Podcast Episode 11: Happy and Healthy: Exploring the important relationship between food and mood with Nutritionist, Emma Ellice-Flint
Increasingly, we are becoming more aware of the important relationship that exists between what we eat, and how we feel. Often described as our ‘second brain’ the gut is known to house an extensive network of neurons that, just like our actual brains, have a profound impact on our mental state. With research now suggesting that gut bacteria could manufacture about 95 percent of the body’s supply of serotonin, it has never been more important to take a look at what we cook. Joining host Lauren Redfern to discuss the connection between the foods we eat, and our subsequent mood, is Nutritionist Emma Ellice-Flint. Through their discussion, Lauren and Emma help to shed light on how mood and food are connected, exploring how an understanding of this is particularly important during the perimenopause and menopause when emotional stability can prove challenging. Emma outlines how the addition of certain foods (particularly fermented foods such as yogurt, kimchi, and tempeh) can prove particularly helpful in stabilising our gut microbiome, and in turn, our mood!
Emma Ellice-Flint is a Nutritionist and former chef. Currently she consults with clients on nutritional advice, weight management and gastrointestinal health related issues.
Lauren Redfern [00:00:06] Welcome to the podcast for the Newson Health Menopause Society, a multi-disciplinary collective of interested professionals passionate about improving hormone health across the world. The society exists to educate and inspire others to raise the standard of menopause care and access to treatment, to facilitate research collaborations across specialities and countries, and to provide expert advice and guidance to our associates. The ultimate aim of the Newson Health Menopause Society is to improve the lives and future health of women and all who experience the perimenopause and menopause. I’m Lauren Redfern. I’m a medical anthropologist and I’ve been exploring the experiences of those using testosterone as part of their HRT treatment. In this podcast series, I’m going to be talking to guests from a variety of different disciplines in order to share knowledge and ultimately improve our understanding of the perimenopause and menopause.
Lauren Redfern [00:01:05] Changes to a person’s mental health can be one of the first signs of the onset of the perimenopause. Debilitating depression and anxiety can appear out of nowhere. Or for those that have previously struggled with premenstrual syndrome or anxiety and depression, symptoms can significantly worsen. Whilst for many HRT can prove life changing in addressing the experience of low mood. There are other factors which are important to consider when thinking about the management of the perimenopause and menopause. Our gut microbiome and the choices we make daily when it comes to our food, for example, is increasingly gaining recognition as an important factor to consider in the management of our mood and wellbeing during this time. Speaking about the importance of good gut health, the nutritionist I’ll be talking to today, Emma Ellice-Flint, has said this ‘beneficial microbiota – the community of microbes living in our gastrointestinal tract – thrives when we eat foods that encourage its health’. While incorrect foods may not only foster a hostile environment for that microbiota, but also encourage unwanted bacteria to thrive instead. The gut microbiota communicates with the brain and vice versa, via several neural pathways. Amazingly, gut microbiota can produce their own neurotransmitters – hormones that can communicate directly with the brain using their own language. Through this connection, our moods can influence and be influenced by our gut’s condition. Happiness, positivity, excitement and optimism are all affected by a healthy microbiota. While tendencies towards grumpiness, anger, anxiety and weepiness may reflect an out of balance gut microbiome. Here to talk to us about the importance of this relationship between how we feel and what we eat is the nutritionist whose words you’ve just heard, Emma Ellice-Flint. Hi, Emma.
