Could your GP soon be prescribing probiotics?

The Gut Doctor will see you now…

Could your GP soon be prescribing probiotics? Hannah Ebelthite chats to Dr Rangan Chatterjee, to learn how the latest advances in gut-health science are shaping his advice Y ou’ll recognise him from his BBC One show Doctor in the House, or from BBC Breakfast, where he’s resident medic. Or perhaps you’ve watched his TEDx talk about making diseases disappear, or read his bestselling book TheFour Pillar Plan? Dr Rangan Chatterjee is the GP everyone would love to see and it’s thanks to his progressive, holistic approach that aims to treat the root cause of illness. So what does he make of the hottest topic in health – the gut? We caught up with him to talk bugs, bacteria and their potential to influence all areas of our health and wellbeing… 68 Health & Fitness // 1 Dr C: While we don’t know what the perfect gut looks like, we do know that we’re looking tor lots of different strains of microbes living there in harmony with each other. One of the biggest ways to drive diversity is to eat a diverse diet.

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So, eating H&F: So the number and diversity of your gut microbes can even affect mental health? H&F: What sort of foods should we be eating to boost gut health? Dr C: Yes, we know intuitively that feeling stressed affects the gut – the classic example is the student who’s nervous before an exam and feels an urge to use the loo. But what we’re now learning is the health of our microbiome (the community of gut microbes) can affect your stress levels, too. It’s called the gut-brain axis. Substances produced by gut microbes can communicate with the brain, via the vagus nerve, to send stress or peace signals, depending on how healthy they are.

Could your GP soon be prescribing probiotics?

H&F: Why is the health of our gut so important to us overall? Dr C: Inside your gut live trillions of microbes that together weigh the same as the human brain. About 10 years ago, we didn’t understand much about them, but we now know the health of these bugs, their composition as well as their relationship to each other, has an impact not only on the way your gut feels – so your digestion, whether you’re bloated or constipated – but also on all systems in your body, including your brain, your mood and possibly even your joints.

GUT health five different vegetables every day of different colours – as different pigments provide different nutrients – is a fantastic way to start. Another simple way is to practise time-restrictive eating – eat all your meals and snacks within a 12-hour eating window. Have breakfast at seven, finish your dinner by seven, or eight to eight, or nine till nine. So, you’re also having 12 hours in every 24-hour period where you’re not putting food info your body. That encourages the growth of more beneficial gut bugs, because when you break from food, a new population comes in to ‘clean up’ the gut walls.


Is this new science affecting your approach in the surgery? Dr C: Absolutely. I’ve seen increasingly over the past five years that when we address someone’s digestive health – say for something like irritable bowel syndrome (IBS) – they often mention that their skin or joints have improved, too. So now, if someone comes to me with a problem relating to the gut, such as constipation or bloating, and they also have other issues, I tackle the gut first. I had one patient with poor digestion and anxiety. Addressing her gut health solved the digestive issues but she also reported her anxiety levels improved by 80 per cent – all without need for drugs. H&F: Should we all be taking probiotics? Dr C: I can’t honestly say as a doctor that everyone needs to take probiotics all the time. We don’t have that evidence yet. What I can say is I don’t think it can do any harm. Sometimes it’s hard to motivate yourself to make diet or lifestyle changes if you’re feeling low. So forthose people I’ll recommend a month’s course of probiotics – supplements that actually put beneficial live bacteria into the gut where it’s needed. Probiotics show very little downside, if any. Worst case scenario is the patient comes back to me in four weeks showing no improvement, but I’ve not done them any harm.

H&F: There are so many probiotics to choose from, what are the issues to consider?


The microbiome is like a fingerprint, unique in each of us. We all have different bacterial strains in different ratios and it’s impossible to say exactly what strains you need. So there’s no one-size-fifs-all probiotic. You also need to know if a probiotic will survive your stomach acid to get to the lower intestine. Different products have different strains and will boast 20 billion or 100 billion bacteria numbers, but it doesn’t matter what a supplement contains if none of them survive. With so many products on offer, I’d say experiment to see if you feel any benefit and if you do, keep faking if. These days, I recommend a liquid probiotic formulation called Symprove (from £52 for four weeks’ supply; and that’s because good evidence, from University College London in 2015, shows this probiotic does get to the lower intestine. And while Symprove only contains four strains of bacteria (all well studied), new German research shows they change the environment of the microbiome such that your existing gut bugs, the good ones, can thrive, while the bad ones die out. H&F: Are there lifestyle changes that can help? Dr C: It’s the boring stuff. Movement, sleep, relaxation. Nothing is going to magic your gut health back to life if you’re only sleeping five hours a night and you never switch off. Keep active – but not too much, as chronic over­ exercising damages gut health. Get enough sleep and turn your phone off an hour before bed. High stress wreaks havoc in your gut. So, diary-in 15 minutes of me-fime a day.


What about antibiotic use – should we all say no? Dr C: Antibiotics can be life-saving, but there’s no question we overuse them. There’s no way I, my kids or my wife would fake an antibiotic unless a) we had to, and b) we take a good probiotic with them, because they wipe out all your good gut bacteria. I feel I should be felling my patients the same thing I would tell a family member. Even if you’re prescribed them, ask, ‘Do I really need these? Can I wait seven days before faking them?’. In French hospitals, when they prescribe children antibiotics, they give probiotics, too. Even though I can’t prescribe probiotics on the NHS, I’ll say to my patients, ‘If I was you, I would get some’. And take your probiotic at least two hours away from the antibiotic – not because the probiotic would stop the antibiotic working, but the other way around. Take probiotics throughout the course of antibiotics and for a month afterwards to help repair that damage. H&F: Where do you see the future of probiotics and medicine? Dr C: I think maybe in the next 10 years we’ll be able to personalise probiotics, analyse your microbiome and prescribe the specific bacterial strains you’ll most benefit from. Until then, I’m using what we know about gut health to help people feel better, get more out of their lives and stay away from doctors.

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