S7E05 Gut health and MS with Dr Emma Short

Emma Short  00:00

So rather than say I will avoid ultra processed foods, say I will, if I want to snack, I will have an apple, because generally our motivation is likely to stay higher if we have positive approach goals rather than negative goals. So focusing on the positive,

 

Overcoming MS  00:18

Welcome to Living well with MS, this show comes to you from Overcoming MS, the world’s leading multiple sclerosis healthy lifestyle charity which helps people live a full and healthy life through the Overcoming MS program, we interview a range of experts and people with multiple sclerosis. Please remember all opinions expressed are their own. Don’t forget to subscribe to living well with MS on your favorite podcast platform so you never miss an episode. And now let’s meet our guest.

 

Sam Josephs  00:53

Hello everyone, and welcome to the Living Well with MS podcast. My name is Sam Josephs, and I’m a registered nutritionist and senior facilitator with Overcoming MS, so my specialty is the diet pillar of the program, and today, I’m delighted to be joined by Dr Emma Short, who is the doctor specializing in gastrointestinal and soft tissue pathology. She’s also the author of a new book, Healthy Gut, Happy You and I’m delighted to have you here with us on the show today. Welcome Emma.

 

Emma Short  01:30

Thank you very much, Sam. It’s lovely to be here. Thank you.

 

Sam Josephs  01:33

So first of all, do you want to tell us a little bit about yourself and about your journey into Gastroenterology and what it was that kind of fueled your interest in this area?

 

Emma Short  01:43

Yeah, absolutely. So I work as a pathologist, and I specialize in gastrointestinal and soft tissue pathology. So as a pathologist, I’m the type of doctor that diagnoses diseases. So if somebody had a biopsy, or if they had, for example, their colon removed, I would get the tissue specimen dissected if it needed dissecting, and then the tissue sample is processed to create glass slides, and I then examine these slides using a microscope in order to diagnose diseases.

 

Sam Josephs  02:14

Okay, very interesting. And what was it that led you sort of along the path to write this new book of yours, Healthy Gut, Happy you.

 

Emma Short  02:25

So for a long time, the gut was neglected in clinical practice. It was just sort of as the tube that absorbed nutrients and made the poo. Over the last sort of 10 to 30 years, we’ve become much more aware that the gut does so much more than this, and one of the amazing things that the gut does is house the microbiome, and we now know that the microbiome plays a major role in our health and well being, and when it goes awry, diseases can result. So the book is a short, easy to access guide explaining what the gut microbiome is, what it does and how we can nurture it in order to improve our health and our well being.

 

Sam Josephs  03:06

Yeah, great. Before we go any further, you probably ought to define a little bit and explain a little bit about what exactly the microbiome is and some of the ways in which it can influence overall health. Yeah, absolutely.

 

