Inside Matters

Professor Alexandra Johnstone joins Dr James McIlroy to explore what makes us hungry, what helps us feel full, and why healthier choices are rarely a matter of willpower alone.
A conversation on chrononutrition, protein, food inequality, GLP-1 medicines and the future of public health.
The big idea: Our bodies, habits and surroundings all influence how we eat. Better health therefore needs more than individual resolve: it needs practical advice, supportive environments and policies that make nourishing food easier to choose.
Breakfast, body clocks and the timing of food
Is breakfast really the most important meal of the day? Professor Johnstone’s answer is an emphatic yes—but not because breakfast has any magical property. Her research focuses on chrononutrition: the relationship between what we eat, when we eat it and the body’s roughly 24-hour circadian rhythms.
The timing of the largest meal may not dramatically alter how much energy the body burns, but it can change how eating feels. A larger breakfast appears to help people feel fuller and may make a calorie-reduced diet easier to follow. The body also tends to be more sensitive to insulin earlier in the day.
There is no universal clock-time definition of breakfast. A useful way to think about it is the first meal within two or three hours of waking.
Fasting is a tool, not a loophole
Intermittent fasting and time-restricted eating can be useful for some people, but they are behavioural strategies rather than shortcuts around energy balance. Professor Johnstone favours including the morning meal and offers the practical reminder: eat breakfast like a king and dine like a pauper.
What does a healthy breakfast look like?
From traditional cooked breakfasts to fortified cereals, the conversation explores nutritious options while highlighting the difference between everyday foods and occasional treats.
Hunger and appetite are not the same thing
A clear and helpful distinction between true hunger and appetite, and why reducing eating behaviour to willpower alone is so misleading.
Why protein is filling
Protein is the most satiating nutrient. The episode dives into the science of satiety, the importance of whole-food sources, and why solid protein tends to be more filling than liquid forms.
Fibre does a different—but equally important—job
While protein excels at satiety, fibre is essential for gut health. The trade-offs and benefits of both are explored.
The obesity paradox and fixing the food environment
Obesity is strongly patterned by inequality. The discussion covers food insecurity, the obesogenic environment, retail promotions, and the need for policy changes that make healthier choices easier.
Ultra-processed food: a debate that needs more evidence
A nuanced look at ultra-processed foods, their role in the diet, and what the current science can – and cannot yet – tell us.
GLP-1 medicines: powerful treatment, unanswered questions
The benefits, limitations, and challenges of GLP-1 medications, including muscle preservation, long-term use, and access/inequality concerns.
Alcohol, Mediterranean patterns and the value of connection
The role of social connection, shared meals, and balanced enjoyment of food and drink.
A practical takeaway: build patterns, not perfection
Realistic, compassionate advice for building sustainable eating habits without shame or moral judgment.
What comes next
Professor Johnstone shares her vision for the future of nutrition science, including better guidance for shift workers, updated protein recommendations, and improved food systems.
About the Conversation In this episode of Inside Matters, host Dr James McIlroy speaks with Professor Alexandra Johnstone, Chair of Nutrition at the University of Aberdeen.
Timestamps:
00:00 Meet Professor Alex Johnson
01:53 Breakfast and Chrononutrition
05:13 Fasting and Eating Windows
07:59 What Makes a Healthy Breakfast
10:42 Hunger vs Appetite Explained
15:49 Protein and Satiety Science
18:20 Obesity Paradox and Poverty
19:53 Fixing the Food Environment
23:11 Gut Brain Axis and Weight Defense
27:06 Obesogenic Retail and Policy Changes
31:16 Alcohol Mediterranean Diet and Blue Zones
38:05 Why Protein Fills You Up
38:52 Protein Satiety Mechanisms
39:32 Amino Acids vs Whole Protein
40:48 Liquid Meal Replacements
43:49 Ultra Processed Food Debate
50:41 Scotland Diet Reality Check
52:37 Red Meat and Cancer Risk
53:47 GLP-1 Weight Loss Challenges
55:07 Microdosing and Inequality
01:04:19 Muscle Loss and Nutrition
01:05:50 Fibre Deep Dive
01:08:21 Sweeteners and Microbiome
01:10:44 Future Vision and Wrap Up
 

For years, the spotlight in microbiome research has been firmly on the gut. We’ve learned that diversity there is generally a good thing—linked to resilience, health, and better outcomes.
But what if one of the most important microbiomes in the body follows completely different rules?
In a recent conversation, Dr James McIlroy sat down with Professor David MacIntyre, Director of the Robinson Research Institute, to explore a rapidly emerging field: the female reproductive tract microbiome.
What they uncovered challenges many assumptions—and could transform how we think about pregnancy, birth, and early life health.
 
