The Melanie Avalon Biohacking Podcast Episode #189 - Dr. Megan Rossi

TRANSCRIPT

Melanie Avalon: Hi, friends. Welcome back to the show. I am so incredibly excited about the conversation that I am about to have. On this show, I love bringing on people of all different perspectives. I know that a lot of my audience is dived deep into the paleo world and the keto world and even the carnivore world. So, I get really excited when I get to bring on fantastic guests who are really big in the plant-based sphere. So, when the people who represent, Dr. Megan Rossi reached out to me, I was so excited. I was actually familiar with her work. I hadn't read her books, but I was familiar with her. I listened to her on some podcast interviews. So, I was an immediate yes. Super excited, dived into her two most recent books, which are Love Your Gut as well as How to Eat More Plants: Transform Your Health with 30 Plant-Based Foods per Week (and Why It's Easier Than You Think). 

What I was really appreciative about and loved was that I love when I feel like the work is very comprehensive and open minded and receptive to people of all dietary paradigms. I'm sure we'll dive into this in the episode, but you're not going to read these books and walk away and think that you can only eat plants and can't have animal products or something like that. So, it's very approachable. I loved the science and the studies and I didn't get any sense of bias. It kind of reminded me of I recently had actually, Simon Hill on the show, and I was talking to him last night because he's coming back on. So, I mentioned that I was interviewing you today, Megan, and he said, “Hi.” I figured you guys probably all knew each other. 

Megan Rossi: Fellow Australian. Yes, indeed. 

Melanie Avalon: Yes. So that was great. But in any case, I so been looking forward to this. I have so many questions, especially about some topics that Dr. Rossi touches on that I think will be very interesting for listeners to hear. So, Dr. Rossi, thank you so much for being here. 

Megan Rossi: It's an absolute pleasure. I look forward to diving into all things, gut health. Like you said, my role and my research background is very much about empowering people with the evidence and what people choose to do with that evidence. Whether they want to go paleo or veg or omnivore, whatever they choose, I'm totally fine with. I just want people to make informed decisions at the end of the day. 

Melanie Avalon: Yeah, that's what I love so, so much because I found in both camps, both the plant-based sphere, and we can put definitions behind that and also, like in the carnivore world on the flipside, people can get really intense and think that they can only have this one food group. And I think it leads to a lot of issues. But then It's also confusing because some people do seemingly thrive on 100% meat or 100% plants. So, then it's just confusing.

Megan Rossi: Yeah, absolutely. We can probably touch on why people may feel better, for example, when they cut out, in the short term, all plants. That's something I certainly see in my clinical practice. People have gone on these carnivore diets, and they've cut out all the plants like, “Oh, my God, I'm not bloated anymore. It's not triggering any of my IBS symptoms. This must be amazing for me. But then I get them to look at the research what happens in 10 or so years' time to these people who typically have completely cut out all sources of dietary fiber, because fiber which I think your audience will probably be aware of, essentially is fuel for our gut microbiome. If we don't have fiber, which essentially has to come from plants, it's a backbone of all our plant-based foods, then actually you're starving a lot of your key anti-inflammatory microbiome, which is also linked to longevity. 

Melanie Avalon: For people who do seem to experience anti-inflammatory benefits. Like, people will go on carnivore and say that their health issues go away, their inflammation goes away. So, what do you think is happening there? 

Megan Rossi: In terms of when they talk about the changes they've made, I think it's important that we look at what changes they've made for a lot of people. Yeah, I mean, they've cut out ultra-processed food and we know that actually, ultra-processed food is terrible for our health. In fact, yeah, having some quality meat is going to be much better for our health than having all these ultra-processed foods. You can see some gains by cutting out a lot of these processed foods. And then the other thing can stem from the fact that when we eat dietary fiber, like I said, that fuels our gut microbiome. And our bacteria, when they break down that fiber, they produce a range of really beneficial chemicals, like these short chain fatty acids, like butyrate and propionate, etc. But if you have a very sensitive intestinal lining, which is very common in like 30% of people, it could have happened because you had a virus or high-dose antibiotics, or you've got IBS, or another functional gut disorder. 

Your nervous system in you that innovates and feeds into your gut is hypersensitive. When your gut bacteria produce these actual quite beneficial chemicals and a little bit of gas, which is a natural byproduct of fiber fermentation actually can trigger it and make and stimulate those nerves and make them feel not very good. And in the short term, those feelings can actually instigate like a very low grade level of inflammation. So, then when people take that, they go, “Oh, my God, I feel great.” What people need to realize is that if they can slowly teach their gut to tolerate and be able to digest that fiber, actually the health gains far exceed that of what they would feel like without any fiber in their diet. But they have to go through a bit of a pushing period. 

So, it's kind of I often use the analogy of like going to the gym. When you first start to hit the gym, it hurts. You're like, “Oh God, my muscles are really in pain a lot of the time.” But actually, we know the end goal is beneficial to be stronger, to be healthier, etc. Sometimes we actually celebrate that pain and we kind of push through it. Actually, if we think about teaching the gut to tolerate fiber, that is a very similar thing that we experience that, yeah, for a lot of people who've got that sensitive gut, you need to just go slow, teach your gut muscles-- your gastrointestinal system is just big fat muscles, so you need to teach it to tolerate it and then actually it builds up its strength and by two to three months you can tolerate so much more fiber. And not just tolerate, but reap all of the health benefits that we see stem from things like those short chain fatty acids, such as better mental health, better metabolic function, lower risk of heart disease, and obviously could go on with quite a long list, according to the science. 

Melanie Avalon: What was your history with diet? What things have you tried historically and what led you to where you are today with everything? 

Megan Rossi: So, I actually grew up at a farm in Australia. Good gut health is very much inherent to my upbringing, eating fresh fruit and veg, playing and all that stuff. But actually, it wasn't until I was in my final year studying nutrition and dietetics when I lost my grandma to bowel cancer. So, I had a bit of a, I guess, my first conscious account of the gut was really quite a negative one, and I was just confused. We hadn't learnt that much about the gut at uni union and I was like, “What's going on here?” I graduated and started working both in the hospital setting as a dietitian for all different types of conditions, whether it was kidney disease, different cancers, mental health issues, weight management issues. 

But also, I was very fortunate to be the nutritionist for the Australian Olympic Synchronized Swimming Team. What I found incredibly striking is despite people coming of clearly very different backgrounds, hospital setting, elite athletes, they're all coming to me complaining of the gut and that was 2010. I was like, “God, what is it about this organ. It's haunting me.” So, that's when I decided, I'm going to sign away my early 20s to do a PhD in the area to look at whether we target the gut through the right nutrition, whether that can improve the health of not just our gut symptoms, but actually systemically. Can it improve things like our kidney function, can it improve things like our mental health? And it was, yeah, that PhD that transformed everything for me in terms of going, "Wow, the gut is something we should be celebrating, not feared." If we understand it and treat it right, it can be incredibly empowering. That was what led me to the UK 2015 move over to work as a research fellow at King's College in London.

Melanie Avalon: So, on the flipside of people who go carnivore all meat based, do you see people who go completely 100% plant based and that's not sustainable? 

