The Link Between Your Gut and Your Health

One of the biggest buzzwords in nutrition, wellness and overall health discussions is gut health. But what does it actually mean to have a “healthy gut?” As a registered dietitian specialized in gastrointestinal (GI) disorders, I’ve heard and seen it all. The true, the wildly untrue and the downright bizarre. Here I walk you through what the research does and doesn’t say about nutrition and gut health as well as some of the most common gastrointestinal ailments I see in my clinic. That said, I want to be clear that this blog post does NOT supplement traditional medical advice. If you feel that you or someone you love is experiencing these symptoms please seek professional medical care and evaluation.

The Anatomy of the Gastrointestinal Tract and the Role of the Gut Microbiome

Generally speaking, your gastrointestinal tract (GIT) is regarded as a long (and complicated) tube extending from your mouth to your anus. Food travels from our mouths, down our esophagus and into our stomach. There stomach acid and muscular contractions mix our solid food into a liquid (this is known as primary, or mechanical digestion) where it is then emptied into the small intestine. This is where secondary (enzymatic) digestion happens and the nutrients from our food are extracted and absorbed through the intestinal wall into the blood stream. Whatever is not absorbed through the small intestine then makes its way to our large intestine- the colon. Here some vitamins and minerals are absorbed, however largely this is where fecal mass (poop) is formed. 

Now no discussion of the GIT or gut health would be complete without a proper discussion of the gut microbiome. We used to think that the primary role of our colon was to compile and void fecal matter, however research over the last two decades has shown that we have been grossly underestimating the role and importance of the colon. If you’ve never heard of your gut microbiome, it is a rich colony of bacteria living in your colon. Recent research has shown links between microbiome health to everything from cancer to “obesity.” However I urge you to approach claims of this nature (especially when they are coming from supplement brands) with extreme caution. Here is what we know: having a diverse and healthy microbiome supports overall health. While there is some research to support that over/under growths of certain strains of bacteria are link to disease states, this research is by no means cohesive or well understood. At this time there is not sufficient evidence to make any sort of nutrient or supplement recommendations beyond those that are generally known to support a healthy gut (we’ll dive into this more in the next few sections). Any provider, supplement company or website that tells you otherwise is just plain full of-welll you get the idea...

Pre and Probiotics- What are they and do I need to take them? ​

Some of the most frequent questions I get are about pre and probiotics. What’s the difference? Do they work? Which brands are the best? Fear not I have all of the answers! 
Pre and probiotics both function to help support our gut microbiome. I think the easiest way to think of the difference between pre and probiotics is to think of the microbiome as a garden or a farm. What do gardens need to thrive? Well of course you need seeds, but then you also need water, sunlight and soil. Probiotics are the seeds. They are the actual bacterial cultures themselves. They present naturally in many foods such as yogurt, kimchi, Kefir, Kombucha and sauerkraut. They are also available in supplement form (more on this in a minute). Prebiotics are your sunlight, water and soil. They nourish the seeds so that they can grow and thrive. Like probiotics, prebiotics are also available in foods, namely fiber rich vegetables, fruits, nuts and whole grains. Prebiotics are also sold in supplements, both independently and in conjunction with probiotics. Generally the supplemental form of prebiotic is a fiber called inulin. While many people tolerate inulin with no adverse effects, many actually do not tolerate it well. As such my general recommendation is to try and get your prebiotic (fiber) from foods. Similarly most folks don’t have a need to supplement probiotics unless they have specific GI disorders, have had a recent infection or are taking antibiotic medication. If you do choose to supplement, be wary of misleading advertising and false health claims. Many companies try to tote their products’ superiority by claiming they have “more” cultures than their competitors. The thing to keep in mind here is that any probiotic you take will have an order of billions of bacteria per dose. That is going into a colon that has an order of trillions. I.e. whether your probiotic has 3 billion cultures of 5 makes little to no difference in the grand scheme of the microbiome. Similarly many products claim to boost only “good” or “anti-inflammatory” bacteria. As I said earlier, we do not currently know enough about the effects of specific types of bacteria on gut health to make clear recommendations regarding supplements.

Fiber: Friend or Foe?

In a world where low carb is all the rage- high fiber has become a trend in its own right. And while yes, fiber is essential for good gut health, not all fiber is created equally. As I mentioned in our discussion of pre and probiotics, inulin is a fiber commonly added to foods, but also one many individuals do not tolerate. Most “low carb” foods such as tortillas, breads, and cereals have inulin added in. If you tolerate inulin well, this can be a great way to incorporate more fiber into your diet. However if you do not tolerate inulin well, it can lead to GI misery. Similarly increasing your fiber intake drastically can cause GI effects such as bloating, diarrhea and flatulence. 
​
So when we think about our fiber intake we want to think about two things: 1) varying our sources of fiber 2) getting enough, but not too much. Most adults need between 12-15 grams of fiber per 1000 calories in their diet (for more info on how to calculate your calorie needs, check out my YouTube here: https://www.youtube.com/watch?v=IdvUDrnP6vc ). So that leaves most of us with ~25 grams per day. Keep in mind, more is not necessarily better. 
The best way to make sure you are getting adequate fiber is to log your intake into a food tracker such as MyFitnessPal or Loseit for 3-7 days and evaluate your average. If you need to increase, do so slowly. If your average intake is 10 grams per day and you want to increase to 20, start by eating 12 grams per day for one week, then 15 grams per day for one week, then increase to 20. If you notice increased bloating or GI disturbance back down until you are comfortable again. For resources and great ideas for fiber-rich foods, check out this article from Healthline: https://www.healthline.com/nutrition/22-high-fiber-foods. ​

What About Food Sensitivities? ​

We can’t talk about gut health without also talking about food sensitivities. While food sensitivities are in fact a very real phenomenon, they are frequently misunderstood and misdiagnosed. 
​
First, let's distinguish between a food sensitivity and a food allergy. Food (and all) allergies involve your immune system. Essentially your immune system has deemed some part of a particular food as a foreign invader and then recruits all of it’s resources (antibodies, b-cells and t-cells and other leukocytes) to try and remove it. This can result in a host of symptoms including vomiting, diarrhea, rashes, itching and swelling. The only way to confirm a food allergy is with a combination of blood and skin prick testing from your doctor. These tests will measure your antibodies to certain foods, indicating that it is in fact trying to recruit your immune system to attack that food. 