Emma Short  03:20

So a microbiome describes the collection of microorganisms that live in a certain environment. Specifically, it refers to their genetic material, and we should use the term microbiota, but most people are more familiar with the term microbiome. So by microorganisms, we mean the tiny, little creatures that you can’t see with your eyes, you’d need a microscope to see them. So we’re talking about bacteria, viruses, fungi, protozoa and archaea and so on. So as humans, we’ve got a variety of different microbial ecosystems on us and within us. So we have a skin microbiome. We have microbiomes in our airways microbiomes in our urog enital tract, but the gut microbiome is the largest numerically, and it’s the most diverse of our microbiomes. So the gut microbiome describes all of those microorganisms which live throughout our gastrointestinal tract, which is effectively a long, muscular tube that extends between our mouth and our anus. So the gut includes our esophagus or gullet, our stomach, our small bowel and our large bowel. But the vast majority of the research so far has been done particularly looking at bacteria, and particularly looking at the bacteria which live in the large bowel or colon. So generally, when we’re talking about the gut microbiome, we’re usually talking about the bacteria that live in our large bowel or colon. And we now know that these are incredibly important for our health and our well being. They’ve got hundreds of different functions, but very much in a nutshell. Well, they’re involved in defense. So our guts are amazing. They have to be permeable enough to allow us to absorb nutrients, but impermeable enough to keep out any potential harmful bacteria or other microorganisms we might ingest and anything else toxic we might ingest as part of our diet. So we have what’s called an intestinal barrier, and this includes the microbiome. So the bacterial species a layer of mucus, the epithelial cells, which line the intestines, and then the inflammatory cells within the gut. So the gut microbiome, they almost act as that physical bounces. They can by taking up space, they can keep out any potentially harmful bacteria, harmful things we might ingest. Some of the bacteria will produce antibiotic like molecules, and they’re also very important in maintaining the integrity of the mucus layer and in providing nutrients for the cells that line the gut. Secondly, the gut microbiome are very important in the development, maintenance and activity of our immune system, and also in regulating inflammation, both within the gut and throughout the body. They also have a synthetic function. So the gut microbiome is involved in producing, for example, some of the B vitamins, vitamin K, some amino acids, which are the building blocks for proteins, and also some neurotransmitters, which are chemicals that allow nerves to speak to each other. The gut microbiome is also very important in fermenting fiber. So fiber is something that we can’t digest and break down because we lack the enzymes to do so as humans, but the gut bacteria can ferment fiber into these amazing, tiny little chemicals called short chain fatty acids. Most of these are absorbed rather than being pooed out, and they affect pretty much every organ system that you can think of. Short chain fatty acids affect our mood, how hungry we are, how much food we eat, how well our liver functions, our cholesterol levels, our blood glucose levels, and I could go on, they pretty much affect every organ system. So the gut microbiome is incredibly important in many, many different aspects of our health and our well being.

 

Sam Josephs  07:23

And I’ve, I’ve, is it true? I’ve heard if we were to remove all the bacteria from the microbiome, we’d have about two kilos.

 

Emma Short  07:31

Yes, yeah. So that’s very true. So the gut microbiome can weigh up to two kilograms. So it counts for, you know, not an insignificant part of our body mass, we’ve got between 39 and 100 trillion bacteria there. And for every human gene we have, we have at least 100 bacterial genes. So genetically, we’re effectively more bacterial than we are human.

 

Sam Josephs  07:55

Yeah, yeah, amazing. And I’ve heard in some papers, they’re describing it almost like a separate organ or a different organ in the body. It’s absolutely important in terms of the far reaching effects that the microbiome just contained within the gut has on things like brain, nervous system and all throughout the body as well. The Overcoming MS program recommends as a diet, a whole food, plant based diet with seafood as well, if desired. We know that this plant focused approach is really nourishing to the microbiome. Can you explain why that is?

 