Megan Rossi: Absolutely. I actually have a case study in my book, How to Eat More Plants, you know this person, who actually had a very healthy, I would say fairly gut boosting diet, although she wasn't aware of it because it was very like traditional Mediterranean sort of diet where it wasn't just plants only, it had fish and fermented dairy and pasta, all that stuff. She thought that going 100% plant based, i.e., vegan was going to better for her health. So, she’s made the switch and I share about all the side effects she started to experience; breaking up the skin, putting on quite a lot of weight, feeling mentally quite down. Yeah, it highlighted that veganism didn't suit her. Plus, she probably didn't do it in an overly healthy way because we see all these like plant-based foods out there that are completely crappy and have got a whole lot of food additives in it. 

Actually, some of our researcher at King’s is investigating the safety of some of these food additives on our gut. So, I think we need to be very cautious about some of these 100% plant-based kind of meat alternatives out there. So, absolutely, I definitely actually don't advocate for most people that they go vegan for a health perspective. I understand animal cruelty, environmental, all those reasons why someone would want to go 100% plant based. But again, I talk about it in the book that if someone wants to go 100% that actually probably need to take supplements because they're going to miss out on some key nutrients that we know is fundamental for thriving including things like omega-3, which we mainly get from our oily fish. Yes, you can get some plant-based sources, but it's not the right type of omega-3 that has that really significant impact on things like our mental health and our gut health. 

Melanie Avalon: Yeah, see, and that's what I was saying in the beginning about being open to everything because I think people can get really intense with everything. I'm really interested in this idea about the gut adapting two different plans. So, I have two questions about it. One, you talk in and it's probably going to run because I read both of your books back-to-back and all my notes are together. I'm not sure what was from which book, which, by the way, they came out pretty like back-to-back. Was that the plan all along to release them pretty close together? 

Megan Rossi: Yeah. So, not necessarily. The first book, Love Your Gut came out in the UK first and some European countries and then there was a bit of a delay with publication in the US. Yeah, and the other one came out quite quickly after that. But I actually took, yeah, good two years in between to write the second one. I'm not a fan of publishing for the sake of it, so I wanted to make sure there was new science. So, I waited for this quite landmark study to come out to highlight some of the key concepts in how to eat more plants. 

Melanie Avalon: Which landmark study? 

Megan Rossi: Looking at the plant diversity. So, the studies which show that those who eat more different types of plants have better gut health, particularly 30, was kind of the number they chose in that research study compared to those who eat the same 10 on repeat. And I think that was so fundamental because we always know that all the guidelines are always saying, “Have more fiber, have more fiber.” 

This new concept about plant diversity that we actually need to get all the super six in our diet to have optimal gut health is really the new science that stemmed from our understanding about our gut microbiota. Before that, we thought all fiber was the same, it didn't really matter the source. Now we appreciate that there're close to 100 different types of fiber plus all the phytochemicals, which are the beneficial plant chemicals. It's really that that underpins the key concepts of what I call the diversity diet, which is not a strict diet at all, but it's just following these five key principles which the science has backed to show that's the optimal way to really enhance our gut microbiome, which is what's been linked to mental health, skin health, hormonal health, and yeah, we could go on. 

Melanie Avalon: So, you mentioned in one of the books how there're over 300,000 different types of plants. I think that's what I wrote down. 

Megan Rossi: Yeah, yeah, yeah absolutely. Yeah, yeah, yeah.

Melanie Avalon: Okay. I'm like looking at my notes, I'm like that's a lot of plants. My question there, okay, so that's a lot of plants, "What is the argument from an evolutionary perspective that even though there are that many plants, that we would need to eat that many plants? So, like historically, when we were evolving, how many different types of plants would we eat? And if we've never eaten these plants, why would we need to eat these plants?

Megan Rossi: Yeah, look, I mean the fact that there are over 300,000 edible plants available highlights that all different cultures have consumed them and depends on where you live on the world, depends on which of those 300,000 that you consumed and that we grew up on. Historically, absolutely, our ancestors used to have so much variety and it was very seasonal, but they did have close to 80 different types of plants potentially across the season. There was that diversity that they were having. And again, it depends on the regions to what was growing and being produced during those times. 

But then the thing that's quite scary is that from those 300,000, I think it's about 75% of the food we eat in the Western world comes from four plant species and a couple of animals. We have narrowed it down so much. I'm definitely not saying that we have to go back to having the 80 different types of plants in one week or really going to different countries to have to get some exotic plant of some form, but we need to expand our diet beyond this kind of four that we're currently all consuming. Particularly based on the new science, which highlights that there are these six different plant-based food groups, I'm not going to put you on the spot and see if you read the book correctly. 

Melanie Avalon: Wait, wait, can I try? 

Megan Rossi: Yeah, the super six. 

Melanie Avalon: Grains, legumes, fruit, vegetables, are herbs and spices one? 

Megan Rossi: Absolutely one more to go. 

Melanie Avalon: Can I have a hint? 

Megan Rossi: Nuts and--

Melanie Avalon: Oh, nuts and seeds, yeah. 

Megan Rossi: Yeah, yeah, yeah. There are these six different categories, which actually nutritionally speaking, are all providing us with an array of different fibers. Obviously, if we go into each of the subspecies within that, then you see, there are the tens of thousands of these phytochemicals. So, they're all very unique. So, yeah, no, we really have narrowed things down and as a result the science has shown that we've lost about 30% of our microbial diversity in our gut. So, we've actually lost quite a lot of the skill set and the functionality. So, yeah, we have a long way to go, I guess, to try revamp that and focusing on each day, have you got something from the super six in your diet, is a really great way to kind of start moving in that direction of re-diversifying your diet. 

Melanie Avalon: Here's a huge question I have, which is, so you're talking about how you can teach yourself to slowly eat these different foods. Do those different foods require specific microbes? And if so, where are they? Do we all have them and they're dormant? Do we not have them? Are they on the actual food themselves? 

Megan Rossi: That is a brilliant question. What is just so exciting about gut microbiome is that they can actually learn to develop skill sets, so we can actually teach them. If we start to consume, for example, seaweed and historically, we have not really consumed much seaweed, actually, a lot of the microbes in our gut can actually convert to digesting seaweeds. Plus, there're some other cool things that actually seaweed often contains some dormant microbes on it. If you ingest them, then you actually start to have more seaweed kind of growing microbes as well. They've tested that in looking at fecal samples of people who don't normally have seaweed, get fed seaweed and they can see that their microbiome changes not only the genes so that the function and the ability to digest the seaweed, but also they get new microbes which have come from the ocean. So, yeah, it's pretty amazing in terms of how our microbes can learn to digest new foods as well as where we get these new microbes from.

Melanie Avalon: One of the things you do in the book is you talk about, there're all these words, there're the microbiota, the microbiome, the metabolome. So, maybe we can put some definitions behind that. But so, out of all of the microbiome species, like what I just heard about how we can teach current ones, does that mean you don't actually need that many diversity of species because they can learn how to do things or what's the nuance there?