00:00 Show Returns
01:34 Why Reproductive Microbiome
05:15 Low Diversity Health
09:24 Lactobacillus Protection
12:06 Human Uniqueness
14:17 Population Differences
16:31 Oral Probiotics Myth
19:25 Vaginal Biotherapeutics Trial
22:11 Host Immune Response
27:03 Dysbiosis Triggers
30:42 Microbiome and Preterm Birth
33:06 Labor Inflammation Pathways
38:10 Pregnancy Microbiome Shifts
39:11 Screening and Group B Strep
40:57 Microbiome Screening Potential
42:06 Global Data Predictive Signatures
43:23 Limits of Current Risk Tools
45:30 Point of Care Profiling Vision
46:50 Swab Mass Spec Barcoding
48:27 Composition Versus Host Response
49:58 Metabolic Dark Matter
52:13 Beyond Bacteria, Viruses, and Fungi
55:48 Vaginal Probiotic Trials
57:39 Phase Two Trial Endpoints
01:01:28 Vaginal Microbiome Transplants
01:05:46 Birth Seeding After C Section
01:10:57 Do Vaginal Strains Persist
01:14:05 Ten-Year Personalised Medicine
01:17:45 Wrap Up And Where To Find
 
A Different Kind of Microbiome
When we talk about the gut microbiome, diversity is often considered a hallmark of health.
The reproductive tract? It’s the opposite.
In healthy women, this environment is typically:
Low in diversity
Dominated by one key group of bacteria: Lactobacillus
This might sound counterintuitive—but it’s by design.
Why low diversity works here
Certain Lactobacillus species—particularly Lactobacillus crispatus—play a protective role by:
Producing lactic acid, keeping the environment acidic (around pH 4)
Preventing harmful microbes from growing
Blocking pathogens from attaching to tissue
Producing antimicrobial compounds
In short, they create a stable, protective ecosystem.
When this balance is disrupted and diversity increases, it’s often linked to:
Infection
Inflammation
Poor reproductive outcomes
A Unique Human Feature
One of the most surprising insights?
Humans are the only species known to have a Lactobacillus-dominated reproductive microbiome.
Even our closest primate relatives don’t share this feature.
That suggests this system evolved relatively recently—and likely offers a meaningful biological advantage, particularly in pregnancy and childbirth.
The Link to Preterm Birth
Preterm birth—defined as delivery before 37 weeks—affects around 1 in 10 pregnancies globally and remains a major medical challenge.
The microbiome appears to play a key role, particularly in early preterm births.
What’s happening biologically?
In a healthy pregnancy, labour is triggered by controlled, sterile inflammation
This process helps:
Break the membranes (waters)
Open the cervix
Initiate contractions
But if inflammation starts too early, it can trigger premature labour.
Where the microbiome fits in
A Lactobacillus-dominant microbiome helps:
Keep inflammation low
Maintain a strong mucosal barrier
Reduce infection risk
When this balance is lost:
The environment becomes less acidic
Inflammatory molecules increase
The barrier weakens
Risk of infection—and preterm labour—rises
Once inflammation starts, it’s very difficult to switch off.
That’s why prevention is so important.
What Disrupts the Balance?
Several factors can shift the microbiome away from its protective state:
Antibiotics (even when used for unrelated infections)
Sexual transmission of bacteria
Hormonal changes
Menstruation
Hygiene practices like douching
Even small changes in pH or environment can allow harmful bacteria to gain a foothold.
Can We Predict Risk Earlier?
One of the most exciting areas of research is using the microbiome as a predictive tool.
Scientists are working towards:
Identifying microbial “signatures” linked to higher risk
Measuring both:
Which microbes are present
How the body is responding to them
New technologies can now analyse a simple swab and generate a metabolic “barcode” in minutes—potentially enabling rapid screening.
The long-term vision?Routine testing that identifies at-risk pregnancies early—before symptoms appear.
Can We Change the Microbiome?
If we can measure it, can we fix it?
1. Oral probiotics: limited impact
Despite widespread marketing, there’s little evidence that oral probiotics reliably reach or colonise the reproductive tract.
They may have indirect benefits—but they’re not an efficient delivery method.
2. Targeted vaginal probiotics
More promising is direct delivery of beneficial bacteria.
A recent clinical trial explored a vaginally delivered strain of Lactobacillus crispatus:
Safe and well tolerated in pregnancy
Successfully colonised the microbiome
Showed early signs of reducing preterm birth risk
A larger, definitive trial is now underway in the UK.
3. Microbiome transplantation
Inspired by faecal transplants, researchers are exploring vaginal microbiome transplants.
Early studies show potential—but challenges remain:
Regulation
Standardisation
Safety at scale
For now, this remains experimental.
The First Microbial Gift: Birth
The microbiome’s role doesn’t stop at pregnancy.
During vaginal birth, babies are exposed to their mother’s microbes—an important early “seeding” event.
Babies born via caesarean section:
Have different early microbiomes
May face higher risks of certain conditions (e.g. allergies)
There’s growing interest in “vaginal seeding” for C-section babies—but:
Evidence is still emerging
Safety concerns remain
It’s not yet standard practice
A Shift Towards Personalised Pregnancy Care
Looking ahead, this field is moving towards a precision medicine approach.
Instead of treating all pregnancies the same, we may soon:
Assess individual microbiome profiles
Measure immune responses
Identify personalised risk
Apply targeted interventions early—or even before conception
The goal?
Not just preventing complications—but optimising pregnancy from the start.
Why This Matters
This isn’t just about microbes—it’s about long-term health.
By improving the maternal microbiome, we may:
Reduce preterm birth
Improve newborn outcomes
Influence lifelong health trajectories
As Professor MacIntyre puts it, we’re on the cusp of a major shift—from reacting to problems to preventing them before they begin.
 