Emma Short  08:36

Absolutely. So I’ll just explain a little bit about how our microbiome forms. So the previous thinking was that when we’re babies in the womb, we’re germ free, so the initial major acquisition of the gut microbiome is when we’re born. So we find that babies who are born via the vaginal canal have a slightly different microbiome to those who are born via cesarean section. The next thing that’s really important is the method of feeding. So it depends on whether babies are bottle fed or breast fed, and then over the first two to three years of life, many factors are really important in shaping the microbiome. So things like the age of weaning, the type of food that the baby has when they’re weaning, whether they’ve got brothers and sisters, whether they go to a childcare facility, whether they’ve got pets, whether they live in a rural or urban environment. But from the age of two to three, the microbiome stays relatively stable, but the most important factor in shaping it and causing it to change and modify is our diet. So the things that are really important for the gut microbiome are to make sure that we eat enough fiber. So in the Western world, we’re eating far less fiber than we should do. We should be having at least 30 grams of fiber a day, but generally, not a lot of people manage that in the Western world, and that’s really important because fiber is what’s fermented by the gut bacteria to produce those short chain fatty acids that can have a wealth of benefits for our health and well being. What we should be aiming for is to have at least 30 different plant based products a week, and that includes not just fruit and vegetables, but also nuts, whole grains, legumes, beans and so on. And within that, aim for diversity. So aim for lots of different colors, flavors, textures. And that’s because, like humans, different bacteria like different nutrients. They need different things to flourish. So if we aim for diversity, we’re nurturing as many different bacterial species as possible. So fiber and diversity are really important. Other things that are important can be to include polyphenols in our diet. So polyphenols are often found in plants. In plants, they’re there to protect the plants against things such as ultraviolet light invading like pathogens. So things that can harm the plants, but they’re also very beneficial for humans. So generally, human populations that have a diet that’s rich in polyphenols have a reduced risk of chronic diseases such as high blood pressure, diabetes, certain cancers, and the Polyphenols are also very good for our gut bacteria. So polyphenol rich diets promote the growth of anti inflammatory bacteria and reduce the growth of bacteria that can have pro inflammatory effects. And the type of foods and drinks that include Polyphenols are things like dark berries, red onions, spinach, dark chocolate, coffee, so those things have got quite strong colors. And other things that can be beneficial are to have fermented foods and drinks in our diet. And I’m not sure we may come come on to talk about that later, but that’s because they’re probiotic. They actually contain live bacteria. And then the things we want to avoid are the ultra processed foods and having too much fat, too much sugar in our diets. In the Western world, we tend to get a bit of a double whammy effect. So we’re not eating enough fiber that we’re replacing that by Ultra processed foods, foods that are very high in fats, sugars, artificial ingredients and so on. And we know that if you have a very high intake of ultra processed foods that’s associated with the growth of some bacteria that can be harmful for our health, they have pro inflammatory effects within the body.

 

Sam Josephs  12:33

You mentioned in the book, actually, and it’s really, it’s a bit of a buzzword about the ultra processed foods at the moment, and the sort of the awareness that we have now being exposed to with just sort of how much of our diet is being replaced by these sort of foods. But it’s not just about the foods taking up the space of other Whole Foods in the diet, is it? There’s actually some ingredients within the ultra processed foods themselves, that could be harmful, besides the sugar and the and the fat. Is that true?

 

Emma Short  13:07

So Ultra processed foods. What are ultra processed foods? There’s different ways to classify them. One approach is to look at what’s in there. And some people say they’re more than five ingredients. You have to be concerned it could be ultra processed. But one approach I like to take is to look at the ingredients, and if there’s anything that you wouldn’t find in your kitchen cupboard, then that’s an indication that’s likely to be ultra processed. So Ultra processed foods are designed to taste very to be very tasty, to have nice textures and to leave you wanting more. So they often have lots of artificial ingredients. They contain calories, so energy, but they often don’t, not always, but often they don’t necessarily have much nutritional value, but they often contain ingredients such as sweeteners, emulsifiers. And studies have shown that both sweeteners and emulsifiers can have detrimental effects on the gut microbiome.

 

Sam Josephs  14:03

Yeah, yeah. And this is, this is, I mean, it’s reassuring for people listening who are following the Overcoming MS program as far as diet goes, because the emphasis really is on whole foods and limiting these foods and increasing and including lots of plant based foods as well. Are there any lifestyle factors that can impact the microbiome, the gut microbiome in its health?

 