Megan Rossi: Yeah, no, see you absolutely do want that diversity still because many can learn new skills, but often they need to be taught so they actually can share genes with other microbes. Again, a really cool thing. So, you do like the ultimate goal that we see is people with more different microbes in their guts have better overall gut health and therefore all of those health benefits attached to that. But I think the key premise is that there are millions of different types of metabolites that need to be metabolized and our microbes can learn a lot of them. But still there are some that they can't learn because they're new Bifidobacterium lactis and they don't have the learning ability for the gene of metabolizing quinoa's outer casing, for example. So, we still want that diversity, but it's exciting to know that we can teach microbes to be able tolerate collectively more different diverse fibers.

Melanie Avalon: So, is that horizontal gene transfer that I'll always see-- I always see that phrase thrown around. 

Megan Rossi: Yeah, yeah, yeah, that's it. Horizontal gene transfer. Look at that, you're all over it. 

Melanie Avalon: I always see that everywhere. I hadn't really thought about it, but that's super cool. 

Megan Rossi: They're very smart. That's why they can use that to our disadvantage of things like if we overuse antibiotics, for example, antibiotic resistance can occur by that because they can share the resistant genes and stuff like that. There're some negative effects of that, but there's also some very cool outcomes of that trait.

Melanie Avalon: How do they actually talk to each other? Is that-- [unintelligible [00:18:44] phrase, is that the quorum sensing? 

Megan Rossi: Quorum sensing. Oh my God, I love it. Yes, quorum sensing. 

Melanie Avalon: What does that actually mean though? How do they do that? 

Megan Rossi: So, it's a number of different mechanisms. One is this electric signal, so to speak, where they can kind of translate messages to each other. Also, the types of metabolites they produce, like the chemicals that they half break down, can send messages to and from other types of microbes as well. So, there're quite a few different mechanisms, which is something that we're learning more and more about because also, I think one of the things you mentioned about the different definitions we've got our gut microbiota and that is that collection of those trillions of microorganisms, which is mainly bacteria, but actually we also have the viral component in that and we call that the virome. We have the microbiome component of that, so microbiome and that's the fungal component. And they all have their own talking systems, which we've only just started to uncover because most of the research has focused on the bacterial component of the gut microbiota and hasn't really tapped into the virome component or the microbiome component.

And then just to leave you with that other M word, the microbiota and the microbiome, so they're slightly different, it's just the ending. So, microbiota is the actual community of those microorganisms. And the microbiome, the own part highlights it's like the whole collection. It's the microorganisms, but it's also the chemicals that they're producing. It's just a kind of nomenclature thing. For scientists it means quite a lot because it highlights the difference in terms of the functionality and the outputs that the bacteria and the fungi, etc., produce. 

Melanie Avalon: So, when I said microbiome earlier, I meant microbiota. I knew I was going to get those messed up. [chuckles] One thing you talk about in your book, I've been seeing this more and more just in general talked about, which is the idea that maybe there isn't actually, at least not as binary as good and bad bacteria. Is there good and bad bacteria? 

Megan Rossi: Yeah. No, like you said, it's not a correct sort of concept. We know that out of if we think of there being hundreds of thousands of different bacteria, we know that maybe less than 1% of them are actually really bad. I mean, the same with viruses. Actually, a lot of viruses can be beneficial in terms of how they protect everybody as part of that virome. But there are some really bad ones, like COVID-19, for example. So, the vast majority of microorganisms are actually really potentially beneficial. But it's kind of like humans, if we are treated really badly, we don't have anywhere safe to sleep, we're really hungry, then we can do bad things to other people to achieve that sort of safety and what we want. And the same goes with microorganisms. 

If we don't look after that particular species and we don't feed it the type of food that it particularly likes, like maybe it's kiwi fruit liking bacteria or maybe it's like oat liking bacteria. If you're not feeding it, then it can actually get quite angry and aggressive. Studies have shown that in animals anyway that it can actually start to like eat away at your gut lining. So, that mucus layer that occurs, that can kind of help buffer the immune system. So, yeah, we absolutely know that most bacteria, most microorganisms in general, if we look after them can be incredibly beneficial for us. 

Melanie Avalon: That made me think of a few other things. So, say somebody does have the 1% of the bad or they have not the 1%, but they have their microbiota. part of it is creating issues for them for whatever reason, because their balance is off and they don't have the diversity that they need. So, people will go a lot of different routes. I mean, they'll go the starvation route with going carnivore, they'll go the attacking route with like antimicrobials and things like that. Or I guess you could go just adding in the good. When people have gut dysbiosis, where should they start? Especially if they do have an overgrowth of part of the microbiota that is not serving them at present? 

Megan Rossi: Yes, that's a really good question and it really would, I guess, depend on their symptoms. If it was something like small intestinal bacterial overgrowth were essentially the microbes. Most of our microbes actually lives in the last 1.5 meters of our digestive system and our digestive system is actually 9 meters long. But occasionally the microbes can curl up a little bit higher into our small intestine and that is what we call small intestinal bacterial overgrowth. So, in those scenarios, what we do in clinical practice is we do particularly put people on more restrictive diets to help to starve off those microbes that have curled up that little bit higher. 

And in turn, after about eight weeks, we start to slowly, systematically reintroduce and that seems to help and treat quite a lot of people with SIBO. But there are other conditions where actually their dysbiosis might be present in turn or presenting is like the one that always gets the cold and flu. They've a really weak immune system, in which case actually focusing on getting in the 30 different plants a week and the super six each day actually is sufficient and probably is the most effective way to kind of rebalance that dysbiosis, that imbalance of those microorganisms. And then, of course, in like a more extreme scenario. So, have you heard of fecal, I'm sure you have, fecal transplants. 

Melanie Avalon: No. I would love to hear your thoughts on because right now, I think in the US, I don't know what it's approved for in the UK, but it's only for, I think, C. diff, right? here. I'm curious about the future of that. 

Megan Rossi: Yeah, I know it's incredibly exciting. Similar to the US in the UK, fecal transplant. Essentially getting the stool from a healthy person and transplanting into someone with a certain condition, it's only been approved, but it's been approved for a very long time in the UK for treating antibiotic resistant C. difficile. They've got a very aggressive type of C. diff where actually some people, a lot of us, have got C. diff in our gut, no issue. But when the C. diff overgrows and the balance is so out of whack that the C. difficile is being really dangerous and they don't respond to antibiotics.

The success rate is like 97% or something impressive with fecal transplants. So, it's actually a life-saving procedure. So, that, like I mentioned, has been around for quite some time and more recently, I'd say in the past probably five or so years the research has really started to take off and go, “Well, actually, if it works for that could it not work for inflammatory bowel disease? Could it not work for irritable bowel syndrome? And what about arthritis?” So, at the moment, I would say the evidence for the condition that's looking most exciting is probably ulcerative colitis, which is a form of inflammatory bowel disease. There are actually quite a few studies out there which do really excite me, but what they're finding, which makes total sense to me, is that the donor and their diet is actually really important. 

So, there's these super donors out there and it's only their poop that seems to be curing ulcerative colitis, which historically was like an incurable condition. So, you don't want to just get poop samples essentially from any healthy person. They have to be like a super donor. The researchers are now kind of profiling the super donors and I'm just trying to understand what's in their gut microbiome that's so key. So, yeah, I still wouldn't recommend anyone go to a private clinic for a fecal transplant. And sadly, in London, there are loads of private clinics and they can do really dodgy things. We know through animal studies that you can transplant things like depression. When people are donating stool samples, often they don't get asked about family history of mental health conditions and things like that. So, you need to be quite careful about, you might be curing something, but you could actually get something worse. 

