Dr Rupy: Should everyone do a gut microbiome test?
Dr James Kinross: Only if they have someone who is an expert that can interpret the results.
Dr Rupy: Okay. Is there any general benefit to taking a probiotic supplement every day?
Dr James Kinross: No.
Dr Rupy: Interesting. Do my gut microbes determine how easily I can lose weight?
Dr James Kinross: Yes.
Dr Rupy: Can my microbes stress me out?
Dr James Kinross: Oh yes.
Dr Rupy: And if I look after my gut, will it help me live longer?
Dr James Kinross: 100% yes.
Dr Rupy: Okay, great. Wow, there's some really interesting things here that we should unpack. So our first conversation went down really well with the community, focused largely around your book and you've got this incredible analogy of climate change and how that mirrors what's going on in our gut ecosystem. And I think on reflection, I really want to make today's episode super practical for folks. We had tons of questions and I want to, I want you to almost teach us how to be activists for our own microbial ecosystem, our own microbes. So, you know, we're waving the flag, we're the just stop oil for our microbes in today's episode. And I think what would be great is, you know, if we were to do the best thing possible in a day for our microbes, our gut health, what does that look like? What does it look like, you know, it's almost like taking your kids to Disneyland and giving them all the treats that they want. What is the equivalent for our microbes from the moment we wake up to the moment we go to sleep at night?
Dr James Kinross: Well, the first thing has to be don't go to Disneyland. I literally couldn't have anything worse for your microbiome than going to ultra-processed food land in the land of the morbidly obese. So don't go there. So I think the first thing I'd say is if we've learned one thing from microbiome science, it's that our microbiomes are really individualised and the major challenge in answering that question is that it will probably vary from individual to individual and it will probably vary from city to city and country to country and we know that that exists. But I think there are some sort of common generalisable things that we can say. And and we're going to make a broad assumption in the answer to this question, which is that diversity is a, is a, I think a measure that we can all largely agree on is a measure of health of any ecosystem. And a human microbial ecosystem is no different in that regard. So what we're aiming for in our daily lives is to maintain diversity and we're also aiming to achieve I think two other key features. Through diversity, we want resilience, which means that when we hit the bumps in the road that we just all inevitably hit because we, you know, live in Western cities if you're predominantly if you're listening to this probably, and we've got busy lives, that actually our gut has just got the ability to cope with that. It can, it can, it can deal with the occasional hit of antibiotics, it can deal with the occasional kind of trauma, but also it's got the plasticity to adapt to it. So I think of the health of a microbiome having those three key things. It's got, you know, it's got, it's diverse, it's resilient and it's got that plasticity that it needs to to adapt. So whatever we do has got to give it those things.
Dr Rupy: That's great. So that was actually probably where I should have started at this, in defining exactly what we mean by good gut health or doing things that are good for our gut health. So diversity, resilience, plasticity. So keeping in mind all the time that everyone's what's good for someone is different to another person. But there are some general sort of practices within that.
Dr James Kinross: Yeah. And and I think, you know, probably I mentioned this last time, when I think about the microbiome, I think about it having these sort of two other kind of important constructs. It's not just the makeup of microbes, it's the fact that it's got some evolutionary basis. So that whatever we're doing is supporting and nourishing those evolutionary relationships that we have, but also that it's got that time dependent relationship with us. So the answer to that question is very different if you're, you know, a neonate or a baby or if you're an older person, you know, in, you know, towards towards the end of life. Those demands are going to be very, very different. They're going to be different for men and women, they're going to be different for people living in a rural community to living in an urban environment. So we've just got to have that flexibility in mind.
Dr Rupy: Okay, great. With that in mind, let's look what a healthy day looks like for a 39 year old man. For a friend. Yeah, yeah. For someone, let's say, you know, who has a working week, commutes, is relatively healthy and is able-bodied so they can put into practice a lot of these things.
Dr James Kinross: So, so the, so the, the good news in answering this question is that the answer is probably full of common sense things that you already know and already tell your listeners and already practice yourself. And the gift of the microbiome is that it explains why those things are really beneficial to do and and why and how they work. Okay. Right. So, so what we're going to do in our day is we're going to, we're going to follow some basic principles, which mean first, do no harm to these microbial systems, right? So the first thing that we're going to try to do is not to damage them. And the second thing that we're going to try and do is we're going to try and nurture the ones that we need and then we're going to try and feed and sustain those microbes that give us the balance that that that that we that we need. And to to achieve those things is is we're going to look beyond food and nutrition. So food and nutrition is super, super important, obviously important, you know, we're going to talk a lot about that, I guess. But we're going to think beyond that. And what I want you to think about when you're trying to do these things is I want you to consider your gut much like a a garden. It's a living thing. And if you treat living things badly, they'll die and they will treat you badly. And if you treat living things well and sustainably, then they will treat you well. So we are, we've got a living ecosystem and we're trying to nurture and protect that living ecosystem. So of a day, what that means is is we're going to, we're going to hopefully, it's not always the same for me, I'm going to wait from a restful night's sleep. Okay. So we're going to acknowledge that the gut, hurdle number one. So we're going to acknowledge that the gut, hurdle number one. Right, if you've got young kids, let's say, it's not always possible, right? And and we sleep badly in this country. We sleep badly in in the West and there's plenty of real, real experts on sleep. I don't pretend to be a sleep expert, but what I do know is that the microbes in our gut oscillate with our circadian rhythms and they help define our circadian rhythms and there's that two-way conversation between the brain and the gut around sleep. And if you're not sleeping properly, you're not going to have a happy immune system, you're not going to have a happy set of microbes. So in this fictional fantasy world, I'm going to wait from a really good night's sleep. And the first thing that I'm going to do is ignore my telephone and I'm going to ignore all that digital content which is going to wake up that gut brain interaction and put it on the wrong footing from from the get go. Right.
Dr Rupy: So when I'm look, so when I'm waking up, as a lot of people do and I used to, you have your phone or your iPad or some sort of device that's going to give you news or notifications straight away. This is not good for our microbes.
Dr James Kinross: Well, it's just not good for our health full stop, right? You know, and and again, it's like a brilliant example of what I was telling you about before. There's a million reasons why you just shouldn't be doing that. And and you know, it's not good for your gut brain and it's not good for your immune system and it's not good for your mental health more broadly. But you know, actually I've had to take, you know, I'm really bad at this. Like I've got to be totally honest with you. Like, you know, I I find these things hard to do myself. So I've actually just, I've actually, I don't know if I can promote products. I have no value. I've just, there's this quite a good startup called Brick run by these.
Dr Rupy: Oh, yeah, I've heard about Brick. Yes.
Dr James Kinross: I've just had to, I've just started using that because I just had if I don't take my phone away from me and I don't have a physical disconnect from it, I'm just on it.
Dr Rupy: Do you want to describe to folks what Brick is?
Dr James Kinross: So Brick is like it's an app you can find it go online, you know, it's just it's a small startup. I mean, hopefully it won't won't fold now that I've given it some hype, but but it's so what it relies is you tapping your phone onto through to their hardware and there's a sort of Bluetooth functionality and it just blocks all your social media apps or any apps on your phone that you don't want to have access to. So for me it's email. So anyway, I just I have to digitally detoxify myself and I've had to be really proactive in how I do that because if I don't do that, I can't sleep and if I can't sleep, I can't function.
