Dr Rupy: I mean that still means that there are probably people in most large psychiatric hospitals who are having medications that aren't working and actually they have an autoimmune condition that could completely cure them.
Monty: Complete cures.
Dr Rupy: Complete cures.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life.
Dr Rupy: For most of medical history in the West at least, the idea that there could be a relationship between the mind and our immune system was completely inconceivable. At medical school, I was taught that there is no relationship whatsoever between our mindset and our ability to stave off infections, so viruses, common colds, even reduce our susceptibility to cancer. But now, that is thought to be incorrect. In fact, there is a clear relationship between our emotions, our microbes and our immune system. And to talk with me about this today is Dr Monty Lyman. He's a medical doctor, researcher and author who specialises in the relationship between the mind and the immune system. He's an academic fellow at the University of Oxford and in today's podcast, we talk about how an irritable bowel relates to an irritable mind, gut rehabilitation and what that entails, the relationship between our mind, body and microbes and what psychological stress can actually do in the body, namely inflammation. We also talk about how an anti-inflammatory lifestyle can heal both the mind and the body by recalibrating what is sometimes an unbalanced defence system. Remember, you can watch this podcast on YouTube and subscribe whilst you're there. It is the no-cost way of supporting us. And whilst you're listening to this on audio, hit the subscribe button on Apple or the notification bell on Spotify. That tiny little thing that you can do pushes the podcast further. You can also find Monty's fantastic set of books online and in all good book stores as well. I highly recommend you get his latest book. It is a wonderful read. I inhaled the book and I have a sneaky suspicion that it's going to get a couple of awards as well because The Immune Mind, the new science of health, I think is going to shatter a lot of strongly held beliefs with the latest evidence and science that we have available to us. On to my podcast with Dr Monty.
Dr Rupy: Monty, what is gut rehabilitation?
Monty: Yes, so for most of us, particularly in the Western world, our guts are so sparse, so desertified of the microbes that the gut needs, the body needs, that the mind needs, that eating the right foods for our microbes, mainly fibre, plant-based fibre, getting the right amount of fibre into the gut actually is like rehabilitation. It's like you've had a knee injury and you're slowly building yourself back up to being able to walk and then run. People should be eating about 30 grams of fibre a day roughly, and a lot of us in the US, North America and Europe have about half of that, 15 grams. The Hadza people of East Africa who are hunter, people say they're the last last hunter-gatherers on Earth and have a diet similar to what our ancestors probably would have had, they have about 150 grams of fibre a day.
Dr Rupy: 150 grams.
Monty: And so eating the right amount of food for your gut is, it needs to be a slow process because actually if you're introducing fibre, if you do it all at the same time, it will just cause you an irritable bowel and an irritable mind. I did this myself when I tried to, earlier last year I decided to try and aim for eating about 30 different types of plant food a week.
Dr Rupy: Which has become very fashionable now. A lot of people are talking about 30 plants a week because of those studies and yeah.
Monty: And I ended up just having three or four onions in every meal that I had. I just had huge amounts of garlic and I just emptied the veg aisles from our local supermarket. And I felt terrible. A lot of the evidence for trying to get a diversified gut microbiome, and we don't yet know what a perfect gut microbiome is, but all the evidence suggests that diversity begets health, basically. And I think I think this on many different levels, but a diverse gut microbiome is associated with lots of different measures of good health. And there have been some big studies that show that a way to get good gut diversity is to increase the variety of plant fibre because they're essentially the food for the gut bacteria. And there's also some some really interesting evidence on fermented foods as well. And I sort of, the way I think about it is I sort of think about it as a way of gut gardening, thinking of your gut as a medicinal garden. And the different types of plant fibre are the fertiliser for this garden. And the introducing new bacteria via fermented foods or probiotics or things like that, that's sort of like seeding the garden. I live near a medicinal garden in Oxford, it's called the Oxford Botanical Garden, but it was initially founded in the 17th century to provide medicinal herbs. Most of the modern medicines we have come from plants. But all the different gut microbes that we have, or lots of the beneficial ones, are basically, they're sort of bags of goodies, basically, they're bags of enzymes that break down and produce lots of healthy molecules for the body. So having a good variety of gut microbes is generally speaking is is good for health. But the trouble is that for in for most of us in the West who haven't been able to get our guts rehabilitated, getting enough fibre, you need to start low and go slow.
Dr Rupy: Yeah.
Monty: You know, as if a physio is telling you this for recovering from a from some kind of injury.
Dr Rupy: Yeah, that's a really good analogy, like having using exercise as the parallel, because it sounds like you went straight to the gym and started lifting 100 kilos.
Monty: Well, yeah, I, as soon as I sort of started looking at these studies, I got really excited. So I ended up clearing the the fruit and veg shelves of my local supermarket and just ate a huge amount of plant fibre in one go. And this is coming from a baseline of not quite junk food, but not not a very diversified diet.
Dr Rupy: What was your typical diet before?
Monty: Be honest.
Dr Rupy: Yeah, we can be honest here.
Monty: I mean, I think for lots of doctors actually, and medical students and doctors, they could be quite arrogant about the importance of diet. I mean, at medical school, I was, I had a friend who once said that I once tried to boil pasta without any water in it, which isn't true, but it isn't too far from the truth. And so it'd be lots of ready-made lasagnas and things like that. The kind of veg I'd have would be stir-fry packets of pre-chopped veg and stuff like that every now and then, but it was just a pretty average diet. I'd buy sandwiches, like just I'd buy sandwiches on my way to to studies or work or whatever. Because I hadn't been taught about nutrition at all at medical school. So I sort of felt that eating wasn't that important. I exercised a bit, so I didn't really think very much of it. But when I started to read these studies, I think, okay, right, I need to sort of up the amount of fibre and diversity of plant fibre in my diet. I went, I went too hard and basically ended up with, I won't go into too much detail, but a lot of IBS, irritable bowel and irritable mind for about a week.
Dr Rupy: So you had the irritable mind symptoms as well, did you?
Monty: Yeah, I think I think that was pretty directly related to just filling my gut with too much too much fibre that my microbes couldn't really break down. But what I did then is I just slowly introduced, you know, half an onion here, a bit of garlic there. And over about five or six months, I noticed a huge change in my physical and my mental health generally. So I think starting low and going slow is is key. There's a really interesting study that came out in about 2021 by the Sonnenburg lab in in the US. And they looked at one group of people who had a high fibre diet for about 10 weeks and one group who had fermented foods for about 10 weeks. And the sort of the big headline from that study was that fermented food is really good for gut microbial diversity and really good for reducing inflammation. But quite an interesting thing was that the the increase in fibre didn't seem to have as much of an effect on the the diversity, the gut microbial diversity. But actually there was a lot of evidence that there was sort of undigested fibre in the stool. So the idea was that, but there were lots of enzymes that were being produced by bacteria to try and break it down. So the idea is that perhaps these people's guts needed to be rehabilitated, maybe over a longer period of time, slower introduction of fibre as well as fermented foods, you might see something different. And I think this is the kind of work that they're probably doing at the moment.
Dr Rupy: Yeah. So I think the takeaway from this is, if you are coming from a relatively low fibre, low diverse diet, you want to go slow and you want to take your time when trying to aim for at least 30 plants a week, rather than going gung ho and using the analogy of exercise, picking up the 100 kilo weights as soon as possible. You know, you need to really build up to that stage.
Monty: Definitely, yeah.
Dr Rupy: And I think the the word gut rehabilitation is is actually quite poignant. It's it's a very descriptive of exactly how we should be approaching this dietary approach.
Monty: Oh, 100%. And I I quite like the word cultivate as well. And I like to apply that to loads of different all aspects of physical and mental health. But the idea of knowing that actually you are a community. Whenever you eat, even if you're eating alone, you're eating with trillions of microbes. And if you have a sense of inward love, not necessarily a completely selfish one, but knowing that you're part of something bigger than yourself, I think that mindset is hugely important because it helps you understand that you are slowly but but steadily but surely cultivating a healthy microbiome, healthy gut, healthy body, healthy mind, you're cultivating a healthy human. There's a lot of understandable talk at the moment about loving the environment and the biodiversity of the world, particularly with climate change, deforestation, pollution and things like that. But I think if we look both ways, if we love widely to the macro, to the large, but also to the micro, you know, charity starts at home. If you treat your body, treat your microbes, treat your microbial friends with love, then that will spill out into everything that you do relating to your body and to other people. I think it they seem like very disparate things, but actually it's all it's all connected.
