike and so it can repair itself. I think they're the key essential elements that everyone can do if they want to get a nice, even, low-inflammatory state in them. And people with many chronic diseases, I think, would benefit from this advice, and most of them are not being given it at the moment. Yeah, it's interesting that it kind of boils down to two essential principles from a dietary perspective. Add more plants and add fermented food. And these are two things that we have done throughout human history that we've lost in the last 100 years.

39:24And so restoring that in a way would be restoring a more natural environment for these microbes. And Will, can you help us understand a bit more about how the plant side of this links through ultimately to this reducing inflammation? Well, it goes back to a concept that Tim introduced earlier, which is that these microbes have the ability to transform our food. If we were sterile, which we are not, there's never been a sterile human. We've always evolved with these microbes. But if we were sterile, Fiber - Sterile meaning not that we can't have children, but that there's no, I just want to make sure I understand this.

40:04That's not right. Yeah. Sterile in terms of not having a microbiome. If we lacked a microbiome, which is not possible, all humans have always had a microbiome, fiber wouldn't serve the purpose that it does. Because fiber exemplifies our relationship with these microbes. It's mutually beneficial. We consume the fiber. The fiber is actually their food. We don't have the enzymes to break down the fiber and release the nutritional quality from it, but the microbes do. They have actually thousands of enzymes that allow them to go to work, typically in teams, unpacking the fiber and releasing what are called short-chain fatty acids.

40:52And these short-chain fatty acids in my more than 20 years of study in medicine, I can say without any question at all, these are the most anti-inflammatory compounds that I've ever come across. And they are responsible. This is how the gut microbes restore our gut barrier. This is also how our gut microbes suppress and control and shape the immune system. And it's also how they have an anti-inflammatory effect throughout our entire body, not just in our gut, but even as far as our brain. So the way in which fiber ultimately manifests is fiber comes into contact with microbes. Those microbes do us a favor, releasing these short-chain fatty acids.

41:34And in the process of doing that, they're having an anti-inflammatory effect on our body. So they basically create this magic stuff, these short chain fatty acids, which I've heard you guys talk a lot about. I've literally no idea really what that means, but that's good stuff. And basically the point is we can't get it directly just in what we eat. That's right. It doesn't seem to work when you give it as a supplement. People have tried giving them supplements in clinical trials and it doesn't work like that. and butyrate is the one that's used most. And it also smells like putrefying fish. So you wouldn't really want to have it as a supplement.

42:12So that's not just like, it's not a big part of what, just to be clear, right? Because I don't understand this. Most people don't. It's not like there's loads of these short chain fatty acids when I eat a banana. It's something that actually you need these bacteria inside us to create out of the regular foods that we might eat. So they always are the product of the microbes. But there are foods that do contain short-chain fatty acids, such as butyrate. So for example, there are dairy products that because the cow has microbes that produces these short-chain fatty acids, you'll find it in the dairy products.

42:50They're in trivial amounts. They're not known to have the same effect on the body. And most likely what's happening is when you drink them, these fats get absorbed almost instantly into your body without actually getting to where they're supposed to be. This is a very different thing than to consume fiber and have that fiber wiggle its way down through eight meters of intestines, 25 feet, and arrive into the colon where the microbes are residing, and then be released in that specific location. I think it's important to bear in mind it's not just the short-chain fatty acids. It's this process of dietary fiber having this effect in the colon.

43:33So it's sort of like delivering this medicine to just the right place in the right way. And in this case, though, we feed the bacteria the input to that and then it actually creates this medicine sort of for us in where it's needed, which is deep in our gut. That's absolutely right. And this is the most clear example of the millions of years of co-evolution that have taken place between humans and microbes. We need them. They need us. And this is how we thrive together. Yeah. And that's where the analogy of them being mini pharmacies is really helpful. To produce these wonderful chemicals, you've got to give them the right supplies.