Dr Rupy: Honestly, the popularity of apps similar and hardware similar to Brick are rocketing because I think a lot more people are coming around to this idea that even if they didn't understand the connection with their microbes, they definitely recognise the impact on their mental well-being, how excitatory it can be, particularly use of these devices at night and the disruption to our sleep. Even just the simple things of comparison and anxiety and all that kind of stuff that's mixed into the the apps that we use and are addicted to every single day.
Dr James Kinross: So true story. In preparation for this podcast, last night I was not doing what I've just told you because I was lying in bed thinking, oh gosh, I've got to meet Rupy tomorrow, I better say something intelligent. So I was doom scrolling and there's a point to what I'm about to tell you because the second thing I'm going to tell you in my list of what we're going to do in the day to protect our microbiome is we're going to wake up and we're not going to take a bunch of supplements. We're not going to do that, right? Okay. So last night I was I was like, I was just wonder how crazy people really are about this. So I was on a Reddit, I was on a subreddit. If you like, if you want a bit of entertainment, go to the Reddit subreddit on supplements. And I just got, I went down a kind of proper supplement like hole. Wow. And the madness of it is just, so so my point is is that another reason to do that is because there's just so much misinformation. There's so much, there's so many people giving you the wrong advice and it's so easy to be sucked into that world. And the best and easiest time to be sucked into a subreddit on supplements is at one in the morning when you should be sleeping. And there was this woman, you know, proudly saying, I've taken 64 supplements a day for 53 days. And I'm just thinking, you know, wow. Yeah. How did we get to this point? Right, your problem is, your problem is something quite different, you know. And we'll talk about that maybe in a bit. So, so digitally detoxify and sleep. And then wake up in the morning and the first thing you should not be reaching for is a bunch of supplements.
Dr Rupy: Before we go into that, I just want to, there is there is a this interesting concept that probably was promoted on Reddit actually, to be fair. But this idea of a kale and cocaine phone, have you heard of this?
Dr James Kinross: No.
Dr Rupy: So it it takes the sort of concept of brick a little bit further. So brick kind of locks those addictive apps and then you've only got, you know, your message app and your phone and maybe Google Maps and that's it, the boring stuff. Having two physical phones, one where you've got all the addictive apps, you know, Tik Tok, Instagram, WhatsApp, all that kind of stuff. You've got that. That's the one that you use, you know, for maybe an hour or two a day and you keep it locked in the drawer. And then you've got your kale phone. Your kale phone is the boring phone. You take that to work and you know, your family can contact you in emergency.
Dr James Kinross: So what you're promoting is a burner phone. Yeah, yeah. I get it. Yeah, that doesn't seem so sustainable to me. It seems like perhaps we're not really addressing the underlying problem.
Dr Rupy: Which is to to have a more sort of holistic relationship with these apps in the first place.
Dr James Kinross: With information and technology and that brings in like broader, broader, you know, I suppose discussions that are pretty timely right now.
Dr Rupy: For extreme problems, sometimes you do need extreme solutions in the interim. So if anyone there is struggling, the kale and cocaine phone is a viable option, but yeah.
Dr James Kinross: Well, we'll recommend that. Yeah.
Dr Rupy: So sorry, yeah, we're going to talk about supplements.
Dr James Kinross: So I'm going to wake up in the morning rested. I'm not going to go to my phone and and I'm going to go downstairs and I'm going to, I'm going to connect with some people. In my house, that'll be my family. I appreciate that's not easy to do necessarily if you're, if you if you live alone. And it's not easy for everybody, but the point I'm making is is that social connection is a is a profound importance in the health of our microbial ecosystems. And of course, you know, your home and the microbes you come into contact with in your home are also very, very important. And so, you know, what I'm going to think about that a little bit. I'm going to go and say hi to my kids and I'm going to connect with them and I'm going to go and kiss my wife if she'll let me. She may not. And um,
Dr Rupy: Well, you talked about in the book, didn't you, about how just the act of kissing is microbial transfer.
Dr James Kinross: I'm not going to snog my wife. She's, I'll tell you right now, she's not having it. But but but what I think the point that I'm making is is that physical connection. So I think there's this fact that came out of some work that when you when you kiss, you transfer like 80 million microbes per kiss. But it's got to be a good snog. And but the kind of broader point is is that physical connectivity and real world networks promote microbial health. Just to divert for just two seconds, there was quite an interesting study that came out of um some work done in Honduras and they were looking at 18 sort of discrete social socially, you know, disconnected villages and how social networks work within those villages and how that works for the sharing of microbes. Within those villages, what they found is is that people at the center of their societies had much more diverse microbial ecosystems, but those orders of connection extended beyond your immediate family into second order kind of social connections. And actually those things existed over time. So, so, so social connectivity and real world connectivity is very, very important. So when I in this fictional day that I'm not entirely sure exists in my life, but I'm having breakfast with my family at the table. And we're taking some time out and we're going to have a little conversation about the day. My 14 year old daughter is probably going to moan and well, sorry, Liv, she's going to, she's going to be charming and and be super excited about her day and I'm sure really interact with me. But we're going to try and take some time to to do that.
Dr Rupy: I love that. I mean, perhaps you can't do this every single day, but I think, you know, even if it's just through the, even if it's just through the lens of your microbial health, perhaps there's something you can do on a weekday, a weekend, you know, a Saturday or a Sunday. I mean, I love the idea of one day when my son is older and he is charming as well. He'll want to spend a few hours in the or an hour in the morning like having breakfast and having connection and hugging and, you know, eating some delicious food that he would have cooked as well.
Dr James Kinross: But also like with your friends, like that's what the Honduras study like, I think, um, you know, one of the greatest problems that we face in a modern urban society is loneliness. Like loneliness is a, it's, it's a catastrophe and it creates harm through multiple different multifactorial ways. Um, and as men, we're also not particularly, you know, in mid-life, we're less good at kind of building those those relationships. They're they're really profoundly important and we need to work at them. And and and again, there's a million reasons why that's good for your health. It's probably have nothing to do with your microbiome frankly, but but it is also good for your microbiome.
Dr Rupy: Brilliant. Um, have we brushed our teeth yet?
Dr James Kinross: Oh, um, I probably have and I would brush my teeth after breakfast in my day.
Dr Rupy: After breakfast. Is there a reason? Is there a reason why like for the health of our oral microbiome or gut microbiome?
Dr James Kinross: So, so, yes. So oral health is um extremely important and it's extremely important for your microbiome and and the oral microbiome particularly we are rapidly discovering has an array of functions that determine everything from brain health to gut health more broadly. We're beginning to understand that, but also your oral microbiome defines how you taste and experience food. And um, in fact, it influences how you, perhaps have um, the foods that you might crave and and and feelings around appetite. So, so I tend to brush my teeth after I've had my my food because I want to experience that that that food. Um, and um those microbes are kind of important. I'm doing that, but then also when I go out to start my day, I've got, you know, fresh breath teeth, which I think is probably good for my patients because they probably don't want me breathing on them.
