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Health is in the gut of the beholder

I want to take you on a journey through recent scientific discoveries in nutrition that are shaping our knowledge of food in medicine. We could not start anywhere more exciting than with our digestive system.

Despite the exhausting and confusing gut-health messages in the media, the science behind our microbiome (the population of microbes that live in or around the body) is compelling. Studies looking at the microbiome have accelerated over the last decade and doctors are calling it ‘the forgotten organ’.³⁷

The trillions of microbes (including fungi, bacteria and viruses) largely concentrated in our colon are thought to protect us from infections,³⁸ break down molecules of food,³⁹ create neurotransmitters and even alter our immune system.^40,41 These microbes could impact diseases as far-ranging as dementia⁴² and diabetes.⁴³ Neurologists, endocrinologists and psychiatrists are all looking at gut-focused treatments for a range of conditions we never thought were related. Even critical-care specialists who work in intensive care are getting involved in the conversation about how the gut impacts treatment of the sickest patients in hospital.⁴⁴

The hype is real. Gut health is very important and the current discussion in medicine is going far beyond the expensive yoghurt drinks on supermarket shelves. Rather than a fad, I see the popularity of foods to help our microbiome as a return to traditional methods of eating that our ancestors developed. And there’s evidence for this across all cultural backgrounds. In Japan, pickled ginger is consumed with sushi and miso broth is prepared before large meals. Indians drink fermented yoghurt-based drinks (‘lassi’) and eat a range of pickles with curries. Middle Easterners enjoy kefir, Nordics have smörgåsgurka and Koreans love their kimchi. Spotting a trend? Fermented foods have a long, well-established history throughout different societies’ eating habits, but a lot has changed in Western diets.

Food just doesn’t have the same qualities it used to. We pasteurise, radiate and add a ton of additives to processed foods to make them sterile for convenience and shelf life. All of which have been shown to negatively impact the microbiome.⁴⁵

This concept of bacteria being beneficial is alien to a lot of people because we’re taught to think of them as harmful. But the vast majority of bacteria that live in our body are performing vital functions that allow us to maintain our health. These bacteria are in constant communication with our own cells and it’s important we look after them. I want to encourage you to eat foods that protect and boost your microbiome while introducing bacteria back into your diet.

Eating a diet that nurtures our microbiome is what the current research lends itself toward, but that does not necessarily mean you need to consume expensive supplements and tinctures. Instead, here are some evidence-based and safe dietary interventions to improve your gut health … deliciously!

Eating a diet that nurtures our microbiome is what the current research lends itself toward, but that does not necessarily mean you need to consume expensive supplements and tinctures.

• Prebiotic foods are where the power is! These are specialised types of fibre that are indigestible by the human intestine, but our microbes are able to break them down. Prebiotic fibres essentially feed our microbes and keep them healthy. Not only are they cheap and accessible, they bring a wealth of different flavours and textures to a meal. Jerusalem artichokes, asparagus stem, flax, chicory, wholegrains and pulses are great examples of fibre-rich foods your bugs and taste buds will love, and this book is full of examples of how to get them into your diet. I make everything from stews, meatballs and roasts from these ingredients. This ‘health’ food is delicious and easy to incorporate into your way of eating. Plus, by generally increasing all types of fibre, we can potentially reduce the incidence of cancers, cardiovascular disease and inflammation of the bowel.⁴⁶

• Probiotic foods taste delicious and are a natural way of introducing live bacteria into your body. Despite the popularity of probiotic capsules and powders it’s important to remember that none of these products is created equal. It’s true that some research has shown benefits for urinary-tract disorders⁴⁷ and irritable bowel,⁴⁸ but the study of which bugs can potentially impact a condition is still very much in its infancy.^49,50

For now, I encourage experimenting with different ingredients like traditionally prepared kimchi, sauerkrauts and probiotic yoghurts that are full of different strains of bacteria that may have benefits.^51,52,53 Look for unpasteurised varieties usually found in the fridge section of supermarkets. Experiment by folding them through salads or simply adding them to the side of a dish as a garnish. They can complement the simplest of dishes and add another dimension of flavour.

