One recent weekend working as the registrar in a London hospital, Dr Saliha Mahmood-Ahmed was responsible for all the patients that were admitted. “At the end of the weekend I took a step back and looked at all of the patients. I realised that everyone had been admitted with a non-communicable illness. And of those illnesses, like heart disease or a stroke, the majority of them could have been prevented to a certain extent by long-term beneficial patterns of healthy eating,” she says.
Mahmood-Ahmed is on a mission to fix this. Emerging science over the past two decades shows that our gut influences weight gain, high cholesterol, mental health, poor sleep, as well as chronic diseases. “Our understanding has advanced so much that today we can actually say that it is important to feed your gut microbiome,” she says.
As a gastroenterologist, chef and winner of the BBC’s MasterChef competition in 2017, Mahmood-Ahmed’s dual background in food and medicine means she’s in the perfect position to understand the role of diet in our health. Her message to us? It’s time to feed your gut the food it loves most.
“I like to think of the gut as the organ that’s inside you that you never knew existed – a mass of gut bugs, full of trillions of micro-organisms, that’s living inside each and every one of us.”
What we eat directly influences their composition and these gut bugs in turn influence many aspects of our health. “It’s a symbiotic relationship,” says Mahmood-Ahmed.
While only a small proportion of people will experience digestive symptoms that cause them to think seriously about their gut health, the bigger picture for all of us is to understand how a lifelong pattern of eating influences our gut bugs. “There’s a relationship between the composition of the gut microbiome and risks of developing things like Type 2 diabetes, stroke, low mood, and our ability to fight infection,” she says.
However, working within the NHS, Dr Mahmood-Ahmed has seen first-hand a skills gap between her medical colleagues’ understanding of the gut, and being able to help patients choose gut-friendly foods. “Traditionally we’ve relied upon our dietetic colleagues to talk about lifestyle medicine.”
Yet she believes passionately that food is medicine. In her book, The Kitchen Prescription (Yellow Kite), she shows how to make easy recipes that are full of flavour and great for gut health.
Everywhere, Mahmood-Ahmed admits, she sees signs of our dysfunctional relationship with food. Not least within the NHS, an organisation she is dedicated to but that she believes has allowed its food culture to be eroded away.
As a society, we consume too many ultra-processed foods and not enough fruit and vegetables. Few of us meet the 30g of fibre per day recommended by the British Dietetics Association. Fibre, though, is what the gut feeds on. “Eating enough of it prevents dysbiotic colonies arising in the bowel.”
Mahmood-Ahmed would like to see fruit and vegetables being prescribed to patients. “Long-term, that is going to be cheaper than a lot of the medication we are prescribing people.”
As a mother and home cook, as well as a writer, chef and doctor, she knows how pressured modern life can be. It’s taken her time and experimentation to come up with easy and tasty recipes that work day to day. She’s been humbled by the response from readers. “One woman sent me a private message saying: ‘After a month of eating your recipes, I feel like I’ve pooped well for the first time in 10 years.’”
Other benefits of eating to keep your gut in good health include weight loss as a result of stabilising blood sugars, lower cholesterol, and more energy. “Some people won’t notice the difference, but you can guarantee that you’re preventing inflammation and chronic diseases in the future,” Mahmood-Ahmed says.
What to eat
The foods that you should feed your gut bugs with are fundamentally from the plant kingdom. “I’m not vegan or a vegetarian, but I eat a plant-centric diet where plants make up the majority,” Mahmood-Ahmed says.
Plants are not just fruit and vegetables, but also wholegrains, legumes and pulses, nuts and seeds, and spices. “Those five groups can be a blueprint in people’s minds when they go shopping. Tick them off on your mental checklist so that you can be sure you are getting the good things you need in your diet.”
The above are what Mahmood-Ahmed labels “prebiotics”. “They are like the Miracle Gro that you apply to a lawn to help it grow. They will help ferment the production of good bacteria.”
After that comes the whole world of probiotics: specific foods that contain lots of live bugs. “Things like live yoghurt, kefir, kombucha, sauerkraut and kimchi.
“I would encourage people to experiment. Not everyone has the taste for them. It’s important to experiment with them occasionally and see what you can incorporate into your diet.”
Food items to reduce
Dr Mahmood-Ahmed isn’t a fan of denying ourselves anything, but there are some food she advises patients to avoid. “I do eat fish and some meat. I’ll have some chicken once a week, but I would try to avoid the heavily processed meats, like salamis or sausages.”
She favours oily fish like salmon and mackerel. She will eat red meat on occasion: “Usually when we’re with friends or eating out.”
As well as processed meat, Mahmood-Ahmed avoids processed yoghurt, for example low-fat flavoured yoghurt. “It might have the health halo around it because there’s a perception that low-fat is a good thing, but it’s got hundreds of different things inside it.”