Dr Rupy: I love that. Okay. I'm going to try that. You know, I'm actually going to do a little experiment where I taste my coffee one day after brushing teeth and one day before and just seeing because I can in the morning, perhaps because I'm craving my my black coffee first thing in the morning, even though I delay it a little bit. Um, I hydrate before I caffeinate, that's sort of the saying I have in my mind. It just tastes incredible first thing in the morning. Um, it's, you know, I I get the flavor profiles and my mid-morning coffee after I've had breakfast in in the day, I don't taste it as much. And I don't know why, whether it's because I'm not spending enough time with my coffee to to get the tasting notes or something actually has changed in my oral microbiome that leads me to taste it differently.
Dr James Kinross: Well, I mean it's interesting. I mean there might be a number of different reasons why that why that happens, some of which do have something to do with the microbiome, some of which don't. But but coffee has its own microbiome, right? So coffee beans, I mean they literally have their own microbes that define their taste because they're manufactured through a process of fermentation and you know, you can define a coffee plant by its microbes, right? So um, there again, that sort of it's another way through which we sort of you started this conversation by talking about climate change and and a key thing about the microbiome is that it literally connects us to our external environment. And coffee has reshaped planetary microbial ecosystems because we farm it on a massive scale and everybody drinks coffee, right? We drink two billion cups of coffee a day. And coffee shapes your gut microbiome, 100% it shapes it. Um, and what we know is that there's this super fine amount of coffee that you can drink where actually if you drink two to three cups of coffee a day, it's really good for you. And if you drink a bit more than that, it suddenly isn't so good for you, right? So, so everything that you do, you know, is connected and your microbiome will absolutely influence how you taste and experience coffee because there's an evolutionary partnership with it, right?
Dr Rupy: Yeah, yeah. I love my coffee.
Dr James Kinross: Me too.
Dr Rupy: I can see why, yeah, two billion of us or two billion cups are drunk a day. Um, I'm definitely contributing a lot to that. The uh, you mentioned supplements in the morning and not having supplements first in the morning. What's the reason for that?
Dr James Kinross: Well, I think the point that I'm making and perhaps we'll talk about this a bit more is that, you know, you can't supplement your way to a healthy gut. Okay. So a healthy gut comes from, you know, a combination of factors, but the number one thing and the the key take home message from this talk is by having a diverse and varied diet, right? And we can talk about what that means. But by taking a massive stack or as they sometimes refer to it in the social media world of of of of supplements, you're not, there's no shortcuts to that diverse and healthy diet. Um, some people need to take supplements, right? There are very good reasons why particular people might need and have to take supplements and that's fine. And probably as a nation, we don't have enough vitamin D and you can supplement in specific circumstances to enhance and protect your microbiome. So I do take on my cereal in the morning a bit of inulin and a bit of prebiotic fiber. I just do that and because I've measured my microbiome and shamefully it wasn't as diverse as I needed it to be and that was an easy way that I could correct it. So that's what I do and it and it works and and that's part of a nutritional and food based strategy for for changing it. But I think we fetishize supplements. Just to diverse, to sorry, to diverge a little bit. I was invited to give a lecture at Vita Foods Europe. I think it's called Vita Foods. Vita, it's like this massive expo. It was in Geneva, right? I don't know, tens of thousands of people go. It's like this huge, huge, vast sort of expo hall. And I walked around that and I just thought, why did I waste my time doing a PhD? Like this is just a scienceless exercise of absolute, it's a bullshit fest of marketing nonsense where you can just make any health-related claim about anything and stick it in a supplement. And and it and it's just really, I don't know why I was shocked about it really. So I'm not saying that not all supplements have value, plainly some do. But there's a lot of mis-marketing and mis-selling of these supplements and there's a lot of misunderstanding how they actually have and derive a health benefit because quite often those supplements are sold in combinations. You're not taking one thing, you're taking multiple things in a single product and they interact and those interactions with your gut and your microbes within your gut are often really complex and and um derive out of, you know, interactions between communities of microbes, most of which are very poorly understood. And very rarely do we give them in a targeted way. We say, okay, we're going to measure something, we're going to note either a specific deficiency or we're going to say, look, actually your microbiome really needs these things. We're going to give it and then we're going to measure to prove that it has an actual benefit after the effect. Which to me is also kind of slightly backward. If we're saying that these things are really important for your health and you really should be taking them, well then there should be some evidence, there should be some mechanism and you should probably be measuring what you're doing. So I think just taking supplements blindly expecting them to help your microbiome is probably not helpful.
Dr Rupy: So you mentioned vitamin D that, you know, is part of government guidance. And at the top of this, we talked about probiotics and how they're definitely not something that you would suggest. And it is really tempting for a lot of people who consume that marketing information about, you know, foundational health, looking after your microbes, particularly with the rising, I mean, I don't know if you've seen the Google trends of gut health and the number of times that's typed into Google now, it's just like this massive mountain over the last four or five years. But you can understand why people fall prey to this idea or this concept of probiotics in a supplemental form and just taking that every day. Is there no evidence whatsoever that as a foundational supplement for everyone that would be beneficial?
Dr James Kinross: So I am not anti-probiotics. Like I, I advocate for probiotics in specific clinical use cases. I recommend probiotics to my patients in specific instances and there is evidence, there's lot, you know, there's nearly 17,000 published studies of probiotic uses in multiple different clinical scenarios where they have real value. So I'm not saying that they are not in and of themselves, you know, valuable. There is no question that there is mis-marketing of probiotics. And that's largely because they're trying to bypass EU regulations around health claims that they can make and they're selling into this nebulous wellness market, like whatever that is. I mean, who knows what the hell that is, right? So you can, you can say whatever you want because it's wellness. And quite often these probiotics contain lots of sugars and they contain lots of other um, stabilizers that go into those probiotics which they don't really, you know, shout quite so loud about. And there's very poor advice given around how to take probiotics and we are very bad at targeting probiotics to specific people for specific reasons. And and part of that is because um, we don't, that quite a lot of that information is missing. We don't really know how to target them. Quite a lot of probiotic strains, so lactobacilli and and biffs and the bifidobacteria are actually derived from, you know, non-human sources. They're not designed to be in your gut, you know.
Dr Rupy: I don't think a lot of people realize that.
Dr James Kinross: No, they're not, they're not, you know, they're not, they're not found in humans and discovered in humans because they're natural members of the human gut. You know, they are artificially being placed into that gut. And this idea, I think many people think that you take a probiotic and suddenly your gut blooms into this diverse ecosystem. That's absolutely not what's happening, you know. And you read these probiotic formulas and and they say, oh, it's got, you know, five, you know, billion colony forming units. You think, well, God, that's a lot. But then you think about the fact you're dropping this into a hundred trillion, a community of a hundred trillion bacteria. It's like a drop in the ocean. And it's maybe one strain or two strains or five strains, you know, where there should be 500 or a thousand strains or or species. So these things don't necessarily change the community structure of the microbiome, they don't change the wholesale function of the microbiome, but they might have very specific health benefits in very specific use cases. For example, lowering cholesterol, right? So if you've got a high cholesterol, actually there's pretty good evidence that taking a regular probiotic, that means waking up and doing the opposite of what I've just said, taking it every day for at least a minimum of 12 weeks and then measuring what your cholesterol was before and after and demonstrating it has an effect. Because if it doesn't have an effect, then you're wasting your money and you need a different strategy. And maybe you're on the wrong probiotic and maybe you need to change again. So, so, I think, um, it's, I think the point that I'm trying to make is it's a nuanced topic and it's not a panacea. Taking a probiotic, you know, one of these kind of endlessly marketed probiotics is not going to suddenly make your gut healthy, but it might have a very specific health benefit if you're taking it for the right reasons.
