“of course eat fruit and veg (including Broccoli, which I hate) every day, at least an apple and an orange.”

UK guidelines are *at least* five 80g servings a day, in the full rainbow of bright and dark colours. Several countries recommend seven to nine portions a day, in line with published research.

Clever Guts guidelines are *at least* seven servings a day, mainly vegetables, 20 to 30 different varieties a week (p.191).

“Eat fish at least 3 times a week.”
UK guidelines are up to four servings a week, ideally oily – eg. mackerel/ sardines/ trout/ salmon – but minimising large species due to heavy metal accumulation (eg. tuna/ swordfish).

PhillG: Once you have at least weeks of your detailed food and symptom diary, research and analyse
“How does your intake of the various food groups/ types fit with official healthy eating guidelines for UK adults, any targeted NHS advice for your medical issues, the basics of the Clever Guts diet?”
Consider serving sizes, maximum/ minimum number of servings, balance, daily/ weekly variety for ALL food groups/ types.

Hi PhillG you havent provided sufficient detail for me to advise further, As suggested a detailed food diary and medical history would be key. I see no reason (based on the limited information you’ve provided) not to follow the excellent advice in Clever Guts. But again, beware of stopping the meds until you are certain your bowel is not inflamed. Regarding Fecal Matter Transfer google Prof Ailsa Hart at St Marks (Northwick Park) hospital.

SCAD would appear as a rare autonomous clinical entity distinctive of old age, although it is still not well defined. It is likely that prevalence of SCAD could have been underestimated in the past since its main clinical presentation (namely bleeding without pain) is often found in elderly patients with diverticula. Endoscopy and histology could be helpful to discriminate it from infectious diverticulitis. Increasing evidence encourages the concept that SCAD includes pathogenetic and therapeutic aspects peculiar of IBD. This could be relevant for clinical management of SCAD. Indeed, the resolution of a severe, refractory case of SCAD has been recently reported with biological drugs used for IBD therapy. This observation could encourage, in the near future, the use of biological therapy in severe forms of SCAD as an alternative to surgery.

Firefox – I’ll take that as ‘yeah probably’ 😀

The diversity of my gut microbiome just plummeted, as the sensitive souls made a desperate bid for freedom. Thinking about filthy evil processed food, noooooooooo!!!

Brand, flavour, pack size, full ingredients list? Do you fast before and after each pack? Chew every mouthful thoroughly? Add to detailed food and symptom diary (p.187), post on Insta?

All plant wholefoods contain some prebiotic fibre and/ or resistant starch. BUT some crisps are sliced whole potatoes with or without skins, some made with processed dehydrated potato plus a sundry processed grains …

Then there is the effect of the fatty acids in the frying oil on the gut lining and flora … Inflammatory omega-6? Monounsaturated? Artificial trans fats?

And what about the flavourings? Emulsifiers? Sugars? Page 157 dude.

So if cooked potatoes that have become cold are prebiotic – are potato crisps….? Someone say yes 😉 (and no lectures about salt or anything thanks. )

Why be so pedantic in your diary? Because UK recommended serving sizes are weights and volumes. For example fresh fruit and vegetables 80g. Compare salad leaves or fresh spinach to a dense fruit or veg. Massive overflowing soup plate or just half an apple.

And because you need to know which ingredient(s) in your lentil soup are the problem, and how much you can tolerate of each. Hopefully more as your gut repairs!

Will post properly on diet later or tomorrow, but your detailed diet and symptom diary is key. Every mouthful and sip as you have it not later: research shows we forget, under or overestimate.

Weigh and measure EVERYTHING. Kitchen scales, proper measuring cups and/ or measuring spoons (level). Ingredients lists to hand: digital photos help you analyse later if you have the technology. Yes you can guesstimate if you are eating half a weighed pack. Yes you can convert weight to volume if you measure properly every so often.

