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Bacterial Buddies
Show #274 - Date: 6 Sep 2020

References from the show:

Categories: Immune System, Nutrition
Keywords: Dr Carol Granger, microbiome, microbiome DNA, microbiome testing, microbiome diversity, immunity, immunotherapy, immune system and microbes, foods that provide good microbes, prebiotic food, parasites, role of gut in health


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Robin Daly: Welcome to The Yes to Life Show on UK Health Radio. I’m Robin Daly, host of the show and founder of Yes to Life, the UK charity that helps people with cancer find out about integrated medicine to support their recovery. Today’s show focuses on an area of health that’s been in the news a lot in recent years. A little while back, no one had even heard of the microbiome, but now it’s regular tabloid material.

I’m pleased to talk to an expert in this territory, microbiologist and nutritional therapist, Dr. Carol Granger. I’m speaking to Dr. Granger over the internet.

Robin Daly: Welcome back to the Yes to Life Show.

Dr. Carol Granger: Hi, it’s really nice to be back and to discuss this interesting area with you today.

Robin Daly: Would you believe it’s been three years since you last came on to talk about the safe integration of nutritional therapy with conventional treatments?

Dr. Carol Granger: Gosh, I can’t believe time has gone so quickly!

Robin Daly: A lot has happened since then. Today we are going to focus on the role of the gut in health. Recently we’ve heard a lot about the gut and about the importance of the microbiome. In the long run, do you think this is a case of it being fashionable? Even in the world of health and medicine, there’s always hype around new findings and today’s news is tomorrow’s fish and chips paper. How much of that hype will stand the test of time, do you think?

Dr. Carol Granger: I think you’re right — there is a lot of hype around the microbiome. There are lots of television programs and articles. I have a feeling that more than half of the enthusiasm about it is justified. What I find encouraging is that it’s actually answering many questions that have remained unanswered, and that people who are working in mainstream cancer care are also looking at this area. Yes, there’s some hype in it, but I think also it’s an area where there will be a confluence and a coming together of opinion, because I think it’s a very important area and it answers many questions about health.

Robin Daly: Okay, interesting. So, for listeners who maybe don’t know you, would you tell us a bit about your background and your training and what you’re working on now?

Dr. Carol Granger: I actually started my working life in mainstream healthcare sciences. I trained in biochemistry and microbiology and I ran a microbiology lab for a few years. I did my masters in microbiology on something called endotoxin, which is something that bacteria shed. In fact, now that’s a really important area of interest in health. I did that for 20 years and worked in various jobs in biochemical diagnostics, microbiology, medical devices, and even in a human tissue bank. Then I had a change of career. When I was 40 I retrained and now I work as a nutritional therapist. I picked up a bit of herbal medicine training along the way. I work as a nutritional therapist mostly with people with a cancer diagnosis, but I also see some people with neurological conditions.

I’m also a co-chair of the Research Council for Complementary Medicine. I’m really interested in the professional body side of things and helping practitioners to collect evidence and to work in an increasingly professional way. One of my big areas of interest is collaborating across professions. When I did my doctorate at the University of Westminster, I looked at the practice of nutritional therapy for people affected by cancer, particularly how nutrition practitioners can collaborate with other professionals, with oncologists and cancer teams.

Just touching back on the microbiology, that is one of the reasons why I’m so interested in the microbiome—it pulls together my interest in microbes and the nutrition world. It’s great that it’s becoming such an area of interest and there is a lot of research going on.

Robin Daly: That background in microbiology is quite unusual for someone who’s a nutritional therapist. That must be a fantastic basis to be standing on?

Dr. Carol Granger: Yes it is. When I worked in a microbiology lab and grew microbes, we were really quite restricted in the way that we could identify bacteria. You could only pick them out if you knew what they wanted to eat and you had the right growth media for them. Now we’ve got all these wonderful genetic techniques, you can identify so many more bacteria, you can find out what really is in the gut because you can look at the DNA.

The techniques in microbiology have exploded the amount of knowledge that we can gain. The original microbiome tests that I used to do when I started in practice were really culture techniques. They were okay, but they were quite restrictive. Now with these genetic techniques it’s wonderful because from a stool sample you can actually look at the DNA from the different microbes that are in there. As long as your library is accurate that you’re comparing your sample to, then you can identify hundreds of different species. We know that there are many different species in there, but the techniques of microbiology have actually made it a much more interesting area. The information that we get from these tests means that we can make better decisions based on them.