Emma Short  14:31

Yeah, absolutely. So, although diet is the most important factor in adulthood in shaping the gut microbiome, lots of different lifestyle factors are also very important, and these are all interwoven like a web. If you affect one, it then impacts everything else. So some of the lifestyle factors that are important in the microbiome are sleep, exercise, social connections, activities such as smoking. So if we look at sleep, we know that if you have a short duration of sleep, or if your sleep is very fragmented, that has a negative impact on the gut microbiome, but also, if you’re tired, you’re less likely to make healthy food choices, you’re less likely to exercise. So it impacts lots of other things. Similarly, we know that exercise is good for the gut microbiome, so generally, it’s the cardiovascular exercise in moderate quantities that’s good. So the activities that increase your heart rate and breathing rate, like running, skipping, cycling and so on, strength work hasn’t been shown to be as as as effective as cardiovascular exercise in terms of having a positive impact on the gut microbiome, but it’s important for so many other things that we still recommend it absolutely. And similarly, if you do if you exercise, you’re more likely to sleep better, you’re more likely to feel less stressed, and so on. So everything’s interwoven. If you do moderate amounts of cardiovascular exercise, it increases bacterial diversity, and it’s that diverse microbiome that has a positive impact on our health and well being, and it also increases its functional capacity. So as well in as well as being diverse, it’s better able to produce those molecules and chemicals that are that are beneficial to us. Social connections are important as well. So if we think about married couples, or couples who aren’t necessarily married, but are in a partnership. If they describe their relationships as being very happy, we find that there’s an enhanced bacterial diversity compared to people who are in relationships that don’t rank them as being quite as happy, and that’s independent of diet. So it’s probably likely to be due to the fact that if you’re in a relationship and you feel safe and happy, you’re more likely to make healthy choices in terms of exercise and sleep and feel less stressed and so on. And also, there’s more likely to be more sharing of bacterial species through physical contact. Smoking, as you would imagine, smoking is bad for the gut microbiome. We see reduced bacterial diversity in smokers. High levels of alcohol consumption are also bad for the gut microbiome. Again, we can see reduced bacterial diversity, enhanced proliferation of some of the species that are pro inflammatory and with high levels of alcohol use, we can see sort of enhanced intestinal permeability. So there are lots of different lifestyle factors that are very important in shaping the gut microbiome, and often these impact each other.

 

Sam Josephs  17:33

Yeah, yeah. I think that’s also reassuring as well for people on the program, and the idea because physical activity is one of the pillars of the program as well. So making sure that we’re incorporating some cardiovascular alongside the resistance work. It’s it’s good to know that directly and doggies obviously.

 

Emma Short  17:54

Yeah, pets are gears, absolutely. Putting upside nature is as well. Actually spending time outside in the natural environment that benefits your your gut bacteria as well.

 

Sam Josephs  18:04

So you mentioned briefly short chain fatty acids, and in the book you, you, you have a short interview with the neuroscientist Dr Miguel Matthias. I’ve actually been to a couple of his lectures before, very flamboyant and very interesting, and his run into some, some really interesting places in the last few years, he’s a real font of knowledge for the microbiome. So you talk about short chain fatty acids being beneficial for the blood brain barrier, one of the mechanisms that allows the processes of MS is thought to be having a leaky blood brain barrier. So can you explain a little bit more about the role of these short chain fatty acids and how that could be relevant in the world of MS?

 

Emma Short  19:02

So the blood brain barrier describes a complex vascular network that supplies our brain, and it similar to the guttash. It has to be very clever, because it has to be very selective in what it lets in. It needs to let in nutrients and things that will nourish our brain cells, but it needs to keep out anything that can be potentially toxic, so it’s a selective, semi permeable barrier. And short chain fatty acids, particularly at butyrate, are known to be very important in maintaining the integrity of of the blood brain barrier. In terms of the gut microbiome, there’s been studies in both humans and mouse models that have shown that the gut microbiome is likely to be important in both the initial development and then potentially the progression of multiple sclerosis. So what we find is that if you look at the microbiome of somebody with multiple sclerosis, we find that it’s different to somebody who hasn’t got multiple sclerosis. It’s not necessarily a reduction in bacterial diversity, but we see different species present. So we see higher numbers of bacteria that are thought to be pro inflammatory. And interestingly, if you take the microbiome from somebody who has multiple sclerosis, and transplant it into a germ free mouse, which is a mouse that’s been brought up in a sterile environment so they haven’t got haven’t got bugs within them or on them. The mouse will then develop a similar phenotype, so similar symptoms, to human multiple sclerosis. There was a big study that was a bit was originally set up in 2015 that’s doing a lot of research looking into exactly how, what role and how the microbiome plays in multiple sclerosis. Because it’s not it’s not straightforward. It’s not as easy as you’ve got this microbiome, you’ll develop MS. Absolutely not for some people, the dysbiosis, so the higher levels of inflammatory species are found before the disease develops. In other people, it’s seen after the disease has developed. We see different microbial compositions dependent upon the stage of the disease, depending on the different types of disease, so primary progressives versus secondary progressive and so on. So it’s not a straightforward picture. The evidence does show that people with multiple sclerosis may have a different microbial composition to those who haven’t got multiple sclerosis, but actually unpicking it to determine all the mechanistic effects is work that’s in progress. It’s probably thought most likely to be due to the effects on inflammation. Yeah, but a lot of research is being done in this context, and it is, you know, it is an exciting avenue to explore, because once we’ve got more understanding, we can then think about ways that we could change the microbiome to have a beneficial effect using things such as, you know, prebiotics, probiotics, fecal transplants and so on.