Dr Debra Silberg joins Inside Matters for a deep, wide-ranging conversation on gut health, drug development, and the future of microbiome therapeutics.
Dr Silberg is the Chief Scientific Officer at Beyond Celiac, a former global clinical leader at Shire/Takeda and AstraZeneca, and one of the most respected figures in GI medicine and microbiome science.
In this episode, we explore:• How she moved from basic science to medicine to pharma leadership• Why the GI field needed so much research — and how it transformed• The real science behind ulcers, H. pylori, and the Barry Marshall story• What she teaches in her popular “Understanding Your Gut” course• Prebiotics vs probiotics — what actually matters• The truth about gluten, celiac disease, gluten sensitivity and rising incidence• The microbiome’s role in inflammation, autoimmune disease, mental health & IBS• Whether microbiome drug development is finally turning a corner• Why the gut–brain axis may be the most exciting frontier in medicine
Dr Silberg also shares insights from her work with Finch Therapeutics, her role at Beyond Celiac, and her experience advising the team at Biotics.
If you’re interested in gut science, the microbiome, diet, or how modern medicines are built from the ground up, you’ll get a huge amount from this conversation.
Be well, trust your gut — and thanks for listening.
00:00 Introduction to Dr Debra Silberg
00:54 Dr Silberg's Career Journey
02:26 Insights on Gut Health and Microbiome
04:05 Understanding GI Diseases and Treatments
07:41 The Role of Diet in Gut Health
15:59 Celiac Disease and Gluten Sensitivity
25:04 Exploring the Microbiome
27:43 Exploring Therapeutic Approaches to the Microbiota
31:36 Challenges in Microbiome Drug Development
34:22 The Gut-Brain Connection and Mental Health
39:13 Transitioning from Academia to Pharma
41:45 Insights into Drug Development and Success Stories
44:55 The Long Journey of Drug Development
52:01 The Role of AI in FDA Reviews
55:04 Quick Fire Round: Future of Microbiome Research
You must not rely on the information in this video as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of the information in this video.