Robin Daly: Interesting, we will speak about that later. I want to talk about the microbiome in relation to immunity today. I wonder first, if you could do a roundup of all the ways in which our bodies interact with our gut and the effects that a healthy, or poor, microbiome can have on our health and wellbeing?

Dr. Carol Granger: That’s a really good question. Just to give some idea of what the microbiome is, where it is, and to expand a bit on the idea of the microbiome in the gut: the microbiome is the collection of the DNA, the genetic material, of all the different microbes and living in and on the body.

The interesting thing is that the microbiome is not just in the gut. So the old thought was that the rest of the body was pretty much clean and sterile, but you had these microbes in the gut. It’s very interesting because the microbes in the mouth are different and have different diets, and they actually have an impact on the microbes in the gut. That has a big impact on the immune system.

I’ll give you a couple of examples. If you have somebody that has periodontal disease, they have pockets of microbes in their mouth and they carry down every time that person eats. Every time the person swallows, the microbes are carried down into the gut and those unfavorable microbes can actually trigger all kinds of things such as inflammation.

When we think about the interactions between the microbiome and immunity, there’s far more to it than just what’s going on in the gut. When I did my nutritional therapy training, we used to say all roads lead to the gut. Everything is really in the gut and if you get the gut sorted out, then you get everything else sorted out. There’s a lot of truth in that, but also there is much more to it because what’s in the gut is also in the mouth, the esophagus, and in the stomach. The interactions between the microbes and the immune system happen throughout the body on all the wet surfaces. Particularly in women as there is the vagina biome as well, and that has an impact on immunity. We know that there are multiple interactions going on and that everything that goes into the mouth has an impact on the immune system because it’s having an impact on the microbes in the mouth and these microbes are going down into the gut.

There are complexities of interactions. The biggest interaction is in the intestines. That’s where the biggest interaction is because the microbes stay there for a long time and they interact with white blood cells in the blood vessels lining the intestine, that’s the biggest scene of interaction of between the immune system and the microbes.

Robin Daly: Right. How does this colony of bacteria, a healthy colony or otherwise, affect our overall health?

Dr. Carol Granger: There are a couple of areas that we really don’t know about. It sounds as if we’re clear about these things, but we really are not. What we know about the microbiome probably constitutes 1% of the knowledge that we need to collect to make better decisions about it.

In terms of what a healthy microbiome looks like, then the first word is diversity. That’s what really matters. It’s not just one or two species of microbes that are really good, there are some that are really good, but there are also some that aren’t very favorable. The most important thing is that you have a very diverse microbiome – and that means lots of different species.

For example: there has been some research going on looking at different groups of people around the world that have different types of lifestyles and different diets. If you look at people who live on an industrialized diet consisting of processed food, alcohol, and lots of environmental things that they’re exposed to, they have very few species of microbes in their guts and elsewhere. If you look at the gut of somebody who is living on an unprocessed diet in an unindustrialized area, you find that they actually have a wide range of microbes, and not just bacteria. They probably have a few parasites as well, and we know some of those can be quite helpful for the immune system.

In some cases they have a few yeasts as well, and overall they have a much more diverse microbiome. So the broader the microbiome, the broader the range of species, the greater the range of signals that the immune system gets exposed to. This is addressing one of the many questions about the differences between diets in different parts of the world.

If you look at some groups of people and you say, why don’t they get these chronic diseases? Why don’t they get these problems while people living in the industrialized world seem to suffer more with them? It does seem that a big part of it is that the microbiome in people living on an industrialized diet, or a Western diet, have actually got far fewer species of microbes in their microbiome. That doesn’t give their immune system as much of a workout. There are one or two species that are really helpful, but more than anything, it’s diversity that makes a difference.

Robin Daly: So there’s a direct correlation between diversity and the health of the microbiome. A healthy microbiome is one that’s very diverse.

Dr. Carol Granger: Right. Further, when they took stool samples from people and looked at their microbes and their diet they found this nice correlation. There have been a few experiments where they got people to swap diets. In one study, they took a group of African Americans and a group of people living in a rural African location, who were on a very unprocessed diet, and they got them to swap their diets. They then took stool samples and saw that it only took a couple of days for rural Africans, living on an unprocessed diet, to lose vast numbers of species of microbes after they were put on the so-called industrialized diet from North America. That was the link with their diet. It doesn’t take long for you to lose many of these species when you lose dietary diversity, and particularly where you are losing lots of plant foods from the diet.

Robin Daly: The flip side of that is it’s not too hard to build it up again.