Melanie Avalon: You answered my question. I was literally going to ask the donor process, how do they do the screening. And in the beginning, when they first started doing this, well, I don't know how long they've been doing it. Were they doing any screening or were they just taking people that didn't have C. diff?

Megan Rossi: Yeah, exactly. Historically, in the hospital setting, so doing all the general checks, you don't have like HIV and those sorts of things that could be directly transferred and they knew about, but yeah, historically they weren't. Actually, there were some case studies which was published in a journal, I shouldn't laugh, but it was just kind of made everyone go, “Oh, gosh, we need to be really careful.” And some people reported putting on like excessive amounts of weight after getting the C. diff therapy and kind of then looking back at the donors and things like that. So, they're now starting to be even within the health system where it's been approved, they're starting to be okay, we really need to vet our donors. 

Melanie Avalon: There's a tangential question I had about that which is our tastebuds. You talk about the turnover rate of the taste buds in your book. So, how much of that is informed by the microbiota or by what we're eating? Do some people have an inherent desire for certain foods that's ingrained in their tastebuds or is it all just based on their environment, like their microbiome 

Megan Rossi: Yeah, really cool question. So, yeah, as I talk about in the book, I find the whole area of taste so exciting and empowering because the research really does show that you can essentially teach yourself to like pretty much anything because one of the things I often get in clinic is people go, “Okay, I get it, I want to feed my microbiome. I get plants are healthy, but I just don't like the taste.” There're the two different elements that one is well, actually most people don't prep plant in a delicious way and I feel like adding a bit of extra virgin olive oil and some rosemary and roasting veg can transform them, make them crispy and all that stuff. You can make veg super tasty, which is half of the How To Eat More Plants book is kind of the practical tips of making it really enjoyable. 

But the second part of that is about training your tastebuds, like you alluded to is our tastebuds turn over every 10 or so days. And yes, there're some genetic components in there where we are predisposed and if we go back even earlier in our lifespan, actually there're some studies that suggest that the food our parents, our mum eats in utero actually can dictate our taste preferences once we're born. There is a lot to say for things like the environmental component, but there's going to be a little bit of genetics at play as well. But because our tastebuds are constantly turning over, we can reteach kind of the sensitivity to certain types of flavors and sweetness and salt and stuff like that. The food industry is a great example where they've actually taken out tens and tens of tons of salt in some of our basic foods, like cereals. Not that I'm recommending we should be having them, but they have taken them out slowly over the years, like so much salt and consumers haven't even noticed because they did it using the science. That's slow, gradual reductions in salt and our tastebuds become more salt sensitive. 

But in terms of plants, the mechanisms we think actually like you again alluded to it could involve our oral microbiome. So, yes, we've got the gut microbiome, we have a vaginal microbiome, we've got an oral microbiome, that's just little niche communities in the different parts of our body. The oral microbiome is actually really important in taste perception and certainly does also change when we do change our diet as well with the types of microbes that kind of prefer to reside in our mouth. So, we do think it's kind of dual functionality in terms of the tastebuds regenerate and we start to make the receptors in our mouth kind of more sensitive to that but also the microbiome changing and therefore the chemicals that they start to produce change as well which changes like our pleasure function and all that sort of stuff. 

So, yeah, the moral of that ramble essentially is that we can train our microbiome to our tastebuds to enjoy pretty much everything. If you think as kids, coffee, wine, dark chocolate, I hated, but now I'm like, “Oh my God, I can't live without them.” And again, that's just training your tastebuds over time. 

Melanie Avalon: Yeah. I am fascinated by the oral microbiome I have actually, I had on a company called Bristle. I think they're probably just in the US. But they actually do oral microbiome testing and they're super cool and really deep into the science. I was going to ask you actually earlier about the SIBO. I saw a study, I don't know, might have been about a year ago, it was actually proposing that SIBO might be caused by not so much bacteria migrating up from the large intestine, but actually down from the oral microbiome. Have you seen that? 

Megan Rossi: Yeah, I would say it probably is more like the bacteria have migrated up from the large intestine because that's where the bulk is. But I think that research is suggesting our oral microbiome actually acts as like this bodyguard to the rest of our body, essentially. So, if it doesn't protect us right, then it can let some of the bad guys into our intestine, which then can wreak havoc lower down. There's a thing called the ileocecal valve which is like this little trapdoor that kind of separates the large intestine and the small intestine, and certain bacteria can kind of aggravate that. If it flicks open then that can make those bacteria lower down the colon kind of cool up higher. So, it very much is all connected. So, yeah, I definitely do see the research coming out around how the oral microbiome is kind of that gateway and is incredibly important for predicting kind of what goes on and who lives in the lower part of our intestine.

Melanie Avalon: So, I had my own experience. I got food poisoning back in 2014. It was a while ago, but I had diarrhea for like a week and then I got a colonoscopy and that sort of cleared everything out. But ever since then, oh and then I did rifaximin, which is one of the go-to antibiotics for SIBO. That was the beginning of my digestive woes. I went through an obsessive period with the ileocecal valve because there's all this stuff online about its stuck open or it's closed and like, you have to do this massage. And I was convinced. I was like, “This is all the valve.” I don't know, especially because I have like a weird feeling right where it is supposed to be. Do you ever do stuff like-- there're like these massage things online where they'll say you can like open or close it manually? 

Megan Rossi: Yeah, I mean, I don't know if I'm convinced you can open and close it that kind of easily via pushing and prodding in certain places. But we do know that things like bowel massage and that's in the first book, Love Your Gut, which is really helpful for people with constipation. 

Melanie Avalon: I loved that section. 

Megan Rossi: Yeah. So, doing that bowel massage actually has shown to significantly help with constipation. And if you kind of relieve that constipation, then that is more likely to shut that valve because the pressure when you constipate can build up and pops it open. That's why if you do have a history of constipation that's being associated with the increased risk of things like SIBO because it kind of makes that trapdoor not very effective. So, indirectly it can shut it and close it. I wouldn't say you can kind of press a button on your gut and then it opens and closes. I don't know, maybe in the future we'll find out more of a technique or get some sort of magnet thing inside us that could make that happen, but I don't know. 

Melanie Avalon: You talk a lot in the book about the movement of the intestines, in the small intestine and large intestine and what activates that. And you say that fat and carbs stimulate that movement, not so much protein. I was wondering why specifically those different macronutrients would do that. 

Megan Rossi: Yeah, look, I love the functionality and the physiology of the gut. It's just so exciting and I think we're so fixated on what we put into our body, but once we swallow it, we've actually got no idea what happens to our food. So, I find this really exciting. There're two key movements to keep in mind. So, we've got this migrating motor complex. Essentially after we've been fasted for 90 minutes, that's when that migrating motor complex kind of kicks in and that kind of comes from like, your stomach and go through your small intestine, kind of cleans your intestine and pushes things down a little bit. So, that can be really helpful to get activated for people who struggle with constipation, kind of move food down to the large intestine and that occurs, like I said, after about 90 minutes of fasting. I'm usually totally fine with people snacking. If people struggle with constipation, one of the strategies I do try for about two or so weeks is to reduce the snacking so they have at least those 90-minute windows or even longer than that to ensure that migrating motor complex has time to kind of kick in, to kind of sweep the food down. 

