Intro and Outro: Hello, and welcome to the Microbiome Medics Podcast. Intro and Outro: I'm Dr. Siobhan McCormack. And I'm Dr. Sheena Fraser, and we're your co-hosts. Intro and Outro: We are both GPs and lifestyle medics with a shared passion for microbiome science.
Intro and Outro: We'll be translating the evidence and packaging it into actionable, Intro and Outro: bite-sized chunks so that you could harness the power of the microbiome to improve Intro and Outro: your own health and that of your patients. Sheena: Hi, we're back. The microbiomedics, we're back together again. Sheena: Hi Shiv, how are you doing? Siobhan: Hi Sheena, I am great. It's really nice to see you this morning.
Siobhan: And yeah, it's nice to be doing a podcast with you, much as I love all these other fab guests. Siobhan: It's kind of nice because we can kind of relax and just talk about our obsession together. Sheena: Yes. And actually, it's lovely because there's so much we can talk about. Sheena: And because it's been such a long time since we got together, Sheena: we've also been doing lots of things separately and together.
Sheena: So we should probably let the listeners know what we've been up to as microbiome medics. Sheena: When was the last time we got together? Was it October? I think it was way back. Siobhan: Yeah. So I suppose it's, I kind Siobhan: of think it's important for people to know that we're both jobbing GPs. Siobhan: You know, this is kind of our sideline obsession, which we don't get paid for. Siobhan: We do all this out of love, which much to the sort of shock of friends and relatives,
Siobhan: I think. So I think, why are you doing this? Siobhan: And I guess we just kind of think it's really important. We love it. Siobhan: And like you, I see microbiome science as really central to my job as a doctor. Siobhan: And I try and get it into consultations as much as possible. Siobhan: But obviously, there are time limits. We kind of get 15 minutes per patient Siobhan: in general practice. So it is really difficult to try and introduce it, Siobhan: although I think both of us do.
Siobhan: So that's why all these other things like doing the podcast and going to meetings Siobhan: and conferences is a way we can kind of really indulge ourself with the kind Siobhan: of getting up to date with all the latest science. Siobhan: And yeah, kind of, we love it. So I don't know, what was the last meeting we did together? Sheena: I guess the last meeting we did together was the anaesthetics meeting, Sheena: and that's going to lead us into this podcast.
Sheena: But yeah, we went down to London together. Sheena: We were presenting at the Royal College of Anaesthetists. So nice to be asked Sheena: by them to come and present. Sheena: And we presented our version of anaesthetics and the gut microbiome, Sheena: which was really exciting to research as well. Sheena: Just another fascinating area of microbiome science and I really enjoyed it Sheena: I have to say what a lovely bunch down in in London and what a lovely bunch of anaesthetists we met.
Siobhan: They were and I was really surprised because I have Siobhan: to say I suppose I put anaesthetists together with surgeons who wonderful as Siobhan: they are I don't see them as being particularly interested in you know either Siobhan: lifestyle medicine or the gut microbiome and how wrong I was and you know when Siobhan: we take on a new subject and look at it from a different mountaintop, Siobhan: look at a different perspective, I just learn so much.
Siobhan: Because when we started looking into this subject, so the Royal College of Anesthetists Siobhan: asked us to talk about the gut microbiome in anaesthetics. Siobhan: And I kind of thought, yeah, we always say yes. Siobhan: And then afterwards, you put the phone down, you think, oh, gosh, Siobhan: I don't know how, how's that going to work? Siobhan: And what is the role of the gut microbiome in anaesthetics? And it really kind of gets you thinking.
Siobhan: But maybe before we jump into that there was also the Siobhan: uh in march we we met in edinburgh which Siobhan: was lovely with the british society of gastroenterology doing Siobhan: the first their first gut microbiome conference Siobhan: which was you know fantastic it was Siobhan: i think i've got the name here transforming medicine through the Siobhan: gut microbiota interface um they were talking about microbial therapeutics and
Siobhan: human diseases and that was all the uh the great researchers in the uk meeting Siobhan: together which are a very impressive bunch of researchers from all over the Siobhan: country and that was very intense and very exciting. Siobhan: But also really Siobhan: I suppose, very conventional medicine based in that we're lifestyle medics. Siobhan: So we're trying to get this down into primary care.
Siobhan: So these very complex and highly Siobhan: researched areas, which aren't being translated yet into primary care, Siobhan: they're going to take 10, 15 years to kind of get to us really, Siobhan: some of the stuff they were talking about. I don't know, what are your thoughts about it. Sheena: That's a bit of a depressing thought for me, but yeah, it was interesting.
Sheena: It's nice to see a load of secondary care colleagues from fields like gastroenterology, Sheena: surgery, medicine, who are really interested in microbiome science. Sheena: And that certainly came across at that meeting, that this is a bunch of medics Sheena: who really get it and see its role in medicine.
Sheena: And I guess the purpose of that meeting was to bring all of these interested Sheena: clinicians and researchers together and to sort of try to work out whether, you know, Sheena: microbiome science really truly has a role in medicine. Sheena: And, you know, I think by the end of it, certainly by the debate at the end Sheena: of the conference, everybody was very much on side that microbiome science does Sheena: have a role in medicine and should play a big role.
Sheena: And, you know, that's really heartening to see. Sheena: We're still a long way off, as you say, Shiv, but I really feel like if we have Sheena: more and more medics, clinicians, Sheena: surgeons interested, then maybe there is a chance that we can get this becoming Sheena: much more mainstream than it is already. Sheena: And there's some really good people driving it. So, you know, Sheena: You know, I'm hopeful. I'm hopeful that it will get there.
Sheena: And hopefully before the 10 to 20 years that you're talking about. Siobhan: Yeah, I suppose I'm talking about the sort of, you know, the very sort of niche Siobhan: areas they're looking into. Siobhan: But this actually brings me on to kind of what we're doing and my T-shirt, Siobhan: which obviously this is an audio podcast, so no one can see it.
Siobhan: But Sheena knows I kind of make these very cheap, you know, like T-shirts because Siobhan: we don't have any sponsors and we kind of just do it all ourselves. Siobhan: So, yeah, this is my latest T-shirt. Siobhan: Sheena, I have one for you and for the listeners who want to know what it says.
Siobhan: I was trying to define microbiome medic because, you know, talking about we Siobhan: believe that actually you can be a microbiome medic now, Siobhan: that there are all these fascinating things in the pipeline in terms of probiotics, Siobhan: prebiotics, symbiotics and other uses for FMT other than for C.
Siobhan: Diff. but i kind of feel that we can Siobhan: bring this to the bedside now so it's a t-shirt with Siobhan: a definition which you know it's pretty short because it Siobhan: has to fit in a t-shirt so i i put um trained Siobhan: health care provider using microbiome science to inform medical practice so Siobhan: that's what i kind of think micro microbiome medic is so it's anyone who is Siobhan: you know learning about uh human microbiomes and using that or using that perspective
Siobhan: to inform what they do at the bedside which is i kind of think what we do. Siobhan: What do you think, Sheen? I mean, do you think about the gut microbiome and Siobhan: human microbiomes when you're seeing your patients and try and explain how that Siobhan: affects your consultation? Sheena: It affects every aspect of my consultation. Sheena: I had somebody in just yesterday who we were talking about gut health.
Sheena: He had actually had a diagnosis of diabetes and instead of going on medication, Sheena: he decided that he was going to sort his diabetes out himself and do this via Sheena: diet and lifestyle exercise. Sheena: And he'd done a brilliant job, put himself into remission from his diabetes on his own. Sheena: And he'd done this without any support from healthcare practitioners. Sheena: And he'd done this without any knowledge of microbiome science either.
Sheena: And we got chatting because he was saying how disappointed he was with his diabetes Sheena: physician who didn't support him at all in his endeavour to manage his diabetes with lifestyle. Sheena: And I said, well, have you heard of the gut microbiome and how that impacts upon diabetes? Sheena: And he hadn't. And so we had a really good conversation about that. Sheena: And he's even more fired up to because his gut instinct was that he could do
Sheena: this with diet. But he he didn't know the pathophysiology from a microbiome Sheena: perspective and how that that ties in with this. Sheena: And so, you know, it's really interesting for me as a physician to, Sheena: you know, to see how people can take hold of their own disease themselves. Sheena: And to use, you know, really good mechanisms of reversing disease through lifestyle, Sheena: diet, exercise, sleep, all the rest of it.