Dr Rupy: Yeah. Monty, I wanted to ask you about mental health and whether you feel that this huge rise in anxiety, depression and a whole plethora of other mental health illnesses is related to our food environment and what we're eating.
Monty: I think that a lot of negative mental health outcomes that we are seeing in our modern society are likely linked to poor physical health, poor immunity, which is tightly linked to having a poor microbiome. And one of the biggest factors that that you can use to change these things are is the diet. So it's it's hard to directly prove causation in these things. But actually we, I think I think there is good evidence that if we change the culture about diet, the education about diet and change the way we where we eat, the way we treat, the way we see our bodies, that should translate into better mental health generally.
Dr Rupy: And you you talk about this trifecta of our mind, our body and our microbes in the book. When did you first realise that there was this relationship? When was the first sort of light bulb moment that has led to this idea of, okay, maybe food can impact your microbes, that can impact your mental well-being amongst a whole bunch of other health and wellness areas.
Monty: I think I was first became really curious about the relationship between the mind and the immune system specifically when I was studying medicine and working as a junior doctor and I know that whenever I get stressed, my eczema flares up. And in the immunology textbooks that I read about, so textbooks about the immune system, there was no mention of the mind or even the even the brain really. And in all the psychiatry textbooks, there was no mention of the immune system whatsoever. So I found that really I found that quite curious. And I also found it very strange that at medical school we learned about when you have a paper cut, you have in the area of skin where there's damage, there are nerve cells that are that are activated and there are immune cells that are activated to fight bacteria that that might break through the skin. But what I but what we've known for a long period of time is that nerve cells produce molecules that stimulate immune cells and immune cells produce molecules that activate nerve cells to make pain, sort of increase pain in that area if that makes sense. So the immune system, it's been known for a while that the the immune system and the brain and the brain and the nervous system speak the same language.
Dr Rupy: Got you. They have this connection.
Monty: But it's only been fairly recently that we've actually discovered the connection between them. I think a critical moment for this was in 2014, so exactly 10 years ago, when a a team of researchers at the University of Virginia accidentally discovered a connection between the immune system and the brain. So for context, for most of modern medical history, it was assumed that the the brain was completely immune privileged was the word. So the immune system sort of stopped at the neck and dealt with microbial threats or microscopic threats. But when it came to defence, the brain dealt with macro threats, large threats. So a lion or a fellow or an enemy tribesman trying to trying to stab you with a spear or something like that. So that was that was the idea in terms of defence. But in 2014, a team from Jonathan Kipnis's lab at the University of Virginia were looking at the the veins that drain the brains of rats. It's not the most sexy area of neurology. Most people are focusing on the the nerve cells in the brains, the neurons. But actually they were they were this team were looking at the the sewage system of the brain because there's a fluid that's produced in the brain and it sort of comes out into into the spinal cord and into into the veins. But one of these researchers, someone called Antoine Louveau, was looking at the brains of one of these mice and saw a really neat line of immune cells lying right next to this this vein that was part of the brain. And it looked really odd. They were sort of queuing up very politely in mid-air basically. He had no idea what was going on. So he applied a stain to look for lymphatic tissue. So lymph nodes or lymph vessels are basically the sort of the arteries and the veins for the immune system basically. And when he applied this stain, it lit up in green basically. There was this, he had discovered new anatomy. There was a new, there was a lymphatic vessels that connected the brain to the rest of the immune system. And for centuries, for decades before this, that anatomy had been there, but had only actually been discovered 10 years ago. And I think that was a pivotal moment because it led to lots of discoveries that actually there are immune cells, the brain is surveyed by immune cells from the body. The skull has its own bone marrow that produces its own immune cells that look after the brain. And inside the brain as well, there are immune cells within the brain. These things are called microglia. And they were assumed to be, I mean, glia literally means glue. And they were assumed to be sort of scaffolding that sort of held up the the fancy neurons. But actually, we now know that these are immune cells that were donated by the immune system during the development of the embryo. And they went into the brain during during the development of the embryo and they've stayed there sort of ever since. And they can produce inflammation, they can clear up infections and things like that in the brain. And all of this is in the last 10, 15 years, this is this is all brand new stuff and it's actually beginning to show that the brain and the immune system is deeply interconnected and it's part of, I believe it's part of the same system, which I call the the defence system in the book.
Dr Rupy: I I want to give listeners an idea of the magnitude of this discovery because what you said to me is phenomenal because it's almost like we've been staring at, I don't know, a garage and we see the car in the garage, but we don't see all the other trinkets that collect in the garage, the tricycle in the corner, the spare tyre, we've just been focused on the car and we've ignored all the other supporting items that are around this garage. And I remember at med school thinking that the immune system stopped at the blood brain barrier, which I believe you described in the book as well. Like all the immune cells are circulating around the body, going around the lymph system, bone marrow, thymus, all that stuff, but nothing goes in the brain. And now what you're saying, and since this discovery in 2014 is, actually our brain is littered, full of these immune cells that are all providing not just a defence role, but a they shape how we think and and how we remember things. And you mentioned microglia. I wonder if we could talk a bit more about those folks as a supportive role beyond the defence.
Monty: Yeah, precisely. I mean, so microglia are, they're one equivalent is like the the Swiss Guard in the Vatican City when the which is quite a bizarre example, but they were in the early 1500s, the the Swiss army donated these soldiers to look after the Pope. And they still do that to this day. They still have to come from the Swiss army, but it's from a completely separate place, but they're sort of they're in the Vatican. They're sort of protecting the Pope. And actually that's they're basically microglia is sort of the only or the key sort of immune cells that are in the brain. They they don't they don't sort of exist outside of the brain, but there is some evidence that they get early training when in in the sort of developing developing fetus, developing child from immune cells from outside the brain that can come in and can help sort of train them to sort of tell the difference between sort of things that are sort of self and non-self and things like that. And they when so they they often play a good physiological role. So what what they do is they help sculpt the brain. So we often think about when we develop from children into adults that sort of new bits of the brain are sort of added on in a sense. But actually sort of it's the opposite. Instead of the brain being built like a sort of a Lego set, it's like a a sculptor sculpting a sort of a a figure out of marble. And the sculptors of the brain are microglia. So when there are nerves in the brain that aren't being used, there are these immune molecules called complement molecules which sort of lie across these nerves. And they're basically sort of they're basically sort of eat me molecules. So they sort of it's like sort of having a really a really tasty um sort of a bit of chocolate smeared on these on these nerves. And then the microglia come and eat them. But if the nerves are being used regularly, then they have a sort of a don't eat me signal on the top of them and the microglia sort of avoid destroying those synapses basically. So they're so microglia are really important at sort of helping the developing brain. And when we talk about sort of neuroplasticity, the idea of nerves that fire together, wire together, and you know, use it or lose it, the idea of that that that the circuits that you use when you learn and develop. Actually, it's the microglia that are helping sort of sculpt the brain in that sense. But there is another side to them. So if there is persistent inflammation for whatever reason, if there is inflammation in the body that damages the blood brain barrier or infections in the brain or lots of other different different things, microglia can become hyperactive and can end up destroying cells in the brain. And there is emerging evidence to suggest that these inflammatory cells as well as inflammatory molecules may play a role in lots of different neurological and psychiatric conditions. And there's a lot of research that's going into looking at sort of dementia and Alzheimer's disease and the idea that actually a lot of the damage, the proteins and the the protein accumulation and damage that is sort of classical of things like Alzheimer's disease might be a consequence of prolonged inflammation as well as as well as a cause of the damage if that makes sense.
Dr Rupy: Got you. Yeah.
Monty: So there's they're microglia have a sort of a they're a double-edged sword basically, along with the rest of the immune system. So you know, inflammation is a good thing and it's an adaptive thing in the short term. Like pain is a short is a good thing in the in the short term. Stress is a good is an adaptive thing in the in in in the short term. But when it becomes chronic, when it becomes long-term, that's when that's when the damage starts to wreak itself on the body.
Dr Rupy: I want to underline that point actually, because I think that's a really important observation for people to understand that stress is neither good nor bad. Inflammation is neither good nor bad. It just is. But where it becomes uncontrolled or out of balance or homeostasis as we call it, that's where problems arise.