44:18And so that's what our job is, is to make sure they have the right things to make these amazing chemicals for us. If I was really thinking, I want to reduce this inflammation, so I want to be giving the best sort of foods to the bacteria, you talked about fermented foods, but in terms of feeding the bacteria, what are the other sort of key rules that you'd want people to hold on to? So a diverse range of plants is important because that creates a whole range of diverse, different microbes. And the more diverse your set of microbes are, the more different chemicals they can produce together, the less waste there is.

44:56And interestingly, there's a new study showing that the more diverse your microbes are, the less nutrients there are left for invaders. So if you've got a salmonella or something, it can't take hold in your gut because your community of microbes is absolutely eating all their nutrients. So they will literally starve. Whereas if you haven't got very many, because you have a rather limited diet, that new invaders like E. coli or salmonella will take over. The different colors are there because they've got these polyphenols in which are these defense chemicals, which are a general energy for all your microbes.

45:33So in order for them to flourish, they use that as an energy source as well. So regardless of what they're eating, they all like those polyphenols. And then thirdly, you've got the fermented foods, which are these probiotics that have this effect. We still don't exactly understand why they just pass through the gut, stay a few days, and seem to energize your gut microbes to really get our immune system in order and then pass through down the toilet. So that's why you need to have them regularly. So they're the three things that essentially need to happen. But you know, one thing, Tim, with the fermented foods, the study that you're referring to, which was out of Stanford, and it involved Professor Christopher Gardner, who's on the Scientific Advisory Board of ZOE.

46:23One of the major findings, in addition to fermented foods reducing inflammation, is that the addition of fermented foods in a period of just eight weeks, which is exciting and fascinating, were able to actually increase the diversity of the microbiome. And this is a pattern that we see time and again, because when you look at people who have these inflammatory conditions, specifically the autoimmune diseases, if you look under the hood, their microbiome typically has less gut diversity. So it's quite fascinating that when you move the gut from less diversity to more diversity, you also reduce the inflammation.

46:59It's a pattern that we see time and again. Yeah, I'm constantly told by patients that their doctor has said, your immune system isn't very good, so don't eat fermented foods. And I think we need to be moving away from this rather primitive advice, apart from the very rare individuals who might be having cancer therapy with literally no bone marrow or no white cells. But I think you'd agree, Will, that the vast majority of people would benefit from having more fermented foods in their diet. I think that that's a myth that really exemplifies how misunderstood fermented foods are and how far we've drifted away from what was a traditional diet.

47:40Well, I think that's really interesting. Now, for people listening, at this point, it feels like only food can reduce inflammation. But, Will, I think there's a bunch of other things that you talk about that you can do in addition. I think that there's so much that you can do, frankly, without even lifting a fork. And that to me is quite empowering. Because, for example, if you're a person, I've taken care of many people with Crohn's disease or ulcerative colitis, and these people have the worst food intolerances. It's very hard for them to do some of the things that we're describing here, to say, eat more fiber.

48:14I fully acknowledge that as much as I want them to do that, that's not easy for them. So perhaps for them, a place to start is to do these other things. And it includes sort of the classics that we always think of. So for example, sleep. Sleep is incredibly restorative. And people who get a better night's sleep have a healthier gut microbiome. In studies where they take people into a sleep lab and deprive them of sleep, it doesn't take long for you to start to see the effects of deprived sleep on the gut microbiome. It happens very quickly. So sleep and exercise, by the way, many different forms of exercise have different effects on the microbiome.

48:56So don't just always do the same thing, switch up your routine. But I would recommend both cardiovascular exercise and also weight bearing or strength training. I think both of those are complementary to one another. And then Tim alluded a bit to intermittent fasting or time-restricted eating. And to me, this is an important concept in terms of reducing inflammation and also supporting the gut microbiome. And if we could just do one thing, and that would be to have an early dinner. To me, early depends on your own personal lifestyle, but that would be before 7 p.m. And then to say, no food, no alcohol after dinner.