Dr. Carol Granger: That’s a really good point there Robin. It means that for many people, a simple intervention is to eat many more different types of plant foods. Most of the foods that feed your good microbes are plant foods and there are a few that are not. For example, oily fish helps to support the growth of some helpful bacteria, but it’s mostly plant foods. So for many people, an intervention that is relatively easy to do is to increase the range of vegetables that you eat, as unprocessed as possible. Obviously there are some people with restrictions on that.

I work with people that have had lots of surgery on the gastrointestinal system for cancer, and there are people with food intolerances, but that in itself, food intolerance, can develop as a result of problems in the microbiome. Obviously people need individual care if they have specific restrictions, but just increasing the range of plant foods that are eaten on a regular basis is one way of increasing the range of species that are present in the gut.

Robin Daly: That’s pretty positive. It’s interesting to note the parallel here with agriculture, reducing the number of species that are generally around, like apples, there are only handful of species of apples that get sold in a supermarket. That has an effect in the environment, the number of species. That has an effect on us in exactly the same way.

Dr. Carol Granger: Yes, that’s a very good analogy.

Robin Daly: You’ve already mentioned some of the things we know of that support or suppress a healthy microbiome, are there other key factors that we should know about?

Dr. Carol Granger: When I work with my clients, to try to improve their microbiome, I say there are three pillars to improving your microbial health. I’ll say at the beginning, there are some people who, because of the treatments that they’re going through for cancer, may not be able to do some of the things that I’m going to talk about. Always look at your own situation and discuss with your healthcare professional if these measures are appropriate for you.

In general, there are three pillars to good microbial health. The first one is to eat foods that provide good microbes. These are cultured foods. For dairy foods, they are things like yogurt, kefir, creme fraiche, and a few cheeses as well. Predominantly what most people will come across is yogurt and kefir. There are other similar fermented dairy foods like labne, which is a middle Eastern strained yogurt.

The idea of the first pillar of looking after your microbiome is to eat foods that give you good microbes. You can’t really go wrong if you choose cultured yogurts, kefir, or labne.

Obviously there are some people who can’t have dairy, so there are some non-dairy options, look for ones that contain live cultures. There are other cultured foods as well; things like sauerkraut, kimchi, even live apple cider vinegar. A lot of sauerkraut sold in supermarkets is actually pasteurized to ensure a long shelf life, but when they pasteurize it, they’re actually killing off all the good microbes. You need to have these things live—so when you’re buying them, look for ones that say live cultures or unpasteurized. All of those will provide good microbes. That’s the first pillar of microbe support – to take good microbes in, through cultured or fermented foods.

The second pillar is actually the most important bit, diversity in your microbes. Foods that give you live bacteria are called probiotic foods, and you can take probiotic supplements as well. The foods that feed your good microbes are called prebiotic foods. They include things like mushrooms, butter beans, lots of different green vegetables, green olives, olive oil, most unprocessed plant foods and vegetables, fruit, nuts, and seeds.

They provide prebiotic components and that’s because they contain different types of fibers. Most fibers are the foods that your microbes want to live on. Your microbes ferment those fibers and they produce some very good beneficial compounds that actually help your gut. So those prebiotic foods give you lots of different vitamins, but the broad range of diversity of your vegetables, spices, herbs, nuts, and seeds, all those plant foods, they also help different species of microbes to grow.

Bacteria have their own dietary needs, some bacteria can only live on certain types of compounds and others live on other types of compounds. The second pillar of microbial health is prebiotic foods. The probiotics give you the good microbes, the prebiotics feed the good microbes.

The last pillar is to avoid things that deplete the beneficial microbes. These are two main things in the Western lifestyle. That is to reduce alcohol intake because alcohol depletes the level of good microbes in the intestine and elsewhere, and to avoid refined sugar. We know that a lot of sugar in the diet suppresses microbe diversity. High sugar intake is linked to a lower the range of microbes in your gut. So missing out those two adverse compounds, alcohol and sugar, is a good move.

Those are the three pillars of microbial health. Eating the good microbes, or the probiotics. Feeding the good microbes with prebiotics, and avoiding the things that deplete good microbes, alcohol and sugar.

Robin Daly: Interesting. My generation was taught that the only good thing to do to a microbe is squirting it with bleach! Along with over-cleanliness, there was a focus on the consumption of things which actually kill microbes directly, such as antibiotics.

You haven’t mentioned that group of things. Is that is because they don’t feature as prominently as the things you have mentioned?