 

Sam Josephs  22:03

I have been looking at some of the research, and it does feel like it’s in very early stages of beginning to understand how certain populations of bacteria can impact one person in one way and not another.

 

Emma Short  22:18

That’s the thing with the gut microbiome. It’s fascinating, but it’s very complicated. So you know, exactly as you said, one bacteria in one person could do one thing. It could do something completely different in somebody else, you know, dependent upon that individual’s genetics, their lifestyle, what other diseases they may have, what medications they take, what else is in their gut. So although at the moment, most of the research has been done at the looking at the bacteria. It’s not just bacteria that are there. There are also, you know, viruses, fungi, archaea and so on. And more research is being done looking at all these other microorganisms, but exactly how they’re all interrelated would be, you know, it’s very different between different people. Everybody’s got different microbial compositions. So, yeah, so the same, you know, the same dietary intervention in one person can have different effects to that in another person.

 

Sam Josephs  23:10

Yeah, it’s fascinating. And I know we’re going to see a lot more coming up over the next 10 years, hopefully, sort of helpful things that we can do. I know, for example, some of the medications can improve the microbial populations in the guts of people with MS, things like Copaxone has apparently got a beneficial effect on the microbiome. So whilst we’re waiting for all of this sort of new research, is there anything sort of super unusual or surprising that you’ve personally discovered in your research around the microbiome, about some weird and wonderful thing that it can do or is responsible for?

 

Emma Short  23:56

I think that there’s so many things. For example, if we think about obesity, we know that the gut microbiome can play a role in causing obesity. So individuals who have obesity have reduced bacterial diversity compared to people who don’t have obesity, we see higher numbers of a certain species that this species then promotes enhanced appetite, enhanced food intake, increased uptake of fat into fat cells, reduced energy reduced energy expenditure. So whenever you think of anything to do with the gut microbiome, it has so many effects throughout the body that it’s quite astounding that this is only something that we’ve only just come to learn about within the last, you know, last few decades.

 

Sam Josephs  24:45

Yeah. It’s real. Watch this space, isn’t it? Yeah.

 

Emma Short  24:50

And I think probably at the moment, in terms of testing the gut microbiome, it’s done in the research setting or commercially, there’s, at the moment, in a lot of time, there’s not enough evidence to translate it to the clinical setting. At the moment, hopefully there will be in the future. But in the future, the ideas are that we may be able to analyze a gut microbiome in order to predict who might develop certain diseases, to diagnose certain diseases, to predict somebody’s response to treatment for certain diseases. And then we can also think about how we can modify the gut microbiome in order to, you know, reduce the progression of diseases, to reduce symptom severity and to treat some diseases. So I think in the future, it will be a really, really exciting area in science and medicine.

 

Sam Josephs  25:36

One of the things going back to your book, I just love how practical it is. So it’s kind of, it’s a real handbook of, sort of a synopsis of what the microbiome is and how it can impact various areas of our lives and our health. But then you have a really helpful kitchen staples section and the swaps bit, where you give really practical advice on, you know, how people can create a shopping list, so they’ve got some of those gut healthy foods at home, and how they can make simple swaps. And a lot of the recipes that you’ve got in the book are actually really Overcoming MS friendly. They may be one or two things that, you know, very easy to tweak, but there’s a lot of vegetarian recipes, and it’s very plant focused as well. What are your sort of go to daily boosters for your microbiome that you personally aim to include?