And then the second one is the mass movement. This is the one that's kind of that final kick in our intestine through the large intestine. And this is the one that kind of gets activated when we have the fat and the fiber. And in terms of the physiological kind of mechanism around that, there's this gastrocolic reflex. So, when we eat food in our stomach, what that does is actually pushes like, sends messages via the nervous system to lower down our intestine into the large intestine and say, “Look, we've just got a new meal coming in my stomach, we need to make room.” It kicks the food and pushes it out. What seems to kick on that is the fat and the protein. And I don't know if there's some--

Melanie Avalon: For the fat and the carbs?

Megan Rossi: Sorry. Yeah, not the protein, you are right. The fat and the fiber, the carbs, I mean fibers, so I don't know the historical reason why that would have happened in terms of evolution, in terms of why protein doesn't do it as much for protein. But yeah, it's what they found, they infuse people and they look at how powerful that gastrocolic reflex is.

Melanie Avalon: I'm just thinking about it more like why that would be. 

Megan Rossi: Yeah, I know, it is very fascinating. And again, I guess to translate that into the practical side of things, that's why again if people are struggling with things like constipation, I do recommend for their breakfast that you do have something with fat and fiber in it. So, it could be something like with oats and live yogurt, for example. It's a really great combination to get the fiber and the fats in it to help with that mass movement kick, which is already typically elevated in the morning. That's why most people do actually poop in the morning because of that mass movement activity is elevated then.

Melanie Avalon: I love the section you have on leaky gut. I was wondering if you could talk a little bit about leaky gut because I think when we think leaky gut, everybody thinks they have it and they think it's bad. But you provide a much more nuanced perspective of the concept of leaky gut. So, what is happening with leaky gut? 

Megan Rossi: Yeah, so if you think about our intestinal lining, it kind of shuts off the bad stuff that our body doesn't want to get from our gut into our blood system. It's kind of got this really smart system, I have to say. We've got these little bodyguards in our gut lining which says no you're not allowed in the club and others that are allowed in the club, like nutrients allowed in the club, etc. So, in terms of this concept of leaky gut, it's when the bodyguards aren't doing their jobs. They're actually letting things into our body that they shouldn't. And the scientific word is gut permeability. So, our gut is more permeable. And we actually measure this. We've got a clinical trial at King’s at the moment where we measure gut permeability, i.e., gut leakiness. We do it through these different sugars and measure how much sugar comes through the urine and stuff like that. 

What we know about gut leakiness is that, actually it's not like this black and white thing. We actually from day to day all get a bit of a leaky gut. If we are stressed, our gut becomes more permeable. The body guards don't work as well. Alcohol, high-fat meals, they all cause, in the short term, leaky gut. But that's completely fine if it's only short term. Like our body is built to have the immune system to be able to fight off any little sneaky things to get across in the short term. But if we constantly have a leaky gut, we can obviously get more systemic ongoing inflammation. But the thing about the leaky gut we're discovering is that it's more of a symptom that something else is going on. Like I said, it's either the stress or the alcohol that's causing it. 

And similarly, the longer-term things are like if you've got celiac disease, it's the gluten that's causing the leaky gut. You take out the gluten out of your diet and by about a year, people with celiac disease who are gluten free no longer have a leaky gut. The same with things like inflammatory bowel disease. That's what we got a clinical trial on. They again when they're going through their inflamed state, they have a leaky gut. When their immune system cuts that inflammation, then the leaky gut goes away. So, leaky gut is very much a symptom and not a condition so far in terms of our scientific understanding.

Melanie Avalon: That barrier with a gut that does become leaky, is it a knowledgeable barrier? Is it like a sieve that just lets things in or out? Or is it actually scanning and deciding whether or not to let things in and out? 

Megan Rossi: Yeah, so, normally it's very intelligent in terms of it screens everything that lets in. When it becomes leaky, then it's not very good. It lets things sneak through that it shouldn't. 

Melanie Avalon: Okay, the exercise making it leaky and alcohol, is that because we're stressed and it's like a diversion of priorities or energy, or is it actually functional? Like, does exercise making it leaky, does that have a purpose? 

Megan Rossi: Interesting about the purpose, no, I think it probably relates more to the fact that, like you said, our blood system is kind of diverted to our muscles, and therefore it's not innovating the gut. Some of them don't have enough oxygen, therefore they don't do their job very well. In terms of the exercise thing, I think it's so important to highlight that obviously exercise is so beneficial. In terms of the leaky gut, it's worse kind of if you have, like, really long marathons. That's why you might see some people who start to poop blood, etc., after marathons because they've just pushed their gut so much, drawn away all that blood. So, a little bit of gut leakiness in terms of if you go for a big HIIT session hour or whatever, in terms of the negative effect is negligible compared to the benefits of actually exercising. So, I don't want people to kind of fear that and go, “Oh, my God, no, I'm making my gut leaky," because-- absolutely go for exercise, but it just highlights it's a very transient thing and we shouldn't kind of be as fearful as I think social media would want us to be.

Melanie Avalon: Social media, yes. And okay, I'm super glad you brought up gluten. So, I've had a really interesting, I don't know, evolutionary process and thoughts about gluten, which is, when I first discovered the concept of gluten, I was all about how awful it is. Everybody needs to be gluten free and it's the worst thing ever. I was very narrow minded in my perspective of it. I've been reading more and more. I still feel like, I don't know because I've seen studies where gluten creates intestinal permeability issues regardless of if people have celiac or not and granted that's often in vitro. I do think there's an issue with pesticides associated with gluten and grains in the US. But stepping back, because I read a lot of more plant-based books and had a lot of guests on the show, and they'll often make the case about the benefits of grains and how it correlates to health issues or health benefits.

So, I did an exercise and experiment. I think this was before maybe interviewing might have been Simon Hill or may be Dr. Neal Barnard, but I went into Google Scholar and I tried to just be as unbiased as possible. I was like, “Don't be biased, pretend that you don't know anything about grains or gluten and try to research grains and see what comes up.” Honestly, the majority of the studies with grains were correlating it to health benefits. And it was a really interesting experience. And you talk a lot about grains in the book, and you even have a section on all of these different, like, heirloom grains and cool grains people can try. But that was a long windy way of getting to the question, which is, what are your thoughts on gluten and grains? And should we be gluten free? Should we eat more grains? 

Megan Rossi: Yeah, look, I totally understand where your confusion has come from because there's kind of people out there who often will call themselves or they are medical doctors are spouting stuff, saying that it's like this evil toxin. No matter how educated someone is, if they're constantly exposed to that sort of negative press and they start to believe it, and then they have something with gluten in it and they start to feel sick and that's a nocebo effect. We see it all the time in our clinical trials. I absolutely think that we as a population eat too much gluten. Now, it's not because gluten is bad. It's just because we eat too much wheat at the expense of all of the other hundreds of types of grains out there. Therefore, we're not getting that grain diversity and we're not exposing ourselves to all of these amazing phytochemicals that we could potentially be getting from whole grains.