Dr. Carol Granger: I think that they are very important, that’s a really good point. The three pillars suggested are the ones that people have direct control over. On the other hand, for people going through treatment, lots of medication actually knocks out microbes rapidly. A course of antibiotics is going to knock out a lot of your microbes. It certainly won’t knock out all of them, but it will knock out many of the ones that you need. People that are in treatment for various conditions may not have much control over the medications that they have to take, but they do have control over what they’re eating.

Now it’s a really good point that you mentioned about the compounds that kill off microbes.

Some research is looking at things like antiseptic soaps on the skin that are also potentially depleting the microbes in the intestine. So the overenthusiastic use of disinfectants in the environment, in the home, for example, seems to be linked to an increased risk of developing allergies. That is because when kids are growing up in an ultra-clean home, they are not exposed to the good microbes that help educate their immune systems properly. I think when people are thinking about allergies, then overexposure to these ultra-disinfectant compounds can be the problem.

Of course, we’re in a slightly different situation at the moment with coronavirus and people have to wash their hands more often. They are encouraged to be cautious about bringing microbes back into the home and might be disinfecting shopping when they get in, but I think this is an unusual situation that we are in at the moment. In general, using a lot of disinfectants and anti-microbial soaps and shower gels are not really good for the health of the microbiome overall in the body.

Robin Daly: Another thing that jumps to mind is that while vegetables and fruit et cetera are great for the microbiome, some vegetables and fruit are doused with things which inherently are not good for the microbiome. That must play into it to some degree?

Dr. Carol Granger: Yes, you’re right. People who live in rural locations in parts of the world where they have an unprocessed diet, where there may be just a cursory rinse to vegetables or brushing the dirt off of them, get exposure to lots of different microbes from soil which is helpful. It’s a bit of a balance—if you pick something out of your garden and you use it, then, hopefully you haven’t sprayed your courgettes with pesticides. When people are buying vegetables that are not organic, then yes, there may be traces of things on the outside of the vegetable, which would also have an impact on the microbiome. Many root vegetables are treated post-harvest with a fungicide that gives them a longer shelf life, and of course, when we take that into the body then it has an impact on our own microbes.

Robin Daly: Hence the big difference between the industrialized nations and the non-industrialized ones. There are many ways in which we’re not really supporting our microbiome that well. Given that, how widespread would you say poor gut health is in the UK?

Dr. Carol Granger: Well, if I just went on the basis of the people who I see in my practice, then I’d say it’s probably most of the adult population. I’d say that nobody has really looked accurately at poor gut health in the UK population or European population.

There are ongoing studies looking at the microbiome in the gut and in general, if you look in the UK, then I would say that there’s a fairly widespread problem with low levels of good microbes and low diversity in the microbiome.

If you look at the difference between the microbiome in healthy people and the microbiome in people with specific diagnoses, you find differences. There is some really good work looking at the fingerprint of the microbiome of people with different types of chronic diseases. Specifically looking at people with autoimmune diseases and different types of cancers, and then comparing them to people of a similar age, ethnicity, and gender who don’t have those conditions. What they’re finding is that it is very clear that people with chronic health problems have a poorer microbiome than people who don’t have those health conditions. Now, it’s a chicken or egg question – what comes first? Is the microbiome depleted the because the person is unwell or is the person unwell because their microbiome is adversely affected.

It’s very clear, for example, that people with type two diabetes generally have a poorer range of microbes in their gut compared to aged-matched people who do not have type two diabetes. It’s the same with every type of cancer that’s been looked at and all the autoimmune and neurological conditions. They are consistently finding that impairment of health is associated with a poorer microbiome: a loss of key species and overall a lower range of species, and a greater presence of some unpleasant ones.

Robin Daly: As you say, it’s a chicken and egg question, but the associations are very important and we need to understand more about them.

So homing in on the main topic, the relationship between gut health and immunity. There are many factors that affect the immune system, where would you rank gut health among those?

Dr. Carol Granger: I have a top two when I when I work with people who have, for example, a cancer diagnosis. First thing is that we need to do is to sort out the gut. Then we need to look at nutrients, predominantly vitamin D, because vitamin D is really important for immunity. It’s probably the most important mainstream vitamin well researched for immunity. Gut health is a marker of what’s going on with the microbes. So where people have digestive system problems, then you can be sure that alongside that is a disturbance in the microbes, and that causes an impairment of the immune response. So that it is extremely important. Now when I look at somebody’s symptoms and I see that they have long-standing digestive system symptoms, like bloating or bowel disturbance, wind, and just general feeling of discomfort in their abdomen, then that is a signal that their immune system is not served well by the gut microbes.