Monty: Yeah.
Dr Rupy: And I I love this analogy of actually, because I always thought in my mind, your brain is like a Lego kit. And as you progress, as you get older, you add new blocks and you build them onto into your brain. But what you're saying is the exact opposite. It's almost we have a big block of marble and the glia have these signals of chip me here, chip me here, and that's how you prune and don't chip me here because this is important. We're using that quite a bit. So this kind of lends itself towards trying to explore ways in which to stress or expand your playfulness in in, you know, learning languages or sport or movement so you can protect more of this precious marble block that you've got such that your microglia don't come and and chip them away. Is that is that?
Monty: Yeah, yeah, definitely. And I think I really like the use of the word play as well. And that's something that I also playfulness and and play, which I think is something that is key to the the immune system and the brain. So I mean, the immune system in in a way is like it's sort of like a brain. It it there is communication with different immune cells across long distances across the body. There's memory of infections that have happened. It's sort of its own self-organizing system. And the brain's similar to that. And there's now a lot of evidence that they're linked together. But one thing about both of these systems is that they love to find out what's going on. They love to be, there's a reason why young people and or adults generally like to try and do new things and to play and to explore and to learn new things because the brain is trying to refine its model of the world. It's trying to understand what's going on. And the immune system does the same. It wants to know what things that are coming into say for the gut, for example, what foods are good, what bacteria are good, what bacteria are potentially harmful. It needs sort of constant training, the immune system and the brain as well. And that's why I like the idea of playfulness. And I I think when it comes to any kind of lifestyle choice, lifestyle intervention, whatever you want to call it, I think curiosity and playfulness needs to be at the heart of it, of diversity, whether it's to do with you're thinking about your mental health, whether it's about the kind of food that you're eating, whether it's the type of exercise that you're doing, the places that you're going to, curiosity, playfulness, expansion, exploring, I think it's really is really key because actually that's what your that's what your immune system, that's what a healthy immune system, a healthy brain wants. You know, the the opposite of stress isn't complete tranquility. You know, space and time are constantly moving. We were made to move, we were made to test our environment, whether it's through our eyes in terms of working out what's going on or our it's for our immune cells in our gut testing the microbes that are coming through it. It's and that's sort of that idea of of curiosity and playfulness is I think you just need to have that in everything that you do, whether it's and that whether it's dietary or you can consider it a quote unquote mental health intervention, you know, if you're journaling or anything, it's it's it's the same thing.
Dr Rupy: Yeah, something that comes up for me as you're talking about that is this idea of playful challenges. So a playful challenge is, you know, trying to introduce something new or perhaps seasonal onto your plate that week. Or another playful challenge is taking up dance instead of just going to the gym and running on a treadmill, for example. Or playful challenges going for a walk in a different forest environment because we know that there are some benefits of forest bathing, the Japanese researchers have told us about for years. So there's all these different things that we can be doing to challenge our immune system, to challenge our resilience to stress, to challenge our physical body as well, so we can move and adapt and become more robust as we as we get older as well in particular. I want to bring this back down to inflammation and immuno-psychiatry. What let me start off with what is immuno-psychiatry? What what is immuno-psychiatry?
Monty: Sure, it's a very new field that explores the relationship between the mind and the immune system. It's also confusingly called psychoneuroimmunology.
Dr Rupy: Psychoneuroimmunology.
Monty: Which sort of sounds fancier, but I quite like I quite like immuno-psychiatry because it's it's a bit it's a bit simpler. And it's a new field because we've only recently got the the tools to explore the scientific tools to explore this amazing connection between the immune system and the mind. So a lot of the research is is looking at people with certain mental health conditions and thinking actually are some of these mental health conditions caused by the immune system or does the immune system contribute to these mental health conditions? Therefore, if we identify the right people, can we treat these mental health conditions with the immune system? But then there's also the other direction as well. And there's a lot of interesting research showing that mental health can affect the immune system.
Dr Rupy: So the other way around.
Monty: The other way around as well. So so stress, for example, I think we all have an intuitive knowledge that stress ends up etching itself into the body and into our physical health. But we are now realizing that this that is partially done by the immune system and that the brain can remember inflammation and can restart inflammation.
Dr Rupy: So a really interesting new study that sort of peeks behind the curtain of the relationship between the mind and the immune system and how the brain remembers immunity and how the immune system listens to your thoughts. It was done by a team in 2020 led by Professor Asya Rolls. And basically they experimentally inflamed the the bowels of mice and used this really sort of fancy new technique called chemogenetics, which I probably wouldn't be able to explain very well, but basically you can work out which neurons in the brain are being activated, exactly which neurons by the inflammation. So they did that. So that was pretty pretty cool in and of itself. But what they did next was they after the mice had completely recovered from the inflammation for about a month, the team then using another technique, activated the neurons in the brain. They didn't didn't inflame the bowel or anything like that, just activated the brain. And in the same part of the body, the inflammation flared up again just by activating the brain. So it's clear that the brain has a sort of map of inflammation in the body and the immune system in the body. But under specific circumstances, and you know, it's going to be fascinating to see how this might relate to humans, the brain, the immune system sort of can communicate to the brain and if the brain sort of activates certain parts of the immune system, then you can have inflammation without any external trigger. And and there is some other studies that show that during acute stress, so in a in a very stressful situation, our sort of inflammatory markers increase in the blood. And then looking into this in more detail in animal models, they've worked out that some teams have worked out that the the brain communicates to muscles, the muscles produce molecules that recruit immune cells from the bone marrow to fight an infection. So the so so if you're thinking about say, if you, you know, we walk down to the studio later and onto the street and you turn the corner and there was a in the middle distance was a hungry lion.
Dr Rupy: Okay.
Monty: And um, and um, immediately as you clock it, you know, your body goes into the fight and flight.
Dr Rupy: Yeah.
Monty: Um, um, fight or flight mode, which we know all about in terms of adrenaline and things like that. But actually, the immune system is activated as well. And particularly bacterial elements of sort of antibacterial elements of the immune system. So so for example, neutrophils are sort of taken out of their barracks in the bone marrow and out to the sort of the walls of the body in the skin and the gut, assuming that if you're going to be attacked by a lion or whatever it is, that the if the skin's breached and microbes come in, then you want to be able to fight those off.
Dr Rupy: So it's like a preemptive signal to your defence that we're going to be in a fight. And if we get cut, we would be ready to fight any pathogens that we can come into contact with.
Monty: Precisely. Yeah, exactly. That's that goes right to the the crux of it really. And that's why I think some researchers and and why I definitely believe that the immune system and the mind are part of the same defence system. So when you see a lion, it's not just your brain thinking, okay, am I going to am I going to fight or am I going to run away? Actually, the immune system is the brain recruits the immune system to fight.
Dr Rupy: Gosh.
Monty: And then the opposite's also true. So when we're infected with a virus or a or a bacteria or whatever, most of the symptoms that that we have are mental.
Dr Rupy: Yeah.
Monty: We end up, this is something called sickness behaviour. You end up retreating from others, you end up feeling really depressed, you often appetite changes, it can sort of decrease massively. Um, you sort of just feel gross being around other people. And actually other people, there's a lot of evidence too that other people feel gross when they're around you as well when you're infected.
Dr Rupy: Yeah. I can attest to that. Yeah, yeah, yeah. My wife wants to stay away from me when I look like I'm ill.
Monty: Yeah. Well, I mean, there've been some some interesting studies um on this in Mats Olsson, who is a researcher in in in Sweden, who I who I interviewed for the book, did a sweaty t-shirt study. So basically, um people um were were brought in and they were asked to to smell the t-shirts worn by so one group was people who were healthy and another group were people whose immune systems have been activated by a bit of bacteria. And um probably unsurprisingly, the the um uh participants rated could could even if they couldn't quite describe how, they could they could tell who had been infected and who hadn't been infected.
Dr Rupy: Just from smelling the sweat?
Monty: Yeah, just from smelling the sweat. And there have been studies that show that humans are very we're very exquisitely attuned to noticing human motions, so biological motion. And we can tell when people are sick um by the way that they walk, even when it's not hugely obvious. And the idea is that when you're when someone's infected with a bacteria or a virus, it's hugely adaptive to rest and sort of conserve energy because the immune system requires a lot of energy, but also potentially to remove yourself from the herd from other people as well. And it makes sense for other people to be repelled from you for that period of time at least.