Also on the list are ready meals, which have additives and preservatives that aren’t good for gut health. A 2017 study by the University of Cambridge found that people who ate home-cooked meals more than five times a week were 28 per cent less likely to be overweight compared to people who cooked their meals less than three times a week. “Always cook from scratch where possible.”
How to shop for your gut
Shopping is an art form when you’re cooking gut-healthy food. “The way I teach my kids is that there’s three zones in the supermarket that we’re interested in,” says Mahmood-Ahmed.
These are: fresh fruit and veg; frozen fruit and veg; canned and dried goods. “If you can get the majority of your shopping from those three zones, I can guarantee you will be adding much more plant diversity to your diet – and at a fair budget as well.”
Mahmood-Ahmed looks for discounted fresh fruit or veg that will freeze well. “A bruised berry will be used later in a sorbet or crumble for my kids, or blended with kefir for a breakfast drink,” she says. In the dried goods section, look for lentils. “They make a dahl that you can freeze in batches. Ten minutes in the microwave and you’ve got a delicious meal with some boiled rice.”
She uses tins of lentils for a quick meal, too. “Drain them and add a little bit of garlic and some spices, and have them on toast.”
How to include the kids
It can be an uphill battle to make children eat gut-healthy foods, so Dr Mahmood-Ahmed’s first piece of advice is not to be too hard on yourself.
“You have to just keep trying and recognise that kids prefer less strongly flavoured food sometimes.”
What’s helped with her own children is to get them involved with meal planning and letting them select their own meals. “We take them shopping and allow them to find the ingredients so they are really invested in the process of cooking and eating.”
While she acknowledges that it can be a time-consuming approach, she says: “Once you go down that rabbit hole, it’s quite rewarding to do.”
As they get older you can help them develop cookery skills. “Give them a blunt knife so they can cut up peppers.”
Getting started
The key is not to feel overwhelmed by the task. Begin by focusing on one culprit meal at a time. “If you think your snacks are a problem, change them. If you think breakfast is where you should be doing better, focus on breakfast. Sometimes it takes changing one meal to get you going for the rest of your diet.”
Be realistic about what is achievable. As a full-time working mother with budget in mind, Mahmood-Ahmed is a discount hunter and meal planner. “It took me a few years to work out how to do it,” she admits.
However, she says you can cook gut-healthy meals in 20-30 minutes. “It takes less time to cook than for me to order a takeaway.”
She is passionate about equipping people with the cooking skills to make things quickly and easily. “It’s why I’ve written my books,” she says.
Cooking from scratch is not only healthier but cheaper, too: “Remember that plant-centricity is cheap. The common mistake people make when they turn vege or vegan is buying highly ultra-processed vegan foods. That’s not going to make it cheaper or healthier. It defeats the point of being plant-centric to achieve good gut health.”
To help you stay on budget, Mahmood-Ahmed’s advice is to meal-plan as much as possible and keep a record of how much you spend eating gut-healthy recipes, and then compare it to your previous food shop. “I think people are often surprised at the results,” she says.
However, she sounds a note of caution when making dietary changes. “When you change what you eat, it may give you digestive symptoms, because your gut won’t be used to having so much veg in it. So you may experience bloating.” This will pass, she stresses. For a full gut reset, “slow and steady does win the race”.
Six hits for your diet: Dr Mahmood-Ahmed’s dream team
Brassicas
“Cauliflower, cabbage, broccoli – the brassica group of vegetables – are extremely gut-healthy and contain loads of fibre.”
Dark chocolate
“Instead of milk chocolate, which contains lots of sugar and fat, dark chocolate – the bitter, good stuff – is a great source of polyphenolic compounds. Those are thought to be beneficial for good gut health and contain properties that help protect against inflammation in the body.”
Live yoghurt
“I try to get patients to switch their yoghurt to a live one that doesn’t contain added preservatives and emulsifiers. A good, live, natural yoghurt that contains active bugs is really going to be good for you. If you see that your yoghurt has a list of ingredients on the back of the tub that you couldn’t source at home, then it’s an ultra-processed product.”
Grains
“Try a new grain every week or fortnight. One week you could try quinoa, the next pearl barley, the next spelt, the next buckwheat, and so on. As well as being great for your gut health, grains are inexpensive in their dried form, they go a long way and are very filling. So instead of just always opting for pasta and potatoes, shift a bit and try some of the grains that are available to us.”
Chia seeds
“I really like chia seeds. I know they sound a bit boujie, but they’re such a high and dense source of fibre. In a food climate where we sometimes struggle to get the right amount of fibre in our diet, having a little hack whereby you can increase your dietary fibre is helpful. You can pop a spoonful on your breakfast cereal, yoghurt or overnight oats. Chia seeds hold on to moisture and they do the same thing in your gut. I’ve had patients who are regularly constipated and the introduction of chia seeds has changed their life.”
Oats
“I’m not talking about ultra-processed ones that you only have to add hot water to; I’m talking about steel-cut oats. Again, a fantastic source of fibre and really well-tolerated by patients with IBS who otherwise struggle to eat fibre-rich foods.”