You might get fobbed off or stonewalled by the relevant clinical pharmacist, general advice on local formulary (which drugs are first second third choice by efficacy, side effects and cost), info on weaning off/ withdrawing, ability to influence prescribers esp. junior docs, someone with a special interest like GrahamPhillips … Lady luck plus persuasiveness needed.

Your family doctor can refer you to a hospital dietician. Likely the Gastroenterology department can cross refer, that *might* be faster or need chasing to get done. You seem willing to put the effort in, the NHS has the expertise if you can access it.

Outpatient hospital pharmacy is much changed since I trained, but I believe inpatient is much the same. There should be a hospital clinical pharmacist attached to each ward/ department. They attend the daily ward rounds with the consultant and junior doctors. Check, advise and change drug regimens on ward.

Contact with out patients varies with ward/ department, probably by NHS Trust, and the individual pharmacists interest/ time/ mutual respect with the consultants!

GrahamPhillips is a UK community pharmacist, also linked to Map My Gut. Very knowledgeable and helpful. Highly recommend following his advice to the letter. 🙂

My background is also UK healthcare: in and out of the NHS. My passion is lifestyle healthcare (nutrition/ physical activity/ smoking cessation) BUT not practised or studied in a few years due to my own health issues!

So please excuse seemingly pedantic or repetitive suggestions, posting at unearthly hours, disjointed or half finished posts. Clashing combo of prescription and over the counter meds, no sleep!

Hi Firefox
Having read and own The Diet Myth by Tim, its what got me on to a diet change and also FMT. Excellent read, couldn’t put it down. Oddly enough recommended by my GP who’s wife (also GP) had read it. Have never been given the opportunity to deal with hospital pharmacist, do they have these in UK?
I’m trying to get back to a normal life that was washed out by Moviprep and of course eat fruit and veg (including Broccoli, which I hate) every day, at least an apple and an orange. Have maybe 3-4 units of alcohol a week. Eat fish at least 3 times a week and chicken fairly often. Rarely beef (it makes a mess of the oven). Lost 22lbs over 12mths. Take vit D3 everyday from Sep to April.
I have noticed that Spicy Lentil soup aggravates bowel so stopped. Even tried wheat and milk intolerance, neither helped. What now?

Regards
Phill

Hi Graham. Perhaps I need to expand. After endoscopy results my local hospital had problems with consultants (Passing over, long term sick and leaving so down by 3) which meant that I had no “expert” help. Meanwhile my GP put me on mesalazine Salofalk 1.5 then 3g. It calmed down, although plenty of BMW (blood, mucus and wind). It meant life was dependant on being near WC. By Dec I finally saw consultant and he was adamant it was SCAD and therefore Salofalk was a placebo and does not work with SCAD. He put me on steroids, but they had no effect, so back to Salofalk, but by early August had a relapse then put on Azathioprine 50g 3 times a day. Read it can take 3 -6 mths to kick in. 4 mths later I’m here and Aza doesn’t work either. Forgot to add that mid Aug had an appointment with a consultant at Guys & St Thomas’ in London in the hope that I might be able to get a FMT (faecal transplant). Unfortunately they do not have funding for anything other than C diff cases.
Today, 3 days in, I’m taking Optibac once a day and stopped taking Azathioprine. Already my bowel is calming down.
I have always had a reasonable diet and always been in good health. Retired from a life time as Plumber/Heating engineer, 2.5 years. Not smoked for 20yrs. Sleep well (8 hours) even though I get up 4 times a night to pass wind I always go straight back to sleep.
Regards

PhillG

Eating healthy for the most part will allow one to enjoy the not-so-healthy-but-tasty foods on occasion, is my philosophy 🙂 I can do without the ham, too, but I do like salami. And cake.

Interesting information, thank you! I did not know you could not get nitrate/ nitrite free cured meats in the US.

I believe there is (or was?) a similar issue with certain European traditional cheeses made from unpasteurised milk, when imported to the US. The mysterious microbial cocktail that creates the characteristic flavours, odours and health benefits, also raises concerns over potential pathogens.