Emma Ellice-Flint [00:02:58] Hey. Hi, Lauren, and everyone so thank you. Thank you for giving me this opportunity actually. I am beyond passionate about this topic actually. It is so important to every human being in fact. My work though, focuses on people in perimenopause and menopause. And so for me, because I’m a nutritionist and I’m focusing on those people, it really comes together that of course I’m focusing on gut health as well, and especially their mood and their mental health. And you know, whether they wake up in the morning and want to get out of bed or whether they’re filled with dread. So how did I come about to arrive at this point? I was a chef, actually, originally, and then about 15 years ago I requalified. I did a nutrition degree and began working in clinic. And I mostly saw women, interestingly enough, with hormonal difficulties and gastrointestinal issues. And the two seemed to go together. And I worked through solutions with them to do with food and saw a change. And what was so interesting to me is I saw a change not just in their physical health, but I saw a change in their mental health too. And I certainly focused on gut health, so I think actually it might help. Lauren, if I give you an example of a recent person I saw in clinic, and I’ll just give you just an example because I think hearing a specific topic like this is just quite helpful. So this person, this woman who came to see me, she was 53 at the time and she was in the early transition into menopause. So she had not had periods for about ten months. And she was recently starting HRT and she felt significantly better from her HRT. Fantastic, great, great start. Absolutely fabulous. She came to see me though, because she would wake up in the morning quite early, about 5:30am with a real urgency to have a bowel movement. And this was a loose bowel movement as well. And she would have about three loose bowel movements during the morning, and she was really troubled by this, number one. And number two, even though she was on HRT and did feel significantly better, she still said to me that she woke with dreadful moods, was what she said, feeling very anxious with a bit of mind fog and feeling quite down in the morning. It was subsequently clear, but she mentioned this to me in passing because she hadn’t realized because she was there for these real urgent loose bowel movements to see me, but actually she reflected on this mood that she had when she woke up. So I looked at what she was eating and we talk through what changes she was prepared to make. And I set her up with a particular breakfast, a breakfast that would be feeding and nourishing her, but also feeding and nourishing her gut microbiome and one that contained, soluble and insoluble fibre in a very gentle way – nothing too aggressive on her gut. Also, a breakfast that contained fermented food. In her case, it was actually dairy kefir, but it could be yoghurt. And the soluble and insoluble fibre actually was fairly simple. We did it through oats that were soaked overnight and ground flax seeds. And this was it. This was seemingly fairly simple. I also persuaded her to add dark berries like blueberries, into that breakfast because they’re high in polyphenols. And your gut microbiome loves, our gut microbiome loves polyphenols as well as lots of gorgeous soluble, insoluble fibre. So a really nourishing breakfast full of prebiotics, fermented foods, polyphenols. Fantastic. And she went away, and made those changes. To be honest, her diet was otherwise fairly good and there were only little tweaks we did. After a few weeks, that urgency in the morning reduced. It was still there partly, but it was less. Didn’t wake her at 5.30, but when she did wake, she still had slightly loose bowel movements, but often that was it. She had just that one in the morning and not further ones in the morning. But what was so fabulous to her, which she didn’t expect, was she woke up like her mood was was fine! She didn’t feel so negative in the morning and what she described as a dreadful mood went. She didn’t wake up feeling unhappy anymore.
Lauren Redfern [00:07:39] I mean, that’s fascinating. And I’m curious to break that down a bit as well, because obviously we started today and I shared some words that you’ve written in an article that’s on the balance website and app for anyone that’s interested about microbiota. But I wanted to sort of break down this interaction between gut health or microbiota and our mood and exactly what that relationship is and why it’s important. Because obviously we can hear in this example that you added in some fermented foods, that you added in flaxseeds and berries, and this was all things that her gut responded to well and helped to improve her mood but is it possible to explain why that is? Because I think for me and I’m sure other people listening as well, there is that confusion to go with why these foods and not other foods.
Emma Ellice-Flint [00:08:23] Okay. Well, I think there’s almost three points to raise here, connected with your gut. And it’s communication or it’s interaction with your mind. And so there’s the vagus nerve, which is a large nerve that runs from your brain to your colon and vice versa. It runs there. And then we’ve got neurotransmitters, which are chemical messengers, and they help regulate not only digestion in the gut, but they also help regulate emotional wellbeing. And you’ve got those and they’re produced to a certain extent in the gut in connection with your gut microbiome. Then we’ve got the microbiome itself, which is basically like an ecosystem of trillions of bacteria and other microorganisms residing in the gut, happily residing in the gut. And this microbiome, it digests food, so it feeds off food that you eat. And some of that food is important to it. And effectively, from digestion, you’re eating some foods which are often called prebiotic foods. It actually produces by-products or essentially it’s almost your microbiome ‘poo’. It produces by-products from its own digestion. And we human beings really thrive off those by-products things like short chain fatty acids. One listeners might be slightly familiar with is called butyrate. And not only does this butyrate help the actual lining of your gut to function really well, but butyrate can actually make us just feel better, have more energy, but also can help with our mood and that feeling of also tiredness and things like that. So there’s kind of those three areas where the gut and the gut microbes or the microbiota influences our mood.