Dr Rupy: Yeah. I think, um, what you mentioned there about having a clear starting point that's measurable, like cholesterol level, testing said supplement in this case of probiotic and then retesting, um, reinvestigating at 12 weeks to see if there's a desired effect is something that's missing from a lot of supplement strategies that people have anyway. So whether they're taking magnesium or omega-3, they're not really thinking about this in a scientific way in their end of one experiment. And I think perhaps that's what the missing piece is for a lot of people with their supplement strategies.
Dr James Kinross: Yeah. I mean, I think you're probably right. And that's why I recommend like to a lot of my patients and people that ask me about this kefir because kefir is, it's cheap. Number one, like these probiotics are really expensive and quite often they're mis-sold in these subscription models that just lock you in. They can be like 70 quid a bottle. Like, you know, it's insane. Like, you know, some of the more kind of, you know, newer ones, they're, they're just sold on hype really. Whereas kefir is a couple of quid. It's cheap as chips. It's probably got the majority of these good bugs that you really need anyway. Plus, it's got all of their fermentation products in there. So it's a pre and it's really a symbiotic. It's got prebiotic fibers and all the other small molecules that they produce. And actually you can put that on your milk and you can have it every day as part of a sustained behavior change. So if you want to have a healthy gut and a healthy microbiome, it's about doing things repeatedly over time because that's what your microbes really need. It's an ecosystem. They need, they need a sustainable environment that they can, that they can bloom and that they can grow in. So, you know, actually getting into a habit where you're putting a bit of kefir on your cereal in the morning is actually probably a more sustainable way of doing it.
Dr Rupy: Yeah, I love that. I mean, I I use like sauerkraut and kimchi in the morning as well, just on top of toast and and that's it sounds pretty weird, I think for some people who are used to, you know, cereal and and all that kind of stuff. But for me, it kind of works really well. And not to labor the point on supplements, I know we haven't even got past breakfast yet, but um, a lot of people are taking to powders, right? So whether it's a greens powder or it's a berry powder or a combination of some of them are, you know, relatively minimally processed because there's a freeze drying and then, you know, a low temperature heat processing and then they just powder it and you're getting like a diversity of let's say 10, 15, 20 different products that are derived from whole foods. Is there any benefit of those?
Dr James Kinross: I come back to our earlier point. Like if you're a well healthy person, I would argue it's much better to have a balanced food intake that is diverse and has a food matrix. So microbes in your gut, they need the the the mechanical structure of food, it has value. And this idea that you can recreate that through a powdered form is incorrect. Like how the the the the ingredients that you take and the way you cook and prepare food has a profound and important impact on your microbiome. And I would argue it's much better to have control of that and you'll end up with a healthy gut than to take these powdered foods. And the problem is is that the people that consume massive amounts of these powdered foods are the people that least need to take them, right? And invariably, you know, in my clinical practice, they're young men in their 20s and 30s that rock up in my clinic and they go, well, I've got bloating and you know, I can't poo properly and I've got abdominal pain. And then of course for them, the the use of these powders is so habitualized and so normalized, they don't even see it as being part of the problem. So then what you've got to do is take a really super detailed history and then and then explain to them maybe these things aren't quite so good for their gut. Lo and behold, you stop it, everything gets better. And what we're discovering is that these powdered products have unintended consequences on the microbiome. So you might be taking them for the best of reasons because they've got prebiotic fibers in them, because they've got, you know, a bunch of, you know, well-established, you know, ingredients that have benefit. But actually, I was looking at this study on on a study of casein and whey protein supplements, right, in powdered form. Actually, you just get these big blooms in the virome. So the viruses in the gut just bloom out. Wow. And we don't know what that means. Like we just don't understand the long-term consequence of that. It might be that actually it's having these um unintended pro-inflammatory changes in in the gut.
Dr Rupy: Before we talk further about that, maybe we should just define exactly what we mean by the virome because I think a lot of people might have heard of bacteria in the gut, but they don't actually appreciate that there is also the virome, which is bigger, isn't it?
Dr James Kinross: Yes, fair point. So, so a microbiome describes all of the microscopic life forms in an ecosystem and all of the things that they need to sustain their health. So, um, that doesn't just mean bacteria, it means other kind of ancient but distinctly different microscopic organisms that look quite a lot of bacteria but which are not called the archaea. It looks like um viruses. So these are kind of non-self-replicating, they're not technically alive um forms of DNA or RNA. And we have lots of different types of viruses in the gut and some of these viruses are called phage. And what phage do is infect bacteria. Okay. All right. And they are hugely important in the gut because they have a really big influence on how particular kingdoms of bacteria, you know, grow and dominate and live in the gut. We also have eukaryotes. So eukaryotes are multicellular organisms and this is where it kind of all gets a little bit, you know, weird because you've got multicellular organisms like worms and nematodes and these sorts of things that have their own guts with their own gut microbiomes living within your gut and your gut microbiome, right? So you've got, you know, microbiomes within microbiomes. And all of these microbes are living in this dynamic community where you've got kind of trophic levels of food. So you've got, you know, big bugs eating small bugs, right? And they're, you know, in turn eating smaller bugs and they're and they're in this constant dynamic relationship where you have keystone, you know, organisms, much like any other ecosystem. And, you know, you've got equivalents of your kind of carnivores and your herbivores, right? And they're they're existing like this. So there's this dynamic interaction between these different forms of microscopic life forms and they are constantly interacting with your gut and your immune system and they're constantly producing small molecules as they interact with each other that are having a further impact on your gut. So it's this like wildly complicated system, this wildly complicated system. And what we're just doing is dumping a bunch of powder on it and just expecting it all to be okay. Like it's madness, right? So of course, there are unintended consequences because you have system complexity. And that's why like the microbiome is so important in understanding like individual health and personalized health care because it's just so variable between people. And so I would argue that, you know, taking these like my least, oh God, I don't want to be too like every time I name a brand, I get into trouble. But like, like these like Huel. Yeah. It upsets me so much. Like this idea that like we're just eating out of plastic containers in our lonely lives in our offices. Like it, I don't know, it just seems so regressive.
Dr Rupy: I know, yeah. Yeah. And I think, I think um, the what you described there, like the the the sort of, I have a lot of friends actually who, you know, have powders and they also have IBS and they text me and they're like, what do I do? I'm like, how many protein powders are you having? What what else are you having every single day? What is habitual for you? Because it those are usually the culprits that explain your symptoms. And the way you've described it in terms of the study looking at whey and casein and how that blooms the virome and you just don't know what what the downstream consequences of that are, that actually brings it to life for folks, I think. Because when you start disrupting that food matrix and maybe we should step back and and define what we mean by the food matrix, the the complex 3D nature in which regular whole foods exist naturally. When you break that down, you're essentially pre-digesting a lot of food that your microbes would have had to work towards and therefore, you know, you're you're leading to a bloom of of other microbes down the digestive tract.