In this episode, Dr James McIlroy chats with Dr Tanya Mongan, clinical associate professor and gastroenterology consultant at the University of Nottingham. Dr Mongan specialises in gut health, particularly the gut–brain connection and faecal microbiota transplantation (FMT).
She talks us through the current state of FMT, why it works so well, and how it’s becoming an increasingly important treatment for conditions like inflammatory bowel disease. We also explore her cutting-edge research into microRNA-based medicines—a new field examining tiny molecules that can help protect the gut and may one day be used to treat conditions linked to an unhealthy microbiome, including cystic fibrosis and neurodegenerative diseases.
This episode breaks down the complexities of the microbiome in an easy-to-understand way, covering everything from the limits of current testing to the promise of personalised gut treatments. Dr Mongan also shares insights into exciting new tools such as organ-on-chip models, nano-delivery systems for microRNAs, and even zebrafish models used in gut research.
If you want to understand where gut science is heading, what’s real and what’s hype, and how future therapies may become more precise and personalised, this is a must-listen.
Chapter Markers
00:00 Introduction to Dr Tanya Mongan and gut health01:51 Has the microbiome “bubble” burst?03:45 The big challenges in microbiome science06:13 What the future of microbiome testing could look like12:45 Understanding faecal microbiota transplantation (FMT)19:22 How FMT works and what current research shows26:29 Why the microbiome is so complex34:57 MicroRNAs: a new frontier in gut health37:41 Where microRNAs come from38:18 How microRNAs help protect the gut39:00 Why delivering microRNAs is difficult39:19 Nano-formulation: new ways to deliver microRNAs40:37 The advantages of organ-on-chip models42:02 Personalised “gut avatars”43:58 Zebrafish and other models used in gut research49:27 Clinical applications and future directions53:17 Microbiome therapy and FMT in clinical practice56:57 The future of microbiome research and treatment01:01:23 Diet, supplements, and the microbiome01:04:34 Weight-loss drugs and how they affect the microbiome01:07:52 Fascinating facts about the microbiome01:09:24 Final thoughts and wrap-up

Revolutionising Liver Health: The Link Between Gut Health, Genetics, and Lifestyle
In this episode, we dive deep into the intricate connections between liver health, gut health, genetic predispositions, and lifestyle factors. Our guest, Gary, a seasoned physician and entrepreneur, shares his extensive experience from pioneering liver disease research in the 90s to running a successful metabolic clinic focused on functional medicine today. Learn about the evolution of understanding fatty liver diseases like NASH and MASH, the impact of processed foods, and the groundbreaking treatments emerging, including the promising effects of GLP-1 therapies. Gary also discusses the pivotal role of a clean diet, exercise, and quality sleep in managing liver health, and the challenges of implementing these changes in a clinical setting. Don't miss this insightful conversation packed with practical advice and forward-thinking approaches to improving liver and overall metabolic health.
00:00 The State of Food Quality in America vs Scotland02:39 Understanding Fatty Liver Disease: Past and Present05:29 Genetic and Environmental Factors in Fatty Liver Disease08:13 The Evolution of MASH: From NASH to Metabolic Health10:46 Emerging Treatments and Medications for Liver Disease13:35 The Role of GLP-1s in Managing Liver Health16:18 The Gut–Liver Connection: A Historical Perspective19:07 Building a Successful Liver Clinic: Insights and Challenges33:52 Understanding Metabolic Health and Genetic Testing35:13 The Importance of Gut Health37:39 Transforming Workplace Wellness Initiatives45:48 The Future of Functional Medicine51:30 Addressing Liver Health and Alcohol Consumption
Takeaways
The quality of food in America is declining, impacting health.
Fatty liver disease is increasingly common, especially among those with higher body mass indexes.
Genetic predisposition plays a significant role in liver disease.
MASH is a critical condition that combines fatty liver with inflammation.
Advancements in GLP-1 medications show promise for treating liver disease.
Gut health is essential for overall wellness and liver health.
Guy Neff's journey reflects a blend of medicine and business acumen.
Building a successful liver clinic requires navigating numerous challenges.
Functional medicine is gaining traction as a holistic approach to health.
Routine testing for liver health is crucial for early detection and intervention.
You must not rely on the information in this video as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of the information in this podcast.