I wish the precise combination of factors governing the health risks from regular intake of processed/ preserved meats was known. I can do without bacon and sausages, but not the cured ham!

SarahAP: See the ‘Plan Ahead’ paragraph (p.188 of the CG book). It is important to know *exactly* what you have eaten or drunk from the start of your detailed food and symptom diary, and throughout the elimination/ ‘remove and repair’ phase. If these suggest any food allergies or intolerances, you need to be strict during the reintroduction phase too (sorry!).

This is because even a tiny amount of soy, wheat, eggs, nuts or milk can cause problems for susceptible individuals. A reaction can be delayed or swift, and you can’t be sure exactly what you have been exposed to unless you ‘supervise’ the chef and all their lackeys!

If your health issues are primarily down to an imbalanced, poor quality, processed or low variety diet you may have more flexibility. You may be able to eat out, if sticking to the basic principles (a little wine, fish, veggies, cheeseboard and fruit, coffee say).

Thanks Graham. I’ve put together a plan based on the Mediterranean low carb diet and I’m doing IF 16:8 about 4/5 days out of 7 and I’m going to review/revise it in 2 weeks – so I’ll let you know how I’ve got on

Jussyb: a carefully structured elimination and reintroduction diet is the scientific way to identify food intolerances. Start with a detailed food and symptom diary (p.187 of the Clever Guts book) with no additions or subtractions to your usual diet. Weigh, measure and log every last mouthful or sip.

The potentially beneficial microbes in kefir and some other fermented dairy products are bacteria and yeasts! However you would be wise not to introduce kefir until you have satisfied yourself you don’t have an intolerance to the sugars or proteins in dairy.

PhillG: have you been completing and analysing a detailed food and symptom diary (p.187)? With proper weighed and measured amounts this is invaluable for any lifestyle health professional.

How does your intake of the various food groups/ types fit with official healthy eating guidelines for UK adults, any targeted NHS advice for your medical issues, the basics of the Clever Guts diet? By food groups or types I mean those containing added sugars or refined carbohydrates, oily fish, other healthy fats, fruit and vegetables (esp. prebotic rich ones) and so on.

Similarly consider your overall lifestyle against official guidelines: physical activity levels, stress management, sleep patterns and quality, alcohol intake, smoking, weight management, sun exposure mid spring to mid autumn (for vit D). Not even health professionals get all this right … Especially not them/ us!

The risks of raised cholesterol have been overstated; it all depends on the type of cholesterol and a lot of other parameters. In short, :”fat does NOT make you fat” (Sugar, carbs and processed foods do that) There are plenty of non-dairy fermented foods (Michael mentions them all in his book) but bottom line, Kefir will not cause you a cholesterol problem

Impossible to fully answer your questions without a lot more detail. But in principle combining the clever guts and 5:2 or 16:8 is a perfect combination and yes, you should lose weight (fat not muscle).

PhillG: are you in contact with the hospital pharmacist attached to the Gastroenterology ward/ department, and with the Dietetics department? These specialists are more qualified and knowledgeable *in their respective fields* than your family doctor. They could liaise with your Gastro consultant, and with each other.

If your NHS team want science, bring it to the best of your ability. The Clever Guts Diet is written for the layman, but is authored by a GP and references published studies. Better still, Prof. Tim Spector and Prof. Rob Knight (American Gut Project, and authorities in the field) have both published books on the gut microbiome.

The British Gut Project, and offshoot Map My Gut, are attached to UK university research laboratories. You absolutely should be able to discuss your results with any relevant NHS professional.