Dr James Kinross: But the the structure of food also means it has a set of chemical and physical properties that have health benefits irrespective of the microbiome. So they absorb toxins, they absorb bile acids, they help you absorb vitamins, they help you absorb essential nutrients, right? So there's a key part of this that's got nothing to do at all with the microbiome, but actually you just need it and you need it in your gut. And then it's super important. But but I think it also comes back to, just to kind of take a step back, just to reflecting on what you were saying. Like I think we've just become, we've got a very warped sense of what health norms are. So for example, like a lot of young people, you know, are obsessed with the gains and they want to be in the gym and they've got this idea of what physical health is, right? And to them, physical health means muscle gain, it means muscle mass and it means maybe aerobic fitness, it means this sort of fitness. But but that is quite different from gut health, right? That is not the same thing, right? And you need to understand that if you're following an extreme nutritional intervention, and to me, an extreme nutritional intervention is sustaining yourself on powders, then there will be unintended consequences for your gut and they will not necessarily always be healthy. And here's the kicker. Those things will not manifest themselves for 10 or 20 years. So you will be fine tomorrow. You'll be fine the day after. You might get a bit of gut bloating, you might get a bit of IBS. The consequence comes when you've been doing that in a sustained way for a really long period of time. And the other thing that I ask myself is, and again, I see this a lot in my clinical practice, particularly with like disorders of gut brain interaction. We'll talk about that, I'm sure in a bit, but if you're one of these people and you're trying to biohack your way into a healthy gut, like you need to ask yourself, well, okay, why am I doing that? And is there something that else that's underlying this that's potentially driving it? So what I'm getting at here is is that quite often in in in these in these situations, actually there is, there's an underlying breakdown in people's relationship with food that's driving all of this. And actually until you address this, you can't move anything forward.
Dr Rupy: Yeah, it's a really, really important point. And I want to underline that because we talked about it, we touched on it in our previous conversation. And I think that link between our mental well-being, our sense of self, our community, our purpose, these are so linked to to good gut health. And actually, instead of looking at the answer in a packet or a powdered food, we should actually be looking internally and actually our our psychological well-being.
Dr James Kinross: Yeah, 100%. And and and again, like the microbiome science is about looking beyond the packet of food. It's about understanding where that food has come from. Because the microbiome connects us to our environment. So it's about asking, where has that been food grown? What is, what what has been sacrificed in terms of the soil and the planetary microbiome to produce that food or to grow that animal that you're consuming? And it's about asking what um ownership I'm prepared to take over the selection of my own ingredients and how I'm going to prepare those ingredients, who I'm going to share that food with and um, you know, the kind of enjoyment that I'm going to take out of that food. And in modern life, we're just desperately looking for shortcuts because we don't want to solve the underlying problem. And then what happens is you rock up in my clinic going, my gut doesn't work. And and that's the problem, right? There are no shortcuts in this because to my earlier point, you're you're dealing with a living ecosystem. Right? You're you you are as much bacteria at a cellular level as you are human. Which means you've got to treat these microbes with respect and that means you're in it for the long haul. That means nurturing them from early life and and living with them as part of a genuine, meaningful, symbiotic partnership for the duration of your life. And if you're drowning yourself in powders, then you're not doing that.
Dr Rupy: Yeah, yeah, yeah. That's such a good point. Um, we're going to move off the breakfast table and to our commute. On that note actually, um, do you have a mindfulness practice or a gratitude practice in the morning? I mean, your your mornings are probably going to be pretty stretched at this point once you've, you know, had a kiss with your wife and a lovely breakfast with your kids.
Dr James Kinross: She's not going to let me. So, so I want to tell you that I do. Sure. Honestly, like I I I don't have a kind of regular mindfulness practice, but my mindfulness that I've tried to, I've tried to focus on is is cycling. That was my thing, right? I'm just too agitated and restless and that's my makeup. So but I find that the only way I can be mindful is to engage in a repetitive activity that means I physically cannot do anything else. So when I'm on my bike, I can only cycle. I can't, I can't text, I can't email. And it's really, really good for me because I'm exercising and I and this is going to sound really peculiar, so so forgive me, but like I need, I need the sort of physical exertion to kind of go into that space of, totally. Just emptying my mind, right? But also, like I can do it with my friends. So like we, you know, it's like it's, oh God, it's such an embarrassing cliche, but you know, like, you know, because I am a man, it's pathetic, but but actually you're on the road with your friends and you're having a chit chat about stuff that really doesn't matter and you come back after an hour and that's my mindfulness. I feel invigorated, I feel great, I've, you know, and and I've just had a moment of of escape. So that's what I do.
Dr Rupy: Absolutely. That's I mean, a lot of um, a lot of folks use exercise as a form of meditation. Actually a lot of my medic friends have that as well, whether it's running or cycling or you know, if you're an anesthetist, it's a triathlon or a marathon run, that kind of stuff. Yeah.
Dr James Kinross: Well, again, there's that famous quote about why do you do triathlons? Well, it's so I don't descend into alcoholism. And it's and it's probably true. But but on a different note, like I I do prescribe and recommend hypnotherapy as part of my treatment because when you're dealing with gut brain problems, like the brain is an opportunity to heal and treat the gut. And we I'm sure we'll talk about the mechanism through which it works, but but we've got randomized control trial data, phase one, um sorry, level one evidence that actually these things really do meaningfully help. And whether you do that through an app or whether you do that, you know, through, you know, yoga, whatever it is that you do, you really just keep doing it. It's so, so important, I think to to do it. So I'm very strong advocate of it.
Dr Rupy: Fab. Um, commuting. So we're commuting to work now, whether it's in a hospital or an office or whatever. Are there things that we need to be mindful of if we're trying to nurture our our microbes as best as possible?
Dr James Kinross: Well, I think given our thing we've just talked about, you know, if you can, if you can take some physical exercise in that commute to work, I would strongly advocate for it. That might not be in running or cycling, but it might be in walking to the train station instead of getting that bus. You know, a 15 to 20 minute walk, if you're doing that every single day, the health consequence, the health benefits for you are numerous and again, many of those things have got absolutely nothing to do with the microbiome, but they will really, really help. Um, and I think it's as much about what you don't do as what you do do. So it's about not snacking, right? So I again, like, and I speak from my own personal behaviors on that, like to me that was a ripe time for snacking. So really trying to avoid that sort of healthy, unhealthy behavior. Uh, and then and again, spending that time, perhaps that's an opportunity for mindfulness, isn't it? I mean, doing that, you know, using that time constructively rather than so optimizing gut brain rather than embracing and enduring the the quite stressful activity of commuting. Like taking the tube, like it's quite stressful. Like, you know, um, so if you can find ways to to de-stress that situation, I think it's also super helpful.
Dr Rupy: Um, I'm reading in between the lines here, but in between your meals, is it advisable to give your gut a rest essentially? So not grazing between meals and not snacking like you were saying during your commute and perhaps during the working day as well.
Dr James Kinross: Again, so I think there's no one size fits all and and your question assumes you're healthy with a gut that's not symptomatic and you don't have other healthcare problems. And there might be reasons why actually sitting down and eating three big meals a day is not the right thing for you. But I think if you're generally healthy, avoiding snacking is a good thing. And actually what you find is that your microbes, particularly in your small bowel, you know, they bloom out with each meal that you have, right? So, um, you know, again, what microbes want is that kind of general, um, um, sustenance that comes in that comes in cycles. That's what they're they've evolved to deal with.
