Giulia Enders on Gut Health, the Microbiome, and What Your Body Is Telling You

Giulia Enders

It can recenter one of the most important organs we have, and really with that have all these second and third hand effects that you wouldn't even maybe have thought of. All these influences on your mental health, on just your sleep quality, on your metabolism, on your weight, on how you just feel emotionally during the day. It's sometimes more important than genetics.

And why would you not want to get into something that is so easy to influence and change and then has such a wide reach on every aspect of your health.

Giulia Enders

I think a lot of people are afraid that it's like too fragile, too sensitive, too stupid to handle things. And the gut is a very robust organ. If you treat it right and understand it, most of the time it can take a lot actually. And so sometimes when people think they have all kinds of sensitivities, some people do, and then for other people it's more something that damaged the gut. So now when all these foods come into contact — fructose, gluten, dairy and so on — the gut always has an issue, but that's more because it has an underlying general issue that you have to first take care of, and then when it's all healed up and doing well again, you probably are able to eat all these foods again. But people then stop entirely, especially with IBS for example, and they say, "I can't have all of these things," and I would say you're right, you're not imagining this, or you really can't at the moment, but it's not because your stupid gut can't take it — it's because there's something underlying that we need to fix first, and then slowly and surely you'll be able to have all these things again. Sometimes people have a little bit of a wrong view of what their body is actually still capable of and what medicine and things from the outside can do to it.

Giulia Enders

Very simple things are just the basics. Do you have a belly ache? How is digestion? Your body basically sends you a text every morning when you go to the bathroom. Might check it out. It's free. Just turn around and look. And then also some other things are also a bit more subtle when you look at the effect of an unhealthy gut on symptoms like anxiety, risk of depression, just an immune system that's out of check, maybe influenced by some disturbances in the gut, has an impact.

Giulia Enders

I would say eat more of things that you really like, but that are luckily also healthy. That's always the first step. Because what I saw often times in clinic was that people would eat these things because they heard they were healthy, but they hated them, and then they just stuffed their face with the stupid kale. And then always I said, "Oh no, that's not good. Let's look at all these vegetables and fruit there are — which ones of those do you like?" Because there'll be one or two that you like. And it's often way easier to go from there and then start having just a bit more of that healthy stuff. Some people really like asparagus. Others will not mind having an onion more, putting it in your sauce when you have some ready-made sauce. Just things you don't mind, or that you really like the taste of, and then have a little bit more of them. And I think that's always the starting point. Because drastically changing the diet, also putting way more fibre in all of a sudden, will just make you gassy or bloated because your gut is not used to that, and your microbes suddenly get all these foods. It's like a forest and then you just dump some fertiliser on it — what's that going to do, you know? Slowly change your diet, but with the things you like and the microbes like. That's a good compromise.

Giulia Enders

It is individual for some people because gut microbes are individual. Some people might have gut microbes where, when they eat beans, it's wonderful — they get all their fibre, it does all the nice things. Some other people have got microbes where they are horribly bloated when they eat beans. And this relies on your gut microbes. So I would say look at the different vegetables and fruit, and if you want to, go ahead and look for their fibre content. You will always have two types of fibre. One is water soluble, the other is water non-soluble. What does that mean? Take cereal, or the skin of an apple for example — it has fibre that is not able to fully dilute into something gel-like when mixed with water. It'll just stay a bit sturdy and fibrous. And that can mostly not be digested by the microbes because it's tough to really crack up, and it will just form bulk. And this bulk is good because it will knock on the walls of the gut, and the gut is very curious so it bounces back, and this propels digestion. This is really what gets your regular bowel movement, so it's good to have. But this other type of fibre, the water soluble one, is usually what makes up the fruity flesh of the apple for example, or in asparagus, or when you have carbs like rice and noodles and so on. If you cook them once, let them cool down, suddenly their content of resistant starch — and with that, water soluble fibre — rises. So just having your carbs cooked, cooled down, and then even reheated, makes them more prebiotic. Prebiotic meaning food for good microbes in the gut. There are things that are good for the microbiome — let's say beans, onions, green leafy vegetables. But if you don't crave them at all, start with ones that you crave, because that might mean you actually have the microbes that eat them, which is what makes you want to eat it.

Giulia Enders

I think it all started in my teenage years when I suddenly got a skin disease, and I realised that I know nothing about my body. I'll be hanging around in this body for another 70 years or so, and I just don't know how to understand all these processes it's coming from, and I have to go to a doctor who tells me, "I'll just put this on it." Helps a little bit, then it comes back, and I realised, "Oh, I just have to do what he says because I have no idea." And then I started reading and I started being surprised and understanding so much more. Also realising that it gives you quite a friendly kind of power when you know more about the body.