49:41And allow your body a period of time where it's now unwinding, and then you go to bed, and you have a truly restorative period of time that's low in inflammation. That actually is fantastic for the microbiome. And it doesn't take much. We did a study. In that study, the Big If study, we had people doing 14 hours of fasting, which means that they had a 10 hour eating window during the day. And by doing this, we found a number of different benefits, including energy levels increased, better mood, reduced hunger, and I'm personally excited about this one, less bloating. So, and that's quite simply by making those choices.

50:23So once again, there are many different things that we can do that aren't necessarily food that can make us feel better and empower ourselves. Amazing, though, I don't think I'm going to be signing up for that. I have to finish all my dinner by 7pm every night plan anytime soon, Will, but I like your sort of like perfect living. Well, I think it's more just, I want to get people away from the idea of a midnight snack or a nightcap alcoholic drink. That's what I want to get people away from. Amazing. Well, I have to say every night as I'm finally crashing out after finishing the email and eating dark chocolate while watching TV at about 10pm, I think of the pair of you, you know, sort of frowning on my shoulder at my terribly short period of not eating.

51:10But there's always something, it's good to have something to aspire to. Are there any final thoughts on this for somebody who's like come through this story and is saying, okay, so I'm really convinced I want to reduce this inflammation. I'm, you know, I'm worried, in fact, about how maybe I am on the path towards some sort of long-term serious disease, whether it's heart disease or diabetes or whatever. Anything else that you'd want to make sure that they were thinking of as we come to the end here? I would just add that many people are confused. If they went to the internet and said, I've got inflammation, my doctor said, I've got this new disease, and I might go on social media, whether it's TikTok or Instagram, they'd be confronted with this huge array of weird diets and exclusions, things like alkaline water or potato juice or chlorophyll tablets.

52:09Or when I was doing rheumatology, patients were told they could never have anything with tomatoes or overgenes in them ever again. The point is you should be adding things to your diet, not excluding them unless it's ultra processed. So I think that's the main message I would have for people is, you know, if you understand the key role your microbes are playing and you're looking to feed more and more of those guys, don't go down the route of these wacky exclusion diets that have no scientific basis on them and are calling themselves anti-inflammatory diets. An anti-inflammatory diet is one that is generally good for your gut microbes.

52:48I think that's the the message I would leave with. It's a diet of abundance that ultimately we need in order to be successful, not restriction. And I think just to get back to these essential concepts of fiber and fermented foods, and if we could quite simply add these, because the reality is that the opportunities that will have the biggest impact are the ones that we're not doing. So doing more of what we're currently doing is not going to really make a huge difference. What helps is when we take something that we just aren't doing. And we know that 95 % of Americans and 90 % of British people are inadequate in their fiber consumption.

53:25And the average amount of fermented food intake in the United States is zero on a daily basis. So, and if we could just increase that a little bit, we would make a huge difference. And that's where I would encourage people to start this year. And also, last thing, consistency is extremely important. The choice that you make that you can do on a daily basis, it gets back to the snowball idea. If you can do it and you can come back and do it again tomorrow, it's going to make a much bigger difference than that one thing that you did that one time. Brilliant. Thank you both. I'm going to try and do a quick summary on quite a complex topic, I thought, this week.

54:06And please, both of you, keep me honest. So we started off basically explaining what inflammation is. And you both explain that basically if you didn't have the ability to have inflammation, you'd die really fast of like an infection or like, you know, not being able to cure, you know, that my broken toe. So like short term acute inflammation is a good thing. We're built to have that. The problem is that today, many of us get us in a situation where sort of the inflammatory response has been switched on, and it's never switching off. And for people who are therefore in that inflammatory state for year after year, we'll have this terrifying list of basically every disease that anyone could possibly be worrying about.

54:44You're more likely to get it, including, I think, things like cancer that I think, you know, I was really shocked to hear, but also, you know, heart disease, things that you don't really think of as being linked to inflammation at all. That there's a lot of reasons for why that inflammation might be increased, including like our environment and what's happening to us as children. But we talked a lot about how, for those of us who are adults listening to this, it's very much shaped by what's going on in terms of what we're eating. And by the way that that's affecting our gut microbiome, you talked about this incredibly thin layer, I think, Will, between like our body and our microbes and the almost all of our immune system is actually sort of in our gut managing this thing with our bacteria.