Lauren Redfern [00:10:28] It’s fascinating. I actually I don’t know if anyone else saw this that’s listening, but I saw an article in The Guardian recently about they’re creating sort of poo transplants, people that are donating their poos, which apparently they’re called unicorns, these people that have this amazing gut microbiota and they’re looking at making supplements that you can use from this microbiota, which is fascinating. The more we’re seeing this development of really understanding the connection between what we eat and our gut health and our mood and well-being and other illnesses, too.
Emma Ellice-Flint [00:10:57] Yes, absolutely. So faecal microbial transplant, is most definitely a thing. And it really works. It really helps, especially with people with quite long term, quite debilitating mood disorders. It’s very variable and it depends on that particular mood disorder. But it does help. And we think for in perimenopause like psychological and behavioural factors such as depression, anxiety, well mood disorders, irritability and emotional eating, and they all come up so much more in perimenopause and menopause. And so because it’s such a period of transition, really, with the high prevalence of a negative emotional state. Estrogen affects our gut microbiome. It affects our gut, its gut function, but it affects our gut microbiome. Our microbiome is influenced by estrogen and it influences estrogen itself.
Lauren Redfern [00:11:54] And I think that’s interesting. And it was something that I wanted to touch on as well, which is I think it can be overlooked in the conversation about food and mood, which is often the foods we crave when we’re feeling low are not always the best for our wellbeing. And whilst we might know that on a logical level, addressing the consumption of that food, particularly when you’re feeling low, depressed, anxious, it’s not always easy. And I wondered what your thoughts were on this, because I thought it was interesting. In the example you gave of the patient, you were saying that you made changes that felt manageable for her in that context. So yeah, I just wondered what your thoughts were on this and in that cycle, you know, when you’re feeling low and maybe not up to eating the way you know you should, how we can address that?
Emma Ellice-Flint [00:12:41] And most definitely because emotional eating is huge in perimenopause and that menopause transition and not surprisingly, at all. And I understand that emotional eating and drinking actually,like, for instance, alcohol, things like that. And how do you make changes? So let’s make an assumption here. I don’t like sweeping statements but we’re going to make an assumption when we talk about emotional eating. We’re going to assume that’s sugary foods or high saturated foods, comfort foods, chocolates, sweets, cakes, biscuits, alcohol, that sort of thing. I’m just going to make that assumption. So from a dietary perspective, we might call that really kind of like more towards a typical Western style diet. And we know from research that a typical Western style diet reduces both the diversity and the sheer number of the gut microbiome is shrunk from this. And so we’re shrinking down a mechanism in our body that enhances our mental health. So that’s not good. So you’re right. There’s this person in that menopause transition, possibly on her sofa thinking, I can barely get off my sofa. How can I possibly think about changing what I eat? I haven’t got the emotional energy or the physical energy to make these changes. And this is where HRT of course is so fabulous to really help that. But let’s think about that person. If that person can be encouraged to just perhaps think about what she starts her day with, the food she starts her day with, and change that slightly to be one that has a bit more fibre in it. Gentle fibre like oats. It can be in any way possible. It can be in a muesli. It can be in porridge, something like that. And perhaps if they can tolerate include a fermented food like natural unsweetened yoghurt or what’s common in the UK., I don’t know whether your listeners are from the UK., but now in supermarkets in the UK. is kefir a dairy. Kefir is actually very common, and that change is actually significant. It’s really significant.