Sorry but a hair sample test is completely devoid of any logic or any scientific or clinical evidence that is has the least meaning. So please don’t base ANY decisions on it. Kefir is probably a reasonable thing to try but you could start with a less potent pre/pro-biotic such as kombucha or saurkraut. Alternatively I highly recommend Symprove which is one of very few (maybe the only) probiotic to have undergone clinical trials (take a look at their website)

It sounds like you might have some form of inflammatory bowel disease in addition to irritable bowel. The first thing you need is a proper diagnosis “digested your stomach lining” isn’t a diagnosis. There is NO WAY you’d be waiting 4 years for a referral to a gastroenterologist. You really need to start there. Also having a stool analysis may be helpful. If you post a ten day detailed food diary (ten days on your old diet then another ten on your exclusion diet) I might be able to help a bit.

Are you taking any prescribed meds on an ongoing basis?

Best of luck

Graham

https://www.optibacprobiotics.co.uk/faq/can-taking-optibac-probiotics-prevent-or-cure-cystitis

What are your current symptoms? What dose of azathioprine are you taking? If the azathioprine isn’t working are they planning to add mesalazine? Have they prescribed steroids? These are all the standard treatments and they you are likely on to MonoClonal Antibodies. NOW: have you had your microbiome tested/analysed? Without that you are flying blind. That would be my recommneded next step. Then we look into your medical history, lifestlye (do you sleep well? Do you get 8 hours of quality sleep?) and diet. Maybe if you have dysbiosis this can likely be addressed by diet. Then if symptoms resolve you can have another endoscopy. If the gut looks ok you should be able to gradually withdraw from your drugs slowly and cautiously. Under NO circumstances would I suggest an immediate change from the drugs to the probiotic. And I’d suggest attack your diet and lifestyle by preference. Pro-biotics alone will not help. If you do want to try pre/probiotics I’d recommend Symprove. Take a look at the website. It has clinically, scientifically proven efficacy. Very few pre/pro biotics have undergone proper scientific study. Hope that helps. Graham

You can access the probiotic reviews by Consumer Lab at http://www.consumer lab.com. Under reviews, just select probiotics. Consumer Labs has impartially tested products for over 20 years so I rely on their testing rather than just take the word of the manufacturer.

In July 16 I had the dubious pleasure of having an endoscope inserted through my anus having first cleared my bowel with Moviprep. The reason for this was that as a result of the Bowel Screening Programme, faint blood traces were found. The endoscope was passed all the way round to my appendix, with the only problem showing to be moderately active colitis. ??SCAD ?IBD. Since then my GP/ NHS Endoscopy Dept have tried all sorts of drugs non of which have worked. Don’t get me wrong my GP is very good but he admits he is a scientist that only trusts scientific controls tests of manufactured drugs. He admits that things like Homeopathic may work but he cannot condone them. I went to a Homeopath and they may recommended Optibac Probiotics.
My question is how do I stop taking Azathioprine, which I’ve been on for 4mths now and in my opinion, doesn’t seemed to have kicked in yet, in favour of Optibac and a proper gut friendly diet?
Thanks in anticipation of some alternative advise.

I’m in NSW and very keen to buy the seaweed capsules as well – am just about to embark on the Remove and Repair phase of my gut flora journey – any advice on what you do when going out and sharing a meal? Is it OK to occasionally diverge from the path or do you have to start all over again?

Thanks for your input, Firefox7275. I was inspired to check Wikipedia for information on food processing, and it offered a rather nuanced view point, although the article on Food processing was thought to be biased. There is also an article on Convenience food, which apparently is also called tertiary processed food, and it mentions things like long shelf-life, i.e., preservatives and other food additives. Wikipedia offered no definition of tertiary processed food, but I found one on glosbe.com: Food so prepared and presented as to be easily and quickly ready for consumption.