Giulia Enders

Well, I had these open wounds coming up, and then he said, "Oh, it's like eczema or something." And I put steroids on it and it went away, but then it just came back. And I thought, well, this can't be it for the rest of my life — so what else is there? And I found all these things about the gut, about how probiotics sometimes can help with things like this popping up, or how food can even show up on the skin. So that was just a topic I got into, and then I tried all these things very unscientifically at the same time, this and that and a little bit of the other. But after a while I realised, oh, it was getting better. I could visibly see how it was getting better, and how I could help myself just by trying things out and by having more knowledge.

Giulia Enders

Yes, definitely. Some of the things I wouldn't recommend today with the knowledge I have now, but I was young and just did it.

Giulia Enders

I overdosed on zinc, and back then I really got a very sensitive smell. Like I could smell things from further away. At least that was my impression and experience.

Giulia Enders

I read later on that this may be possible. And I just had this happening to me, so I thought, oh, well, wow, okay.

Giulia Enders

Yeah — before that I wanted to go into energy engineering. I'd already done internships and I was really into that, but then I realised, oh, I can read these medical texts, even papers or books, for hours, even if I'm really tired. So something within this topic is grabbing my attention, and it's really easy for me to get into. And especially when I discovered the gut, that was it. From there on.

Giulia Enders

Well, there's lots of immune cells residing in the walls of our gut, and they're checking out what's going on. At least, the gut is one of — like the heart of our immune system? I mean, the immune system has different locations where it's being trained, but the gut is a very large and very central one. Because especially there, there's all this exchange happening with the outside world. When you look at us from the outside, you would almost think the skin is the biggest surface to the outside world, but the gut is a huge one where you have all these substances coming in, crossing the wall into the blood. So that's a quite intense process. And of course the immune cells will be there to see what's going on and really be sure that there's nothing wrong happening. And there they'll also learn tolerance. Usually in a healthy gut, that's the training boot camp of tolerance. They'll be like, some peanut came, but it was all right, our cells are still doing fine. And then all these immune cells are gathering and saying, oh, this is peanut — it seems to be quite okay because we're still doing fine. So, should I be watching out for peanut next time? So these are some of the processes that can lead, for example, to sensitivities or allergies, or just a gut that's not feeling well.

Giulia Enders

Definitely. It's all the same stuff. It's having your veggies, your fruit. It's —

Giulia Enders

Absolutely. And as I said, usually in the fruit, you see that the skin of the apple, for example, has the water non-soluble fibre, and then the flesh has the water soluble fibre. And those are prebiotic. And you can basically pick any vegetable. Then you have something like banana, which has a little less, but if you pick a green banana, for example, the starches are not yet unpacked, so it's not so sweet — because unpacking the starches, making some sugar out of them, is what makes the banana sweet. But if it's really green, this hasn't happened so much, so there's more prebiotic in them. That's why in some countries green bananas are also used when you have diarrhea, because they might help feed good microbes, which then fight off the diarrhea-causing microbe.

Giulia Enders

Fibre is maybe an overlooked thing because we have managed to produce foods that have less and less fibre, because the caloric density is again higher, which makes the dopamine cells go "yay" — then we will rather pick those. But I think the effects of fibre are just so nice. When you look at metabolic health, for example — one study I like to quote looked at Pacific islands where the rice cooker was introduced. People put on a lot of weight. And one hypothesis explained in the paper was that the rice was suddenly not cooked and then cooled down and reheated, it was cooked and just stayed warm. So the starches and carbohydrates in the rice were so super fast accessible that glucose in the blood spikes, goes down, you get hungry, you need another snack. But if you have the rice cool down, the starch crystallises again, and then when you eat it, it takes more time and more enzymes to unpack this crystallised starch. So it slowly gets your blood sugar up and then down again — you don't have this spike. And this is also good for your weight, because when they then had people cool down the rice after cooking, people would also lose weight again. So you see that it's sometimes not only about the number of calories on the package, but really also how you prepare these foods, which then makes a metabolic impact.

Giulia Enders

When you have noodles, when you have potato, when you have rice — these typical starches — when you cook them and cool them down, they get more prebiotic. So potato salad, for example, wonderful. Or just having cooked potatoes in the fridge and then frying them up again with a little bit of olive oil. That's already better for the microbes than just having them all fresh.