Dr Rupy: Yeah.
Monty: So that's so we talked about the the mind recruiting the immune system during stress. Well, the flip side of that is during infection, the immune system recruits the mind. So it's all part of the same same system basically. And we're only just discovering the interconnectedness of this.
Dr Rupy: Well, it sounds like this is an evolutionary trait. I always I always like to think of things through what would evolution have designed us for. So we're we're optimizing for procreation, expansion, survival. And I guess it ticks all those boxes because you want to make sure you're not infecting the community that is responsible for your collective survival. You uh as an individual, recognizing someone who is ill, you'd want you want that to be innate as well. And you'd want to have that adaptive behaviour whereby you actually rest and allow your body to fight off any pathogen that you're currently. Isn't it fascinating?
Monty: It's so fascinating. I mean, it's and it's the implications are pretty are pretty huge. It was interesting when you were saying about procreation as well. Um there's there's some evidence to say that um pregnant mothers are also more sensitive to various different things and actually become more judgmental of other people.
Dr Rupy: Really?
Monty: The idea being trying to, you know, maybe trying to protect themselves from other people. And and yeah, there was this PhD thesis that I read last year that was really interesting that demonstrated that there is a quite a big connection between people's um aversion to certain um smells. So if people have a heightened sense of disgust, basically.
Dr Rupy: Yeah.
Monty: They're more likely to be more judgmental of other people, uh and more likely to be sort of biased against sort of out groups and people like that. Um and it's interesting to think about how the immune system and the kind of the effects of pandemics and sort of infections generally influence society in a way that we don't realize.
Dr Rupy: In the knowledge of this being a very important factor when it comes to the likelihood of psychiatric conditions, I noticed in the book you talked about some studies that looked at a previous history of autoimmune conditions and a later diagnosis of a psychiatric illness like schizophrenia. And this appears to be mirrored across different countries in quite large cohorts. So the Danes, Taiwanese, I believe. There's there's quite a few examples of this. What what is the likelihood that we've actually got people with a psychiatric diagnosis that actually have inflammation at the core, the root of why they're ill in the first place?
Monty: Yeah, really interesting. There's over the last sort of 10, 15 years, we've realized that there are some people with severe mental health conditions. So psychotic conditions. So psychosis basically means it's a sort of a a break of one's understanding of reality. So you end up having hallucinations, sort of visual or auditory hallucinations, or you end up having sort of delusional thoughts that are sort of out of context with one's one's culture. And a sort of chronic version of that is is called schizophrenia. But there is evidence that some people with with psychosis actually it's caused by the immune system directly attacking the brain, antibodies directly attacking the brain. And when these people are treated with these with with um sort of treatments that we know about that remove antibodies, these people can make complete cures.
Dr Rupy: Complete cures.
Monty: Complete cures. This, I mean, this this proportion of people with say psychotic disorders is probably relatively small. It's probably less than 10%. But I mean, that still means that there are probably people in most large psychiatric hospitals who are having medications that aren't working and actually they have an autoimmune condition that could completely cure them. So that's a quite a small subset of people. But then I think there's a larger group of people whose, as you mentioned with sort of autoimmune conditions in the body, creating inflammation that can affect the blood brain barrier, the brain and can contribute to or cause mental health conditions that we kind of don't yet know about. And you know, we didn't know about these autoimmune psychosis conditions until very recently. And it's I think humility is key. We're likely to find out over the over the coming years, decades that there are many mental health conditions or things that we call mental health conditions that are that are sort of full body conditions that are sort of that can be directed by the immune system.
Dr Rupy: Yeah. And if there's, I'm just trying to bring ourselves back to the clinic here because there must be a way to try and isolate people who fit that criteria. Maybe, you know, not the not even just the people who can make a complete remission, but at least have some uh relief of their symptoms with an anti-inflammatory approach combined with all the other things, right? I'm not trying to discount that antipsychotics and antidepressants may have a role, but certainly the anti-inflammatory tools that we have at our disposal may also have a role. But there are probably some things that we can investigate already using quite simple tests, right? So.
Monty: Yeah, definitely. I think I think you raise a really important point about these subgroups. So depression, for example, so major depressive disorder, often we can think about it as one condition. But actually the diagnostic criteria, you can end up having 227 different combinations of symptoms that can give you a diagnosis of depression. It's likely that there are different subsets of depression. Some people respond well to conventional antidepressants, many don't. Some respond well to more well to psychological therapies. And there is likely to be a proportion of people who will respond well to sort of immune mediated therapies as well. And as you say, it's about, you know, identifying what works with who, basically. So it's the idea of stratified, personalized medicine, basically. Going so one area that that some of my um fellow colleagues at University of University of Oxford are looking at are trying to work out sort of with with psychosis, autoimmune psychosis is working out what are the best ways of detecting this. So we have, I mean, the gold standard is by doing what's called a, well, it's a spinal tap basically. So taking a bit of fluid from the spine, which is quite it can be quite a difficult thing to do to get the to to properly diagnose this. But there are other blood tests that that people are testing to see whether we can sort of work out, you know, if you you come into a, hopefully, the the ideal and that we are working towards with whether it's depression, psychosis, whatever is that you come into a clinic and you have a blood you have a blood test, you have a good diagnostic workup, and then the symptoms and the blood test, the inflammatory markers, as well as maybe the microbiome in the future as well, are combined to suggest that this person might have might have inflamed depression or this person doesn't. And then that would direct them to the right kind of treatment. We're not there yet, but I think that's going to be, you know, it's often said that it takes an average of sort of 17 years for something to go from the the lab bench to the clinic, often often longer. But we're at a really exciting time where we're getting to see the start of this really interesting science and hopefully big clinical changes are are happening soon. There are some big studies looking into um treatments for autoimmune psychosis or these subset of of inflamed depression. A lot of those results are coming out over the next year or two. So it's very exciting time for the field basically. But yeah, I think it's it's it's something that you don't necessarily want to over over medicalize, you know, you want to focus on the people who would really benefit from the kind of the medical interventions. But then I think it's also something that we can sort of we can all apply to our lives. This this link between the immune system and the mind as well.
Dr Rupy: You mentioned the interesting observations of the rheumatologists giving the monoclonal antibodies and the these anti-inflammatory drugs and then you've got the, I guess they would be gastroenterologists giving the the pro-inflammatory drugs. How is that being mediated? I I remember in the book you talked about the amygdala. Perhaps we can talk to folks about what the amygdala is, this almond-shaped organ, part of the brain. And um and and how that might be involved in in the response.
Monty: Yeah, that's really interesting. It's there are there are bits of the brain that are tightly linked to various aspects of um mental health, obviously. So so the amygdala is sort of it's yeah, you have these sort of two almond-shaped um lobes of the brain that are sort of they they tend to be known as the kind of sort of alarm system, fight or flight activators, which is which is one thing that they do do. Um but the amygdala is is also linked to an area of the brain called the insular cortex, which insula means island, but actually it's one of the best connected bits of the brain. But some really interesting studies are showing that this area of the brain is key for the brain to understand what's going on in the immune system in the body. And um there's evidence that so going back to the amygdala that actually if um inflammatory molecules go to the amygdala, they can basically activate it and basically create sort of fight or flight, anxiety, depression like symptoms sort of in in animal models. But also some some evidence in humans that actually inflammation of these areas can sort of hypersensitize it from a from a sort of psychological point of view as well. And so it's likely that inflammation in in the body can sort of molecules, inflammatory molecules, so the smaller molecules can get through to the brain via the blood brain barrier, particularly if the blood brain barrier is compromised or damaged in any way. But they can also interact with nerves. So there's something called the vagus nerve which communicates lots of things to the brain. Information to the brain from we assumed it was just things like sort of the gut generally and other organs and things like that. But actually it communicates information from immune cells in the body and immune organs like the spleen and things like that as well. So so there are loads of modes of communicating inflammation to the brain and also lots of ways in which chronic inflammation in the body can sort of get into the brain and can damage the brain basically and can change the way that we um the brain works and leading to sort of um various different mental health conditions.