You specifically mentions nitrates and nitrites, which I also checked. I compiled the following info from the two articles on nitrate and nitrite (my editing):
According to Wikipedia, nitrates are reduced to nitrites in the saliva. A rich source of inorganic nitrate in the human body body comes from diets rich in leafy green foods, such as spinach and arugula. The use of nitrite for curing meats goes back to the Middle Ages, and in the US has been formally used since 1925. Because of the relatively high toxicity of nitrite (the lethal dose in humans is about 22 milligrams per kilogram of body weight), the maximum allowed nitrite concentration in meat products is 200 ppm. At these levels, some 80 to 90% of the nitrite in the average U.S. diet is not from cured meat products, but from natural nitrite production from vegetable nitrate intake. Under certain conditions – especially during cooking – nitrites in meat can react with degradation products of amino acids, forming nitrosamines, which are known carcinogens. However, the role of nitrites (and to some extent nitrates) in preventing botulism has prevented the complete removal of nitrites from cured meat, and indeed by definition in the U.S., meat cannot be labeled as “cured” without nitrite addition.

So not so straight-forward 🙂 but I suppose salami on pizza may be something to enjoy infrequently. But back to my original issue, “processed foods” then is to be understood as “tertiary processed foods” with unnaturally extended shelf-life for convenience purposes.

I’m in South Australia. Has anyone tried this company? https://www.microba.com.au

Hi — this is out now! You can read the story here: http://www.dailymail.co.uk/femail/article-5048863/How-drop-dress-size-Christmas.html

Everyone’s ‘remove & repair’ stage should be different, based on our individual food and symptom diaries. We also have different food availability, lifestyle constraints, budget and personal taste.

Hence I see the plans and recipes as examples, the somewhat flexible ‘avoid’ and ‘include’ guidelines being more important. By all means include more variety in ingredients and recipes, but keep logging everything.

A seemingly traditionally preserved meat or cheese may well be from an intensively reared farm animal. So the food may have been unnaturally ‘processed’ long before it left the animal and found its way into a (heavily processed) sandwich.

If you can source traditionally preserved/ fermented meats – no nitrates or nitrites – from animals reared outdoors, by all means include small servings in a balanced and varied wholefood diet.

The closest widely available option here in the UK is Prosciutto di Parma PDO. If would love to find a similar spicy chorizo!

To me the term “processed-food” represents something different/ more than the individual words.

A modern processed food item isn’t quite the same as a traditionally preserved food item. Where humans once salted/ air dried/ pickled/ fermented, we now add preservatives, artificial flavourings, sugars, colourants, and kill the potentially beneficial microbes with ultra high temperatures.

FYI there is a 1 week spread in the Daily Mail before the launch of my Clever Guts Diet Recipe Book the following week. All about feeding up the right bugs in your gut for a healthy microbiome and incorporating intermittent fasting

http://www.dailymail.co.uk/femail/article-5048863/How-drop-dress-size-Christmas.html , their title not mine!

Hi Number2 its not that simple. British Gut is cheap but you get what you pay for. BG gives minimal detail. I would suggest you consider what you are trying to achieve. Suggest you post some more info and I’ll try to advise

The term “processed food” is used a lot and usually means it’s unhealthy, but isn’t the term a bit too vague to be useful? There are so many ways to *process* food. Michael talks well about fermented foods but then under the heading “Processed foods” (p. 156) mentions a salami sandwich, implying it’s bad because it’s processed. But salami is fermented, at least when made the traditional way. I suppose there are good and bad versions of what’s called salami, but the term “processed food” is still confusing to me.

British Gut Project.

If you have not consulted a registered dietician recently, it might be worth doing so with a copy of the Clever Guts book and your detailed food and symptom diary. There are prebiotics that aren’t also fibres, but that might well involve supplements rather than wholefoods. Given your history, it would be safest to supplement only under medical supervision.

Did the dietician distinguish between soluble and insoluble fibres? Are you able to have more whole plant foods in the form of blended soups and smoothies?

Do you eat a really wide variety of nutrient dense animal foods (oily fish/ other seafood/ organ meats/ whole organic eggs/ traditional aged cheeses/ other fermented dairy)?

Has anyOne with a bowel anastamosis between small and large bowel had success on the clever guts diet. Due to recurrent obstructions I have been advised to be on a low fibre diet. Which has not resolved ongoing diarrhoea, therefore wanting to try clever guts. With all good gut bacteria diets there are hard things fibre fruits veges, nuts, seeds, salads, and I don’t have these as advised by Dietician.