So, do I think we're eating too much gluten? Yes. Do I think it's the fact that gluten on its own is bad? No, it's more of like the indirect effect that's bad is we're not getting much diversity and I think it's really important when we actually look at gluten, it's a type of protein. Like, you highlighted the studies where it's showing that it's bad in people without celiac disease or in those with non-celiac gluten sensitivity, i.e., gluten intolerances, so you take those people out and those studies that are suggesting it's still bad for people, like you said, they're based on test tube studies or animal studies. We know that the vast majority of animal studies actually don't ever translate to humans because our immune system or the antibodies are so, so different from animals as well as the in-vitro setting. So, it's really difficult to extrapolate that out.

Where I take my evidence from, it's always looking at human studies. Human intervention studies where they've given people gluten-containing whole grains, and they've shown actual health gains, not when they've given gluten on their own, but they've shown that actually gut symptoms don't necessarily stem from gluten. It's more of the fructan component. People just felt normal when they had the gluten bars that were blinded versus having a fructan, which is kind of a different story. But in terms of the whole grains, when they actually gave people whole grains as an intervention and yes, it did contain gluten in it, but also it contained loads of fiber and other stuff. They reduced their heart disease risk, they reduced their blood pressure medication requirements, reversed the type 2 diabetes and stuff like that. I find it really difficult to understand that if gluten was bad as a toxin, how people could be experiencing these health benefits when they're actually administering this in their body. 

So, yeah, I think we just need to be really careful about where we get our evidence in terms of animal in-vitro versus actual human clinical trials. I always look for, has there been a human clinical trial showing this. If there has and I'm like, okay, now I'm really interested. If it's in the in-vitro setting in the animal studies, fine. If it's a really new and novel concept, it needs time to progress. We've known about gluten for a very long time. It still hasn't progressed into any clinical trial that I'm aware of outside of obviously celiacs and those with gluten intolerance. I'm kind of like, “I don't think it's correct what people are saying that it's this evil toxin.” 

Melanie Avalon: I don't know if we're talking about the same study, but I was reading one of the ones that was looking at, I think it was like they gave them bars with different levels of gluten and fructans. What was interesting about the study and this is why I think it gets even more confusing. I'd have to revisit it, but I think like the conclusion they made was that it might be the fructans, not so much the gluten that was causing the issue in people. But then if you actually looked at the breakdown of how people reacted, it was like some people were reacting more to fructans and some were reacting more to gluten. I just think it's so complicated and people are so individual and it's hard to even know sometimes what the studies are showing because I think the conclusion of the studies often will not necessarily reflect the breakdown of the actual data. So, I just think it's confusing for people.

Megan Rossi: Yeah, no, no, I totally get it. My colleagues actually did that study. It was really great. I think, like you've said, they took people who believed that they had a gluten intolerance. They wanted to show that actually the majority of them didn't react to gluten when they were blinded. They actually were reacting to another component of wheat called fructans. And that's one of the FODMAPS. They kind of go into more detail about FODMAPS in the book. But we do know that actually there is a percentage of people who have non-celiac gluten sensitivity, i.e., gluten intolerance. And that's what I cover in Love Your Gut is actually how you would diagnose gluten intolerance and you can do it at home. It goes through this step of you, first you have to, it’s three-hour process. It's like the gold standard for identifying a food intolerance because very annoyingly there is no blood test, no urine or hair test that can test for an intolerance outside of lactose intolerance. Milk, sugar intolerance, there is test for that. But all the others, you have to go through this process. So, it's called the 3R process. You would record your symptoms and what you eat. If you see an association with specific food or a category like gluten, you would then restrict it for two or three weeks. If you see an improvement, you then really importantly have to do this blinded systematic reintroduction. 

So, you've probably seen it in the book where I actually go through that diagram of showing you what dose to reintroduce the gluten at and get someone to blind you to it and follow the pathway. It gives you quite clear insight to actually is it really gluten or could it be another component that may be triggering gut symptoms. When I do that with a lot of my patients and clients, actually majority of them find it's not gluten that they're reacting to. Similar to the clinical trial, actually, most people it's the fructans. It feeds back into fructans, actually a prebiotic. So, they're good for the gut bacteria. It's the whole gym analogy. You want to train your gut to be able tolerate more and more fructans. But in the short term, if you've got a sensitive gut and you throw fructans at it, similar like the inulin category, you're going to get bloated, you're going to feel like terrible. But it's that slow, steady increment because yeah, it's a prebiotic that feeds your gut microbiome fertilizes them and has some rave health benefits. 

Melanie Avalon: I love that part of the book because it's very comforting for people with gut issues and provides a plan that you can actually follow. And I just think it's so, so helpful for people. And then what I love is you said-- say that you do do this whole process and you realize that you weren't having the issue that you thought you did. Even that is good because now you have more knowledge about what works for you and what doesn't. 

Megan Rossi: Yeah, absolutely. It should be a celebration, not a negative finding. It's a celebration that, oh yeah, now I can eat some sourdough and not be convincing myself that actually that's causing me issues. In turn, I'm feeding my gut microbiome those sorts of fibers and polyphenols. So, yeah, no, I always believe that even those kinds of null findings actually can broaden your diet is a real benefit. 

Melanie Avalon: So, I got so excited though. I was gluten free for, I mean, I'm still gluten free, but I was gluten free just based on the concept of gluten for a long time. And then I actually got a blood test and I actually, I do have a wheat allergy, which granted, that doesn't mean its necessarily gluten, but it felt good. I was like, okay. 

Megan Rossi: Yes, finally validated those symptoms.

Melanie Avalon: I can actually stick to this.

Megan Rossi: I know. And I think that's what's really exciting about, I guess where the signs of that with gut issues. This category of functional gut disorders, which essentially is what the first book goes through. We now understand and validate those experiences. Whereas historically, so many of my clients would come back to me and say, “My doctors told me it's all in my head, and I don't really have these symptoms.” Now we're like, “But look, we actually do. It's called functional gut disorders and there's Rome criteria for it and get diagnoses for it, and we know how to treat in certain ways and stuff like that.” It is a really empowering space that people who've been suffering for so long can get a diagnosis and can understand that. Yeah, it's not just in their head, so to speak. 

Melanie Avalon: Well, then also, what's little bit disheartening for people. At least I thought this was disheartening when I first heard about it. I was like, okay, so they're saying it's all just me being oversensitive, which was visceral hypersensitivity. Like, basically the idea that people with IBS are just more sensitive. 

Megan Rossi: But there is a mechanism behind this. We literally have these hundreds of millions of nerves, part of the enteric nervous system that go from our brain to feed our gut. They have these nerve endings. If you've got a nerve ending, like, free in your tooth, it absolutely kills. It can cause you so much pain. So, there really is a physiological function behind visceral hypersensitivity. So, it's not that you're just sensitive. Your enteric nervous system is kind of more on fire, which can result in excruciating pain for a lot of people. So, there's a mechanism there. Don't you worry. 