Sheena: But I can give them the reason why it works through the, you know, Sheena: the role of the gut microbiome and what you're actually doing when you're exercising Sheena: and when you're changing your diet and how that is actually affecting things Sheena: from a gut microbiome perspective. Sheena: And that's just one example. I mean, there's so many different aspects of our role. Sheena: I mean, I think of everybody who has a disease as having an element of gut dysbiosis.
Sheena: And I start from there. And I try to fix their gut as a way of fixing their disease. Sheena: And for me, that's fundamental to everything. But yeah, how are you using it, Shiv?
Siobhan: Yeah, I find that patients really like the narrative because it can seem very Siobhan: complex and a bit blaming when, Siobhan: as a lifestyle medic, you talk about their sleep or their diet or it feels like Siobhan: a burden or a judgment on their lifestyles and their choices, Siobhan: which is absolutely not what lifestyle medicine is about.
Siobhan: And it's very much focused on upstream determinants of health and inequalities Siobhan: in health and the importance of behavior change and psychology and coaching Siobhan: and the science behind that, you know, why we do what we do. Siobhan: Why I like the gut microbiome narrative is because it removes all that judgment. Siobhan: And it's really this wonderful story about the fact that you're 50 percent microbial
Siobhan: by cell count and over 99 percent microbial by gene count. These are team players Siobhan: in your body and this idea that... Siobhan: I know it's humanising a bit, but this idea that they want to help you and can Siobhan: help you with every aspect of your physiology and health. Siobhan: And actually, if you feed them the right things and treat them the right way, Siobhan: they are an incredible team to have on board.
Siobhan: And they're beneficial in so many ways in every aspect of your health and physiology.
Siobhan: So I think as a narrative, patients really like it because if you say, Siobhan: feed your gut microbiome, whole food, Siobhan: plant-based, uh lots of polyphenols colors Siobhan: of the rainbow that's something they can go away with and and do and it kind Siobhan: of they get it very easily just a few phrases um and they like the idea of looking Siobhan: after you know the gut microbiome it just seems to to fire up their imaginations yeah.
Sheena: Absolutely it's it's quite non-threatening isn't it and it's um and and it's Sheena: something you know that we can all buy into, we can all see as something really, really positive. Sheena: I am noticing the tide is turning a little bit. Sheena: I think patients are beginning to understand that processed foods are harmful for them.
Sheena: And I'm having some really good conversations with my patients now about returning Sheena: to whole foods, returning to home cooking, Sheena: using fermented foods, and just getting back to real food again. Sheena: And I'm really finding that patients are buying into this more. Sheena: So that's really enthusing me just now. Sheena: And my workforce, my wee workforce and my GP surgery are definitely on board as well.
Sheena: And my trainees from the hospital seem to really take all of this on board as Sheena: well when they join the surgery. Sheena: So I'm also enthused by their interest. Sheena: And they're the new generation of doctors. Absolutely. And I think if we can Sheena: get them interested in this and... Sheena: They can then bring that forward for their patients for the future. That's great for me.
Siobhan: Yeah, I just wanted to say, Sheena, you just reminded me when you were talking Siobhan: there, the other thing that I really like about the gut microbiome and diet Siobhan: in particular is it's all about nourishing and abundance. Siobhan: Whereas so much of what we talk about is negative, remove things, Siobhan: stop eating this, don't eat so much of that.
Siobhan: This is all about, we want more, we want you to eat more, Siobhan: we want an abundance of beautiful foods to fire up and Siobhan: feed the gut microbiome so we want you know more variety Siobhan: more diversity more whole food plant-based stuff Siobhan: so it's all about filling up your plate with beautiful food Siobhan: that's delicious and wonderful and that's very different from the message there
Siobhan: has been for the last few decades about you know what you mustn't have restriction Siobhan: removal so this abundance yeah so abundance and nourishing it's got to be a Siobhan: good thing it makes you feel good you know yeah i want you to I want my patients to eat more, not less, Siobhan: you know, of all this beautiful food. Siobhan: And it's kind of, you know, if they're eating the right stuff, Siobhan: they can eat as much of it as they want.
Siobhan: So, yeah. So it's kind of from that point of view, I really like it.
Sheena: Definitely. Definitely. It's got to be something really positive. But more than that, Sheena: if medics understood the mechanisms by which disease is forming through this Sheena: disruption of the gut microbiome, Sheena: then bringing disease back to those measures and considering, Sheena: well, if everything comes back to damaging of the gut microbiome, Sheena: that imbalance of the gut microbiome, then surely,
Sheena: you know, you should be starting with lifestyle interventions and diet manipulation, Sheena: not considering that as a side point, maybe a few months down the line once Sheena: they've started the drugs. Sheena: You know, that's where I'd like to see the shift, you know, and like to see Sheena: people considering that, you know, what went wrong for that person that they Sheena: ended up with this disease? What happened to them?
Sheena: You know, was it, what disrupted their gut microbiome? Was it antibiotics? Sheena: Was it stress? Was it, you know, was it something catastrophic in their life? Sheena: Or was it just poor diet over a long time? Or, you know, poor lifestyle? Sheena: And what can we then do to fix that? rather than saying, well, Sheena: you've got this disease, let's just dive in with this particular drug and that particular drug.
Sheena: Because you're then not fixing the fundamental cause of that disease. Sheena: And whatever drove that disease and that dysbiosis could potentially drive another Sheena: disease in the same person if we don't tackle that. Sheena: And so for me, that's fundamental. And, you know, when my patients are being Sheena: diagnosed with serious conditions like diabetes or rheumatoid arthritis or whatever, Sheena: I'm thinking, well, what happened to that person?
Sheena: What went wrong and how do I fix that so that the next diagnosis for them isn't Sheena: a cancer or heart disease or, you know, something else that's going to be catastrophic for them? Sheena: And how do we then control the symptoms of that disease by lowering inflammation Sheena: in the body and improving the state of the gut microbiome? Sheena: So I think it's that shift and that different way of looking at disease that I want to see more of.
Siobhan: Yeah, I mean, you're very much talking about a systems approach that we were Siobhan: taught as medical students. You were taught in compartments. Siobhan: You have respiratory, you have cardiovascular, you had endocrinology. Siobhan: Obviously, that's not the way the body works. It's working as this continual, Siobhan: dynamic, responsive, adaptive system. Siobhan: An important part of that is the gut microbiome and other human microbiomes.
Siobhan: Now, we're not saying that those are the only molecular mechanisms, Siobhan: but certainly when anything shifts in the body, the ecosystem in your gut, Siobhan: for example, shifts as well. So it's very responsive and adaptive to what else Siobhan: is happening in the body. Siobhan: And you can't look at one part without looking at its effects on your gut and Siobhan: microbiome ecosystems.
Siobhan: So, yes, I just think it's a kind of easy way of getting your head around the Siobhan: idea of systems biology. Siobhan: It's like you know looking at the ecosystem and how your body works i find it Siobhan: helps me um you know think in a very constructive and positive way about the Siobhan: whole body working together definitely.
Sheena: Definitely okay so we've talked about the gastroenterology meeting we talked Sheena: a little bit about the um anesthetics meeting what else have you been up to ship. Siobhan: Yeah so there's um, Siobhan: And the lifestyle medics are incredibly proactive about incorporating the gut Siobhan: microbiome, particularly and other human microbiomes into lifestyle medicine.
Siobhan: So the BSLM, our own organisation, the British Society of Lifestyle Medicine, Siobhan: but also we've been asked by other international lifestyle societies to come Siobhan: and talk, particularly Malaysia. Siobhan: We've been asked to talk at their conference over the last three years. Siobhan: And I find that quite interesting that they have embraced it so wholeheartedly.
Siobhan: And I suppose it makes sense that these lifestyle pillars that we're talking Siobhan: about, so with physical activity, nutrition, Siobhan: sleep, connectivity, time in nature, healthy relationships, it makes sense if Siobhan: we've always had the microbiome within us and we've co-evolved together with these.