Giulia Enders

No — there's this rule, I think by Tim Spector, who made this prominently, and it's very good, and he did wonderful research for it: that if you have about 30 different types of fruit and vegetable a week, then you're really in a good window where there's so much variety of different foods that there can be a variety of different microbes eating them in your gut, which then contributes to your health.

Giulia Enders

Yes.

Giulia Enders

When you look at cancer, there's different types. We have a hereditary kind of colon cancer, for example, but we also have colon cancers where we now have leading indicators that the microbiome plays a part in it. And when you look at fibre, what it does is also propel digestion. So all this metabolised stuff that's ready to get out of your body doesn't sit there for very long releasing possible toxins, for example, which then come in contact with your gut cells. So there is a type of pro-inflammatory, or even pro-cancerous, process that is being influenced positively by fibre. That's one, by influencing the gut microbiome; two, by influencing the process of digestion itself; and then three, effects that have to do with metabolic risks of cancer. Fibre, and the way it slows down the intake of blood sugary things — when you have spikes of blood sugar all the time, this can be pro-cancerous by multiple routes, by making the immune cells a bit more aggressive, by promoting pro-inflammatory causes. So it's a very complex building, but the simple answer is yes: fibre can protect you from colon cancer, for example, and other cancers related to those metabolic processes.

Giulia Enders

A very simple link is sugar. When you look at sugar, it is high energy, and immune cells will realise they now have this budget of energy to spend. And of course they are pro-safety, and they say, "I'd rather have some more safety guards and some unnecessary inflammation than too little." So this is a little bit the tendency they lean towards. Because when you look at our history, over thousands of years it's always better to have this additional safety, but we rarely ever had enough energy for that — our energy budget was always limited, cut off at the very necessary things. And suddenly we have all this energy to spend, and the immune system, as we see, is a bit switched on by sugar. It goes a bit more into the aggressive direction because it can. And this is one process that sugar will tip off. We see, for example, people drinking soft drinks high in sugar for 10, 20 years have a significantly elevated risk of inflammatory diseases. And this isn't always the one cause of an inflammatory disease — there are different other possibilities: pollution making the immune cells irritated and aggressive, our genetic predisposition where there are fewer calming signals in the immune system, and so on. But sugar is one of them, and it can tip off these processes, and this can have a range of effects.

Giulia Enders

That is true, and you can definitely say that concentrated high fructose corn syrup is one of the ones where we see these ungood effects most clearly if it's administered in too high a dose. But I'm not convinced by these things saying "have a date instead," because there's just the same molecule in it. The fibre of the date might slow down the uptake a little bit, but if you have dates that have been made to be this big and super sweet, then they're also full of sugar. So I would say don't kid yourself.

Giulia Enders

Yes, that's —

Giulia Enders

Well, I think the thing to get wrong is just to ignore it really. In Germany you have two different kinds of toilets. We have one where it goes into the water, which is, I think, the American and Canadian type that you will know of as well. And then we have this toilet that has a presenter — you will have it presented there, and from there you can flush it with water, but you will really see, and also, not to go into too much detail, you will smell a little bit more too. So there it's really hard to ignore. But you can also look at it in other ways. There's, for example, the behaviour it has when it's floating. When there are no air bubbles in it at all, that means bacteria haven't really done their work there, so it sinks to the bottom immediately without sometimes swimming a little bit. That's a sign that you're not digesting properly, for example — can be a sign. Then, if you have lots of fats in your stool still, it's a sign that maybe you're not digesting fats really well. You might even get that checked out if it's very prominent. Then, of course, you have things like structure and colour where you can get some hints from. As I said, really black colour or blood-reddish colour, that's always a warning signal. There's also things like it being a bit more to the green side, or yellowish, or something — and grey is a warning signal as well. And then when it comes to consistency, I think this is for most people probably the thing they realise the most. We have the Bristol stool scale — it's written in wonderful British language, like smooth and soft like a snail or something. It's really fun to check out if you want to. There you can see that if you go more to the constipated side, what forms are already indicating that. And then you can of course also realise that diarrhoea, or stool being too soft, is I think often an overlooked problem, because it can mean that your mucus is not intact or your digestion is not going so well. There is — maybe this is predominantly German, I don't know — but I can say that people were also a bit embarrassed about the topic when it all started in Germany 10 years ago. But there's a literature piece where they describe the holy perfect way where you go to the toilet and you wouldn't even have had to wipe, because it was so perfect there was no wiping necessary. So, I think what that actually indicates, and that was way before we realised this scientifically, is that when you have a very proper, intact gut mucus lining, it will really surround the last bit of digested stuff and pack it up so it doesn't really touch much of your skin or mucus area when it comes out, and it just is a clean business.