Dr Rupy: Because I think in my my own sort of learnings and and discovery of this topic, my idea was this highway between the brain and and the gut and the brain and the rest of the body. But the way you describe it, it sounds very circular. It sounds very sort of um it's in constant motion. It's not really like, oh, it's a like a the M1. It doesn't go you don't just go up and down. It's it's literally like there's so many different connections going on. Is that how you see the?
Monty: Definitely. I think um I think between sort of mind, body and microbe, we're sort of like a like a wheel where one bit's body, one bit's um mind, one bit's microbe. But a lot of it is sort of indistinguishable. And everything sort of ripples out and communicates with other bits of the brain. I mean, thinking about it from a sort of an adaptive point of view, there's this idea of redundancy, which means that the body has lots of different ways of communicating similar kinds of information if so if one goes offline or whatever or one doesn't really work, then other ones can work if that makes sense. So you so we we there's a lot of evidence that nerves, specific small molecules, various different things can link the gut microbiome, um the immune system and the brain and they're all communicating to each other, all speaking the same language. And we're only just beginning to encode this. I think it's it's fascinating that that there are immune cells in the gut that can be activated by the brain. And we don't kind of yet know how that works. And they can cause they can cause inflammation when just when the brain's activated. We know that that happens, but we don't quite yet know how this communication um completely how this communication works. So I think it's it's the the this new science is really exciting, but I think it's kind of it's something that should humble us as well. That actually there are these there are these many links that we don't yet know about and we're we are just only beginning to to discover. But yeah, I think I think seeing yourself as a loop is key. It's you know, it's um if you one analogy I think of in terms of chronic disease, if you it is the idea of a stuck sort of lid of a jam jar. You can't just apply pressure in one direction, you need to do it in two. So if it's like any kind of physical health condition or mental health condition, you know, you need to recruit your body and your mind. I often people often feel that understandably that if you think about any sort of psychological aspect to a chronic quote unquote physical illness, then you're dismissing you know, you're dismissing them or it's something to do with their personality or something like that.
Dr Rupy: Yeah, I I definitely have experienced pushback of that in in clinic and yeah, talking about.
Monty: And and and then also also the other way people can tend to sort of over psychologize things, but actually sort of psychology is biology and it's all part of a similar thing. And it's tricky because it's in terms of in terms of understanding it because we we were taught as medical students, I guess I sort of the way we were taught is that you know, the body had was designed to sort of house different nice neat systems that didn't talk to each other. It's like the body was designed to create different medical specialties. That's sort of how it how it feels. But actually it's they're they're it's thinking about the different ways the body is adapted is survival is key. And why would you just have one bit of the body that is focused on on surviving and not and why why wouldn't they be interlinked?
Dr Rupy: Yeah, I suffer from that hangover of how I was taught medicine actually of constantly thinking about different areas of the body. And even in the way like we discuss different topics on the podcast. I mean everything always comes back to microbiota. The number of times gut health comes up on this pod is, you know, it's it's always going to happen. But I think perhaps we could do a better job of connecting everything from the discussions we have around women's health, the discussions we have around heart health and the brain and everything else. I mean, it is very, very circular. And it reminds me of um a quote actually that I wrote down from your book that I I loved. It was uh it's from a a Sufi mystic. The body is an instrument of the mind and the mind is an instrument of the heart. And that that for me really spoke to me after like learning a bit more and reframing my idea about this whole system being circular rather than a back and forth arrow. Is there is there a reason why that why you added that? Was that something that you've come across before and that's finally made sense or?
Monty: I first heard it at a um a lecture. I think it was um related to a medical school, but not when I was I was a medic. And it just felt so I can't quite remember who who said it, but it kind of it just it felt like something completely new. It sort of jarred with the kind of the the sort of traditional teaching that the sort of the post-enlightenment West generally in terms of medical teaching had come up with, you know, is there have been lots of brilliant advances by sort of medical advances by um the post-enlightenment West, but actually that's come at the expense of leaving the messiness of the human mind, psychology, emotions to one side if that makes sense. And we're only just beginning to understand how actually subjects that to a lot of doctors and to and at medical schools and various different things are seen as quite woolly, you know, things like um loneliness or um um you know, social oppression, things like that. Um are actually they're biological. They're, you know, we are completely enmeshed biologically with our with our context, our environment and all of our organs are and they're all connected in that sense. Um in circular ways, not in sort of very um straightforward straightforward ways necessarily. Um and what I'm really excited about is that actually we're now we now have the the scientific tools and instruments to be able to explore the relationship not just between the mind and the immune system and the microbiome, but actually our environment generally and how we perceive that and how that affects us and how that affects others.
Dr Rupy: Yeah. You you mentioned loneliness. I wanted to to ask you about loneliness actually. So I'm I'm glad you brought it up because I think a lot of people have heard about the harms of loneliness being as harmful as smoking. I think the US general surgeon was talking about that a couple of years ago. And most people might think of loneliness as um it's it's sad that people don't have support and love, but it's not necessarily related to physical illness. But everything that I've heard from today and how the brain and if you're not nourishing your your brain with the social connections and the environment can have a direct impact on your immune system, that can have an impact on not just your ability to fight infection, but also heart health, metabolic health, etc. It sounds like it's going to be an important factor in uh in prevention as well as management of conditions.
Monty: Oh, 100%. That's it's really interesting. Actually, we see, yeah, in our um very atomized society, we either don't think about loneliness, we sometimes think about isolation and individualism as being quite empowering or as as you said, you know, it's people who are lonely, we can think of, you know, you can say it's sad, but it doesn't really affect you physically. Um but actually the brain perceives social isolation, social rejection, loneliness as a threat to the body, a threat to the whole organism. And there have been studies showing that um when people are socially rejected or isolated, the same bits of the brain are activated as then when you're experiencing physical pain.
Dr Rupy: Physical pain.
Monty: Physical pain. And also actually that's the that's a similar part of the brain that is activated by infection as well. And there's there's not that much research into this, but it's I think there's a huge hugely interesting crossover between seemingly disparate threats to the body. So infections and inflammation, pain and social rejection are kind of sort of processed in in similar ways, which is really interesting. So actually that's loneliness is is as physical as it is psychological and social. As as is various different kinds of structural oppression. It's very hard to measure, which is why people often don't um kind of stay clear of these subjects and can say, oh yeah, you know, there are lots of confounding factors, you know, if you're lonely, you're probably going to have a worse diet or whatever and things like that. But it's it's all it's all interconnected.
Dr Rupy: And again, using that evolutionary lens, you want to regard loneliness, i.e. the lack of social cohesion, uh or rejection as high as an inflammation response or as a, you know, a physical threat. That that sort of makes sense when you appreciate the the lens of why we've been designed, you know, to to get.
Monty: Definitely, you know, fostering community should be a public health intervention. It should it it's it's really serious. Um we are made to be communal, to be social. Um in a similar way in which we need to be communal and social to the various bacteria that are or the various good bacteria that nourish our body and our and our brain. We need to be connected to different people. Um and the effects of a lack of that are physical as well as as well as psychological and social. So actually, I think there is there is a huge public health um urgency for governments to focus on these sort of seemingly social um societal issues and actually treating them as whole body.
Dr Rupy: Yeah.
Monty: Whole mind, whole society interventions.
Dr Rupy: Yeah.
Monty: Um so yeah, and that's and it's really exciting that the science is beginning to show that.
Dr Rupy: Yeah, because we can begin to give the attention to things like social isolation as much as we would do a pandemic. You know, if it has the same um threat to morbidity and mortality, then it should be given the same amount of attention and funds directed to it, etc. Um it would take a lot of lateral thinking, I think, for any government to get around to that stage. But if the science underpins it, then I think you you might see a turn. Um I wanted to talk about some of the case studies actually that you mentioned in your book. And um I I found these pretty phenomenal. And I think now from everything that we've learned about the journey that you've taken on us on the immune system, inflammation, the mind, um they they kind of become understandable with this context, right? Um perhaps one that we could talk about is April Burrell, the person who was in a catatonic state for 20 years. This is phenomenal.