Hi,

Having read the book and logged onto this website I am somewhat confused about where to access Microbiome stool testing for a UK resident, as the references seem to be for availability in US, Israel and Australia etc.

I would like to ask if anyone has found a company who has the test for a reasonable price for someone in the UK. The book refers to the test being available for less than £100.

If testing is available would it be possible to post the name, contact details and price etc. please?

Thanks in advance to anyone who answers and shares their experience and details of where a UK resident can access the stool testing.

Sorry to hear about your husband’s rash. I’ve not bought any seaweed capsules but would certainly try them if my psoriasis returned. If he’s on steroids though you’d not be sure which was helping.
Good luck. Hope it clears quickly.

I have discovered that although I love drinking several good cups of tea and one decently brewed coffee a day plus fruit juice and some water, my gut shuts down unless I replace all bar 2 of the aforementioned caffeinated drinks a day with lots and lots of water. I eat lots of fruit and veg though latter is often roasted. I can’t find anything in the Clever Guts book index about fluid or water.
Having Raynauds I prefer hot to cold drinks on the whole.
Does anyone else share this fluid problem?

Hello,
My husband and i have started on the Clever guts journey and have been really enjoying it. We haven’t been super strict since getting to the reintroduction phase but more often then before we have really improved our eating. Both of us have lost around 5kg in weight.

Why I’m writing here is that around the same time my husband developed a really bad rash, finally going to dr and trying different things he now has the result of a skin biopsy that he has psoriasis/dermatitis and its not the contact form. Which is very strange to us as if anything we have really improved our not so bad diet to since this skin condition has developed. He is gong on a course of steroids and see what happens, not something that we like to do long term. I remembered about the seaweed research and we also live in Australia.

If anyone has bought seaweed capsules and see the results please can you reply – very keen to really up our anti in the clever guts area and help treat his skin.

thank you! Nicole

Hi Rockchick94
Glad to hear thatyou are feeling so much healthier. As a GP we probably should be recommending using using probiotics more often after antibiotics. This is in addition to Firefox7275’s excellent advice. After a bit of research and discussion with our excellent pharmacist we have been impressed by VSL#3 (see link below), if you looking for the bacteria supplements too.

One of the best probiotics with an excellent range of bacteria and containing 450 billion per sachet and a good mix of the right probiotic strains. High quality product, more costly & best kept in fridge.

We are infact in the process of uploading a more comprehensive list of suggested products to the ‘Merchandise’ tab as there is an overwhelming number of options out there! Will let you know when the page is uploaded.
all the best
Clare

Thanks for the responses everyone.

In terms of digested my stomach lining that ie precisely what I mean (or how the doctors described it to me at least). After a horrible experience with some gastro stop medication I had the most excruciating pain and was passing a very strange substance in my stools. I ended up in the ER with no one knowing what was wrong with me and the 8th doctor later explained that the strange substance in my stools was parts of my stomach lining. Not a pleasant experience!

I am not on any medication and after the recent tests came back all fine the doctor said he wasn’t sure what was wrong and to come back if the symptoms persisted. I have previously been put on a gastroenterology waiting list but have been on that list for 4 years…

I have kept a detailed food diet throughout. Prior to the elimination diet I was eating more white carbs such as gluten-free pasta and sourdough bread. I have mainly increased my vegetable and fruit intake on the elimination diet. I was not taking any supplements beforehand.

As I live in a small town my access to a variety of foods is limited. I have eaten lots of nuts, seeds, buckwheat, eggs, etc. On the diet but cut them out in the past couple of weeks as I was worried that they might have been irritating my stomach and causing all of the issues. I have been eating fish throughout and have been eating 2 different types of white meat and 3 different types of red meat throughout also.

I have been monitoring my fibre using a food app and have consistently been getting 20-30g of fibre a day.