Giulia Enders

Well, the perfect toilet clogger would be the one where you just have so much fibre that it really gives a lot of bulk or mass. And then the not-so-perfect ones are when you're really not digesting so well, so you haven't taken up all the food, and too much of it comes out unprocessed basically. That's not such a good thing. And sometimes you can see it even as a side effect of antibiotics, because the antibiotics kill off all these bacteria, and they have quite some weight — they have a mass. They're sometimes described as an organ of its own. So you're basically losing a little bit, or a bigger part, of that organ, and that can sometimes amount to a bigger volume, but it's not necessarily a bad thing if you can handle it well.

Giulia Enders

People in different life stages are more susceptible to the disadvantageous changes antibiotics induce. We see, especially, small kids and seniors have a harder time in studies going back to their microbiome after a round of antibiotics. Then we have all the adults in the middle. For them it's like 50/50 — some of them will actually go back quite well, and others will never replenish the microbes they've lost. Some of them might have lost even nice family inheritance pieces, so to say, that used to protect them from certain diseases, and they will not get those back. So it is not with an easy hand that you should administer antibiotics just for every cold you have. And especially in the United States, I have to say, we see that this is a problem that is maybe responsible for the high number of people having problems with their gut. So, that being said, what can you do? Of course you can have probiotics, especially when you start having diarrhea while you're on antibiotics — we've seen studies that probiotics help with antibiotic-induced diarrhea, especially for children and the elderly, but also grown-ups experiencing diarrhea, that's an indicator probiotics could be helpful. Then we see that when you take probiotics after a round of antibiotics, there are two effects. One is that they can help lower your pH value — for example, bifidobacteria or lactobacilli, which produce these acids, can have a beneficial effect because good bacteria thrive in those environments, others might not, so it will help. But it can also have an effect where they take up the niche and room of your initial microbes, and then when you stop taking them, they're gone, and yours don't return the same way, because they were kind of pushed to the side. So it's not only a good thing. This is where prebiotics are also really important — feeding your good microbes that will actually stay with you and that feed off good foods.

Giulia Enders

Well, the typical warning signs are heavy, extreme pain that you don't usually have or don't know. Then we always have black or bloody stools, which you should get checked out. Weight loss, night sweats — those are the really severe, common ones. But also things like if you have a tendency towards diarrhea and it lasts more than three or four days, then I would also think of having that checked. And if you have really bad constipation, for example, that you've had since you were a child, or for a long time, then I would say it's not an act of immediate attention, but it can always be improved, so it makes sense to go and check some things out. But if it's suddenly starting — suddenly you're constipated and you don't even know why, you didn't used to be like that — that's something you should have checked out pretty soon.

Giulia Enders

There is an aspect that is a bit of a disadvantage, and this is the seat of the toilet that looks like a chair. We sit on it in a posture we would usually know from sitting on a chair. And our body has the smart mechanism of having a muscle going around the end of the gut, holding it back a little bit, so that when we stand or sit in that position, not all of it is immediately in position to come out. So it creates this curve. When we put our legs up a little bit — you could say a 30° angle from horizontal — this gets loosened up, and there's not this curve any more, it's rather a bit straight. And this is just the natural position we'd use when we squat outdoors. And this is then, anatomically speaking, a better way to go to the toilet, because you need less pressure and you're not pressing against your own muscles holding stuff back. This way can reduce the risk of haemorrhoids or diverticulosis, which we see less of in countries where people still use a squatting position when they go to the toilet. So it's a good idea to maybe try to emulate this — you can do so with a little stool in front of your toilet where you put your feet on. I've heard so many people report back to me that this has helped them, or that they really miss it now when they go elsewhere — they'll use the tiny bin in the hotel toilet to put in front of the toilet so they have this position, because it just feels more natural. And there's been a study on that by Dov Sikirov, a researcher who compared these different sitting positions and could show that it's much easier, or also feels better, for people — they really got everything out — when they're in that position than in a normal chair-stool position.