Lauren Redfern [00:14:56] I mean, I wondered as well, because you mentioned the Western diet in there, and I think colloquially we can hear the term inflammatory foods used a lot in relation to gut health and particularly how inflammation can lead to mild depression that can be stored and held in the gut. And I wondered if we could spend a bit of time talking about actually what inflammation and inflammatory foods means and how we can look to moderate that intake, as you’re saying. So adding in those fermented foods, adding in maybe coffee. But yeah, what we mean by inflammatory foods and why that’s important to mood and gut health?
Emma Ellice-Flint [00:15:34] Okay. Well, it’s actually this is fairly new, to be honest, although I think we’ve all in the nutrition world, we’ve all noticed this. But as far as science goes, this is fairly new and the food and mood centre, actually based in Australia, are doing masses of research connected with, for instance, eating a Western style diet. The inflammation this creates in the body and what it does to our mental health and our brain. And there’s some great research coming out of there. And then also at the same time, we know how a Mediterranean style diet, which is very anti-inflammatory, is so great for mental health. And what’s gained through research, we’ve seen this both epidemiologically and through double blind, placebo-controlled trials. So you look at this and you think, what’s going on? And it seems that literally a Western style diet, high in saturated fat, low in fibre, can create an inflammatory state in the body. And this can create an inflammation in the brain, inflammatory state in the brain, and it also lowers the biodiversity of the gut microbiome. And so the two together seem to create this exacerbation in mental health disorders and leads to a lower mood, most definitely.
Lauren Redfern [00:16:57] And I think that’s interesting as well, because I know I’ve read that you’ve written a bit about this and talked about this idea that our guts are our second brain and that there is a bidirectional communication between our minds and our gut health. And there’s some information I’ve read about the role of serotonin within this interaction and how that is important within the gut. And I wondered if you might talk us through that a little bit, because obviously we know that serotonin is important, it’s our happy hormone or colloquially called our happy hormone. So yeah, how this is influenced by our diet.
Emma Ellice-Flint [00:17:26] Okay. So serotonin is a neurotransmitter and actually what percentage is made in the gut varies between studies. But you could confidently say that, oh gosh, I’ve actually read anywhere between 70% and 90% of serotonin is made in the gut. And this is, as you mentioned, it’s a chemical that makes us feel better it’s fairly simple, but actually affects digestion. It helps literally peristalsis, which is the movement of food through our gut. So makes the gut feel better as well, interestingly enough. And so serotonin is one of those chemicals that influences our mental health and it is itself influenced by the food we eat and the state or the wellbeing of our gut microbiome. I mean, there you have it. That’s a very clear connection with it. And this can go on to be, to lead into people, say, with IBS. So irritable bowel syndrome. And this is where somebody might have a real disruption in a normal functioning of their gut. It may be more tendency towards constipation or more tendency towards loose bowel movements or both. And also critically here they maybe have a like depression or a low mood and pain in their gut as well, and more susceptibility to definitely gut cramping, gut pain. But it’s the interplay between mental health and the gut really is expressed here in IBS. And work can be done on improving the gut microbiome in IBS and work can be done on improving mental health in IBS. And it seems to have a bidirectional influence on what’s going on and both improve both.
Lauren Redfern [00:19:25] Absolutely. And I mean, I think it’s interesting because I was thinking about this as well in terms of how obviously you’re working with people that are perimenopausal, menopausal mainly. And it must be interesting because there are a number of those patients that will have suffered with clinical depression and anxiety in the past and possibly be on an antidepressant. How do you look at with a patient that you’re working with to know, you know, whether addressing diet could be enough? Because I know a lot of women feel they don’t necessarily want to stay on an antidepressant long term. And if that could be something that would help address coming off that, too.