Dr Rupy: Okay. So they're they're sort of trained according to the circadian rhythm, our sleep wake cycle.
Dr James Kinross: Yeah, but also, you know, the the the the rhythm through which you through through which you eat and through which you consume food. And I think what you,
Dr Rupy: so so there should be some regularity as to when we eat.
Dr James Kinross: I think so, but you know, I think what we see in in in the kind of the world of social media is is lots of people who've got very strong belief systems around this. And you see lots of people recommending and proposing quite radical diets as a way to kind of change your health or optimize your health, like the keto diet, for example, or you know, um, various other kind of high protein diets. And the thing that I would say is is that, um, if you have a radical diet like that and you really change the pattern of your eating, it will obviously impact on how you feel and various aspects of your health. Some of them might be positive. Like a keto diet, you'll lose a lot of weight, right? And for some people that might be a really, really good thing. But these things are not sustainable diets. They're not things that are going to give you long-term gut health and they're not things that I would necessarily subscribe to. The one, I suppose, the one, um, the one diet which perhaps doesn't conform to that rule is fasting and intermittent fasting.
Dr Rupy: Okay.
Dr James Kinross: So intermittent fasting has really well evidenced health benefits and for some people it's very, very effective. And one of the things that you do when you fast is that you just very significantly and dramatically reduce the the the absolute abundance of microbes in your gut. Uh, both in the foregut and in the hindgut. And within 24 hours, you'll see a massive cull, a massive dying off of these microbes because they need to eat every day just like you do. Okay. And, um, and that can sometimes be be quite beneficial.
Dr Rupy: Okay. In what way would it be negative? So, and maybe before we go into that, maybe we should define exactly what we mean by intermittent fasting because my understanding of the literature is that it's quite a vague term. It can be anything from water fasting for 24, 48 hours all the way to what is probably more correctly termed as time restricted feeding, which is where you you eat in a defined window of let's say 10 or 11 hours throughout a 24-hour cycle. So you don't change the caloric intake in your day in one instance, you just change when you choose to consume said calories.
Dr James Kinross: Exactly right. And and I think that's part of the problem is that these things are poorly standardized and therefore it's quite difficult to measure the the impact and the consequences of of changing your diet like that.
Dr Rupy: Gotcha. And when folks are are fasting, let's say they're doing a more aggressive fast of 24 hours, uh, in what cases would it be negative? Uh, aside from the fact that you're not taking in the macronutrients of protein, let's say, and you're under-muscled and under-fueled, etc. Uh, if you were doing that regularly, where would that, where where would you fall into some traps?
Dr James Kinross: Well, it becomes a problem when you effectively become malnourished, right? And that definitely does happen. So you see people who perhaps are slightly over-obsessing maybe in this as a because they really believe that it's going to give them long-term health benefits. And actually they just tip the other way and they end up, you know, malnourished. So I work with a dietitian and my first job is to get them to a dietitian and to give them a proper nutritional assessment to make sure that actually, you know, they're not, they're not malnourished. And the problem is is that you then quite quickly become depleted in essential vitamins, essential, um, um, amino acids and small molecules that your gut really, really needs. And that's a problem because if you lose too many microbes, it's the microbes that provide a lot of these things, right? So, you know, um, vitamins A, D, E, K, for example. So you need microbes, you need them, right? So if you go too far the other way, you can't, you just can't sustain yourself. You can't sustain your muscle mass and it becomes a problem like starvation is plainly a bad thing. So, so it's maintaining that balance. And it's also not obsessing so much about nutrition and diet and thinking about these other broader things that we that we've talked about.
Dr Rupy: You mentioned keto, um, and there are other high protein diets where very high protein and low carbohydrate, so it's imbalanced in what we would deem an ideal diet, which is, you know, something Mediterranean styled. Um, why do you think some people are thriving on these diets? And do you think they're short-term gains for potential long-term consequences if you were to stick to these diets over the course of years?
Dr James Kinross: Yeah, so I think if you're, if you're going to a sort of radical, you know, red meat diet or a high protein diet, you're you're biohacking your gut and you're going to see very dramatic and sudden physical transformations which can in the short term be very, very appealing. But I would strongly counsel against doing these things as a sustainable way for gut health because animal proteins in particular are fermented in the gut, right? Your your colon is a fermenting engine. And a byproduct of excessive animal protein fermentation is the generation of very toxic small molecules which we know are really bad for the gut. So, you know, these are paracresol, they're sulfides, they're all of these nasties that are that they're frankly, they're they're not just pro-inflammatory, they're carcinogenic. And again, it's what we came back to before, it's what we said about, um, you know, you're going to do, you're going to make these nutritional changes and the the health consequences for you because it's going to influence your risk of non-communicable disease is going to be down, it's going to be down the track and down the road. Your gut needs, it needs fiber and it needs a diverse diet because without that, you cannot have a diverse microbiome. And without a diverse microbiome, you cannot have the resilience in the gut and you cannot have a healthy brain, you cannot have a healthy immune system, you cannot have all of these kind of other healthy, um, uh, axes that the gut is so profoundly and, you know, linked into like gut lung, gut liver, all these sorts of things. So these things are dangerous. You should not be doing them. And if you're doing it, you know, you need to perhaps ask yourself why you're making those those decisions. So, yeah, I would strongly advocate against them.
Dr Rupy: Okay. Um, let's uh, move on to lunch. Okay. I mean, we've talked a lot about food already, but we'll move on to to lunch time and what we're doing during, you know, work time. Are there practices that you think we should be thinking around this time of day in particular from from the lens of what we're doing to look after our gut?
Dr James Kinross: So, I think that um, um, again, beyond common sense things that many of your listeners will already be doing, no, not particularly. So I think in, you know, looking at the types of food that you consume at lunchtime, given that actually what you're trying to do is to give yourself enough energy to focus and get through your afternoon of work or physical activity into the afternoon. Um, and and having again, a balance of foods and a diverse lunch. So having a varied lunch, so each time maybe thinking about shaking up, trying to eat the same thing over and over again isn't such a good thing. Making sure that you have, uh, you know, your five portions of fruit and vegetables in that is really, really critical and avoiding, you know, ready me, ready made, ready prepared foods is is really key. Um, and avoiding, um, minimizing, I should say, ultra processed foods in your in your in your consumption would be kind of fairly standard advice. But I think that's something that most of your listeners will already know and probably already do.