Giulia Enders

Constipation is, well, the problem of having the feeling you're not really emptying all the way when you go to the toilet, of having a too hard or too difficult time going to the toilet. You really need a lot of force to get stuff out, or even need to manipulate it a little to get it out. It can be too hard — these little pieces of stool, like a goat would have, for example, is a good indicator that it has just spent too much time in the gut, already got all the liquids taken out, and then some more, so it's really dehydrated a little bit. Those are different aspects and can have different causes. For some people it's right at the end, that they're having a hard time coordinating actually getting it out. For others, it's all the way before that, that it's too slow — it's not being transported fast enough somewhere along the way. And that can happen with a low fibre diet, where you just have pizza and pasta and white flour, and that's it basically. So there are different causes for that. But a way to handle it is almost always easy and has really great results, and I've personally never experienced a patient who didn't get better with just some simple tricks here and there. And then, of course, there are some severe cases where really something's off — motility disorders, where since birth you've had a really hard time going to the toilet — and there we need to be a bit more creative, but there are wonderful solutions for that now too.

Giulia Enders

Some more fibre, some more probiotics in your diet. There's things like flaxseed, chia seeds — you really need to add some additional water too, to really have them soak up, and really have some material that the gut can then propel forwards. Those are very simple things.

Giulia Enders

Chewing is a good thing if you want to take some work off the hands of your stomach, because the stomach really has to get all this muscular work going if things aren't chewed correctly, and its exit, so to say, will only let very tiny particles through. So if you don't chew well, it has just a bit more stuff to do. And also, you tell your brain what kind of nutrients are coming in when you're tasting them already — actually, just looking at certain foods will start the process, but really having them in your mouth will already get some things going and some juices flowing. It's a nice thing, but I also have to say a lot of the foods we eat nowadays don't necessarily need chewing any more. When you look at highly or ultra-processed foods, they're almost falling apart into sugar particles already — white bread, white pastries, white flour stuff. You can chew, but very soon it'll just be sugar in the very first inches of your small intestine — it's all sugar going into the bloodstream.

Giulia Enders

So, when you look at all this advice we get all the time about food — there's been an era, something like the Taylor Swift eras, you could almost say. There's been the era of having low fat in order to not put on weight. There's been an era of having less sugar, sugar substitutes. Now, when we look back at these discoveries, scientific opinions you could say, but of course with evidence — you can say, well, they're not entirely wrong, but they really weren't entirely true either. And what we're looking at now — which era are we in now? I think this is the era where we say, ah, probably it's about the ultra-processed foods that are bad. We still have some of the remaining advice, like, of course, don't have too much sugar — that's still very good advice. And I think here the nice thing is to have a clear amount, which is 25 grams — this is what the World Health Organization says is the amount of sugar you can have without it, in the long run, affecting your health. And when you look at fats, it's still true to say it's good to have polyunsaturated fats, olive oil — don't heat it up too much, because then it breaks apart and can reshape chemically, not be so good any more. But those are the things that still hold. But the rest of it, people say, well, rather have the full-fat yogurt, because it's not engineered so much, and the way it's digested is a bit more natural to the body, and doesn't have all these horrible effects we earlier thought. And now, when we look at people having diets without all these additives, we see how healthy they are. And we see, even when we have people stopping their usual diet with all these processed foods and going back to a more natural diet without all these additives, we can track all the effects, and they show right away that it's much healthier for their body. So you get the idea that, oh, maybe that was the thing.

Giulia Enders

Some effects you'll see after three days. Some might take one, two, or three weeks, but that's really the amount of time — you hardly ever take more than that in the department of the microbiome to reach all these really nice changes, because they eat every day, so if different foods come in, they adjust every day. And then, of course, you have more long-term things, metabolically speaking — your cholesterol, for example, also just your overall immune function or stress hormones. These things can indirectly be influenced, and those will take a little bit longer, because you still have all this storage fat, for example, when you talk about blood lipids, or also just feeling better when your immune system is maybe not so angered by some additives or food processes, or a sensitive gut wall. This is, I think, a bit more individual and could take a bit longer.

Giulia Enders

Yeah, that's true. Especially when you talk about low fat, there were all these processes to remove — to have that. But I think what is actually more the culprit here is dopamine. We have a lot of processed foods because we make them more appealing to our dopamine-releasing cells. When they realise you have a very high caloric density, they reward it, because it means you ate just something very little but it gave you a lot of energy — little investment, lot of turnout, and that's what those cells are about. And they reward it, not knowing what it does in the long term sometimes, and unconsciously oftentimes, but nowadays also targeted and very consciously — the food industry has seen, okay, this is my target audience, those are the cells that rave when something comes in, and they will motivate you to buy it again and again and have some more of it even. So I think it's not really only the mistake or wrongdoing of these nutrient-wise or health-wise hypotheses, but really also a dopamine system that screens out for reward louder and louder these days. And it understandably does, though, because it's being, how do you say, wrenched?