Robin Daly: Okay, so looking after our microbiome should be right up there in our strategies to build our immunity.

In the case of cancer and cancer treatment, what are the specific factors working against the health of our microbiome that we should be aware of?

Dr. Carol Granger: That’s the largest group of patients that I work with in my practice. Most chemotherapy agents given intravenously also affect the microbiome because they spread throughout the whole of the body. When people are going through chemo treatment, they’re given other supporting drugs, like Dexamethasone, and usually the anti-nausea drugs, like Ondansetron, and Metoclopramide. All of those have an impact on the gut microbes.

So as somebody goes through their chemotherapy, two or three week cycles, they will often see a change in bowel habit. That’s a very common observation. They might have a few days where they are very constipated and a few days where their bowels are loose. During the cycle, the microbes will actually be depleted. Is that a price worth paying? Well, yes, it is a price worth paying because you can take steps to help put the good microbes back in there. One thing to mention is that where people are given anti-nausea drugs, talk with your team if you find that they’re also causing bowel disturbances or having an impact on your microbiome.

In terms of how you can protect yourself during that time, it’s following those steps that we mentioned earlier about having cultured foods, as long as your medical team are okay with having live foods, and eating, even if it’s only small amounts, lots of different types of vegetables. That will help restore your good microbes. As you go through each cycle, try to keep that up. If you have individual goals or dietary needs, then talk to your team, your nutrition practitioner if you’re working with one, about how you can incorporate a wide range of microbes from different vegetables into your dietary regime.

In terms of other treatments, there is some really interesting research about immunotherapy. Immunotherapy is now being more widely used, these are drugs like checkpoint inhibitors, Nivolumab and Pembrolizumab. People having those treatments seem to have a better response if they have a broad range of microbes their intestine. So their microbiome seems to also help the immune system alongside these checkpoint inhibitors.

That’s why people are having immunotherapy, it’s used in things like head and neck cancers, and melanoma. I have a lot of patients with melanoma that are having these checkpoint inhibitor drugs, also called PD-1 inhibitors. If you have good microbes in your gut, it’s like a boot camp for your immune system.

One last point is about radiotherapy. When people have pelvic radiotherapy, that also disturbs the microbes in the intestine. In that case, again, it’s important to try and follow those three pillars of microbial support that I mentioned: trying to make sure that you eat foods with good microbes, eat foods that feed the good microbes, and avoid the things that deplete your good microbes.

So treatments can have quite a significant impact on the microbes, but it is possible to recover from that.

Robin Daly: All very important. As a practitioner, Carolyn, you must want to know what the condition of your clients’ gut is, and whether your efforts to improve it are actually proving effective. How do you measure the health of the microbiome?

Dr. Carol Granger: Thankfully there are some really good tests around now. I do microbiome tests on people. They get a kit and they send a stool sample, or collect stool samples over a few days, and then send those off to laboratories. There are several laboratories doing these tests now. I use a laboratory that’s validated, I’d go with the one that your practitioner, if you’re working with a practitioner, recommends.

There are lots of labs that are doing these studies and they should be using DNA techniques. The DNA techniques basically harvest all of the DNA in the stool sample and then they compare that DNA against a library of DNA fingerprints that come from different bacteria. DNA is the gold standard now, looking at the DNA of the microbes. If you just do culture techniques, then you miss out on bacteria that can’t survive in the culture conditions. Some of the older stool tests were really just using culture methods and that’s like working in the dark. I use DNA analysis and culture techniques. The culture techniques look at which microbes survive and which ones thrive. When you get a DNA result back, that’s got all the DNA from the bacteria, but you don’t know how many of those bacteria are dead and how many are alive, because you’re just looking at their DNA. Alongside that, I would have the culture method done as well, of specific species that I know are important. I mentioned earlier, diversity is the most important thing, but there are a few key species that are very important for immunity. These are things like: Ruminococcus, Lactobacillus, and Bifidobacterium, and Fecalibacterium. That’s a really important one in terms of immunity for people with a cancer diagnosis and particularly people going through immunotherapy.

There are lots of tests out there that are very helpful. Some tests also do direct microscopy to look for parasites. That’s really the only way to do it. You can’t work in the dark without these results. Some of these tests are really quite expensive, so I would use them judiciously at an appropriate time. I wouldn’t ask somebody going through chemotherapy to do one of those tests while they’re in treatment. I would wait until they finished treatment and three months past the last infusion, because otherwise you don’t get a good idea. These tests are a couple of hundred pounds, so to have them done in the middle of a course of chemo is not worth it because you know that the next week they’re going to get another big dose of Dexamethasone and knock everything out.