In this episode, Dr. James McIlroy interviews Dr. Ran Blekhman, an associate professor at the University of Chicago, about the microbiome and its role as 'our second genome.'
Dr. Blekhman shares his research findings on the genetic and environmental factors that shape the microbiome, the heritability of microbial genes, and the relationship between the human genome and microbiome. They also discuss Dr. Blekhman's groundbreaking research that analysed over 168,000 samples to understand global microbiome patterns, the influence of early-life microbiome development, and the potential of microbiome-based diagnostics and therapeutics. Tune in for a comprehensive dive into one of the most promising areas of genetic and microbial research.
00:00 Introduction to Dr. R Blackman and the Microbiome01:23 Podcast Growth and Listener Engagement01:56 Starting the Conversation with Dr. Blackman02:04 Exploring the Second Genome02:24 Human Genome vs. Microbiome03:23 Genetic Interactions with the Microbiome04:02 Understanding Microbial Genes and Functions05:40 Heritability and Environmental Factors06:53 Microbiome Diversity and Heritability08:57 Research on Microbiome Heritability17:18 Baboon Model System for Microbiome Studies18:56 Population Scale Microbiome Research25:27 Global Patterns and Data Integration33:36 The Untapped Potential of Microbiome Data35:08 Hypotheses and Discoveries in Microbiome Research36:46 Geographical Variations in Microbiome49:18 Technical Challenges and Methodologies52:20 AI and Machine Learning in Microbiome Studies54:59 Future Directions and Clinical Applications01:00:38 Exploring Early Life Microbiome01:03:30 Conclusion and Further Reading

In this episode of Inside Matters, I'm joined by Dr Johan van Hylckama Vlieg, Chief Scientific Officer at Freya Biosciences. As a global leader in microbiome research, Freya is pioneering innovative approaches to women’s health through biotherapeutics that are rooted in groundbreaking microbiome science.
00:00 Introduction to Dr. Johan van Hylckama Vlieg and Freya Biosciences01:39 The Potential of the Microbiome03:08 Challenges in Translating Microbiome Science to Treatments05:29 The Rise and Fall of Microbiome Hype08:58 Immunotherapy and the Microbiome20:37 Women's Health and the Microbiome35:01 Tools for Measuring Vaginal Dysbiosis35:31 Intervention Studies and Donor Programs36:23 Engraftment and Immune Response37:39 Strain-Level Analysis and Engraftome39:08 Vaginal Microbial Transplantation44:13 Single Strain vs. Consortia47:15 Freya's Development and Future Vision50:04 Lessons from Kaleido01:00:47 The Gates Foundation and Global Health01:03:45 Predictions for the Microbiome Field
A Hidden World with Huge Potential
Dr van Hylckama Vlieg has spent more than 20 years exploring the vast and complex world of the microbiome — the trillions of microbes that live in and on our bodies. These tiny organisms play a huge role in our health. Over time, science has moved from simply identifying these microbes to understanding how they influence our immune system, metabolism and overall wellbeing.
Yet despite this progress, turning those discoveries into real treatments remains a challenge. Dr van Hylckama Vlieg explained that while the science is compelling, the industry needs solid clinical data to bring investors and pharmaceutical companies on board. He sees microbiome-based immunotherapy as a particularly exciting area where transformative breakthroughs could lie ahead.
Why Women’s Health Matters
Freya Biosciences has chosen to focus on the female reproductive tract — a part of the body where the microbiome is less complex than in the gut but just as important. Dr van Hylckama Vlieg spoke about the key role of lactobacilli in maintaining vaginal health. When these helpful bacteria are dominant, they protect against infections and support fertility. When the balance is lost, a state known as dysbiosis, the risks rise significantly.
He also highlighted a wider issue — the historical lack of funding and focus on women’s health. This is something Freya and others in the field are determined to change, and their research is already moving things in the right direction.
A Bold New Treatment: Vaginal Microbiota Transplantation
One of Freya’s most innovative developments is vaginal microbiota transplantation or VMT. Inspired by the success of faecal microbiota transplants for gut health, this approach involves transferring a healthy vaginal microbiome into someone with dysbiosis. Early results are promising. Many women show a successful shift to a healthier microbial state.
Looking ahead, the goal is to leverage the successes of these natural transfers and develop targeted microbial treatments that can be scaled up. This could lead to safe and widely available therapies that restore balance and improve reproductive health.
Challenges and the Road Ahead
Reflecting on his previous experience at Kaleido, another microbiome venture, Dr van Hylckama Vlieg spoke about the need for strong links between science, clinical design and commercial strategy. Though Kaleido faced setbacks, the underlying science remains solid and is being explored by others in the field.
His outlook remains positive. With more trials underway and deeper understanding of how microbiomes influence disease, there is hope that these therapies will move from the lab into everyday medicine. Particularly in areas like immunotherapy, the potential to address root causes rather than just symptoms could be a game-changer.
Final Thoughts
Dr van Hylckama Vlieg’s insights offer a compelling look into a rapidly evolving area of science. As researchers and companies like Freya push forward, the possibilities for transforming healthcare through the microbiome are growing fast. From improving fertility to preventing infections, these tiny organisms may hold the key to better outcomes for millions — especially in areas of health that have long been underserved.