Giulia Enders

By social media, by processes that are not so fulfilling, by times sometimes getting a bit tougher. People want a good feeling, and food is a way to get it.

Giulia Enders

Yes, and I do this all the time. And sometimes I'm really surprised at what I find when I look at the ingredients lists. Some things marketed as super healthy, with all these foods and all this fibre — and you look and it has 40% sugar. What? Or some drinks — oh, it's super healthy, wonderful juice, blah blah blah — and it has more sugar than Coca-Cola. And I'm a bit drawn to doing this now, and I buy these ready-made foods, and I have them as well. I think it's really difficult to cut them out entirely — whoever's got the willpower to do that, applaud to you — but I think if you have a good 80/20 ratio, you're good. So 20% processed foods or stuff from the supermarket, fine, and if you manage to get to the 80% of real foods that come from the soil or the tree, good balance. But check out the ingredients list. And I check for things like methylcellulose, and polysorbate 80 — PS80 — and carrageenans. It's really sometimes almost horrible to look at what substances are in these products. So really go for the companies that look out for your health as well.

Giulia Enders

I don't know if you have this term, and it's not necessarily a pretty one either. In Germany we have this term "bierschiss," which means when you have too much beer, you'll just have this ungood poo, where you're like, oh, this is bierschiss. It's too soft. It smells funky. It's something where you realise that wasn't a good idea. And it's a mixture of alcohol annoying the immune cells, alcohol not being good on the nerve cells, alcohol getting chaos into the microbiome. So all of this comes together and gives you this weird text message on your toilet the next morning, saying, "What was that?"

Giulia Enders

Well, it is definitely a form of feedback, yes.

Giulia Enders

With coffee, it contains polyphenols. It contains antioxidants. So it's not necessarily a bad thing. The thing that can be problematic is the caffeine in it. If you have lots and lots of caffeine, it has an effect on your dopamine system — not like drugs, but it elevates the response of the dopamine system. So that's actually also what you really wish for — the email from your boss saying "wonderful work" feels just a bit better, a bit more motivating, you're a bit more active, fit for the day. And this is good, nice to have, we like to have it, but in too large an amount — and that is the case when people really have a sort of withdrawal when they don't have it on vacation, or somewhere on the plane, or whatever — then this becomes, I think, a bit problematic. And then you might think also of sleep, because we've seen all the studies, and rarely is science so clear on one point — there are always multiple opinions usually — but with coffee there's really not been a study where you don't see an effect. People will say, "But I have no trouble falling asleep." But then you see, in all the measurements, the quality of sleep after falling asleep is poorer. And then what do you need in the morning when you wake up? Coffee. So it becomes this vicious circle, where I think this is a main factor that can then influence the microbiome. The polyphenols and antioxidants — wonderful, they are actually good for the microbiome, you could say, but you can have them with decaf coffee just as well. And if you have your coffee within a time window, say 12:00 to 4:00 p.m., perfectly fine, and then you'll be able to sleep wonderfully. But people have coffee after that, and I don't believe them that it doesn't do anything, and I think if they could switch to decaf and just check it out for a few days, and really be honest about whether their sleep is better now — and if they say it's not better at all, then you do whatever you want. But before that, I would say have the experiment.

Giulia Enders

Yes, try it.

Giulia Enders

There are different approaches to frequency of food intake. For some people, they will really notice a difference when they keep a window of four hours between meals — they'll say, oh, this is so much better for me now. For others, they don't — they get too low blood pressure, they don't feel so well. So it's again something where I would rather have people listen to their own instincts and have a healthy snack than say, "Oh, snacks are not good, so I shouldn't have any at all." There are different opinions on the time frame — should we only eat from 11:00 in the morning to 7:00? Should we only eat when there's daylight out? Should we have breakfast in very large amounts and then a small dinner? There are all these different theories, and I don't think there's a common solution for everyone, one-fits-all — I don't think there's something like that. But it's good to experiment with it and really find out for yourself. For example, when you look at visceral fat — that sudden belly coming in in your 40s or afterwards — then oftentimes you see some improvement when you actually watch the times you eat, if you have some time in between where you really don't eat, or if you say, "After 7:00 in the evening, I won't have food until 10:00 in the morning." People will actually realise there are some differences then. But as always, it's not one-fits-all, and I would just have people know about this and then experiment rather than tell them what to do.