Emma Ellice-Flint [00:20:01] Well, I don’t know about coming off the drug that’s very individual. However, most definitely in my work, my clinic work, often I am actually addressing a gut issue, which is why someone’s literally physically or virtually walked into my clinic room. And we address it. And what I have with the review concerns, I have a person coming back to me saying, oh my gosh, not only has it improved my gut symptoms, it’s improved my mood. I had no idea it could do that. So we work on the gut. We work through improving someone, what someone’s eating. Little ways, big ways, depends on that circumstance for that person. And they have this lovely knock-on benefit, I guess you could say, of improving the mood. It might be, it’s so subtle, it might be in energy, in feeling uplifted or it might be in the negative thought processes they might have. It might be like in the clinic case I gave at the beginning here of somebody who woke up feeling quite a lot of dread and anxiety and that she had that lifted from her through food changes.
Lauren Redfern [00:21:07] Yeah, and it’s interesting. I did a podcast recently with Deborah Thomas, who’s a physiotherapist, and one of the things she was saying is that often bowel issues, but also flatulence issues, can be a real barrier to exercise. And we don’t think about these things as you know, I was thinking in the case you gave of the lady that came to see you with loose bowel movements, that in itself is enough. If I was waking up at 5.30 every morning needed to go do that, I’d probably be feeling pretty low and depressed as well in and of itself. So I guess managing that and those symptoms is so important in our mood.
Emma Ellice-Flint [00:21:40] Absolutely. Absolutely. Now, let’s talk about what specifically can help. We talked a little bit about I’ve dropped into conversation some breakfast ideas. But, I think what I’d love to draw back to is what you mentioned about this inflammatory state, this pro-inflammatory state, that a lot of people who are eating the Western style diet or just not eating very well can be in this state and don’t even realise it. And I often do come back to a Mediterranean style diet and there is research actually connected with menopause and a Mediterranean style diet which does show benefits, which is great because often the research I see is with people, perhaps with mental health issues and a Mediterranean style diet, but rarely is it in perimenopause and menopause, which I love to get that kind of connection, but I have seen it. And so a person doesn’t have to live around the Mediterranean to follow this style of eating. I think what really, really sums up a Mediterranean style eating is anti-inflammatory oils, especially extra virgin olive oil, but also the oils you get in nuts and seeds, the oils you get in seafood, definitely including fish, especially oily fish. So those omega 3 oils from those, avocados, of course, fall into this category. That’s really important. So lovely anti-inflammatory oils, also in a Mediterranean style way of eating you get lots of natural fibre because that style of eating is high in vegetables. Really high in vegetables. Also fresh fruit sometimes, but also it’s high in nuts and seeds, again, they contain fibre. It’s got legumes and pulses in it, loads of legumes and pulses and lots of whole grains. So that’s fantastic. That’s really good. But also we’ve got what’s called polyphenols. Now, these are plant chemicals that we find are just really beneficial, just all over. They act like anti-inflammatory antioxidants in the body. And so polyphenols are particularly high in the Mediterranean diet in – they’re in everything. They’re in fruit, vegetables and they’re in nuts and seeds and they’re in legumes and pulses. And in particular, they’re in herbs and spices which are very high in the Mediterranean diet. They’re also high in things like cocoa and actually coffee and extra virgin olive oil, for instance, and that all comes into it. So yeah.
Lauren Redfern [00:24:09] Well, I’m very excited to hear that I can drink coffee and not feel super bad about it. So I wondered as well if you might have any suggestions of sort of, we talked a little bit about this with the emotional eating and I guess I use the word junk food, which I hate because I think, you know, all food in moderation is generally okay if we’re having a balanced, healthy diet. But any sort of healthy junk food alternatives, I guess, that you could think to reach for if you are craving, you know, sweet foods or kind of the inflammatory foods we talked about.
Emma Ellice-Flint [00:24:39] Well I think dried fruit is fantastic, things like dried figs are amazing, dried apricots they’re gorgeous, dried prunes, dried dates. They’re all really super sweet and they’re lovely and they’re really healthy. They’re really fantastic. The other thing is, I think if someone has the energy to make something, say they are craving a sweet food. If they made like some homemade oat cinnamon, coconut type cookies, then their homemade cookies are going to be infinitely more healthy than something that’s bought, that’s all it is. They always are. So it’s if they have that energy, I mean it’s fantastic making a batch of kind of oaty ,cinnamony, yummy coconutty type cookies. I have the recipe for that on my website.