The Gut-Health Revolution | Dr Chris Damman on Nutrition, Microbiome & the Future of Wellness
Dr Chris Damman brings decades of experience from the biotech world and leading global foundations to share his vision for the future of health and nutrition. In this episode, we dive deep into the transformative power of gut health and the emerging science shaping how we eat and live.
Gut Health: Ancient Wisdom Meets Modern ScienceDr Damman explains why gut health is central to well-being, describing it as a “full-circle” return to ancient wisdom where food is medicine. Backed by science, he shows how whole foods can prevent disease and support healthier lifestyles, without being restrictive or unrealistic.
Next-Generation Nutrition: The 4 FsWe explore the idea of “next-generation nutrition” — simple, practical ways to improve your diet with fibre, polyphenols, healthy fats, and fermented foods (the “4 Fs”). These ingredients, found in traditional diets around the world, play a key role in promoting longevity and gut health.
GLP-1 Agonists: A Promising Yet Cautious PathDr Damman discusses the potential of GLP-1 agonists — groundbreaking drugs that help manage appetite, weight, and blood sugar. While powerful, he emphasises the importance of pairing them with real dietary change to avoid over-reliance.
Weed, Seed, and Feed: A Gut Health StrategyUsing the analogy of gardening, Dr Damman breaks down how to support your microbiome: weed out the harmful bacteria, seed the good ones, and feed them with the right foods. This holistic model offers a sustainable approach to digestive health.
Fermented Foods & ProbioticsWe also cover the role of fermented foods as natural sources of probiotics and why they may be more effective than many commercial supplements. These foods are vital for balancing the gut and reducing inflammation.
The Future: Nutrition Tech & Smarter ChoicesDr Damman is now focused on innovation, developing a smartphone app that helps people make smarter food choices by understanding nutritional quality at a glance. His work blends science and technology to make healthy eating both accessible and personalised.
ConclusionDr Damman’s insights are a refreshing mix of practical advice and scientific depth. From diet to digital tools, he shows how we can all take charge of our gut health and live longer, healthier lives. Look out for his upcoming book and app, designed to change the way we think about food.
 
Chapters:00:00 – Introduction to Dr Chris Damman01:36 – What is Next-Generation Nutrition?05:01 – How the Microbiome Journey Began10:20 – Malnutrition and the Four Fs17:59 – The Truth About Ultra-Processed Foods23:22 – GLP-1 Agonists: Are They a Game Changer?28:45 – The Future of Nutrition and Health35:49 – Smarter Choices with Nutrient Profiling Tech40:38 – How to Balance 'Red' Foods in Your Diet42:11 – Healthier Baking: Tips That Work43:25 – Personalised Diets for Your Microbiome46:12 – Understanding FODMAPs and Gut Symptoms51:51 – Microbiome Therapeutics and Supplements01:01:38 – What’s Next for FMT (Faecal Microbiota Transplantation)?01:05:00 – Gut Health Technology on the Horizon01:10:55 – Final Thoughts and Takeaways