Giulia Enders

Mhm.

Giulia Enders

In the beginning, I have to be honest, I didn't like it at all, because I thought it's so invasive — it's people thinking their gut cannot clean itself.

Giulia Enders

Because usually, after two weeks, a gut really replenishes all its cells. So if you just eat healthy for that time, you're good. But I have to say I've heard so many patients saying that it helped with things like pain in the joints or other things, that I'm still not thinking it's the perfect solution for everything — it does have risks, we've seen patients with trouble after, or complications, not many, but it's not without risk. But for some, they feel that it's good for their health, and I'm a person who says that is the main thing — that's what health is about. So if someone reports that, then I say, okay, good. But still it shouldn't be done too much. I think it's something to resort to when things have gone really wrong and you feel like you need a reset. We've experienced patients, for example, with irritable bowel syndrome after colonoscopy being suddenly way better, and it's not because of the colonoscopy — we just checked with the camera for a few minutes — but maybe because they really cleaned everything out and could restock their microbiome a bit more easily than they could have if everything was just stuck in place and you just throw some different foods on it. So now I'm more open to it, and I think it does have interesting effects that I don't disregard any more.

Giulia Enders

So I think supplements, and this whole fascination about them, tickle me in a specific way. Once again, as I said, if someone takes something, notices an immediate shift, says, "Oh, I really immediately feel like this because of it," then go for it — check if all the dosages are right and if the quality is good, because there can be some trouble with that — but then I'm not against it. That being said, we see that normal healthy grown-ups usually don't necessarily benefit from it. Some supplements even have disadvantageous effects in big studies — really big studies, like vitamin E and a higher risk of lung cancer in people who smoke. What was that all about? It's because you don't know all the effects one substance will have on you, and there might be things that occur naturally that, if you have them powdered up or concentrated, well, whatever, even if it's still in a reasonable amount. But what I find people miss while they're on this whole supplement journey is they really go for all these nice slogans, but they miss the bigger picture. And the bigger picture is the one we have so much solid research on, and it's the things your mama told you — it's sleeping well, it's eating well, it's dealing with your stress well, having some joy in life. Movement. Those are the things, and this is the big bulk — this is 80% of your health. And then some supplements might do one or two percent — they're good to you, but usually they don't do so much more than this. So weigh it. All this money, all this time researching, and then these other things that have shown effects that are so important — really maybe put some of that time and energy and money into those departments as well. That's all I'm saying.

Giulia Enders

People will say this helps you with your blood sugar, because activating your muscles can really take blood sugar and nutrients into your muscles and get them to work right away instead of just putting them into storage, so to say. So it's a hormonal, metabolic reason. If people stress too much — if they walk and their heart rises and they breathe really fast, so it's a stressful walk — then it's not necessarily good, because stress will then have the opposite effect. But if you have a comfortable walk, that's what you want after a meal.

Giulia Enders

Mhm.

Giulia Enders

Mhm.

Giulia Enders

Mhm.

Giulia Enders

I think that's a perfectly right approach. And it just goes to show that oftentimes, when we try to make humans adjust to the system instead of the system adjusting to humans, we do a stupid thing. We waste money, we waste resources, and we make it less pleasant and less nice for people. And that goes for hospitals, that goes for workplaces, that goes for education. I think there are so many areas in life where we could just use the knowledge we already have on the body and make smarter choices that benefit everyone. I'm not saying be all hippie about the flowers — well, you can, it's nice — but I'm saying it also makes sense in all these other aspects, economically, emotionally, societally, and I would love to see that more often. And especially when you talk about food in hospitals now, it's absolutely true, and the crazy thing is we have all the research showing it. We have the research on wound healing after surgery, for example, and the quality of foods, on psychiatric diseases even. We have all the research. But you know what? We do this in many other areas too, when it comes to how you put together a workplace, how you educate children, how the brain learns best. We have all the research. We just don't do it. So that's, I think, a shared goal here, where I try to make this knowledge in a way palpable, that you can then use it rather than just have it somewhere in the books.