Melanie Avalon: Although that was interesting, I didn't realize until I read your book that the definition of IBS, I think it does require pain, because for me, I don't have actual pain. I just have bloating and motility, like constipation, diarrhea-type issues. Does that mean I don't have IBS? 

Megan Rossi: You don't fulfill the criteria for IBS.

Melanie Avalon: I was like, what? 

Megan Rossi: Run it? But I think this is helpful because so long we've been lumping all these different types of functional gut disorders into the one IBS, and that's made research really hard because we recruit people with IBS, but actually, they don't really have IBS. They've got all these other things going on, and therefore, the results don't really become very clear because we're treating different types of conditions. We're trying to put this, like, one name on it. So, yeah, it sounds like you might have more of like functional altered bowel habits or functional bloating or I mean, you've probably read the book in terms of looking at bile acid malabsorption and stuff like that, which is actually really common in people who don't actually get pain, but have altered stools and can get quite bad diarrhea and stuff like that. So, yeah, I think it's really important that we are starting to actually narrow down the criteria.

So, for IBS, yeah, you have to have stomach pain at least one day a week and that pain needs to be associated with your stool habits in some way, whether it gets worse when you poop or better when you poop, and experience of that once a week, at least once a week, pain needs to have occurred for at least 12 months. It can't just be like, a short term to two-month thing in order to get that IBS diagnosis. 

Melanie Avalon: I mean, that really blew my mind because I've been like, reading about IBS for like a decade. Then I read your book, I was like, “Oh, okay.” 

Megan Rossi: Yeah, yeah, no, no, but to be fair to you, the criteria has changed, so the Rome criteria, we're now to Rome IV. So, when we're at Rome II, it was more of gut discomfort rather than pain, but they've made it more specific, so they do update. So, you were right a couple of years ago, but you've just missed the update. [laughs]

Melanie Avalon: Well, good thing I read your book. Just some questions about the food that you actually talk about because you have a point system in your book that people can follow. How do people follow that. I just have a really specific question about it. 

Megan Rossi: Yeah, look, I came up with this system based on that research that I mentioned about the 30 different types of plants a week, which came out of Rob Knight's [unintelligible [00:54:55] in the US was really a landmark highlighting about those who ate 30 plants a week had better gut health than those who had the same 10. So, I thought, look, how can I translate because as well as working at King’s, I'm a clinician. I have the Gut Health Clinic in the UK. I think, how will my clients and my patients relate to this. I came up with this system because everyone loves counting numbers. People like the whole calories thing, which is not backed by science, kind of people get on board with it. 

So, yeah, I came up with this plant point system where each different type of plant gets one point, and herbs and spices only get a quarter of a point, same with coffee. So, if you eat 20 strawberries across a week, you'll only get one point. Whereas if you ate five strawberries, one banana, blueberries, blackberries, and some apples, you're going to get five points. It really just gets you thinking about this concept of diversity, because remember each different plant contains the different profile. I have in the book the image of the apple and highlight the apple's got over 300 different plant chemicals in it, just like this boring, humble apple. It's got things like dopamine in it, which is like a feel-good hormone. It's got things like inositol, which we know is actually really beneficial for PCOS. There's just so much within this apple that so many of us snub. I know that's just a boring apple. Yeah, it just kind of helps people think of that target of getting of at least 30 points per week in their diet. 

Melanie Avalon: That was mind blowing reading about the apple and the bacteria that are on it and you talk about how the imperfect produce likely just might be better. 

Megan Rossi: Yeah, absolutely because they're produced through, like, trying to protect the fruit and the veg. So, yeah, they actually have been shown to contain more having kind of the malformed, kind of the bruised plant. So, yeah, again, in the recipes I advocate for people to use the bruised ones to not chuck it out. Obviously, it saves money, saves the environment also and might even be more nutritious for you. 

Melanie Avalon: My random question, because you have herbs and spices. When I eat cilantro, I eat a ton of it, like a ton of it. I'll eat it like spinach. If that's the case, can I make it one point, because it's--

Megan Rossi: Yes, I will grant you that will be an exclusive just for you. No, yeah, no, absolutely. When I was thinking through the system, I was very much like, if people are going to have more than 15 grams of the herb, then yeah absolutely. Like the basil the same. You can count that as a whole point because it actually is not just providing the phytochemicals, but it's also providing the fiber. Whereas if you're having just like 1 gram of cinnamon, there's no fiber in it. That's kind of how I came up with kind of justifying the system.

Melanie Avalon: What about on the flipside, say you do a spice, one that has like 30 spices in it. Does that ramp up your--

Megan Rossi: Yeah, the next thing people ask me is.

Melanie Avalon: I bet you get asked this a lot. 

Megan Rossi: Yeah, yeah it's like, “What about if I have one pumpkin seed? Is that going to count as a point?” You know what, I mean, it's very much about getting people in the mindset of thinking diversity. If people want to cheat the system and have one pumpkin seed and count, I'm like, you know what, you do you. But what I noticed ends up happening because obviously I've observed hundreds of clients who followed the system. And if you're having like a tablespoon of mixed seeds on your breakfast cereal, yes, that one portion might only contain like 3 grams of pumpkin seeds, but actually, if you add that up, most people have like five days a week, that's going to reach like the 15 grams. So, actually across that week of hitting that target, the pumpkin seeds will count up to a whole point, so to speak, I don't get people to fixate on portion sizes straight up.

That's kind of the second step. I talk to them and there're images in the book about times, like, what would be classified as one portion of veg or what's classified as one portion of nuts. When people are more confident with the whole initial getting in diversity, that's kind of at the forefront of their habits, then we start to think, “Okay, well, I want to make sure I'm actually having a decent portion of each one.” For the herbs and spices, typically each herb and spice get the quarter of a point. But if a dish has got like 15 different types of herbs and spices, I just say, be realistic, maybe give it an extra three points or something, don't take the piss.

Melanie Avalon: You have a very long section on herbs and spices and it's fascinating, the different ways they can either literally have hormones in them. Those hormones when it's literally the hormones like melatonin, is it the exact same as we would produce endogenously? Does our body know the difference between endogenous and exogenous hormones?

Megan Rossi: Yeah. So, no, but some of their metabolism, so when it goes through, like, the gastric at a really low pH, it can, for some of them, change the structure of them. But in terms of things like the melatonin, they've showed that eating really large amounts of pistachios, which is one of the highest nuts in melatonin, actually can impact your blood levels of melatonin. For some of them, yes, it can have that same effect. Although structurally it could be identical for others, when it goes through that digestive system, it can be changed. Therefore, the functionality of it might not be the same as in vitro, the stuff we produce ourselves. 

Melanie Avalon: That was actually another major reframe I had in addition to the grains, because I was always very much on the anti-soy train. That actually kind of relates those to the gluten, where I think it might be like, glyphosate and stuff surrounding it that might be the issue. 

Megan Rossi: I think that's it, yeah. 

Melanie Avalon: And so, with soy, it might be like the process form and the GMOs. But I interviewed Dr. Neal Barnard for his book. At the time, it was his most recent book. He has a lot of books.

Megan Rossi: Some people just love to publish, are they? 