Robin Daly: Yeah, guaranteed that their microbiome is suffering if they’re having chemo, basically.

Dr. Carol Granger: Yeah, absolutely. They are not done on the NHS, they’re done privately, and because they are expensive, if somebody is going through straightforward chemotherapy, I would wait until the end of the chemo regime. For somebody who is going through immunotherapy, it’s worthwhile looking at the microbiome at any time during treatment, because the microbes in the gut are having a direct impact on the results from that treatment.

Robin Daly: Makes sense. Okay, I like to round off with a more general question about the approach to healthcare.

I know that you’re passionate about integrative medicine, something we have in common, but we have come to it from different angles. I certainly don’t have your kind of expertise and experience. Could you tell us exactly why you think that integration is the right way forward for the management of cancer, chronic illness, and generally in health?

Dr. Carol Granger: That again is a really good question. I think it’s because people who have a serious health condition, including cancer, and other health problems such as neurological problems and autoimmune conditions, deserve the best of all care. That’s why I feel that if practitioners of different professions can work together, then we all gain. The person with the health problem gains most of all.

Working with people with a cancer diagnosis, patients can often feel that they’re put in the middle of a tug-of-war. That isn’t fair on the person. If the two sides of healthcare come together, which I don’t see as sides, more as different perspectives, we can come up with the best possible wraparound care for that person.

I’ve been working in two collaborations that have reinforced how important this is. I’m involved in a collaboration within the NHS research arm, The Institute of Health Research, on nutrition for cancer patients. I began contributing to that when I was doing my doctorate as probably the only person who is not working in the NHS involved in that collaboration, and my voice is heard. Recently we had a paper accepted for publication and it includes people from different backgrounds: dieticians, a breast surgeon, gastroenterologists, a health psychologist, and me as a nutrition practitioner in the private sector. It’s about how people with a cancer diagnosis can get the best evidence-based nutritional advice.

Working within that collaboration is hard work, really hard work, but it has made me realize that the people that will benefit most of all are the patients with the health issue.

I also work with a group of oncologists where I write for them about nutrition. Working with them and listening to their perspectives I realize how important it is that we all pull together.

You can tell I’m really passionate about collaboration. That’s why throughout my professional years I have volunteered in different bodies to help professional development.

I’m co-chairing the Research Council for Complimentary Medicine and that’s all about making it possible for patients to get the best of all care. Whether it’s mainstream healthcare, which is wonderful, but also making sure that the voice of the complimentary services is understood and that their contribution is accepted by evidence and the fact that we actually do good work, we help the patient.

Robin Daly: Excellent. Thank you, we will end it there. Thanks so much, Carol. It’s been really informative.

I’m looking forward to seeing you at our amazing online autumn event: Your Life and Cancer 2020. Spread across two weekends, you’re among over 40 top international experts, featuring in discussions and your scheduled to be interviewed by expert host Miguel Toribio Mateas, who is a neuroscientist and nutritionist and microbiome researcher, and chairman of the British Association for Nutrition and Lifestyle Medicine. I think this will make for a fascinating discussion, which I’m sure will add considerably to the material we covered today.

Dr. Carol Granger: That’s great, I’m really looking forward to that.
Robin Daly: Thanks so much for this interview. It has been brilliant and very informative. I hope our listeners have gained from it.

Dr. Carol Granger: Thank you. Thanks for inviting me.

Robin Daly: The growing understanding of the central role of the microbiome is beginning to produce the science to underpin many of the dietary and nutritional approaches that have been found helpful over the years.

Hopefully this will lead to a greater respect for the role that nutrition has to play in recovery from serious diseases like cancer. As I mentioned, Carol is one of over 40 experts featured in our online event in just a few weeks. Your life in cancer, 2020 is spread across two weekends, 26 to 28th of September and 10th to 12th of October.

The first one is tailored to those new to integrated medicine, and the second to people who want to expand their knowledge. The event has its own website at yourlifeandcancer.com, so check out extraordinary lineup of speakers and subject matter. You can also book your place at either or both weekends for just 25 pounds per weekend, as long as you catch the early bird prices.

Thanks for listening today. I’ll be back at the same time next week with another Yes to Life show here on UK health radio. I do hope you’ll be able to join me again, goodbye.

Kindly written by Literary & Transcript Editor Amy MacLennan