 

Emma Short  26:36

So one of the things that I have every day is a seed mix. So you can mix together pumpkin seeds, sunflower seeds, chia seeds, any seeds that you like. So because we’re aiming for that diversity, at least this different plant based products in a seed mix, you can easily get 5, 6, 7, seeds. So you’re getting a really good way through your diversity content just with one spoonful. So I always have seed mix every day. I also try to have berries every day, so you can buy, you know, mixed bag of frozen summer berries. And within they’ve often got strawberries, raspberries, black currants, red currants, blackberries. So again, within there you’ve got diversity. And berries are good because hey’ve often got those dark red, purple, rich colors, and they’re rich in polyphenols. So for breakfast, I’ll tend to have yogurt with the seed mix with frozen berries. So already, at the start of the day, you’ve got fiber, you’ve got phytonutrients, you’ve got polyphenols. With that diversity, with that fiber. I also try to have fermented foods and drinks every day, so we haven’t really talked about prebiotics and probiotics and also now post biotics. So prebiotics are those fiber resistant starches that benefit our healthy bacteria. So some of the best prebiotics are ingredients that most of us have got, things like onion, garlic, bananas, and they’re the some of the good fiber sources that are healthy gut bacteria, like probiotics, are the actual live bacteria themselves, and they’re the bacteria that, when you take them on board, they have a positive health benefit for the host. So for the person that’s taking them, you can get probiotics in capsules. You can get them in lots of supermarkets, health food source, online and so on, but you can also get them in fermented foods and drinks, so things like kefir, kombucha, sauerkraut, miso, and they’re really good because they’ve got the live bacteria. Something that’s just important to be aware of is that probiotics as capsules and supplements are not regulated currently, as a drug or a medicine, they’re seen as a food supplement, so the way that they’re marketed and regulated and so on is different to that of a medicine or a drug. So sometimes, some of the probiotics that you get, they may not even you know, the bacteria may not survive, because our gastrointestinal tract can be quite hostile in the stomach, we’ve got acid digestive enzymes. As we go further along, we’ve got the bile acids and so on. So if you were, if you were thinking about taking a probiotic supplement, it’s really worth thinking about, you know, why am I taking it? Is it for a specific indication, or is it for health in general? And it is worth diving into the literature and doing a bit of research to see if I am doing it for a specific health problem. Has any research been done? Which bacteria was used in the study, not just the species, but also the strain of bacteria at what dose? What was the dosing regime? How long was it taken for? And so on, because you don’t want to waste your money on something that might not have any you know, any benefit whatsoever, but you can get probiotics, as I mentioned in the fermented foods and drinks. Another thing just to be aware of is that, because these are live bacteria, it’s usually recommended as a blanket that they’re not taken by anyone who’s very, very young, very, very elderly or immunocompromised in any way. But I do try to have fermented foods and drinks every day as well.

 

Sam Josephs  30:04

Do you ever recommend these probiotic supplements, or even prebiotic powders or anything to your patients or for anyone in particular? Do have you ever seen a particular use for them?

 

Emma Short  30:17

So for prebiotics, in terms of powders, I think it’s always best to have the whole food. So it’s better to have a banana, to have the onion and garlic when you’re making a pasta sauce, because then, as well, you know, you’re getting the fiber, you’re getting the other nutrients that are present within the whole food. So for the prebiotics, I would recommend having the whole food. Cook with the whole food, eat the whole food. For the probiotics, I think that very much does depend what you’re taking. What’s the indication? So for some, because there is a, you know, in certain health conditions, there is evidence that probiotics can be beneficial. So it very much depends upon why somebody wants to take it. Do they have a specific reason, and is there any scientific evidence that a probiotic will be beneficial? You know, for example, in irritable bowel syndrome, there is evidence that probiotics can reduce symptoms and anxiety. But it is really important to look to see what research has been done and make sure that if you are taking a probiotic supplement, it’s something that has been shown to have a clinical benefit.