Siobhan: Microbes, that they will also respond positively to those things, Siobhan: whether it's relating to the circadian rhythm, to what we eat, to sleep, Siobhan: to stress, our response to stress. Siobhan: We know that the gut microbiome responds to all those things as well. Siobhan: So it is interesting that that medical speciality in particular has hugely embraced Siobhan: the gut microbiome and we're being asked a lot to talk there.
Siobhan: And that's why I'm surprised when the Royal College of Anesthetists asked us Siobhan: to come and talk because that was kind of someone who I hadn't expected to reach out. Siobhan: But before we go on to that Royal College of Anesthetists talk, Siobhan: which I think it would be really useful for the listeners to hear, Siobhan: not only how we kind of thought about doing it, but maybe talk them through Siobhan: some of the aspects of the talk.
Siobhan: But there's one thing I wanted to ask you about, which was the Royal Society Siobhan: meeting that you attended. Siobhan: I think it was in October, which sadly, I couldn't make it. Siobhan: But I wonder if you could just give us a brief summary of that and, Siobhan: who was there and how you found it.
Sheena: So that was a lovely meeting. The Royal Society put on a meeting for pretty Sheena: much stakeholders in microbiome science in the UK, Sheena: and actually not just the UK in fact, because we had representatives from Amsterdam Sheena: and we had Jack Gilbert from the US. Sheena: So quite an interesting bunch of people, researchers and clinicians who were interested.
Sheena: I think the aim of that meeting was to ask the question, how do we get microbiome Sheena: science into mainstream medicine? Sheena: And so it was really focused on, well, what is the research? Sheena: What's happening in microbiome science right now? Sheena: And how does that relate to what we're doing in medicine? Sheena: And then, you know, what can we do as a group to forward microbiome science Sheena: into mainstream medicine?
Sheena: So there were even discussions around the political side and how you actually, Sheena: how you get topics into parliament. Sheena: There was a really interesting discussion on that. Sheena: That is not my area of expertise, I have to say, but really fascinating to hear about it. Sheena: Tib Spector was there, Jack Gilbert was there, Sheena: And these are, obviously, if you've listened to microbiome medics podcast, Sheena: you'll have listened to my discussions with them.
Sheena: But these are very big people in the field of microbiome science. Sheena: And these guys are really driving forward the research and they're driving the Sheena: interest in microbiome science through all of their social media work as well.
Sheena: So fascinating and interesting there is a paper being written off the back of Sheena: that meeting a scientific paper on on forwarding microbiome science into mainstream, Sheena: so it'll be interesting to read that when it Sheena: comes out and yeah it was lovely to be a part of it to be honest from all the Sheena: work we've put in over the last few years I felt like there was that was a bit Sheena: of an acknowledgement for our interest which so it was really really nice to
Sheena: be asked along so yeah because. Siobhan: It's quite quite a small meeting how many people were there it was. Sheena: Only i think less than 40 of us yeah yeah. Siobhan: Really interesting no it sounds it sounds fantastic should we have a chat about Siobhan: the royal cottage of anistis talk. Sheena: Yeah and um if i yeah.
Siobhan: If i maybe kick off because you kind of said hey they've asked us to come and Siobhan: talk and i went away and had to think about it and i thought how should we do this? Siobhan: And I suppose the first thing that came up in my head was this idea that all Siobhan: doctors, but we're talking about anaesthetists here, you're not only a doctor Siobhan: of your speciality, so anaesthetics, you're also unwittingly, Siobhan: to most of us, a microbial ecologist.
Siobhan: So an ecologist is, I suppose ecology is a study of the relationship between Siobhan: living organisms and their environment. Siobhan: So it's kind of how species interact, how changes in the environment impact Siobhan: species and how ecosystems function, really.
Siobhan: So as an anaesthetist, you will Siobhan: not be thinking that you're a microbial ecologist, but everything you do, Siobhan: you know, when you're seeing that patient during the operation and when you're Siobhan: advising afterwards will be affecting not only the patient in front of you, Siobhan: but the microbial ecology of all Siobhan: the human microbiomes but we're focusing on the gut microbiome today and I kind
Siobhan: of thought that's a really sobering thought for all of us really that whether Siobhan: we know it or not everything we do say every drug we take every activity you Siobhan: do has an impact on your microbial ecosystem so I kind of thought that was a good starting point. Siobhan: And then the other idea that we had was quite often when anaesthetists do discussions, Siobhan: they talk about, they divide into three things.
Siobhan: So preoperative, intraoperative and postoperative. So what happens before the Siobhan: operation is quite often anaesthetists will see patients either immediately Siobhan: before or in the few days before. Siobhan: Ideally, they would see them several weeks before the operation so that they Siobhan: could build them up in a positive way to prepare for the operation.
Siobhan: Then what happens in the operating room, in the theatre, and then how they manage Siobhan: a patient post-operatively. Siobhan: So I'll kick off with the pre-op stuff and then maybe we'll move on from there. Siobhan: So we were thinking when you see the patient in front of you, Siobhan: most patients who are in an operating theatre, the fact that they're in a theatre Siobhan: having an operation means they likely have a disease.
Siobhan: We know that people usually with one disease have more than one.
Siobhan: Those people are often on drugs and when Siobhan: people are on one drug they're often on several drugs so there's this Siobhan: idea of polypharmacy where you're on more than five drugs at Siobhan: a time all these drugs are interacting with each other most of these people Siobhan: will have some degree of dysbiosis and most people because 60 percent of the Siobhan: uk population you know consume most of their calories and ultra processed food
Siobhan: will have dietary issues and that will be affecting their gut microbiome so i suppose, Siobhan: drugs, Sheena, that was the thing that you highlighted. Siobhan: What about the patient in front of an anaesthetist? How can they think about Siobhan: drugs or how can we all think about drugs and the gut microbiome? Sheena: Yeah, absolutely. So I think when you're thinking about drugs, Sheena: you have to consider that drugs in their own right can impact on the gut microbiome.
Sheena: And for example, antibiotics can have quite damaging effects on the microbial Sheena: species And depending on how wide-ranging or how broad-spectrum these antibiotics are, Sheena: they'll have different impacts on the gut microbiome and other human microbiomes as well. Sheena: So they can have a direct impact like that. Other commonly used drugs that patients Sheena: will often be on before they enter into that operation are things like PPIs.
Sheena: Proton pump inhibitors are essentially antacids. Sheena: They're commonly used medications that reduce acidity in the stomach and help Sheena: to get rid of things like stomach ulcers and gastritis. Sheena: Acid reflux, these kind of conditions. So very, very commonly used drugs. Sheena: But what they do in altering the pH is they change the microbial ecosystem in
Sheena: the upper part of the gastrointestinal tract. So the stomach and the small intestine Sheena: then becomes higher in pH. Sheena: And that actually encourages more of the gram-negative bacteria, Sheena: the ones that can actually cause more infections and disease. Sheena: So you can get overgrowth of bacteria in the upper GI tract with time.
Sheena: And that actually means that there's more of these bacteria around that could Sheena: potentially cause harm for the patient if their immunity was dropped for any reason. Sheena: So that could certainly alter their predisposition to infection potentially. Sheena: So PPIs are very commonly used.
Siobhan: So what about opioids and anti-inflammatories, which obviously is something Siobhan: that you might be on as a patient for pain relief from the condition which is Siobhan: taking you into the surgery? Sheena: Absolutely. Anti-inflammatory medications like ibuprofen, aspirin, Sheena: these are effective painkillers, very useful, especially if you have like joint Sheena: problems and things like that. Sheena: But they are very inflammatory for the gut.
Sheena: They can cause damage to the mucous lining of the gut and they can cause leaky gut. Sheena: So they can cause more inflammation within the gut microbiome. So they're not ideal. Sheena: Opioids, again, can alter the ecosystem as well. Sheena: So there's so many different drugs. I mean, even SSRI antidepressants are actually Sheena: antimicrobial to various different species like Staphylococcus, Sheena: Streptococcus, E. coli. They are actually antibacterial.
Sheena: So they can alter the ecosystem as well. Sheena: So, you know, we're just beginning to learn the impact of many of our commonly Sheena: used drugs on the gut microbiome. Sheena: And so when people are on any medication, you have to consider that that may Sheena: already be altering that ecosystem in the patient. Sheena: So there's that aspect of drugs. And then there's the fact that the gut microbiome Sheena: also can impact on the drugs.
