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Introduction

The long road home involved driving on a stress-inducing freeway where drivers have zero-tolerance for speed limits and tailgating is a regular occurrence. I still had about 10 minutes left until I was able to grace the porcelain throne, but my gut had other plans.

As I drove up to the final set of lights, I broke into a sweat, my stomach cramps felt like an earthquake rumbling within my lower extremities and I braced myself for an apocalypse. Anxiously staring at the lights, I looked to my left and noticed a young, flirtatious-looking driver locking eyes and cracking a smile at me without a hint in the world that the woman next to him was about to experience a boo-boo in her pants. 'Yep, it's happening,' I thought to myself as I awkwardly smiled back.. Yes, it happened. The lights turned green, foot on pedal and off I drove back home with the most uncomfortable and revolting feeling of having pooed my pants, in my car, as I smiled back at a stranger.

My passion for gut health was definitely born of a mix of being the daughter of a gastroenterologist and experiencing the unpredictable and painful symptoms of IBS. This three-letter acronym stands for 'irritable bowel syndrome' and, for those who are still not familiar with the term, it is a glitch in something we'll be covering in detail called the 'gut-brain axis', causing a disturbance in the functioning of the digestive tract (i.e. intestines). Bloating, gas, irregular bowel movements, abdominal pain and urgency to use the loo are some common symptoms many sufferers describe (ah, the joy). Some people with IBS complain of constipation, others have diarrhoea and some experience both.

To cut a story spanning over a year short, I started experiencing symptoms on and off after suffering a horrible stomach infection. That also happened to coincide with my moving from Australia to Dubai. So, change of environment? Food? Weather? Who knows. Following a course (and mix) of antibiotics, my guts of steel transformed into the weakest link. My symptoms could only be described as an abdominal roller-coaster: stomach pain then diarrhoea for a few days followed by no intestinal movement whatsoever. Everything I ate seemed to go straight through me or create the perfect pregnancy illusion, where feeling bloated was simply an understatement. After endless trips to the bathroom (and moments when I'd literally lost control of my bowels, such as my poo-in-car story), the investigations began. Blood work, check. Endoscopy, check. Poo samples (many, in all forms), check. The tests ruled out coeliac disease, inflammatory bowel disease and other not so great diagnoses, and eventually, it all came down to IBS and lactose intolerance with a lovely dash of reflux.

Being a dietitian, you would think 'Hold on, check for intolerances? Sensitivities? Try an elimination diet? C'mon!'. However, due to my insane fatigue and endless trips to the oval office, I thought something was seriously wrong that went far beyond that. However, 12 years post IBS diagnosis, I found myself embarking on a low-FOD-MAP diet, adding probiotics to the mix and embracing ways to manage stress. There was a light at the end of that shitty tunnel!

The reason for sharing a little snippet of my story is to break the taboo around poo talk and to reassure you that digestive problems, no matter how mild or severe, need to be addressed out loud. Growing up, our dinner table talk involved a lot of hospital calls my dad would have to answer, shouting out things like 'rectal bleeding', 'anal fissures' and, yes, lots more dinner-inappropriate terminology. The horror on our friends' faces whenever they visited was hysterical to say the least.

During the course of my career, I have been very vocal about topics that you may find yourself secretly searching the internet for. This book will definitely include a lot of faecal tête-à-têtes so if you're squeamish and lacking any tolerance for potty-talk, I apologise in advance as you're not getting a refund, but most importantly, this book also offers a fad-free look at how to manage some of these conditions through diet and lifestyle. Throughout this journey together, we'll be going through the most common gut conditions that we, homo sapiens, experience, focusing on the nutritional management of each.

Now, gut health has become completely mainstream, and pseudo-science continues to inundate people's minds with false claims, promises and celery talk, making any responsible health professional cringe and bang their head in disappointment. Luckily, there will be no excessive celery talk in this book. I have created my brand with a mission to help people navigate the complex world of health and wellness using science as a backbone but, most importantly, using easy-to-digest language that won't, I hope, lose you.

With this book, I want you to appreciate the complex nature of your gut but also to use what I have written as guidance if you're struggling. This comes from someone who has both the qualifications and bowel-changing experience.

Personalised nutrition

A question you may ask is, how can I personalise this general information? Before we get to that answer, let me grab your attention for a minute to talk about the whole concept of personalised nutrition.

Nutrition, as we know, is an essential pillar of health and, as a dietitian, personalised nutrition forms the basis of my practice. Within this profession, (although everyone, their grandmothers and Marie the neighbour have become experts in the field), personalised nutrition uses a whole heap of checks to create your lifestyle template towards better health. These include your medical history, blood work, sleep, stress and activity levels, emotions, thoughts and behaviours around food and, in my line of work, good ol' poo. Yep, your bowel movements and stool consistency can say a lot about your overall health. You should see my clients' faces when I ask them, in detail, about their bowel habits. Based on all the information collected, I formulate a nutritional plan that considers the person as a whole. For example, I may advise George who has been recently diagnosed with IBS to cut down on caffeine and go on a specific diet to manage his diarrhoea, OR I may ask Linda to include some kiwi fruit, prunes and flaxseed as well as more exercise to help her manage constipation. So, the evolution of personalised nutrition actually started with nutritionists and dietitians.

Personalised nutrition is now evolving with two major tools coming onto the scene - DNA testing and analysing your gut 'microbiome', a term we will dive into later. Analysing stool has always been a common diagnostic tool, in a lot of cases involving gut conditions, but more recently, we have been seeing the 'Christopher Columbus' of poo tests created to uncover a portal into the world of our gut microbiome. Microbiome testing and analysis are still at an early stage, but unfortunately (and as always) commercialisation is way ahead of the science. However, tools are slowly being developed, giving us insight into the types of little critters living in our gut, what foods they need, what their roles are, and how they are connected to other body organs and our overall health.

I won't be handing out free stool tests with this book but, for now, I want you to use the knowledge shared here not only to create your own template for managing any of the gut conditions mentioned but also to learn that there are specialised health professionals out there who can truly help you experience another level of personalised nutrition. And by health professionals, I'm talking about specialised dietitians and registered nutritionists, not social media wellness unicorns promoting a combination of celery juice, DIY enemas and other magical leprechaun juices that will cure you from all ailments.

A note about gut cancers

This book is about common, often chronic gut problems that are not life-threatening but have a significant negative impact on quality of life. I do therefore not address cancer; clearly 'gut' cancers warrant a whole book in themselves. Here I just want to offer a snapshot of what they are and warning signs to look out for, given how prevalent they are. Mutations (i.e. changes in our DNA) are known to be able to trigger the development of tumours anywhere along our digestive tract, leading to the development of the big C. The causes behind developing a type of gastrointestinal cancer are complex and multifactorial but it is a combination of genetics, environmental and lifestyle factors. The most common types include:

• Oesophageal cancer
• Stomach (gastric) cancer
• Pancreatic cancer
• Liver cancer
• Colorectal cancer

Colorectal cancer is the third most common cancer worldwide and is a type with which I have become far too familiar throughout my career.

If I had to pick a handful of essential points you need to bear in mind on the subject of gut cancers, they would include:

• Do not skip regular screening, especially if you have a strong family history of...