 

Sam Josephs  31:32

Yeah, thank you. That’s really good advice. In the book. You use an acronym energize. Those letters are there to help remember all the different ways in which we can look after and nourish our microbiome. Do you mind reminding me, and for the sake of our listeners, just explaining again, energize? Yeah,

 

Emma Short  31:56

absolutely. So there’s two slightly different variants of Energize. The first book I wrote. Was generally about health and well being. So energize was originally exercise, nutrition, environment. So thinking about spending time in nature and reduce screen time. R is relationships and social connections. G was goal setting. I was ideas, mindset and stress reduction. S was sleep and E was in empower. So in the original book, each of those had a chapter. We were looking at aspects of each of those parameters to see how we could improve health and well being in the context of the gut microbiome. E, again, is exercise, so making sure you do those cardiovascular activities. N is nutrition, so fiber diversity, polyphenols, prebiotics and prebiotics and probiotics. So the fermented foods and drinks .E, the second E was eat within a defined time frame. So there is some evidence that if you eat within a defined time frame, for example, if you eat over a 12 hour window, and then fast for a 12 hour window, that is beneficial for our gut microbiome, in terms of the optimal eating window, we don’t yet know what that is. Some studies have shown that 12 hour faster beneficial. Others have shown that 14 hour faster beneficial. Others have shown that 16 hour fast are beneficial. Other studies have shown that it’s not beneficial at all. But at the moment, the bulk of the evidence would support eating within a certain time frame. We don’t know what the best one is, but probably a safe window to eat over. As you know, it would be 12 hours for example. So eat over 12 hour window and then fast for a 12 hour window at the next R. Sorry, the first R is reduced stress, because we know that stress has an adverse impact on our gut microbiome. In situations of both acute stress and chronic stress, we have activation of various neural pathways, hormone pathways. It affects our immune system and inflammation, and all of these things can have a negative impact on the gut. So ways to reduce stress is important if we want to think about the health of our gut microbiome. G, I trust you remember the spelling then G is, get outside. So go outside, spend time in nature, because we, when we spend time outside amongst the green the green trees in natural environments, that has a positive effect on our gut microbiome. I is inhibit our intake of ultra processed foods, so similar to what you were saying, and try and focus on a whole food, plant based diet, try and avoid Ultra processed foods as much as you can. S is sleep, as we mentioned, having you know, good quality and sufficient sleep is important for our gut health. And the final E is to enhance and nurture social relationships. Because socia relationships and feeling connected also benefits our goal.

 

Sam Josephs  32:58

When you’re listing them out like that. For me, I’m it really makes me think again of the Overcoming MS program, which is again, sort of picking up all of those lifestyle factors that can really enhance someone’s health. So you mentioned, you know, diet and avoiding Ultra processed foods, the whole food aspect, that’s, again, big crossover with Overcoming MS, the exercise managing stress. You know, mindfulness meditation, that’s one of our pillars to really manage stress. And getting outside as well getting sunshine as well as vitamin D, is part of the Overcoming MS program. So I feel like, for those people listening, who are, you know, following the Overcoming MS program, they’re really doing a lot already to nourish the microbiome, and hopefully have, you know, and a big impact on the way that these microbes could be affecting inflammation, and it might well be some of the ways in which the Overcoming MS program is so successful. Finally, one of the pillars that we have of the Overcoming MS program is changing your life for life, and this is around behavior change and motivation and understanding ways in which you can sort of implement these lifestyle factors on a lifelong basis. Do you have any tips for motivation for people you know wanting to do more for their microbiome?

 