Monty: So this is a remarkable story that yeah, only makes sense in the context of the the changes that have happened in the last 10 years. Um so in the late 90s, um she was a 21-year-old promising accounting student um from the US. And she started to to develop symptoms of what we would call psychosis. So hallucinations um and delusions. And um she was sort of had psychiatric assessments and she didn't really respond to medications, the conventional psychiatric medications for for psychosis. And she got worse and worse and worse until she entered a stage of of catatonia. So that's basically where you have hugely reduced um movement or words or facial expressions. And she would just sort of stand still, muttering um nonsensically for hours, days, years on end for almost 20 years. And there was no treatment that worked for her until the late 2010s. So this is about sort of four or five or six years after the discovery of the links between the immune system and psychosis and mental health. Where some people who had antibodies attacking their brain, when they were treated with um medications that reduce these antibodies, they recovered. And so in the late 2010s, she had some of this treatment and completely recovered. Um so for 20 years, she she lost 20 years of her life. Um and it's amazing to think, it's scary to think about the people living today, but particularly those in the past who have suffered horribly for whom there could have been a a treatment that was effective. Um and I think stories like this and other stories of um of young people who end up um having symptoms of psychosis and schizophrenia, um where it's discovered that actually it's an autoimmune cause. Um I think this should spur us on to really work on identifying these people, working on treatments because it makes a huge difference obviously to these um to these individuals. And what's quite interesting actually is that the way in which the immune system sometimes attacks the brain and causes these conditions may explain why some dodgy treatments in the past continued. So um there's a reason why autoimmune psychosis tends to um happen in or tends to occur in in in young women. And that's particularly because um they can be caused by a teratoma, an ovarian teratoma. So what that basically is is a a tumor um sort of in the ovaries that tends to have that produces various different body parts within it. So you can sometimes have bits of teeth, bits of various different organs and stuff like that. And the idea is that if there are bits of brain tissue in there, then the immune system attacks that, sees it as foreign and then attacks the brain. In the past, people with young women with these symptoms, delusions, hallucinations, things like that, odd movements would often be seen as demon possessed, witches, things like that. And there was an idea of hysteria, which is the idea of a wandering uterus around the body causing these, you know, quote unquote crazy women. Sometimes surgeons would cut out the uterus, would cut out the uteruses of these women. And sometimes these women ended up being cured. But that's because they might have inadvertently taken out the tumor that was causing the autoimmune condition.
Dr Rupy: Gosh.
Monty: So this, so these surgeries were sort of reinforcing the idea that, oh yes, it's the the uterus in these women that is sort of moving around the body and causing these symptoms. But actually what they were doing was inadvertently curing an an immune condition.
Dr Rupy: Wow.
Monty: Yeah. So with April Burrell, it was something slightly different. It's called um neuropsychiatric lupus, which is but it's also a an autoimmune condition where the body attacks various different um cells around the body. It's one of the most confusing, complicated diseases um in medicine, but it can also attack the brain as well. And that was what they discovered that was going on with April Burrell actually. It was
Dr Rupy: So did they give her high strength steroids, I'm assuming? Is that how?
Monty: Yeah, so it's it's so the the it's it's initially sort of high strength steroids and then you can have something called IVIG, which is intravenous immunoglobulin. So basically it sort of mops up the the sort of rogue antibodies. And for lots of these people, the sort of the combination treatment that's being tested now, um and tested by some of my colleagues in Oxford is a combination of this treatment that sort of mops up the antibodies, but also um something called rituximab, which is a medication that basically acts against the immune cells that are kind of spewing out these antibodies as well. And that looks really promising. In lots of people, it's really effective.
Dr Rupy: Wow. Sidebar, is that where we get the word hysterectomy from?
Monty: Yes. Yeah, hysterical, um yeah, hysteria comes from the Greek word for, yeah, uterus.
Dr Rupy: Wow, I had no idea. Yeah, I had no idea about that. That is that's crazy when you when you're still using that word today with the connotations it had.
Monty: Yeah, yeah, yeah. And that's and that's the thing we're often sort of I mean, medicine's done lots of wonderful things, obviously. But but we're often working against sort of complex historical systemic issues when we're when we're trying to to make meaningful change. So it's it's you know, and and often we can't sort of um you know, we we're sort of swimming in in in history and context and these various different kinds of context and assumptions and things like that. Which is why this a lot of the scientists that I've been privileged to interview for this book were basically mocked for their ideas about the gut microbiome affecting mental health and all these different things about the immune system affecting mental health and vice versa, you know, in the sort of the 1990s, the early 2000s. Um and things like that. But actually these people who who've stuck at it are becoming vindicated, which is just yeah, very admirable for those people who are kind of, you know, swimming against a very strong current of assumptions.
Dr Rupy: Totally. I I think I remember coming across the term psychoneuroimmunology a few years ago now and just immediately thinking, that sounds like BS. I have no idea what that means. They've just bunched a whole bunch of words together. There's no evidence for it whatsoever. And I can understand the skepticism of a lot of medics because when you once you've if you've come from a system where everything's in silos, why on earth would you bunch everything together? It just sounds like, you know, gibberish to sell a bunch of supplements and stuff. But now everything's being, you know, validated. That isn't to say like everything out there should be validated or, you know, there are definitely some erroneous actors out there. But I think it just speaks to how open-minded we need to be.
Monty: Yeah. Oh, definitely. And I think that's the importance of science, real science in terms of curiosity. You know, it's not taking, not assuming anything, doing doing the work, um doing the experiments, exploring the data and things like that and not understandably, you know, medicine's a very conservative um profession for understandable reasons. Um and you only want to be doing, you know, rolling out big treatments when there's a lot of evidence for it. So it's it's a balance of sort of curiosity and optimism about these these new connections, but not not necessarily getting too carried away with them. Which is why which is why I think we're at a really exciting juncture because we're uncovering very exciting science um and starting to begin to see how that could translate into the clinic.
Dr Rupy: Yeah.
Monty: Um so it gives a lot of hope.
Dr Rupy: Um probiotics, uh or psychobiotics as John Cryan might refer to them as, I know you've interviewed him for the book. Um what's your thoughts on those? How how far away are we from probiotics having a positive effect and whether we should be prescribing them? Because there's lots of stuff online that you'll find, you know, smartbiotics that are meant to be good for cognition and mental well-being and all that kind of stuff. But uh I my personal opinion is that the science is evolving and I don't think we can spot particular strains. But maybe you've got some insight.
Monty: No, I I completely agree. I think I think it's an exciting field. Um I wouldn't there's nothing that would convince me in terms of the mental health arena, nothing that would convince me yet that there's any there are kind of specific strains that are clinically proven to treat depression or whatever like that. But that's not saying to say that actually um very targeted um probiotics or sort of symbiotics, a combination of pre and and uh probiotics, prebiotics being the sort of the food for the for the microbes could be really useful in in various physical and mental health conditions. And which is why I think I know I completely agree with you and I think in the more practical element of my book, which is relatively small compared to the rest of it because a lot of it is looking at the science and then sort of tentatively looking at what the evidence base is for things that we can do with um with our physical health. Which is why I focus more on on diet, on um plant-based fibre and fermented foods, um things that are things that are healthy, things that we know triangulating through various sort of animal studies and and human studies are good for your gut microbiome and good for your health. And good for your health in lots of other ways. It's not just the gut microbiome. Um there are lots of other anti-inflammatory properties of various different kinds of plant foods, for example. Um is a is a better place to start than pinning your hope on a sort of a a silver bullet specific microbial strain. You know, we have you have trillions of microbes in your gut and it's about the it's about the community. It's about it's it's going back to thinking about um cultivating a community rather than sort of just having one specific replacement or one kind of silver bullet cure because actually it's about it's about diversity is key. Um so actually how that works with specific probiotics, it's it's quite hard to see at the moment. But I'm not not ruling out the fact that you know, there there might be different probiotic strains that might be really useful for various specific conditions because there are animal models that show that sort of um probiotic um various kinds of probiotics can be helpful for different different kinds of health, but it's sort of waiting to see if that really affects um you know, humans in in clinical studies.
Dr Rupy: Yeah, yeah.
Monty: So I think yeah, so so sort of a a hope but a but a sort of a sort of a hesitant hope for the future.
Dr Rupy: I was I'm attracted to the idea of being able to confidently say to people, these strains in this amount, in this dose, great, go for it. It's not going to do you harm, it might do you good. Um but for now, I just sort of refer back to fermented foods, diversity, basically doing what Mechnikov, is it Mechnikov?
Monty: Yes, yeah, yeah.
Dr Rupy: Was doing in the 1900s.