Sheena: So everybody's got a unique ecosystem within them. Everybody's got a unique... Sheena: Variety of microorganisms. And we all have different responses to medication Sheena: and different side effects from medication depending on this ecosystem within Sheena: us and how we metabolize those drugs. Sheena: So that will impact upon the medications that we use in anesthetics,
Sheena: the pain relief we use, you know, everybody's different. And some people may Sheena: tolerate those medications very well and some people may not. Sheena: So that's an important consideration as well. Sheena: And of course, if somebody hasn't had anaesthetics in the past, Sheena: you're going in blind, really. You don't really know how they're going to respond. Sheena: But the ecosystem itself will determine your response to the medication that you're going to get.
Siobhan: Yeah. I mean, just going back to what you were saying about antibiotics, Siobhan: I mean, they're commonly used prophylactically. So that's to prevent infections Siobhan: during and after the operation. Siobhan: And if you kind of think, you know, the rational side to that, Siobhan: we don't want infections. Siobhan: So people get blasted with antibiotics. Siobhan: The trouble is, although they kill potential pathogens, they wipe out all the beneficial bacteria.
Siobhan: And the other thing is a large percentage Siobhan: are resistant to these antibiotics so there's Siobhan: you're wiping out all your beneficial bacteria you're potentially Siobhan: wiping out some pathogens but a lot of the pathogens now are resistant so they Siobhan: get left with a clean landscape you know devoid of beneficial bacteria that Siobhan: could potentially fight them off and they're just you know lying there in wait
Siobhan: to cause these potential surgical site infections. Siobhan: And I guess that's a really, you know, complex balancing act. Siobhan: But certainly this kind of widespread use of, Siobhan: broad spectrum antibiotics for all procedures is being brought into question by some experts. Siobhan: So, you know, that's something that we need to think about.
Sheena: So when we're considering the pre-op journey, I think what's really interesting Sheena: now is the interest that people are getting into prehabilitation. Sheena: And anaesthetists in particular are interested in prehabilitation. Sheena: So really, you know, what is prehabilitation shift? Do you want to talk us through it? Siobhan: Yeah, I suppose it's preparation for surgery.
Siobhan: So our good colleague, the anesthetist, Dr. Sunil Kumar, wrote a book with Dr. Siobhan: Tony Brunning, I think her name is, Preparation for Surgery, Siobhan: which is a fantastic book.
Siobhan: It's a programme of preoperative interventions. so Siobhan: what the aim is if you are a listener Siobhan: and you are preparing for an operation there Siobhan: is an enormous amount you can do that will Siobhan: decrease the likelihood of surgical complications like infections and increase Siobhan: your healing and recovery and increase and improve your post-operative outcomes Siobhan: so things like diet that's basically the lifestyle stuff you know your nutrition
Siobhan: the way that you sleep, reducing your stress, Siobhan: connecting with people, moving, getting out in nature, all these things seem Siobhan: to affect your wound healing, your immune system, through all these lifestyle Siobhan: mechanisms that we talk about a lot.
Siobhan: And this has become a whole area of expertise that really aligns with lifestyle medicine, Siobhan: particularly with nutrition, for example, You know, what you eat pre-operatively Siobhan: and post-operatively really matters. Siobhan: So, yeah, it's a really important area of surgery and anesthetics now, Siobhan: which I'm delighted to see happening. Sheena: Yeah. And all the things you've mentioned, they all enhance your gut microbiome.
Sheena: And I think that's fundamental here because if we enhance the gut microbiome, Sheena: we keep it really, really healthy. We keep the gut barrier super strong. Sheena: We get rid of any leakiness of the gut. Sheena: We reduce the likelihood of any inflammation getting into the bloodstream, Sheena: any of these gram-negative bacteria Sheena: causing infection or creating even inflammation elsewhere in the body.
Sheena: So, so prehabilitation, I'm totally on board with, and it makes a lot of sense. Sheena: What, what was interesting for me is how quickly you can get these changes. Sheena: So, so patients are probably going to want to know, you know, Sheena: when, when should they start prehabilitation? Sheena: You know, at what stage should they be doing prehabilitation before they go Sheena: in for their operation? What do you reckon, Chef?
Siobhan: Yeah, it's a really interesting one, because I have to say, I mean, Siobhan: I suppose talking to most anesthetists, they're saying ideally six weeks, Siobhan: three weeks, you know, a push.
Siobhan: And I kind of got the impression that the way the NHS works now, Siobhan: you know, quite often people, something incredibly high number, 40% of people are, Siobhan: you know, have their appointment cancelled at the last minute, Siobhan: have their surgical slot cancelled, which is really disrupting. Siobhan: And I know, and you'll know from patients who have to travel in for an operation, Siobhan: they have to be there at seven o'clock in the morning.
Siobhan: I've got one elderly lady who had to sort out her dog, sort out her house. Siobhan: She couldn't sleep all night because she was really frightened about it. Siobhan: So she left and got the taxi at five o'clock in the morning. Siobhan: She arrives and then finds out later that day it's been cancelled. Siobhan: It's the third time she's been cancelled. But the amount of stress, Siobhan: the lack of sleep, she's turning up to the operation in a really less than optimal state.
Siobhan: That all impacts your immune system, your wound healing. Siobhan: So we've got to start looking at all these things. Siobhan: So I used to think, look, you know, if as an anesthetist, you saw a patient Siobhan: a couple of days before, then what can you do? It's too late.
Siobhan: But actually, I'm now changing my mind because even one good night of sleep, Siobhan: and certainly if you're talking about nutrition and the gut microbiome, Siobhan: we know from studies, it was a study by David in 2014, looking at changes and Siobhan: how rapidly your gut microbiome could change.
Siobhan: And they were suggesting that when they looked at human subjects, Siobhan: some within 24 hours, but certainly within two to three days, Siobhan: you could have profound shifts in Siobhan: the gut microbiome composition when you significantly changed your diet. Siobhan: And sometimes we're not talking about what you are eating, we're talking about what you're not eating.
Siobhan: If you remove ultra-processed foods, so you're removing things like emulsifiers Siobhan: and additives and non-nutritive sweeteners, which we know are toxic to the gut Siobhan: microbiome, you can get profound response very quickly. Siobhan: Now, whether that translates immediately into gut function differences is, Siobhan: you know, less researched, but certainly...
Siobhan: Even a few days before your operation, if you cut out those ultra-processed Siobhan: food and pile in high-fiber, fruit, veg, pulses, I would say there's never a Siobhan: time when you can't make changes before an operation. Siobhan: And how empowering that is for a patient to know that what they do will make a difference. Siobhan: And I suppose if you're someone thinking, well, what actually difference does that make?
Siobhan: I think a good way to envisage it is you're trying to bolster up your gut microbiome army. Siobhan: You're trying to get the best soldiers there, ready to fight infections, Siobhan: to ward off potential pathogens, but also to produce all these wonderful things Siobhan: such as short-chain fatty acids that we know will improve your immune system Siobhan: and bolster your wound healing and recovery.
Sheena: And I think the other aspect to consider with this, that's talking about people with elective surgery. Sheena: People who are having emergency surgery, who are perhaps already in hospital Sheena: and they're waiting for surgery. Sheena: Sadly, the hospital environment is not perhaps the best for your gut microbiome. Sheena: There's an awful lot of things within that hospital environment that might be Sheena: damaging for the gut microbiome.
Sheena: For example, lack of sleep if you're being monitored through the night.
Sheena: The hospital food we know that the Sheena: hospital food is very processed and lacking Sheena: in fiber lacking in fresh fruits and vegetables um and fermented foods um so Sheena: so if you are in that position um and you are in hospital waiting for um an Sheena: operation then personally i would be wanting you know family members, friends, Sheena: to be bringing the patients in some lovely fresh fruit, Sheena: something healthy for them to eat on the run up.
Sheena: Even, you know, a lovely homemade soup, you know, would be a really nice addition Sheena: to the food that they're getting in the hospital environment to help, you know, Sheena: improve their nutrition and to help give them more fiber on the run up to surgery. Sheena: So if you want to help your loved ones through surgery, then bolster their hospital Sheena: diet with fresh fruits and vegetables and home cooking. Sheena: And then consider.