Emma Short  36:32

That’s a really good question, because a lot of the time, people already have all the knowledge and understanding. They have all that factual information, but what can be hard is translating that into action, but then also sticking to it. So initially, you need the motivation to make the change, and something that can be helpful in firing up your motivation is really thinking about what’s your Why? Why am I doing this? Why is it important to me? How will this benefit me? And really think about, you know, why? What’s the and keep asking yourself, you know, why don’t just you know? Why? You know. Why do I want to do this to feel better? Well, why do I want to feel better to have more energy? Why do I want more energy, you know, so that I can play with my children. So just keep, keep getting it, until you get the really root cause of your why? What is igniting this motivation to make a change? It can then be helpful to set goals. So a lot of people are aware of the SMART framework, so to set goals that are specific, measurable, achievable, realistic and time bound. So rather than just say, I want to do more exercise, say I will go for a walk so specific and measurable, you know, at half an hour walk on a Monday, Wednesday, Friday, I will do this for three weeks, and then I will reassess to set goals, which are SMART goals. When we’re thinking about goals, it can be helpful to have positive goals rather than negative goals. So rather than say, I will avoid Ultra processed foods. Say If I want to snack, I will have an apple. Because generally our motive motivations like to say higher if we have positive approach goals rather than negative goals. So focusing on the positive. Other things that can be helpful are, well, really helpful is to make your behavior a habit. So as humans, it’s innately within us to take the path of least resistance. So for example, even things like, imagine if you had a melon by the side of you and an apple. Most people are more like if they want something quick to eat the apple, because you can just quickly eat it. Where for the melon, you’re going to have to cut it all up. So by making something a habit, it then becomes an automatic behavior. So in order to make something a habit, it’s really important that you stick to it. Habit stacking is very important. So try and tag a new habit on to something you do regularly. So once something that’s often quoted as if you’re cleaning your teeth, do 10 squats to it, you know, to try and improve activity levels. Yeah, so try and make those healthy behaviors become a habit so you don’t have to think about them and put in, put in the mental energy every time you want to do it.

 

Sam Josephs  39:19

Brilliant. I love all of that, all of that really, really clever advice and really succinct and clear, really clear. Is there anything else that you want to share with us? I really loved listening to everything that you’ve said.

 

Emma Short  39:37

Oh, thank you. No. I think the thing is, when I personally have experienced it if you if you start eating better, we know that we see changes in the composition of your gut microbiome within 24 to 48 hours of foods reaching a large bowel. So if you make the changes rapidly, we get a change within the gut microbiome. And you do absolutely feel it when you you know if you make the change in your diet, if you prioritise sleep, if you exercise really rapidly, you feel better, you notice the higher energy levels, and then that then motivates you to carry on, because when you can see and feel the positive effects that it has, that then helps to helps you to stick to the healthy habits when you’re feeling so much better.

 

Sam Josephs  40:17

And like you say, once, once you have the changes in place, and once the microbiome composition itself is different, am I right in thinking the signals from the gut microbiome to the brain to feed it are looking for those more healthier, healthful foods and moving away from so you don’t even get the same cravings anymore? Yeah, I love that. I love the fact that the the microbiome is constantly controlling us a little bit, I think, as well. Oh, that’s been brilliant. Thank you so much for taking the time to be with us today.

 

Emma Short  40:55

Oh, thank you very much for having me. It’s been lovely speaking to you.

 

Sam Josephs  40:58

It’s been so interesting and so much practical information that you’ve shared with us as well, and we will be sharing details of Dr Emma Short’s book on our show notes as well, for anybody who would like to purchase it, I’d say it’s it’s kind of like a handbook, a quick guide to all the latest research about the microbiome and all the different ways and impacts that it has across our lives, and then, of course, this hugely helpful, practical section in the back as well. So thank you very much. That’s really great. Thank you so much. Thank you Dr Emma Short,

 

Overcoming MS  41:35

thank you for listening to this episode of Living Well with MS. Please check out this episode’s show notes at overcoming ms.org/podcast you’ll find useful links and bonus information there. Don’t forget to subscribe to the podcast so you never miss an episode, and please rate and review the show to help others find us. This show is made possible by the Overcoming MS community. Our theme music is by Claire and Nev Dean. Our host is Geoff Allix. Our videos are edited by Lorna Greenwood and I’m the producer Regina Beach. Have questions or ideas to share? Email us at podcast, at overcoming ms.org, we’d love to hear from you. The Living Well with MS Podcast is for private, non commercial use, and exists to educate and inspire our community of listeners. We do not offer medical advice. For medical advice, please contact your doctor or other licensed healthcare professional.