I see the popularity of foods to help our microbiome as a return to traditional methods of eating …

• Polyphenol-rich foods like cacao, dark green leafy vegetables, beetroot and green tea are richly coloured and intensely flavoured ingredients that bring a host of benefits to your body.⁵⁴ Polyphenols are chemicals we find in plants of which there are literally thousands. Some of them have been shown to improve the gut lining, encourage growth of microbe patterns that are beneficial as well as have other advantages to general health. My recipes are designed to incorporate as many different polyphenol-rich foods as possible.

• Spice your food. Turmeric, cumin, sumac, cinnamon and caraway are just some of the ingredients that improve the aroma and taste of foods, but spices in general are another source of polyphenols. We’ll talk more about them in the Medicinal Spices section (see here), but for now consider that the inclusion of these fabulous ingredients could potentially have positive effects on your gut bugs by reducing inflammation.⁵⁵

• A varied diet is key. Your microbes thrive on new, interesting foods, which is why eating seasonally, for example, may encourage you to change things up throughout the year. We want to make sure your microbes are not bored with having the same meals and studies suggest they tend to favour diversity!^56,57 There appears to be an improvement in the range of gut bacteria populations when a variety of foods are consumed, so here’s yet another reason to try out some gorgeous, colourful recipes and mix things up.

• Raw foods. I’m not a raw foodist, nor do I advocate a completely raw diet. And, contrary to popular belief, cooking doesn’t destroy all the micronutrients in foods. Sometimes, cooking can actually increase the availability of phytochemicals,⁵⁸ like in the case of tomatoes⁵⁹ and broccoli.⁶⁰ But, having some raw foods in your diet like celery, kohlrabi or radicchio is great for the bugs. It makes another argument for not overcooking your vegetables and keeping a little more texture to your food, too. Nobody likes overcooked sprouts!

When it comes to a holistic approach of how to look after our microbiomes there are some other suggestions outside of our diets that I encourage patients to think about as well.

• Avoid antibiotics. Your doctor is trained to recognise and prescribe these when there is a clear need for them, but far too often we see them used inappropriately.⁶¹ Antibiotic medications indiscriminately remove large proportions of bacteria including the beneficial types that are good for us,⁶² so I always encourage a reserved attitude to using and requesting them. You are more likely to convince your doctor to hand them over inappropriately by pressuring them, than if you trust their pragmatic and informed decision.

The Royal Colleges of medicine and editors of medical journals are very aware of the growing problem of antibiotic resistance.⁶³ The huge impact on our gut microbe population^64–67 is another reason why the medical community is trying very hard to reduce antibiotic use. Our microbiome is integral to health and antibiotics have far-reaching implications that we are just beginning to realise the magnitude of. So, for now, trust your doctor’s opinion and keep in mind that while you’re on antibiotics it’s even more important to follow my suggestions to keep your microbiome as nurtured as possible.

• Refined carbohydrates, sugars and sweeteners all have a number of links with poor health outcomes. Their effect on your microbiome is an addition to the growing list. I would exercise caution for any ‘diet’ versions of popular drinks and any foods with synthetic sweeteners as they can adversely affect your microbes.⁶⁸ I still use a little sugar in recipes as an ingredient to heighten flavour and taste because it’s not a bad thing when used sparingly. But there are clear disadvantages to consuming it in excess, and indulgence will affect your microbiome population for the worse.⁶⁹

• Exercise, laughter and mindfulness are not what you’d typically expect on a conventionally trained doctor’s prescription pad, but it’s definitely on mine! As well as the wealth of positive effects on mental health and wellbeing, daily meditation and exercise may also have a positive impact on the microbiome.⁷⁰ You don’t need to wear fluorescent leggings and stare blankly into the abyss. Mindfulness is any action that quietens your inner thoughts and allows active mental rest. Try a guided meditation app, breathing exercises or simply gardening as a way of releasing inner tension and letting the mind relax.

The science examining our microbiome is accelerating at an incredible pace. I’m sure we will learn more in the coming years about how to nurture this inner population that is inseparable from our wellbeing. I truly believe that future approaches to medicine will involve a significant appreciation for ‘gut health’. My recipes will show you how to keep your gut bugs happy, which will ultimately have a wealth of good effects for you.

I’ve written more about these lifestyle changes on my website: www.thedoctorskitchen.com

Fibre champions

We need a greater awareness of where we can get fibre into our diets, and these are some of my absolute favourite fibre-rich ingredients. The official recommendation is at least 30g of fibre per day, but I see that amount as the bare minimum.