Sheena: You know, the actual environment itself. If I've ever been in hospital, Sheena: I always take earplugs with me and even one of those eye masks so that I can Sheena: try to switch off from that hospital environment so that I can get some sleep. Sheena: Because if we optimize our sleep, that's really important for our immune system and for our gut bugs. Sheena: So we want people to be considering what they can do in that hospital environment to help that.
Sheena: And anybody who works in a hospital environment who's listening to this, Sheena: you know, think about your patients. Sheena: You know, they need the lights to be darker at night. They need peace and quiet Sheena: in the ward setting to get some sleep. Sheena: They need decent nutrition. Sheena: It's nice if you can open a window and get some fresh air into a ward. Sheena: It's really good if you can get patients up and moving more.
Sheena: They need some movement in their day to help keep them fit on the run-up to Sheena: surgery and reduce stress for them. Sheena: You know, if they are under stress, you know, what can you do as a hospital Sheena: clinician or nurse or, you know, to make that journey less stressful for the patient? Sheena: Because all of that will improve their gut microbiome and that will have a knock-on Sheena: effect of improving their outcomes.
Siobhan: Oh, Sheena, while you're talking there, you're reminding me of the kind of, Siobhan: you know, Victorian TB wards, where they would open all the windows, Siobhan: take the patients out into the sunshine, you know, think about their food, reduce their stress. Siobhan: I kind of think it's weird in 2025 that we're talking about these, Siobhan: you know, Florence Nightingale type input. Sheena: That's a dream.
Siobhan: High tech stuff. Yeah, we're saying that that's a dream. An old, you know, Siobhan: an old sort of, yeah, even some of the London, there was an ENT hospital, Siobhan: or there was a group of hospitals that centered around a small but beautiful Siobhan: park so that the patients could come out in sunlight, you know, and be. Siobhan: So even back then, they understood the importance of that. Siobhan: And that's kind of because we're always looking for the latest high-tech...
Siobhan: Intervention. We've forgotten the importance of things like that. Siobhan: And actually, I guess the difference now as well, although they intuitively Siobhan: thought those things were important, in the last two or three decades, Siobhan: we now have this incredible, you know, the molecular biology behind those things Siobhan: like sunlight at a certain time, circadian rhythm, sleep, Siobhan: you know, the diet, we now have the research to back that up.
Siobhan: And yet, we still somehow don't see the potency of those mechanisms and how Siobhan: important they are and how destructive the hospital environment is. Siobhan: It's almost like the antithesis of everything that lifestyle medicine would Siobhan: suggest it's kind of ripped apart when you go into hospital. Sheena: Absolutely. And we were having an informal chat with some of our anaesthetist Sheena: colleagues on this very topic over breakfast.
Sheena: And one of my anaesthetist colleagues was describing her intensive care unit, Sheena: which is an internal part of the hospital environment and has no windows. Sheena: So no natural light at all. And she was saying that actually she really struggles Sheena: because the patients get circadian rhythm disruption in that ward environment. Sheena: And it's having a big impact on their health and their recovery.
Sheena: And unsurprisingly, now that we know how important Sheena: circadian rhythms are and your you know your exposure Sheena: to light during the day is a very important Sheena: aspect of that so if you're not getting daylight and Sheena: you know sadly the lights that we're exposed to that are artificial aren't giving Sheena: us the sufficient light exposure to to really um set these circadian rhythms Sheena: and of course people in intensive care don't have the ability to get out of
Sheena: bed and get uh you know move around, pop outside. Sheena: So they're really stuck in this environment. Sheena: So again, you know, seems like very poor planning on the, on the. Sheena: You know by the hospital the hospital teams and the architects to consider that Sheena: you know the intensive care environment could be put in an you know in a in Sheena: a place like that and you know very very difficult for the patients in that Sheena: situation and the staff.
Siobhan: I was I was just thinking that Sheen I was thinking about the staff when Siobhan: you mentioned I know the girl you're talking about who was you know lovely Siobhan: and obviously very caring thoughtful doctor but if Siobhan: you think about the staff as well working in those places and we Siobhan: know that uh you know the lack of light Siobhan: shift work as well we know that there's concerns Siobhan: about metabolic health of uh nhs and other workers who are doing you know shift
Siobhan: work uh and the circadian rhythm disruption is um you know ongoing um and the Siobhan: long-term sequelae of that for their health outcomes later down the line yeah Siobhan: it's um yeah food for thought. Sheena: It is, it is. So interesting. Right. Sheena: Well, let's move on from prehabilitation. So obviously, that is a really important Sheena: thing that anybody can buy into and try and do themselves if they're having any operations. Sheena: Let's move to the intraoperative period.
Sheena: So that time when you're in the operation, how does that impact upon your gut microbiome, Shiv? Siobhan: Yeah, so I thought We're talking about similar things. So actually at the time Siobhan: of the operation, we're still talking about, you know, lots of drugs are given Siobhan: at that time, often given another dose of antibiotics. Siobhan: Then there is the anesthetics themselves. So the thing that puts you to sleep.
Siobhan: So you don't, you're not aware and you feel no pain during the procedure. Siobhan: And usually those are either given intravenously through a tube in your arm or Siobhan: they call them the gas man. So they're given, you have a mask that you wear, Siobhan: and so you're having an anaesthetic by gas.
Siobhan: Now, there's not a lot of human studies on the effect of these things on the Siobhan: gut microbiome, but certainly in animal studies, we know that these drugs do Siobhan: affect the gut microbiome composition and function, but also they affect the gut motility. Siobhan: So again, if you're thinking of an ecosystem, anything that affects the environment, Siobhan: so alters the pH or the humidity or the motility slows it down.
Siobhan: That's going to alter the type of bugs that thrive there. Siobhan: So yeah, so got to think about those things as well. Then you're also talking Siobhan: about hospital environment. Siobhan: You talked about the things when the patient's awake, but also the high percentage Siobhan: of antimicrobial resistance in bacteria that are in the hospital environment as well.
Siobhan: So that's an important thing to think about. And also these patients are, Siobhan: there's deliberate tissue injury. Siobhan: So if, for example, you're thinking about colorectal surgeon, Siobhan: they are deliberately cutting through the skin, cutting through the bowel.
Siobhan: And although, you know, I always found this profoundly Siobhan: strange as a medical student when I would spend ages hand Siobhan: washing and you'd have people watching you to make sure you Siobhan: weren't touching anything and the degree of Siobhan: sterility had to be so high and then an Siobhan: emergency patient with peritonitis would be brought in and the Siobhan: surgeon would cut through and suddenly you'd have feces everywhere and
Siobhan: it would seem you know this kind of strange thing that we're talking about sterility Siobhan: and suddenly you were you were opening up a gut in in front of everyone um so Siobhan: that you know there is that aspect that the surgeon themselves are causing a Siobhan: lot of tissue injury and trauma and that's increasing, Siobhan: cortisol and activating lots of molecular pathways in the body as well, Siobhan: which make it more difficult for the body to fight infection.
Siobhan: Yeah. So it depends on the type of operation, obviously. Sheena: Yeah, absolutely. So, yeah, you get a lot of inflammation in the body just from Sheena: cutting into tissues and causing damage to tissues surgically. Sheena: So that in its own right is very inflammatory for the body and very inflammatory for the gut.
Sheena: And just the stress, you know, of somebody going in for an operation sets that Sheena: cortisol high and they then can, you know, drive more of these harmful bacteria in the gut. Sheena: And it's quite damaging for the beneficial species. So there's an awful lot going on. Sheena: And sadly, all of these things sort of come together to create an unhealthier Sheena: environment in the gut microbiome that can then have an impact on that person going forward.
Sheena: And, you know, talking about the gut transit time, you know, Sheena: anything that makes that gut more sluggish is going to then encourage more of Sheena: these unhealthy, harmful bacteria to thrive. Sheena: And so it's really common when people are in hospital for them to become constipated Sheena: through the combination of the Sheena: stress and the hospital food and all these drugs that we're giving them.
Sheena: But constipation, to me, is not a benign thing. It's not a benign phenomena. Sheena: Constipation can be very damaging for the gut microbiome and therefore, Sheena: you know, it can actually be damaging for the rest of the body. Sheena: So it's something that as a hospital clinician, I think you should be very aware Sheena: of constipation and the harms that that can cause.