Lauren Redfern [00:25:28] I was going to say, please do visit Emma’s website as well because it’s great for ideas as well, because I think one of the hardest things is that lack of ideas sometimes that you’re coming to. And I’m also really excited that now I didn’t realise how hungry I was going to get doing this podcast. Oh, that sounds really good. It’s one thing I wanted to touch on just very briefly is that I think there is increasing conversation about this, about how menopause is becoming itself an industry, and within that there are a lot of supplements available designed to target symptoms of low mood, you know, that are related to gut health and diet. And I wondered if you had any thoughts on navigating this around supplement use and if people are going to use supplements to help with that diet, what you might actually recommend.
Emma Ellice-Flint [00:26:11] Okay. You know, you can’t hide from it, especially in particular countries. I don’t know, you listeners say in the UK, in America, in Australia, in Europe that supplements are there and they’re in loads of shops and, and a person might reach for them thinking somehow it might help them. There are some that actually do have some benefit and as long as they’re good quality and they’re therapeutic doses, fantastic. So what are those? Some of the ones I’ve noticed in clinic and I’ve seen research on that can help, fish oils as long as they’re really high quality and from sustainable sources. I’m really very pro fish oil. A fish oil capsule, something like that. Magnesium, I’ve seen that help a woman or someone in perimenopause and menopause because it seems to help with relaxation. It does actually help with bowel movements, it does help with neurotransmitters. It does actually helps low glucose balance and like muscle relaxation and contraction. So magnesium is a good one as well. And the third one is a probiotic of some sort. Now, this is difficult. This is early research. So I would really prefer someone to stick to fermented foods than take a probiotic. There are masses of fermented foods, not just the ones you mentioned, which is unsweetened natural yoghurt and kefir, but there’s sauerkraut and kimchi, there’s some of the soy based ones like Tempe, Miso and things like that. There’s drinks like kefir, water kefir and kombucha. They’re all fantastic. They’re all fantastic. But some people I’ve noticed do thrive from taking a probiotic, especially their gut is really quite unbalanced. And that’s in the short term, not necessarily long term. You just have to go with a reliable company.
Lauren Redfern [00:28:02] Yes. I mean, there’s. Yeah, there’s so much more that we could say about this. And I’m really sad to actually say that I think that is all we have time to chat about today Emma. It’s been such a pleasure talking to you about this and I also feel like I’ve learnt a lot going away, which is always really nice. I wondered if we might end today, if possible, with me asking if you have any take home messages or points you’d like to stress to those listening when it comes to thinking about our gut health and our mood?
Emma Ellice-Flint [00:28:30] Yeah, absolutely. Well, I think this whole podcast has reinforced in people that food and mood, there is definitely a connection. And what you eat and what you drink really matter. They really matter and can make a beneficial difference to a person’s mood, stress, anxiety, feelings of dread even. And they can also make a difference to a person’s gut function, which is fantastic, which in itself can make a person feel a bit sad if their gut’s not functioning very well. So that’s really good. Little changes. Just a few, food changes can actually make a huge difference. So there’s not going to have to be a massive, overwhelming switch to an incredible wholefoods diet. And the third one is try and get some fermented food in your day. Just some natural fermented food would be fantastic.
Lauren Redfern [00:29:24] No, I think that’s perfect and it’s so useful as well to think I don’t I think a lot of people listening, probably myself included, when we tend to revolutionise our diet, we do it all in and it’s like, I have to cut out everything. And I think it’s actually thinking, you know, slowly and sustainably, you can add in those things that are going to make a big difference, as you say.
Emma Ellice-Flint [00:29:42] Yeah, most definitely.
Lauren Redfern [00:29:43] Thank you so much, Emma. Honestly, this has been so fascinating. I’d love to have you back at some point if you come and talk more about nutrition and the importance of food in that.
Emma Ellice-Flint [00:29:51] Great. Fabulous. Thanks, Lauren, and thank you, everyone listening.
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