Dr Rupy: Yeah. You're a medic, right? You worked in plenty of hospitals. You know what we have available to us. It's pretty dire. It's usually a meal deal. Um, you know, a lot of people face this choice every single day because of the lack of options or the high price point of some of the healthier options. What are simple things that perhaps you do? You know, we talked about inulin and how you sprinkle that on your breakfast and stuff. Are there simple things that or strategies that you've come across either through your work with patients or perhaps, you know, ideas from the dietitians that you work with to help people achieve some of that diversity, the five a day and the um,
Dr James Kinross: Well, there's a very good app, Rupy. Which I strongly adhere to. I think I, so when I became vegetarian, Okay. Which I've just done it again. God, that was smug. I can only apologize. I was vegetarian before COVID. Oh, okay. And and then when COVID happened, I thought I was going to die. I thought, well, I better have a steak. And then and then and then I couldn't get back on the vegetarian wagon. And then I just found it so hard to get back onto it. So I've just gone back on again like the end of last year. And what I found is is that if you're trying to make healthy food choices and you're trying to diversify your diet, it's it's having the repertoire of foods and understanding the choice that you have and the access to those foods. So part of the problem is is simply knowing where to go to get that variety and having some help in doing that. So my piece of advice to you is actually is to do it with someone. If you're doing this on your own, it's so, so hard. But if you're doing it a little group of buddies on a, you know, a Snapchat or a group or a WhatsApp group, whatever your kind of platform is, and you've got that level of support, it suddenly becomes so much easier. So if you're connected and you're sharing recipes and you're sharing food stuff and you're sharing food ideas, it's much easier to get into a sustained pattern of behavior change. And I found that to be incredibly helpful. Yeah. So, so again, this is like, I don't know, this is such a personal observation and there's no, it's not grounded in any form of science. Like I've I really try and stop online shopping. Because when I online shop, what happens is the algorithm just gives me stuff that they think I need and I can't get that variety. So what I try and do is I try and really understand who I'm buying food for and I try and go to people that I know to buy food from. And I try and do it in person. And I find there's lots of good reasons for doing that. And again, like, oh man, this is such a middle class thing to say, but like the the local farmers market, like I'm so sorry. I'm that guy. You know, it's expensive. I appreciate that not everyone can do these things and you may not have access to it. But actually when I go there, I find it brilliant. There's a sense of community. I know where the food is coming. Every day there's fresh produce in that in that in that market which I perhaps wouldn't have thought about, which I can bring into my repertoire. I can chat to my mates who are in the same kind of mental zone as me and it gives me that diversity. And then when I cook, I cook for two. Not because I'm eating for two, but because I know that there's going to be food left over that I can take to work with me tomorrow. So I don't have to go to the shop where all the ultra processed foods are that I know that I want to eat. Yeah. Yeah. The other thing that I did is that I've given up um uh fizzy drinks. Okay. So I had a minor low level of addiction to Haribo. It wasn't low level. It was like I was totally dependent on Haribo, right? And um, like because it gets me through a work shift. It's I was literally going to say that. It's so when I'm exhausted, I'm at work, like when I'm operating, like if I'm doing nights and I come out of a night shift, like forget coffee, forget any other stimulants, like a bag of Haribo, I'm high as a kite, right? And I can go for hours. So, so but I just plainly that's terrible, right? And it's full of red 40 and God knows what else. So I was like, okay, that's got to go. So I gave up, I gave up Haribo and I gave up fizzy drinks. So actually a major kind of thing that I've observed in my own kind of life is I have to think very carefully about the fluids I drink and what I'm going to drink and what I bring to work because you want something that is tasty, that's nice to drink and I don't want to drink, you know, uh kind of diet Coke anymore. And I found that's even harder than giving up alcohol. Like to me, I found that so, so difficult. But I just feel so much better. And we know, we just know from lots and lots of evidence that actually these, you know, fizzy carbonated drinks, they cause lots of harm and they're associated with lots of, you know, non-communicable disease risk. We know it changes the microbiome. It's so important for your gut health. So for me, lunchtime, no fizzy drinks, no snacks, try and make my own food and I try and make that food myself and and and bring it in.
Dr Rupy: I love that. And it's so funny you mentioned Haribo because it's like the emergency pack that most medics have and rely on, you know, it's always at the nurses station.
Dr James Kinross: I'm not proud of it.
Dr Rupy: And yeah, and you know what? I I I love the fact that you're being super honest about this because, you know, when I was a junior doctor, it was exactly the same thing that I was relying on as well. And it's happening across the country and loads of people are probably nodding their head and like, yeah, that's me. That's me. I can't get off them. And it's hard because you get that that that sugar, well, you you lose the the stimulant effect and you can get headaches and stuff, especially if you're drinking full fat Coke. My question around fizzy drinks was, a lot of people go from full fat, full fat, full sugar to artificially sweetened fizzy drinks as sort of a go between because the other options are water. And most people when you suggest water to them, they look at you blankly as if, you know, you've just suggested going on a 48-hour fast, you know. Um, what are your opinions on artificially sweetened fizzy drinks as a as a means to sort of coming off the high sugar?
Dr James Kinross: Yeah, I just, you know, I think you've got to go full cold turkey. It's like giving up smoking. I just think it's like, it's a halfway house and you're just because I think whilst sugar has a more kind of, um, and particularly caffeinated beverages have a more addictive, you know, um, physically, biologically addictive, um, component to it. Actually, it's about behavior. It's about sustained behavior change, even if, you know, so for me, what I found was actually it was more about the fact that I just had 15 or 20 minutes and I could go down to the shop and I could buy a can of diet Coke and that that just became total, it just became a pattern of behavior. And so I think actually it's about changing your pattern of behavior. And I would and I would, you know, push back and say that actually, you don't just have to drink water. You can be creative about it. And there are lots of healthier drinks and lots of healthier options that you can have. Um, but carbonated fizzy drinks just they're just very plainly not very good for you and we just drink way too many of them. And I think removing them from your diet is a critical thing.
Dr Rupy: Yeah, yeah.
Dr Rupy: Electrolytes in drinks. This is a relatively new sort of phenomena within the wellness sphere. I definitely see it from the perspective of, you know, if you're cycling, having electrolyte replacement drink that doesn't have any sugar in or a small amount of sugar, um, can be beneficial. What do you make of the electrolyte trend at the moment? Do you think this is harmful to our guts? Do we not know enough?
Dr James Kinross: The honest truth is is that I probably I probably don't know enough about that and to to give you an informed opinion on it. But I think that again, what you're seeing is a slightly obvious trend, which is that it's just marketing. Like I seriously doubt there's any credible evidence that these things, you know, are either really beneficial for your health, which is kind of the claims that they're making, again, in the wellness space, this nebulous wellness space, whatever that is. Um, and it's intuitive to me that if you're consuming massive amounts of electrolytes, that it's probably not that great for you, right? Now, having said that, there's a time and a place for them. And if you're an athlete or if you're doing lots of exercise or you're really dehydrated because you've got traveler's diarrhea, they're really good. You should definitely have them, right? But this idea that you're regularly consuming these things is going to somehow magic your gut into a healthy space is I don't think very credible. And I think you're seeing like really worrying practices with, you know, drinks like Prime and this these sorts of things where that they're actually being marketed to kids. Yeah, yeah. Right. So, so what we're trying to do is to seed these super unhealthy practices into children because what we absolutely know through egregious marketing practices is that if you can do that, these kids will just that's it, they're addicted for for life. So that's the bit that worries me.