In this episode of Inside Matters, Dr James McIlroy is joined by Professor Yan Yiannakou to discuss the developments in IBS treatment.
Irritable bowel syndrome (IBS) is often brushed off as little more than an inconvenience. But in a recent conversation between Dr James McIlroy and Professor Yan Yiannakou, a consultant gastroenterologist with decades of experience, it’s clear that IBS is far more serious than many realise. Their discussion sheds light on the true impact of IBS and the exciting developments in its treatment.
IBS: A Closer Look
Affecting around 10–15% of the population, IBS can be life-altering for some. Beyond the discomfort, it can seriously disrupt work, relationships, self-confidence, and mental health. Historically, because there was little visible evidence of physical disease, IBS was wrongly considered a psychological condition. Thankfully, this outdated view is changing. New research highlights real physiological changes in the gut, such as immune activation and heightened sensitivity, helping to validate patients’ experiences.
Recognising the Symptoms
Professor Yiannakou explains that IBS typically involves abdominal pain, changes in bowel habits, bloating, and excess wind. Previously labelled a “syndrome” because its causes weren’t well understood, IBS is now recognised as a real disease linked to changes in the gut microbiome and immune system. Symptoms can vary from mild discomfort to severe, debilitating pain that significantly affects daily life.
Breaking Down Misconceptions
A key part of the conversation tackles the myth that IBS is “all in the mind.” While stress can worsen symptoms, it is not the root cause. Dismissing IBS as purely psychological can deepen patients’ distress and delay proper care. Professor Yiannakou stresses the importance of treating IBS as the genuine, physical condition it is.
What Causes IBS?
Although the exact causes are still being explored, IBS often develops after a major gut infection, which can disrupt the gut’s immune system. Treatments are now moving beyond simply managing symptoms like constipation or diarrhoea, with more focus on addressing underlying causes, particularly gut microbiome imbalances.
Hope for the Future
Research into the microbiome’s role in IBS is opening up new treatment options. Early trials of microbiome-based therapies show promising results, but more work is needed to bring these breakthroughs into everyday clinical practice.
Final Thoughts
Professor Yiannakou’s insights highlight the urgent need for better recognition and treatment of IBS. Dispelling outdated myths and focusing on the true physiological causes of the condition offers real hope for those living with IBS. As research continues, the future looks brighter for more effective, lasting treatments.
The conversation touches on everything from genetic influences on obesity and the challenges of sustained weight loss, to the exciting potential of GLP-1 drugs and next-generation probiotics. There’s also a fascinating look at how the microbiome might act as both a diagnostic and therapeutic tool in future medicine.
Finally, Max shares highlights from his book The Power of Hormones, which brings together history, science, and practical advice for anyone curious about how hormones and the microbiome shape our lives.
This episode offers an insightful look at where cutting-edge science meets real-world potential—and why the microbiome could be the key to a healthier future.
Timestamps:
00:00 Introduction to Professor Yan Yau and IBS01:02 Understanding the Impact of IBS02:19 Symptoms and Diagnosis of IBS04:41 Physiological Causes of IBS06:29 Severity and Psychological Impact of IBS09:31 Potential Causes and Triggers of IBS14:22 Current Treatments and Challenges16:30 Future of IBS Treatments and Research40:39 Clinical Trials and Patient Involvement42:32 Conclusion and Final Thoughts

In this episode of Inside Matters, Dr. James McIlroy sits down with Cory Greenberg, a professional cyclist and founder of Ride4IBD.
Cory shares his inspiring journey from his initial diagnosis of inflammatory bowel disease (IBD) while training as a professional cyclist, to overcoming the challenges posed by the disease. The conversation covers his approach to gut health in the context of athletic performance, insights into training and lifestyle adjustments, and his efforts to raise awareness through Ride for IBD. Listeners will gain valuable insights into how Cory manages his condition, optimises his performance, and aims to inspire others facing similar challenges.
Through his story, Cory emphasises the importance of creating a sustainable lifestyle and offers practical advice for those living with IBD or looking to improve their gut health.
00:00 Introduction to Cory Greenberg and Ride for IBD01:09 Cory's Early Passion for Cycling03:39 Development Programs and Training11:15 Diagnosis and Struggles with IBD15:46 Managing IBD and Returning to Cycling20:04 Diet and Nutrition for Gut Health37:00 Practical Tips for Gut Health41:16 Debunking Social Media Health Myths41:44 Personal Struggles with IBD43:16 Understanding Inflammatory Bowel Disease44:54 Cycling as a Platform for IBD Awareness45:39 The Genesis of Ride for IBD47:13 Building a Global IBD Awareness Movement50:10 Innovative Approaches to IBD Management55:20 The Future of IBD Advocacy and Support59:42 Practical Health and Fitness Tips01:13:32 Connecting with Ride for IBD