Monty: I mean, he was 100 years ahead of his time. Yeah, absolutely, absolutely amazing and was completely mocked for it. But yeah, no, I think it's um I I think that's I think that's the most sensible thing to do at this point. I mean, I can't necessarily speak outside of the mental health sphere for for for various different gut conditions, but I didn't think I don't yet know of specific probiotics that are kind of a hugely effective in that.
Dr Rupy: Was Mechnikov the uh the purveyor, would you say of modern yogurts and probiotics?
Monty: He's a he's a he's a nutter, amazing, amazing guy. He uh got the I think 1908 Nobel Prize for um immunology. So he was from um Ukraine and ended up going to various different universities and became uh across Europe at the sort of the turn of the 20th century, um spending a lot of time I think with sea urchins in in um the Mediterranean. But basically he ended up discovering phagocytosis, which is the process of um immune molecules, immune cells eating bad bacteria basically. So that's what he got the Nobel Prize for. But then after that, towards the end of his life, he sort of kind of lived up to the sort of the mad professor hype and and got obsessed about um the sort of the elixir of life, the cure for the cure for aging. And he um focused in on a bunch of Bulgarian peasants who had um who basically seemed to live into their 90s, 100s and they put it down to this this yogurt that they that they were drinking, sort of a natural yogurt. And he ended up drinking a lot of it himself and sort of going around sort of saying how how good it was for his for his health. Um but what was really interesting was at the time, the idea of germ theory, the idea that disease can be caused by bacteria was was taking over, which has been wonderful in lots of ways. But it was a sort of a a kind of a war on bugs, basically. The idea that everyone thought that all bacteria must be bad. Um but he was sort of the first person to say, actually, maybe there's something in these the bacteria in this yogurt that is providing um some kind of health, physical and mental health benefits to these uh Bulgarian peasants. Um and unfortunately for him, basically, um just after or a decade after he came up with these these ideas, there was the what was called the the Spanish flu, the H1N1 pandemic and killed a huge number of people. And then antibiotics were discovered, which um was obviously great, but sort of furthered the idea that all bacteria are bad, basically. So so that kind of stopped the the field of um exploring good bacteria in the microbiome for decades and decades. Also sort of um helped back by the fact that we didn't have the technology to properly look at look at bacteria. But he was he was you can't often say that there are people who are sort of a a century ahead of their time. So I'm a big fan of Mechnikov.
Dr Rupy: Yeah, yeah. Me too. Uh he he should be um he should have his own brand of uh of yogurt drinks.
Monty: I think I think there actually is. I think in I think in um South Korea, there is a brand of Mechnikov yogurt drinks. So they're ahead of the game.
Dr Rupy: Yeah, ahead of the game. I can't uh I can't patent that one. Um you mentioned anti-inflammatory lifestyle. Let let's dive into that because this is the smaller section of the book. I really appreciate the science because I think the the science is complex and beautiful. The solutions are actually quite simple, which is why I think it's quite a a short part of the book. The implementation of said solution, that's the hard part, you know, it's getting into habits, getting into routines, you know, making sure you're not going too hard, like with the onions and garlic in the first instance. So maybe we could talk a bit about diet. I know you've already talked about diversity and getting. Do you do you have probiotics every day? Do you do you ferment yourself?
Monty: I I make my own um sauerkraut and um I have experimented with um kimchi and um I have kefir in the morning as well.
Dr Rupy: What's your recipe?
Monty: Um for sauerkraut?
Dr Rupy: Yeah, if it's not a closely guarded secret.
Monty: No, I mean at the moment I'm doing a sort of red sauerkraut, which is basically just red cabbage and beetroot.
Dr Rupy: Okay. What just 2% salt?
Monty: 2% salt. Salt brine for things. I was um also quite enjoy sea kraut, so getting a bit of um um sort of um different different kinds of cabbage and seaweed as well.
Dr Rupy: Nice.
Monty: Um but I'm I mean this is this is all very basic and very easy to do. And I'm I'm not I'm not a good cook. I you know, I'm interested by the science.
Dr Rupy: Yeah, I mean you try to cook pasta with that water.
Monty: Yes. I should never have said that. These these lies that were yeah, um spread by my friends. Um but it's I so I I've over the last sort of year or two, I've been sort of experimenting with different fermented foods and it's really enjoyable and it's really tasty. You know, you just let the bacteria be your sous chefs.
Dr Rupy: Nice.
Monty: Just time and
Dr Rupy: How how long do you put so for the for the uh cabbage and the seaweed one? We're doing a podcast on seaweed soon actually to you know, look through the benefits and you know, there's novel phytochemicals you find in seaweed. And we we have so so much of it in the you know, around the British Isles. It's incredible. Um how long do you do you ferment it for? Are there particular times that you?
Monty: Yeah, um it it varies massively. Um and it's um I think it starts to um the longer you leave it, sort of the the um the tastier it gets. Um um but I can sort of leave it for a month, sort of four weeks to six weeks. Um and then it starts to get starts to get interesting. Um but you need to I you know, you need to make sure you get the right percentage of salt and things like that just to make sure you um you know, aren't developing other sort of cultures of bad bacteria and things like that in there. Um but it's just it's great. And I think with with fermenting it's sort of I I I spoke to David Zilber who's a um who is the head of fermentation at Noma. And he basically said just just start with something you you really enjoy, whether you're just sort of like, you know, pickling chilies or something like that or um just just just create something that you you you know, just experiment with fermenting a food that you like and see what the see what flavors come out of it. And it's it's something that's it's fun. It's um exploratory and it's good for your it's good for your physical and mental health. And the process of it is really really good.
Dr Rupy: Brilliant.
Monty: Um so what was really interesting though, I think with in terms of when you were mentioning, you know, how hard it can be to implement all these lifestyle things. There there are some there are some very early studies that are quite exciting about um the idea that if you get the diet right, maybe that might help with exercise.
Dr Rupy: Ah.
Monty: Because exercise is really hard to do. And I used to exercise loads in my teens and that's one of the reasons why I didn't really worry about food because I thought I was sort of I thought I was above it and didn't need to worry about um didn't need to worry about what I was eating because I was doing so much running and swimming and stuff. Um but since I've started to sort of cultivate my microbiome using um different kinds of um plant foods and fermented foods, without realizing it, I began to sort of crave exercising and running. And then a study came out a couple of years ago um from the team at the University of Pennsylvania. And they found that basically in in mice, um gut microbes cause runner's high. So gut um they had about 200 genetically diverse mice and they wanted to see um how much they wanted to run for. So they were in a in a in a sort of a cage where they could run. And also what their endurance was like when they had to run. And they took loads of parameters, loads of blood tests, loads of um genetic tests, microbiome tests. And they wanted to to use machine learning models to sort of work out what were the best predictors of who would be the like the best exercises. And it was actually the microbiome was a huge had a huge predictive power of working out of predicting how much these um mice would exercise and want to exercise. And they did a lot of very cool tests and they worked out that some um microorganisms produce these molecules called which are sort of they're called endocannabinoids. They're basically um they're called they're called enzymes that break down these endocannabinoids in the gut that activate receptors in the gut that spike dopamine when you're exercising. So why that's the case, you know, why microbes want us to exercise more? Or maybe it's a it's probably a two-way thing. Maybe you know, one theory is that it could be the brain uses the microbial diversity and the molecules coming from microbes as a sort of proxy for how much how well um the the body is being fueled basically. So it's like, okay, yeah, you can exercise more. Or it's also might be beneficial for the microbes to be able to explore more different environments and things like that. So it's it's a two-way thing. So the big the big thing is is seeing whether and there are some studies that I really want to see happen of looking at exploring this in humans as well, which would be really because if if we can encourage people to um have a healthy diet, that also helps initiate healthy exercise, then that's that would be a really good key into a lot of aspects of of good health.
Dr Rupy: Totally. Absolutely.
Monty: Um so that's that's an exciting area. It's it's it's yet to be seen in humans, but it's
Dr Rupy: I've got the title for that paper. It's going to be called improve the gut for your gains.
Monty: We should we should do this now before anyone else does. I think that's
Dr Rupy: That's brilliant.
Monty: That's a great title.
Dr Rupy: That's fab.
Monty: Yeah, that's really that's really exciting.