Food sensitivities are very different. There is no immune involvement, i.e. no antibodies, no leukocytes. Food sensitivities result typically when a food is not digested or absorbed properly. Most foods that we eat are intended to be broken down into tiny parts and then absorbed through the wall of the small intestine. What is not absorbed continues down the GIT to the large intestine as waste. However (as you now know), our large intestine is lined with trillions of bacteria waiting to feed on whatever comes their way. Foods such as starches, sugars and even some fats are meant to be digested and absorbed fully, meaning most don’t make it to the large intestine. However if they do, they then serve as a great food source for our microbiome. The problem? In the process of breaking down said food molecules, the intestinal bacteria create a large volume of gas and water, leading to symptoms such as bloating, gas and diarrhea. 

So how do you know if you have a food sensitivity? Well unfortunately, currently there is no diagnostic test for any food sensitivity. That’s right, all of the commercials you see for Everlywell and similar products are simply a marketing scam. (They test for the presence of IgG antibodies, which are different from IgE antibodies produced for food allergies, but indicate nothing about digestion, absorption or “sensitivity”). The only way to identify a food sensitivity is to work with a Registered Dietitian or other health professional through a series of elimination tests to identify any trigger foods. If you have GI symptoms that make you suspect a food allergy or intolerance contact your doctor or dietitian to discuss testing and treatment options.

Could it be Leaky Gut?

If you Google “gut health” you will inevitably find at least one or two links pointing you to a condition called Leaky Gut Syndrome. Leaky gut has been attributed to symptoms such as gas, bloating, indigestion and abdominal pain. It has also been a controversial topic in the conversation surrounding gut health for about a decade. Originally, the theory of leaky gut posited that some individuals suffered from intercellular gaps between intestinal cells, causing the contents of the digestive system to “leak” into the abdominal cavity. More recently clinicians have begun to accept the definition to include a gradual erosion of the intestinal lining, making the GIT more permeable than it should be. While there is some concrete evidence that leaky gut does exist, that data is still very scattered on identifying the actual cause. While it is generally accepted that significant GI diseases such as Celiac, Crohn’s, ulcerative colitis and chemotherapy can result in intestinal damage (i.e. leaky gut), the effects of various dietary factors, stress and lifestyle factors such as alcohol and smoking remain to be understood. In essence- we have no indication at this time that eating or avoiding certain foods causes leaky gut, and we have even less evidence to suggest that doing so can cure it. If you have symptoms similar to that of leaky gut, talk with your healthcare practitioner or dietitian about ​diagnosis and treatment options.

What About IBS?

Irritable bowel syndrome (IBS)  is another commonly diagnosed GI disorder. Those with a diagnosis of IBS have likely undergone testing for many other conditions such as Celiac, Crohn’s, UC and various food allergies. In fact, IBS is the only ICD-10 diagnosis that does not have a known etiology (cause). IBS is truly the presence of GI symptoms such as gas, constipation, diarrhea and bloating, in the absence of a known disease process. As such, treatment and management of IBS can be very difficult. For many folks, stress is a major trigger for IBS symptoms. As such, managing stress through various mental health practices as well as medications targeting the body’s serotonin systems have proven to be quite effective. Other folks have been able to identify food triggers through elimination diets such as the Low FODMAP diet. Given the complexity of this diet and it’s nuance, I strongly urge you to only take it on under the supervision of a registered dietitian or physician familiar with the diet. Trying to go at it alone will likely end in confusion, unnecessary restriction and ultimately more questions than you started with. 

Did you know that about 90% of people with disordered eating patterns also experience GI symptoms?

Just some final food for thought (see what I did there?), about 90% of individuals who report disordered eating patterns such as skipping meals, restricting foods/good groups, binging, purging and various fasting regimens also experience GI symptoms such as gas, bloating, diarrhea and constipation. When we think about how the GIT is supposed to work, it makes logical sense that drastically altering your diet would inevitably change the way your GIT functions. Eating a consistent and balanced diet is extremely important for optimal gut health. However it is something that many of us struggle to attain. Disordered eating has been so normalized by the popular media, that highly restrictive diets such as keto, paleo, juice cleanses and even water fasts are all considered normal in the pursuit of health. In fact they are not healthy at all. Their restrictive nature is very damaging to your mental health, and over time the lack of balance can damage your gut health too. In fact, keto has been linked to several instances of diverticulitis and bowl perforations. Similarly many OTC supplements that claim to “cleanse” your colon will more likely land you in the hospital for severe diarrhea, abdominal pain and dehydration. Some have even been linked to instances of colitis. Not to mention that any restrictive diet almost always leads to binging which of course can overload your GIT and cause discomfort.  If you are struggling to eat in a consistent pattern work with your behavioral health provider or registered dietitian to discuss strategies to get you on a regular and consistent pattern of eating. 

So there you have it- just about everything you could want to know about supporting your gut. Still have questions or looking for personalized recommendations. Head on over to the services and pricing'