55:35And that basically, the sort of food we eat shapes the bacteria that we have inside our gut shapes what sort of microbiome we have. And that sadly today, the diet that we eat is a diet which is mainly the diet that the bad bacteria wants to eat and not the diet that the good bacteria wants to eat. So, we're ending up with like the wrong sort of bugs, which are actually making our inflammation higher. So that's all very depressing. But the good news, I think, is you were saying, if you change your diet, you can increase the number of good bacteria in your gut, and actually that will dampen down the inflammation.

56:12And I think, Tim, you're saying you could positively reduce, therefore, your risks of diseases and your potentially symptoms from some disease. Is that correct? Absolutely, yes. So that's really exciting. And then you said like there's some really simple practical rules. So firstly, what you eat is really central. Eat more plants because plants have the fiber inside them that feed the microbes. And they create then this magic thing called short chain fatty acids, which I think only Will and Tim understand what they are. But for the rest of it, it's like, that's the good stuff that the bacteria make.

56:47And so you need to give them the fiber in order to make the good stuff. And there isn't a shortcut. You can't just eat like a short chain fatty acid supplement. It doesn't work. You got to get this fiber to make all of these different bacteria make it. Think about lots of different colors, because that's, you know, this other sort of concept, polyphenols, which it means, again, basically lots of foods with these different colors is how I understand it, which again is feeding the microbes that are giving this anti-inflammatory properties. And then separately, I think both Tim and Will, you've got more excited about fermented food over the last few years with this new research, and that actually just eating quite a lot of fermented foods, right?

57:29You said, Tim, once a week doesn't get you there. You've actually got to eat - Several portions a day. Several portions a day. It's quite a high bar, which I have to admit I often don't hit. That could make a difference. And then if people are listening to this, it's not only food that you can do interestingly, like sleep and exercise could both also reduce your inflammation. And I think we wrapped up with this idea of time restricted eating. So having sort of long periods of the day when you don't eat. So not midnight snacking and then having something at seven in the morning, but having maybe 12 whole hours without eating or in fact, if you could get it up to 14 hours, which I never can, then that might be even better.

58:11and finally whatever you do do not follow any diet that comes about after you click on the words anti-inflammatory diet on the internet uh is my takeaway tim because basically you're going to get some totally weird diet where you should exclude things and i think what i heard was you know every good diet is like it's it's good for your gut it's about adding more things in and finally it's about consistency because the only thing that's relevant here is something you can stick with you know for years so crazy diets you know aren't going to get you there something that long-term supports you. You got it.

58:45Brilliant. Well, I think everybody has their marching orders. And I think there's something incredibly exciting about this idea that there's things that you can do right now that really can reduce your inflammation and can really improve your health for the long term by basically bringing on all of these microbes to fight in your corner. Wonderful. Thank you very much. Bye-bye. Thanks, everyone. Bye. I hope this episode has opened your eyes to how important your gut microbiome is in keeping inflammation in check and that you've learned something new from Tim and Will. Are you interested in finding out more about your gut microbiome, as I have done?

59:24With a Zoe membership, you can understand what's going on in your gut microbiome with the most advanced tests available and then receive personalized advice and support on how to eat the best foods to support a healthy gut. Zoe can help you feel better now and live healthier in the years to come backed by real clinical studies. Simply go to zoe.com slash podcast to learn more and get 10 % off your membership. Join us next week when I'll be talking to Dr. Andy Galpin about how you can improve your fitness to live a long and healthy life. I'm your host, Jonathan Wolfe. Zoe Science and Nutrition is produced by Yellow Huins Martin, Richard Willen, and Tilly Fulford.

1:00:03As always, the Zoe Science and Nutrition podcast is not medical advice. It's for general informational purposes only. If you have any medical concerns, please consult your doctor. See you next time.

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