Dr Rupy: Yeah. We're we're in the bulk of the afternoon. Okay. Okay. We're in front of our computer. Yeah. And uh, what I've noticed, um, from folks is they sit by their computer and they have email apnea. So they literally stop breathing and it's a it's a it's a phenomena that I think is becoming more well recognized now. And obviously you have a lot of stress build up and aside from the fact that you're hunched over your desk, you're not going outside, you're not getting fresh air, you're not moving your body, you're not doing micro stretching. Is there anything in that uh, arena where we can actually look after our guts better and and other practices to mitigate against stress that can have an impact on our,
Dr James Kinross: So I think I sort of just to perhaps diverge away from a little bit of what you're getting at because physical activity is plainly important. I think thinking about the office space more broadly is really important. So many of us work from home, like a lot of that's happened after after COVID and and you might be at your computer in in a quite an isolated way actually. And being physically connected in an office, I think is quite a good thing. I appreciate my view might not be widely held by people that work at home. But I think being physically connected with a group of people is actually very beneficial. So making time to to to kind of go for a cup of coffee or to go and see your colleagues is actually very good and it comes back down to that piece we were talking about before about being physically connected, right? But also think about the environment that you work in. Like you have a plant on our desk, right? Actually, this is a really important part of how we reconnect with our microbiome because the place where you spend the majority of your working life directly influences your microbiome. So if your office environment is super sterile and you're smothered in alcohol all of the time, that's not a good thing. It's not a good thing for your skin, it's not a good thing. I'm not saying hygiene isn't good. Hygiene is good. Please wash your hands. Like we like this, it's a good thing. But actually, you should have plants in your office space. Like you should have a connection to nature in your office space because that promotes your, that promotes your, you know, your not just a healthy gut, it's good for for all aspects of your of your health.
Dr Rupy: Yeah, yeah. I'm trying to get more plants in our office as we speak, but um, I tend, I have a habit of killing them unfortunately. We don't don't look after them very well.
Dr James Kinross: You're not alone.
Dr Rupy: No. Yeah. Um, okay, we're at home. Yeah. We've had a lovely day full of fruits and vegetables and fiber. When you eat dinner, should we be having a lighter dinner? This is a common question we get on socials. So that to improve our sleep or to improve any other aspects of our gut microbiome, is that,
Dr James Kinross: Well, we definitely shouldn't be eating late. So I think, you know, I think you want to eat three or four hours ideally before you go to bed, um, because that's going to definitely, you know, um, influence your ability to have a good night's rest. And I think it's much more important to think about the quality of what you're eating rather than the quantity. Or kind of rather obviously. So if you're having foods that is full of stimulants and full of, you know, refined sugars and these sorts of things, very plainly that's going to be, you know, much worse for you than than having a big volume of food. Um, and, you know, portion control is something that we perhaps, you know, should all should all think about. So for me, the short answer is quality much more than quantity.
Dr Rupy: Than quantity. Yeah. And would you, do you suggest gut health wind down routines in the evening, things to help, you know, soothe our gut from all the stimulants that we've had during the day, the stresses of the day, the commute, all that kind of stuff?
Dr James Kinross: I don't particularly, but maybe that's because I'm just not very familiar with them. And I and I think, um, you know, I think again, if you've got a resilient, happy microbiome through sustained practices, those things shouldn't really be necessary, right? So, so I think the danger with this is that you can become obsessive about it. And that actually you stop having enjoyment and fulfillment because a key part of gut health is having fun. Being happy in yourself and in the moment and not obsessing about your gut, right? And I spend a lot of time trying to undo people's obsessions with their guts, right? So what's much more important is that you go and hang out with your friends. And that you just take some time to to be your best self, whatever that is, whatever you choose that to be. I think it's a healthier way.
Dr Rupy: I love that. I love that. I think it's so important because, you know, I know I've structured this conversation almost like a gut health protocol, but it it it really, um, I'm glad you've emphasized the point that A, we're all different. And I think it's the way you approach your day through the lens of joy and happiness that actually has the beneficial effect on your gut health rather than being rigid and stuck or or or, you know, maintaining diligence according to a set sort of routine that someone else has built for you instead of actually being intuitive about it.
Dr James Kinross: I think there's kind of one other thing that I would add to this list of things that we've done in our day. Um, and perhaps this has got nothing to do with food, which is that I would try and avoid taking any medicines that were not absolutely necessary. So for me, that is probably the more important thing when you're talking about microbes specifically, right? So many of your listeners will be healthy and will not need to take medicines. Some of you might be listening to this and you might be on medicines for very specific diseases or healthcare problems where actually you really need to be on those medicines, right? It might be immunotherapy for inflammatory bowel disease or it might be, I don't know, a cancer treatment in extreme case. Just keep taking those medicines. Those are great. But sometimes we take medicines when we just really don't need to because there's we don't want to do the work, right? And sometimes we take medicines because we become slightly reliant on them. So good examples of that would be, you know, paracetamol, ibuprofen. Like, you know, we just consume massive amounts of it, right? So you gave the example of like, uh, being at the computer and getting, you know, well, you, yeah, you get a headache, right? So rather than taking a paracetamol, stop, go away, hydrate, you know, take a minute, right? Don't take the medicine. And, um, enormous amounts of us take antidepressants. We take medicines that are designed to give us shortcuts to the problems of urbanized modern livings like, like statins for too much cholesterol, medicines to regulate our blood pressure. They're evidence-based, they're important medicines, some people need to be on them, but some of us don't want to do the work. And what we know is that polypharmacy, taking all of these drugs has a really big impact on the gut. And it means that we're going further and further away from actually making meaningful changes that solve the underlying problem. So, so a lot of the time it's about trying to really focus on addressing the underlying issue and giving yourself meaningful sustainable solutions to those problems because the drugs that you're taking are probably damaging the gut and perpetuating that cycle. And, you know, I get a lot of patients that come to see me, they're taking medicines to regulate, they're taking antacids or proton pump inhibitors, they're on a bunch of painkillers, ibuprofen being the classic one, you know, because they've been on ibuprofen, they're taking the proton pump inhibitor and then, you know, then they're taking a bunch of medicines to try and help their bloating and then they're taking a bunch of medicines because they've been a bit depressed about this and and then they're just stuck. They can't get out of it. So we've got to break the cycle on our reliance on these medicines because they damage the gut. And, you know, now when I see my patients in my clinic, I will screen, you know, I will take a pharmacological history anyway, but I'm now increasingly screening for things like Ozempic. Interesting. Because these are becoming slightly more malignant forms of kind of bypassing that chronic disease problem, right? And Ozempic is a drug of abuse that is basically being taken by people off license being purchased on the internet because it's a shortcut to solving all of the problems that we've just talked about, to weight loss, to, you know, changing your your behaviors and it these things profoundly affect the gut and the way the gut works. And people don't want to talk about it. So they'll come and they'll see me and and for them it's like a dirty secret that they don't want to admit to. And you have to say, well, yeah, you've got diarrhea and you've got constipation, you've got bloating, you've got abdominal pain because you're on Ozempic. And if you're really, you know, they'll they'll always be a paradox. They'll say to me, I really want to have a microbiome that's healthy. Can we do a microbiome test? I'm like, yeah, we can do a microbiome test, but there's absolutely no point unless you're really committed to to changing these things. So like the big message here is there's no shortcuts in this. You can't, you can only hack your way out of this to a degree and we as a society have kind of got to facilitate and help people to do that. And actually the biggest determinant of your gut microbiome's health are probably the drugs and the medicines that you take. And of course, the biggest one of those is antibiotics, but that's a subtly different thing. You know, you're not going to take them every day.