Melanie Avalon: No, he came on just for a study he had done, actually, he wanted to come on for just a study about soy and all that. That actually made me do a big reframe on soy and phytoestrogens just because I think I was little bit biased in my approach to that.

Megan Rossi: Yeah, no, no, no, absolutely. I think it can be, like I said at the start, in terms of the gluten thing, we can be easily biased by so much bad press around stuff. I think you hit the nail on the head in terms of often it's probably something else. It could be the pesticides that are having these effects, because when we look at kind of the clean version in clinical trials like the phytoestrogens, we see how it has these really impressive anticancer effects. Also, we know that how animals metabolize these phytoestrogens is very different to how humans and that's what the whole breast cancer thing initially was that you obviously would have covered this, I think, with the world leading expert on the topic. But yeah, how it completely had the opposite effect in rats compared to how it does in humans, where it benefits us and it was really quite harmful for them in terms of breast cancer risk. It's so understandable where all this confusion comes from. So, end of the day, I'm always like, has there been that human clinical intervention? If there hasn't been, I'm a little bit skeptical. Don't write it off, but a little bit more skeptical if there has. And I'm like, “Okay, now I'm listening, now I'm going to really check through the mechanisms.” 

Melanie Avalon: And sort of to bring everything full circle from the beginning. I think the same thing happens a lot with meat and even dairy, where I think a lot of it is the context of being processed meat or the people who are eating meat, like healthy user bias. The people that are eating meat tend to maybe have less healthy habits. I think it's a paradigm that is very present in food.

Megan Rossi: Absolutely. And we're such complex humans, aren't we? There's just so much going on behind not just what we eat, but how we eat and why we eat and all that stuff, which really makes like epidemiology trying to pull apart. Is it the salt, is it the potassium, is it the gluten, is it the pesticides? Really difficult. And again, that's why the observational studies where they observe cohorts is really interesting. But again, we need to be careful of what we deduce from those sorts of studies. We want to make sure we get that intervention where everyone's on the same playing ground. Half of them get this intervention, half of them get that, and that's when it comes like a lot less bias and we get that clear understanding of what's most likely to happen.

Melanie Avalon: I want to be really respectful of your time, especially with you being in the UK with all the time difference. So, I will refer listeners to your books because there's so much information, recipes, lots of troubleshooting, just really valuable information for people. One last food question about your diet. Did you consider at all or what would be your thoughts on having wine as a plant food? 

Megan Rossi: [laughs] I love that and I did consider it because we know that things like cocoa and coffee actually are beneficial and I've given them a quarter of a point. I didn't give the red wine the quarter of a point, unfortunately, because we could probably just have berries and get a similar effect. I just know that red wine, although it has health benefits, one glass a day, absolutely because those polyphenols actually have these like, anti-inflammatory and they feed a lot of the mechanisms of how these polyphenols have benefits, actually the viral gut microbiome hence why we need them for another thing, the benefit of red wine. But actually, when we have more than the one glass, those anti-inflammatory benefits start to turn to pro-inflammatory. So, it just would have created a whole new level of explaining, so I've stuck to food sort of compounds it in this scenario. 

Melanie Avalon: Makes sense. I was super curious about that. Well thank you, Megan. This has been absolutely so, so incredible. Was there anything else that you wanted to draw attention to from your books or things that listeners should know about your work?

Megan Rossi: Thank you so much for having me. It's an absolute pleasure. Clearly, we could chat all day and I guess a lot of people ask me, “Which book should I buy?” Generally, Love Your Gut was very much about helping people get on top of their digestive issues and some of the very fundamentals of our gut microbiome. So, where they've got food intolerances, reflux, excess flatulence, bloating, those sorts of things that go through and very practical kind of troubleshoots how to overcome them. It was because essentially, I couldn't see everyone in my clinical practice. I know it's not realistic to see a one-on-one dietitian or nutritionist. That was a very action plan-type book. And then after that book was published, I was like, “Never writing again. It's such an intense journey.” 

I just got so many requests from people like, “Oh, my God, amazing results. Now I feel, like really good. I've heard that our gut is connected to our metabolism and our gut hormone, and our gut skin. Like, how do I make the most of this?” So I was like, really there is a second book there in terms of kind of broadening out and speaking to essentially everyone and anyone about the importance of system, the far reaching benefits of the gut microbiome, and even those people who might still find they've got a bit of a sensitive gut. I've got like, a sense of gut menu plan in the second book that allows them still to get their 30 plus points a week and loads of fiber in a very gentle way on the gut using specific fibers and stuff like that. It's kind of more of that broad based book. The other one is a little bit more clinical. 

Melanie Avalon: I'm always bringing on different guests onto this show, and they often have multiple books, so I always start with whatever book was presented to me or the book that I read. In this situation, your publicist had sent How to Eat More Plants, and it was so good, I was like, I got to read Love Your Gut. [chuckles] That's how you know and you're, like, must read all the things. I can definitely 100% recommend this to listeners and I'm just so grateful for everything that you're doing. 

The last question, and it relates to that-- that I ask every single guest on this show, and it's just because I realize more and more each day how important mindset is, which is something you talk about all throughout your books, but what is something that you're grateful for? 

Megan Rossi: I am grateful, it's going to sound super nerdy, but for my gut microbiome. 

Melanie Avalon: I love it. I love it. 

Megan Rossi: It sounds so nerdy, but when you work on it day to day and you see the research coming through at highlights, so much, so we thought our human cells did on our own, like regulating things like estrogen and fertility, all of that stuff. Actually, we're discovering our microbiome is doing so much for that and we couldn't survive without them. So, yeah, those little guys inside of me, I am very grateful for, and that's why, I do practice what I preach and making sure I have my 30 plus plants a week and load up on the diverse fibers.

Melanie Avalon: I love it. That's a wonderful answer. Well, thank you, Dr. Rossi. This has been absolutely amazing. I just thoroughly enjoyed your books. I enjoyed this conversation so much. I can't wait to see your future work. I know you just said how crazy it is writing books, but are you writing another one? 

Megan Rossi: [laughs] No, I can confirm. I definitely haven't finished, but there're a few studies that I want to see which way they turn before I feel confident in writing anymore.

Melanie Avalon: Oh, that's a teaser. 

Megan Rossi: Yeah, I know, I know, I know because I just don't want to write something and then be like, “Oh, gosh, no, it's changed ridiculously.” There's some landmark that is kind of on the verge. So, yeah, this whole word of personalized gut microbiome and nutrition is really exciting. So, I'm going to wait and see what comes from the research.

Melanie Avalon: Awesome, awesome. Well, thank you so much. We'll put links to everything in the show notes and what links would you like to put out there? 

Megan Rossi: Social media @theguthealthdoctor and then there's also a website for a whole lot of free resources, theguthealthdoctor.com. 

Melanie Avalon: Awesome. Well, we'll put links to all that in the show notes. Thank you again so much for your time, especially with the time difference. I appreciate everything you're doing so much and hopefully we can connect again in the future. 

Megan Rossi: Absolutely. I really enjoyed it. You're very knowledgeable, which was great to have a chat with.

Melanie Avalon: Oh, thank you. You too, obviously, so thank you. Have a good day or night. Bye. 

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