Giulia Enders

I think it means, in the first place — and that's an easy place to start — to not cut it out of the picture, to not ignore it. We now have people, for example, breathing dysfunctionally. So people at the workplace might have this phenomenon called email apnea, where they hold their breath when they hear the sound, or see a new email coming in repeatedly over the course of a day, or breathe really fast and too deep or something, which really heightens the level of stress hormones, makes the muscles in the back clench up, sometimes gives them cold hands and feet, feeling really stressed. Their workplace can also stress them, of course, but there's an aspect of the body that we overlook and don't use to our advantage just because we don't know of it. Or other things, like the gut influencing depressive symptoms — all these physical influences on our life, on our feelings, on our performance. If we would just know them to a degree that we don't ignore them any more, then we can use them. Then we can have breath techniques, like for one minute at 12:00 and 4:00 during the work day, and it really takes off some of these symptoms — you'd be surprised, for some people. We will have people realising they're noise-sensitive when they travel, and this is part of where their stress comes from. We will have students realising the type of learner they are and be able to learn better. So really I think what I want is for people to just have this smart body feeling, that they can actually use to their advantage, and not be victim to mysterious processes that they find overwhelming. Oftentimes it's not so much knowledge that does that.

Giulia Enders

Something easy that the person likes — maybe cooling down your starches before you reheat them or eat them, and then pick one vegetable that you like and just have it a bit more often. And then I think — we haven't talked about this so much — but I like people to know that hygiene isn't about disinfecting your hands all the time. One of maybe the most important hygienes you can have is stress hygiene. And understanding your way of going about stress in terms of hygiene, I think, is actually very beneficial for the gut.

Giulia Enders

What we see is that the effect of stress differs depending on how long the stress goes on for. Short stress is not necessarily bad, because it's like challenging your body — it's like doing a bout of exercise where you're doing something very difficult and then going back to calm again. But stress that lasts longer than this has more unhygienic effects, because it's not only a little challenge and then going back. When you look at the gut with a camera and then really stress out the person, the walls of the gut go pale. They would usually be pinkish, because there's all this blood going on, blood flow is going great. But when stress happens, the vessels really go small, and the gut doesn't get so much energy any more, because your system is giving all this energy to your brain and muscles to solve the problem or run away. And then when you're in stress, your gut will really give up all of its energy — it's a very good-willed, good-natured organ that says, "Oh, there's this big problem, can't digest carefully now." If you're really stressed, some people even throw up or have nervous diarrhea, and that's just to get all these tasks out of the system, so you don't have to deal with digestion now, and you can use the energy for problem solving. The bad part is, if this goes on for too long, you're really abusing this good-willed organ, and it doesn't have enough blood flow and energy to build enough protective mucus. So your stomach might be sensitive, or food particles get too close to the gut, and you're not having enough blood flow to get all the immune cells in the right direction — your immune cells might even get more aggressive. This can have to do with a lack of sleep, this can have to do with the mucus layer being too thin, so suddenly they're exposed to all these things, and they're like, "What's this? I don't like it," so they get all aggressive. And so your gut can get sensitive to food suddenly, or have problems it wouldn't have otherwise, because it just doesn't have the resources to do its job the way it usually would. And over a few weeks that can have very detrimental effects. Also, some microbes — and that's maybe the most hygienic part of it all — thrive on stress hormones, they're really able to deal with them very well, and others are not. You're kind of making an atmosphere for your gut — we're selecting gut microbes that thrive in an environment of distress, and those are not necessarily the good ones we see, at least in studies now. So seeing stress as something unhygienic, I think, is very accurate in that framework. And if you disinfect your hands, you're just making a lot of room — suddenly everything there is dead, and whatever comes next, if you touch a funny rail or something from the air flies there, it now suddenly has room. So if someone's sick and you're touching something, or you're pretty sure you touched something dirty, go ahead. But the most important thing, I think, is not disinfecting your hands, but really looking out for your inner stress hygiene.

Giulia Enders

Maybe not 10 times a day. I have to say I really like my skin microbes. You should really wash your hands when you go home, and before you touch your face and your mouth and so on. But other than that, I don't think it's so beneficial — you just select some creepy ones that don't care for the sanitiser.

Giulia Enders

I think, really, just the vitality and the wonderfulness of being alive. And it sounds so simple, but feeling this a little bit maybe makes it easier for you to do something for your body — just have your body. And I've seen so many patients, when they were at the end of their lives, suddenly realising their body was so genius, was so valuable — they had it all these years. And it's good to see that, but it's also a little bit late. I want people to feel that earlier in life. So that's not one sentence, but it's really what I would want people to take away.

Giulia Enders

Success is purpose rewarded by myself. It is that I know I did something purposeful, helpful, and I myself create the rewarding feelings, not people around me saying that was great or something. And that is the success that I feel most satisfied by.