Sheena: And so, you know, it's probably appropriate to be using more laxatives in hospital Sheena: while patients are there and laxatives Sheena: that are beneficial for the person that's in that position, like, Sheena: you know, these lovely fibrous laxatives like lactulose that are going to actually Sheena: benefit the gut microbiome. Sheena: So that can be really beneficial in that sort of intraoperative and postoperative period. Yeah.
Siobhan: And I would also like to sort of say, because it sounds like, Siobhan: you know, it can sound negative for anyone out there who's about to have an Siobhan: operation or who's just had one. Siobhan: This can be swung into a very positive balance very quickly.
Siobhan: So all of the things we're talking about now, so what's happening during your operation, if you, Siobhan: you know, a few days before your operation, you know, try and look at these Siobhan: things, try and look at your fluid intake, your diet, make sure you're reducing Siobhan: your stress, trying to sleep. Siobhan: And, you know, and actually, Siobhan: realizing how important those things are can be very empowering, Siobhan: really. You know, it makes a huge difference.
Siobhan: And even if you haven't done those things and you're sitting in a hospital bed Siobhan: now, having had an operation, it is never too late to think about your gut microbiome. Siobhan: So don't worry about what you haven't done before. Siobhan: Don't worry about what happened in the operation. Siobhan: You can start all these lifestyle things now and they will positively impact your gut microbiome.
Siobhan: Definitely. So, and we'll be talking about that in the moment, Siobhan: the post-operative things you can do. Sheena: Yeah. Well, actually, I think we should move on to post-operative now because Sheena: I think people are getting the message now how important all of these things are. Sheena: The post-op period is vital. Sheena: This is an opportunity now to really heal the gut and to really get your health back on track.
Sheena: And if you take that post-operative period very seriously, in terms of looking Sheena: at your gut health, then you're going to impact upon your recovery, your wound healing, Sheena: your likelihood of post-operative infections, and other potential complications which we'll move on to. Sheena: But in that post-operative period, what is it that can potentially harm that recovery shift? Yeah. Siobhan: Well, I think we're talking about all the lifestyle things that we mentioned before.
Siobhan: So, you know, the hospital environment is not ideal. We're talking about lack Siobhan: of sleep. If you've not got a window or, you know, access to natural daylight, Siobhan: your circadian rhythm is disrupted. Siobhan: There's constant noise, light, the stress, the high rate of antimicrobial resistant Siobhan: bugs. So I think we've really got to get our house in order or our hospital in order.
Siobhan: We have to look at the architecture and environment in hospitals as a hugely Siobhan: potent way to improve patient outcomes post-surgery and reduce costs because Siobhan: the quicker patients heal, Siobhan: the quicker they leave the hospital, the better for everyone. Siobhan: So there is, you know, our focus obviously is on patient health and patient Siobhan: outcomes and caring for individual patients.
Siobhan: But if you look at the NHS coiffures and, you know, the issues with finances, Siobhan: this is incredibly important for that as well. Siobhan: Yeah, so I think all those things together would make a huge difference.
Sheena: And even for things like post-operative pain. So when you consider the complications Sheena: that people suffer from when they have operations like pain, Sheena: we know from our discussions with Deepak Ravindran that post-operative pain Sheena: is very much influenced by the gut microbiome.
Sheena: So the severity of your pain can be reduced if you enhance your gut microbiome Sheena: and you enhance your circadian rhythms and you reduce your stress levels and, Sheena: you know, all of these things and you improve your sleep. Sheena: And what we don't want is for patients to end up with chronic pain syndromes Sheena: post-operatively because their pain drags on and on and on. Sheena: And we know that the painkillers in their own right can be damaging for the gut microbiome.
Sheena: So if we can improve the gut Sheena: microbiome we can improve their general health and Sheena: their general well-being that's going to reduce the Sheena: pain it's going to mean that they heal quicker their pain will reduce and stop Sheena: quicker and they're less likely to go on to develop chronic pain syndromes and Sheena: that you know that could save the the nhs an awful lot of money because chronic pain is you know, Sheena: is a terrible sapper of NHS funds.
Sheena: But it's more so it's really vital for the poor patients who are stuck in this Sheena: endless, you know, pain journey, which must be absolutely horrendous for them. Sheena: So, you know, if we can try to get people's pain better controlled and get them healing quicker. Sheena: Get them out of the hospital environment faster, you know, all of that goes Sheena: to improving their pain and getting them back on track a lot quicker. Sheena: So that's vital.
Siobhan: When you were talking about that, you reminded me as well as, Siobhan: you know, chronic pain, this idea Siobhan: that post-operatively people's cognitive function can be really affected. Siobhan: Can you talk a bit about that, this post-operative cognitive dysfunction, this POCD phenomena? Sheena: Yeah. To be honest, before we researched this, I hadn't even heard of it. Sheena: But what I had heard of a lot is delirium in hospitals.
Sheena: And you know it's not unusual Sheena: for patients especially elderly patients to develop Sheena: delirium whenever they have something Sheena: significant happen to them like a significant infection or a big operation and Sheena: and it all to me these things go hand in hand but this post-operative cognitive Sheena: dysfunction is specific to a loss of memory post-operatively. Sheena: And interestingly, it's a similar mechanism to delirium.
Sheena: So it's created by an increase of inflammation within the body and the levels Sheena: of gut dysbiosis are common to that. Sheena: And leaky gut is common to post-operative cognitive dysfunction, Sheena: and a less functional gut microbiome is common to that condition. Sheena: So less production of short-chain fatty acids. Sheena: So a gut microbiome that is less metabolically active predisposes you or is Sheena: associated with post-operative cognitive dysfunction.
Sheena: And essentially, what we're finding in these individuals is that they have higher Sheena: levels of inflammation within the bloodstream, but also higher levels of inflammation within the brain. Sheena: And so that inflammation within the brain is triggering this altered memory and problems there. Sheena: So it all comes down to inflammation, gut dysbiosis, leaky gut, in my view.
Sheena: And so, again, patients that pay attention to their prehabilitation, Sheena: look after their guts, are, in my view, less likely to develop this postoperative Sheena: cognitive dysfunction. Sheena: And why is that important? Well, it's pretty distressing for any patient to Sheena: experience something like this, to lose their memory post-operatively. Sheena: But actually, it's also an indicator Sheena: for an increased likelihood of developing dementia in the future.
Sheena: So, again, this is an important condition to consider and to protect our patients from. Sheena: So that post-operative period is important, but the pre-operative period is Sheena: also important in terms of enhancing that gut microbiome and reducing that likelihood Sheena: of developing this condition. Sheena: Yeah. And the other really interesting condition that we came across was anastomotic leak. Sheena: Shiv, you did a lot of research into this. Do you want to talk about it?
Siobhan: Yeah, I became very interested in the gut microbiome and its role in surgical Siobhan: site infections and anastomotic leak. Siobhan: And just for any listeners who aren't aware what an anastomotic leak is, Siobhan: an anastomosis is a join between two parts of the gut usually. Siobhan: So if we take that as an example, you're having colorectal surgery for cancer of the colon.
Siobhan: If the surgeon is removing the cancer Siobhan: he then or she then joins the Siobhan: two parts of the gut together and where that joins Siobhan: together it's called the anastomosis now what you want is you want that to heal Siobhan: well and a really important part of that is the laying down of collagen which Siobhan: are proteins that are keen key to to wound healing it literally knits the wound Siobhan: together and you want a strong and flexible joint there.
Siobhan: Every surgeon's fear is that there is a leak in this joint and it's pretty devastating. Siobhan: The prevalence rates vary from anything from 4% up to something like 11 or 12%. Siobhan: And no one is really quite sure why this happens. Siobhan: I would say, well, it's obvious, isn't it? It's an infection or it's a blood Siobhan: supply issue or it's a technical issue with the surgeon.
Siobhan: But actually, people can't quite work out what it is that makes some wounds Siobhan: break down and others not break down and there is a professor in Chicago who Siobhan: is a gut microbiome professor and also a surgeon who Siobhan: called Professor John Alverde, who's been looking into this over the last couple of decades. Siobhan: And he thinks the gut microbiome are hugely important, particularly in surgical Siobhan: site infections and this anastomotic leak.