Dr Rupy: That is really exciting. I haven't come across that. I know it's in mice or whatever, but still it's really, really interesting. Yeah. And what are the other big levers for um uh reducing inflammation? So we're talking about gut, fermented foods, diversity, exercise.
Monty: I mean exercise, yeah. I mean I think we were talking earlier about sort of how about sort of stress and not stress, the idea that actually short bursts of um sort of short, you know, challenges, you know, short bursts of exercise produce inflammation, but actually more exercise over the long run reduces inflammation. In the same way that if you are exposing your gut microbiome, your your immune system in your gut to different microbes, or if you are doing different things and doing different experiences in your life generally from a kind of sort of psychological, social point of view, you can become more resilient to various different things if that makes sense. So it's the idea is that it's sort of training. So there's there's now quite a big body of evidence to suggest that exercise is good for your immune system and there are um some very cool molecular studies or sort of very very cool sort of in-depth studies that show that there are um some cells in in your bones that are mechanoreceptors. So basically they can detect movement and they can increase the production of good immune cells just the just the kind of the actual process of movement. Um but exercise generally is very sort of is very anti-inflammatory uh in the long run. So that's I mean that's hugely important. Sleep as well. There are um some studies, this is a very early an area in its very early sort of early stages, but studies that show that if you have reduced sleep overnight, then your the numbers of say natural killer cells, which are an immune cell that um they kind of patrol for viruses, but also for cancers as well. Those numbers drop if you have sleep deprivation. I mean, I haven't spent a lot a lot of time dwelling on these studies recently because I've got a a three to four month old son at the moment. But I think that's something that people don't often talk about is the fact that you know, you can have all of these um ideas for living healthily. But then but life but life happens. And I think it's about if you see yourself as a if you see yourself as a community, a community within you and you're within a community and mind, body, microbe is a is a is a circle, then if one of these areas isn't going to work out very well for the time being, so for me, sleep isn't isn't, you know, realistically, I'm not going to be able to get my optimize my sleep. But actually leaning into um meaning and purpose and um love and connection and things like that. You know, if you can work on other things that can help your mind and your body at that time, then you don't need to necessarily become rigid and worried about not doing the right protocols and all this kind of stuff. Actually, it's sort of the the the the mind and the body is is inherently flexible. And I think cultivating flexibility in the way that you see the world and the way that you treat your body is is so key.
Dr Rupy: Yeah.
Monty: It's so important. Um you know, having a baseline of habits and protocols and things like that can be really helpful. But actually being able to um to train, to play, to to bend so you don't break is is is what we were made to do basically. Um so I think it's key it's key not to feel sort of bad that you know, if you're not doing all these various different things, but it's kind of it's the it's the journey, it's just being it's having that awareness.
Dr Rupy: Yeah. And that in itself is something that can improve your immune system, having that good sense of perspective on the purpose behind why you do have poor sleep. It's because you're looking after your child and there is a greater meaning behind it. And that would perhaps hopefully array perhaps not all of it, but array some of the stresses of the poor sleep that you're experiencing, you know.
Monty: Definitely, definitely. And I think it's I think thinking about things in terms of vicious and virtuous cycles, cycles instead of just, you know, treating your body like a, you know, treating your body like a machine. You know, actually treating it as something far greater than that. And I think the idea of um there's research into sort of awe and sort of being um and and feeling that you're part of something greater than yourself. You know, and there's you know, you can look at that in in terms of society, community, faith, all these different things. But actually also thinking about it in terms of how you treat the community of your your body, your immune system, your your microbiome is is is hugely important as well. And I think just as you said, having that perspective um is is really important to cultivate that because otherwise you can um make things worse for yourself when life inevitably happens. You know, the body and the human body and the human mind is adapted to face regular changes, so daily changes and seasonal changes, but also to adapt to the the horrendous chaos that life throws at humans. And I think um you know, resilience can be a word that's sort of bandied around and can sort of um and can often be used by organizations to uh justify not looking after their their employees sometimes and just to have a little bit of resilience training. But actually, I think resilience is a is a really interesting concept. And I think actually thinking about biological resilience and psychological resilience are very much more closely intertwined than we than we think. And that's why I think the immune the immune mind link is a really nice way of of seeing holistic medicine from a sort of an evidence-based way.
Dr Rupy: Yeah.
Monty: Um so I think it's a nice sort of microcosm of of those connections.
Dr Rupy: I love that. That's fab. How how um I want to bring this interview to a close because there's so much more I could talk to you about, but um I'm really intrigued to how you describe yourself to your patients. Like what what is your what is your specialty? How how because I don't think when you were at med school, you I I can I can't imagine you were going to be thinking about practicing medicine in a way that encompasses a holistic way of thinking, perspective, purpose, love. You know. Yeah. I certainly not that wasn't going to be my impression when I started anyway.
Monty: Yeah. Yeah. I mean it's it's it's it's it's a tricky one in the sense. I mean my my title, I'm an academic clinical fellow. So I'm a um 75% of the time I'm a a doctor working in specializing in psychiatry in Oxford. 25% of the time I'm doing research. Um and it it can be hard to sort of communicate the idea of, you know, we were talking about the baggage of different of medicine and the baggage of psychiatry, which is a has had a checkered history. Um and um is quite a very sort of rich but complex um specialty. And I I've I actually I pivoted to so in terms of my what career I've chosen to do. I I I spent a lot of my after my my initial junior doctor years, I wanted to do something to do with immunology. So dermatology or infectious disease or something like that. But then I pivoted into into psychiatry because I found it to be really rewarding specialty in lots of different ways, but also it's I think I found the the sort of immune mind connection really interesting. So I've only been in psychiatry for a couple of years yet. So um I'm sort of in terms of how I how I communicate what what my what my role is to patients. I think it's it's key to I think one of the luxuries actually of of psychiatry is that um particularly community mental health, um which I've I've done I've done um some jobs in that is the ability to actually be able to listen to patients and to understand them as people embedded in their community. So it's not like, okay, that you know, what's the what's the diagnosis? You know, you're a diagnosis, what's you know, what's the medication that's going to sort of algorithmically treat this? It's actually what is happening in this in this person's life that's brought them into mental health services. What are the things we can do to help this person that might not be medications, it might be medications, it might be various other various other lifestyle factors, various other types of support. Um various other liaison with other sort of physical health specialties and things like that. But it's tricky because the in in the structure of the NHS, you know, people go to one hospital for the body, another hospital for the mind. It's kind of it's it's it's people tend to get siloed. And and there's no there's no immediate solution for that. But that's what I I hope that medicine will become much more much more holistic um in in the future. I think I think it inevitably will, but it's
Dr Rupy: Yeah. And I think, you know, your work, your research, your book will hopefully be that bridge between the two and actually encourage people not just within psychiatry, but in with the wider specialties of medicine to be a lot more holistic in their thinking. Um but yeah, Monty, you're great. Honestly, you're absolutely fab. I love all your books. You're a phenomenal writer. Um it you're annoyingly good at telling history and and you know, regaling the science of it. And it's it's really reignited my love for the science behind immunology and actually the inner workings of this magical system. And now like thinking about it in a much more holistic sense about how much of an impact it can have on my mood, my digestion, my inflammation levels, my risk of disease. It's yeah, it's phenomenal. So congrats.
Monty: Thank you. I've absolutely loved it. And you know, before this interview, I was slightly worried because I knew that you would you'd know, you know, you'd know all the studies in in from a previous interview with you. I know that you leave no stone unturned. Um but what has been so fantastic is thinking about everything that you're doing is um fits in wonderfully with all of the new research that I've had the privilege of being able to look into in the over the last over the last few years. So it's just it's been an absolute pleasure. Thank you so much.
Dr Rupy: Fab. Pleasure's mine, man. Thank you so much for listening to this episode of the Doctor's Kitchen podcast. Remember, you can support the pod by rating on Apple, follow along by hitting the subscribe button on Spotify, and you can catch all of our podcasts on YouTube if you enjoy seeing our smiley faces. Review show notes on the doctorskitchen.com website and sign up to our free weekly newsletters where we do deep dives into ingredients, the latest nutrition news, and of course, lots of recipes by subscribing to the Eat, Listen, Read newsletter by going to the doctorskitchen.com/newsletter. And if you're looking to take your health further, why not download the Doctor's Kitchen app for free from the App Store. I will see you here next time.