Siobhan: There are certain bacteria, certain species that produce enzymes. Siobhan: And these enzymes are called collagenases. Siobhan: Now, a collagenase enzyme, think of it like a little scissor that cuts collagen. Siobhan: So they actually break down collagen. Now, if you remember a few minutes ago, Siobhan: I was saying you need collagen to knit your womb together.
Siobhan: Then you have these potential pathogens that can increase in certain circumstances, Siobhan: which we'll go into in a moment. Siobhan: And if you've got a high number of these, you can imagine that you're trying Siobhan: to knit it together and all your work is destroyed by these bacteria that are Siobhan: breaking the collagen down.
Siobhan: Now, these bacteria are often bacteria, these pathogens that are in high levels, Siobhan: particularly after you've used broad spectrum antibiotics. Siobhan: And if you've got a dysbiotic gut, if you've got poor diet and all the things Siobhan: that we've been talking about, they actually increase in numbers during the perioperative period. Siobhan: So you can see that the surgeon's trying hard to make sure the wound is healing.
Siobhan: And the interesting thing about it is that surgeons really feel terrible about Siobhan: this if their patients have an anastomotic leak. Siobhan: And yet the answer may not be all the things they're thinking about. Siobhan: A big part of it might be trying to improve and bolster your gut microbiome Siobhan: before surgery so that your gut microbiome team is carrying on the good work Siobhan: once the surgery's been done.
Siobhan: Now, I won't sort of talk too much about this because I did get into a nice Siobhan: to and email conversation with Professor Alverde and I'm going to be talking Siobhan: to him in a couple of weeks time. Siobhan: So we'll really sort of go into a lot more detail about this. Siobhan: But the thing that really struck me about him reading his papers was this.
Siobhan: He was saying out of all the things you can do to modify your gut microbiome, Siobhan: and this is going back to the meeting we went to in Edinburgh, Siobhan: where they're talking about fabulous fancy pants stuff, the prebiotics, Siobhan: probiotics, symbiotics, fecal microbial transplants, Siobhan: you know, all this exciting stuff in the pipeline.
Siobhan: He said over and above all that, the most potent, affordable, Siobhan: effective, sustainable, you know, equitable thing you can do. Siobhan: Boost your gut microbiome prior to surgery is diet. Siobhan: And I found that shocking because he's talking about stuff that you can pick up at the supermarket. Siobhan: And that seems really, really potent and empowering to patients. Siobhan: There's this idea that there's this health inequality, that you can't access
Siobhan: these fancy medications. And I know there are issues about inequalities in nutrition. Siobhan: I absolutely accept that. Siobhan: But we have to, you know, get that good food to people. Siobhan: And we have to be, you know, working to reduce the price so that the healthy Siobhan: food is the cheap food, so that everyone deserves this, you know, Siobhan: and we're talking whole food, plant-based, you know, a huge diversity of different
Siobhan: foods. That's why there's colour of the rainbows. Siobhan: But again, not what you do have always, but what you don't have, Siobhan: reducing the emulsifiers, reducing the ultra-processed food, Siobhan: reducing the non-nutritive sweeteners, all that stuff. Siobhan: But I was kind of pretty shocked by how passionate he was about diet. Siobhan: And even a few days before, he's done some experiments.
Siobhan: A lot of his studies are in parallel. So he does a lot of epidemiological studies Siobhan: looking at, he'll take all the surgical infection rates in the USA and do clever Siobhan: statistical stuff to them.
Siobhan: He'll also take gut microbiome samples from those patients. But in parallel, Siobhan: who's doing animal studies so there was Siobhan: one study he did last year looking at it Siobhan: was anastomotic rates are increased Siobhan: in animals who have diclofenac which is an anti-inflammatory and a western type Siobhan: diet full of these emulsifiers and non-nutritive sweeteners and low in all this Siobhan: fiber and whole food and they're you know there's substantially significant
Siobhan: increase in anastomotic leak if you have a poor diet. Siobhan: And he traced that back to an increase in the number of these pathogenic bacteria. Siobhan: So yeah, I found that really interesting. Sheena: And just looking at that post-operative infection, a lot of surgeons believe Sheena: that the organism that causes the post-operative infection comes from the skin.
Sheena: And there's still common practices Sheena: out there in terms of using a lot of antimicrobials on the skin surface, Sheena: you know, before an operation, and also, you know, bolstering up protein levels Sheena: and things before operations with things like Ensure drinks.
Sheena: But what I would say about all of this is that, Sheena: you know, your research and our research has shown us that the staphylococcus Sheena: that often causes the post-operative infection is thought not to come from the Sheena: skin surface, but to come from the gut of the individual. Sheena: So it's coming from the gut microbiome, Sheena: And that's a really interesting finding for me in all of this research because Sheena: I would have always thought that it came from the skin.
Sheena: So to consider that your postoperative infection might actually be driven through Sheena: the gut still is really fascinating. Sheena: And yeah, I think that that's something that surgeons should be aware of. Sheena: That really brings home the importance of the gut microbiome. Sheena: And this week I was just chatting to a patient, so again, a patient with a post-operative Sheena: infection that is dragging on. Sheena: So a wound that's not healing, essentially, on a leg.
Sheena: And I started digging into the diet of this patient. Sheena: And the patient had a very carbohydrate-high diet. Sheena: So bread for breakfast, waffles after the bread, bread for lunch, Sheena: certainly getting enough protein.
Sheena: But predominantly carbohydrate-based. So you may not have a lot of sugar in your diet per se, Sheena: but you may be consuming too much in terms of carbohydrates in your diet, Sheena: and that is acting like a sugar in terms of driving the wrong type of microorganism in the gut, Sheena: but also setting your sugar levels high in the body, Sheena: which will then, you know, the sugar levels going up and down throughout the
Sheena: day will then drive the wrong composition of bacteria in the gut and that can prolong infections. Sheena: And we also know from the interview that I did with my dermatology research Sheena: colleague that the type of microorganism within the wounds is altering your wound healing. Sheena: And people that are not healing their wounds properly have a slightly altered Sheena: composition of microbes on the skin.
Sheena: All of these things to me come together. And I think, you know, Sheena: you might think that you've got a normal, healthy diet, but perhaps it's the Sheena: ratio that's not quite right there. Sheena: Perhaps you've got too much carbohydrate in your diet and not enough of the Sheena: fibrous plants to balance that out.
Sheena: And that's what I see a lot of when I dig down into people's diets, Sheena: that they may be having their toast for breakfast and Sheena: then they might have their sandwich at lunch but there's no fruits or Sheena: vegetables involved in those meals Sheena: and then they have all their veg in the Sheena: evening just one portion alongside a big portion Sheena: of carbohydrate with you know a decent protein and
Sheena: that's fairly typical of the western diet that I see right now and I think it's Sheena: the ratio that's wrong and if we were to get more as you say adding in more Sheena: and more of the plants into that diet then that would alter the way that you're Sheena: metabolizing and it would alter the the inflammatory response within the gut.
Siobhan: Yeah i mean it is interesting because obviously um there's a big move away from Siobhan: ultra-processed food but you know i appreciate that some patients or many patients Siobhan: perhaps you know have had chemotherapy are feeling poorly the appetite's gone Siobhan: they're stressed and i see the role of these, Siobhan: concentrated um food products but they we've always Siobhan: got to think food first and you know trying to move
Siobhan: them because there are a lot of emulsifiers and additives in Siobhan: these foods and i think there is uh you know we need Siobhan: more research around uh how we Siobhan: improve um you know we have to use those Siobhan: supplements but how to also to get people off them as quickly as possible because Siobhan: a lot of my patients think that that is better than food um Siobhan: uh they think that that's a superior uh and this idea that you know food is
Siobhan: you know whole food is the go-to and you know you should use supplements only Siobhan: as and when and you should try and you know swap them out as soon as possible Siobhan: although obviously as some circumstances i can see there will be a role. Sheena: Well, I mean, again, if you consider that aspect, you know, I'm not well, Sheena: I'm in a hospital environment, I'm feeling lousy, I need my sugar, Sheena: I need my chocolates, I need my, you know, to feel better.
Sheena: Well, the research, and certainly Felice Jacka's research, actually says the Sheena: opposite, that, you know, driving sugar levels up when you're not well is actually Sheena: going to make you feel worse. Sheena: You're going to feel more tired, more lethargic, your mood's going to be lower, Sheena: and you're going to feel less energy.
Sheena: And Tim Spector voiced that as well. The one thing that people really noticed Sheena: when they change their diets to a more whole food diet and more fiber in their Sheena: diet, their energy levels improved, their mood improved. Sheena: And these weren't outcomes that he was expecting, but that's very typical.
Sheena: And my friend who's going through chemotherapy, she told me oh I need my white Sheena: bread when I'm going through this and I convinced her to try a different approach, Sheena: and try a healthier diet and she said oh my goodness the days I had that post Sheena: chemo I felt so much better, Sheena: my energy was better. I could go out and do some exercise that afternoon straight after my chemotherapy. Sheena: Whereas if I had my white bread and my sugar, I couldn't do it.
Siobhan: Yeah. I mean, that brings us back to hospital and food in hospitals. Siobhan: I mean, we've got the hospital food thing, which is kind of, Siobhan: you know, there's very few hospitals that have a decent standard of hospital food. Siobhan: Most of it's ultra processed, very unappetizing, and, you know, Siobhan: very poor quality and likely to be detrimental to your health. Siobhan: But then I dropped a relative off at a hospital recently as I walked into this new hospital.
Siobhan: It cost millions of pounds to sort of update it. And there's about three or Siobhan: four ultra-processed food, fast food outlets there, sandwich shops, Siobhan: you know, whatever, which are quite expensive.
Siobhan: And just so this idea that the patient not liking the hospital food, Siobhan: they think, well, I'll shuffle down on my Zimmer frame with a relative and go Siobhan: and have a nice cup of tea and some other ultra processed food at huge cost Siobhan: under the hospital umbrella. Siobhan: I mean, the messaging of that is, you know, terrible.
Siobhan: It's that, you know, this place of healing and this place of science, Siobhan: this place of knowledge, you know, the messaging is that this must be safe. Siobhan: This must be good because the doctors and nurses and medical staff are, Siobhan: you know, working under this umbrella and therefore must approve it.
Siobhan: In the same way as you wouldn't expect now, there'd be an outrage if you went Siobhan: to your dentist and there was a vending machine and a pot of sweets that you could dip into. Siobhan: And if your kids were waiting for a while, you could pop round to a little cafe Siobhan: off the side of the dentist and go and get a drink, a fizzy drink and, Siobhan: you know, some chocolate.
Siobhan: People would see that as bizarre. and yet we haven't had that seismic sort of Siobhan: shift in mindset in hospitals about the importance of food and lifestyle in Siobhan: terms of the lighting, the ambience, the noise, Siobhan: the connectivity.
Sheena: So our appeal as microbiome Sheena: medics is that everybody listening to this podcast Sheena: who works in a hospital environment can you Sheena: think of how to improve your patient's Sheena: gut microbiome and can you think of Sheena: ways that you can get this message through to your Sheena: managers and to anybody in Sheena: the local community that has any impacts on Sheena: hospital environment because if we Sheena: don't get these things changed for our patients then we're
Sheena: really going to struggle with prolonged infections Sheena: post-operative pain you know all these Sheena: poor outcomes for our patients and that we don't want none of our patients should Sheena: be suffering as a result of the environment that we're putting them in and that Sheena: that's really vital that we start to look at this with fresh eyes now that we Sheena: understand human microbiomes and all of these other things,
Sheena: So I think going forward, we now need to have a different approach and shift. Siobhan: Talking about hospital food, the campaign for better hospital food in the UK, Siobhan: we'll put the links to that. Siobhan: So if anyone wants to, feels all fired up by this conversation and wants to Siobhan: find out how to make a difference and what's going on, then, Siobhan: you know, have a look at that because that's really interesting.
Siobhan: There's a lot of traction behind that, trying to improve hospital food.
Sheena: So yeah perfect perfect okay Sheena: let's talk about what's next so obviously we're going Sheena: to go our separate ways now Shiv and we've both Sheena: got things coming up that we're involved in so I'm Sheena: actually going to be presenting at the Solas Festival on Sheena: Saturday 22nd I think it is of June I Sheena: do a little presentation on gut microbiome at Sheena: the Solas Festival in Errol Park in Perthshire in
Sheena: Scotland lovely little festival with a lovely well-being Sheena: tent um so i'm going to be there again this Sheena: year um i'm presenting with janice klein janice has been on our podcast she Sheena: is the fermentation queen of scotland and i'm really looking forward to being Sheena: back together with her again um and we're going to be showing people a little Sheena: bit how to make some fermented foods and how to look after your gut microbiome so,
Sheena: So I've got that coming up. And then later on in the year, I'm doing a lifestyle Sheena: presentation at the Primary Care Diabetes Conference in Birmingham in November. Sheena: So Shiv, you've got a really exciting Sheena: study day coming up and I'm really actually gutted. I'm missing it. Siobhan: I am gutted. We have to say gutted. Yeah, there's Felice Jacker, who we're a huge fan of.
Siobhan: She is a professor and she founded and directed the Food and Mood Centre at Siobhan: Deakin University in Australia.
Siobhan: And even more importantly she's the co-author Siobhan: of that kids book that i was raving about a couple of Siobhan: christmases ago there's a zoo in my poo which is a kid's um book on the gut Siobhan: microbiome which is absolutely incredible um but she is the lady who's done Siobhan: loads of style uh trials into uh the effect of food on on mood uh particularly Siobhan: the the most infamous one was the smiles trial i think that was in 2017,
Siobhan: which is kind of the first randomized control trial, Siobhan: which compared modified Mediterranean diet intervention with a control in adults Siobhan: with major depressive disorder and got very positive outcomes. Siobhan: So that's kind of kickstarted this whole area of nutritional psychiatry and lifestyle psychiatry. Siobhan: So she and her team are in London and we're doing a collaboration with the BSLM on the 28th of June.
Siobhan: We'd love to see you there. Although I suspect it's a very small masterclass. Siobhan: So I suspect the tickets might go really quickly. But if you're quick, Siobhan: we'll put some links here. Siobhan: And if there's any tickets, I'd love to see you there. So it's an overview of Siobhan: lifestyle medicine, the diet, the gut microbiome, gut brain axis, Siobhan: mental health, and all the key mechanisms.
Siobhan: With the whole day, Felice Jacker will be there with some other members of her team. Siobhan: And there's a brilliant panel of experts as well. So that's going to be incredible, Siobhan: especially for any psychiatrists, psychologists, lifestyle medics, Siobhan: nutritionists, you know, you name it, healthcare professionals, Siobhan: it's going to be absolutely incredible. Sheena: I'm gutted I'm missing it.
Siobhan: I know. But we will meet at the BSLM conference, which is the 18th to the 20th of September. Siobhan: So that I think it's art and the science, art and science transforming health, Siobhan: something like that. Anyway, it's going to be brilliant. It's in Brighton. Siobhan: Come see us there, you know, and we'll put some links to that as well. Sheena: Lovely. Okay, that's fantastic. I'm really excited. We've got lots coming up.
Sheena: So nice to chat to you again, Shiv. really nice to to do a podcast together finally.
Siobhan: It is i just want to say as well Siobhan: it is lovely to see you um and also just Siobhan: you know because it was your idea to you know talk about the uh anesthetic conference Siobhan: we went to and i think it's really important and it's really important that Siobhan: people who've listened to this then listen to next month's podcast because we Siobhan: will be talking to professor john alverde who is brilliant and one of the top
Siobhan: global experts in the gut microbiome He's amazing. Siobhan: And it will be talking about a lot of the things we spoke about today, Siobhan: but really digging down deep into the molecular mechanisms behind a lot of his Siobhan: work. So, you know, hope to see lots of you there. Sheena: Lovely. Right. On that note, thank you all for listening. Sheena: If you enjoyed this podcast, please leave us a review. We need more reviews.
Sheena: So please leave us a review and we will speak to you again. Bye, Shiv. Take care. Siobhan: Take care, everyone. Bye now. Sheena: Bye. Bye. Intro and Outro: Thank you so much for listening to this episode of Microbiomedics Podcast. Intro and Outro: We really hope you enjoy the content and we welcome your feedback. Intro and Outro: We'd love to hear any suggestions you might have for microbiome topics that you'd like us to cover.
Intro and Outro: And we also appreciate listeners' questions and we'll endeavor to answer them in the next podcast.