Patients often visit a gastroenterology clinic with serious gut issues. Bad gut health could manifest as various symptoms, including bloating, constipation, abdominal pain, diarrhea or inconsistent bowel movements.
Some hear “gut,” and think this term only addresses the stomach. However, for physician assistant Myke Smith, Kaiser Permanente Specialty Center Gastroenterology clinic’s medical director, “gut health” encompasses and impacts the entire digestive system, as food moves from your mouth to your stomach and intestines before exiting the body.
After we swallow food, it moves down the esophagus to the stomach over several hours. The stomach is the body’s first line of defense, killing off many harmful bacteria that could cause illness. Then, it’s processed by the small intestine and through the end of the colon. The gut’s microbiome is an ecosystem of bacteria dwelling within these systems — a complicated mix of good and bad bacteria.
It may be a surprise to learn that other gut-health symptoms include mental effects such as fatigue, brain fog or anxiety. A two-way relationship exists between mental health and gut health, Smith notes. An everyday example might be how your stomach roils before a big test or stressful conversation.
Anxiety and depression can lead to poor gut health due to the release of cortisol and adrenaline. A high-stress day can give some people diarrhea, constipation or gas.
In turn, the symptoms can discourage people from leaving the house, worried about finding a bathroom in time, compounding any depression. The situation can become a self-reinforcing and worsening cycle. The good news? Anti-depressants can sometimes help relieve a person’s GI symptoms.
On the other hand, good gut health can lead to regular, consistent bowel habits, stable weight, good appetite and no nausea and vomiting. Good energy levels and nutrient absorption are typical, with no nutritional deficiencies.
Improving gut health through diet
Improving gut health relies on some expected factors, such as diet. “Diet does play a large role,” Smith says. Diets high in saturated and trans fats can change your microbiome, leaving you with too many unhelpful bacteria. White bread and crackers, unfortunately, offer empty calories that become simple sugars in the gut.
He recommends the Mediterranean diet, which offers “good fats” in nuts, fish, and olive oil, which boost your good bacteria population. It also provides plenty of fiber.
“Fiber is so important that I joke that if everyone got 25-30 grams of fiber daily, I’d be out of a job,” Smith says.
The Mediterranean diet is rich in two sources of fiber. Your body processes soluble fiber into a healthful gel in the gut; soluble fiber is found in barley, oats, beans, and sweet potatoes. Soluble fiber helps create a beneficial environment for your gut microbiome by providing “food” for good bacteria.
Insoluble fiber doesn’t break down the same way but helps food transit through your intestinal system. You can find insoluble fiber in nuts, whole grains, vegetables and fruit with skin on.
Avocados give a BOGO deal — you get soluble and insoluble in one delicious food.
Probiotics provide living bacteria for your gut and are found in the Mediterranean diet’s yogurt and other fermented foods. Smith says that an over-the-counter probiotic capsule can offer an alternative, but the jury’s out on effectiveness. While OTC supplements likely won’t hurt, they can be expensive.
“Taking a probiotic is not going to solve all your problems,” he says. He suggests focusing first on more affordable changes, including improving diet, sleep, and resilience to stress.
Improving gut health through lifestyle changes
Gut health improvement can also rely on increasing your water intake, regular exercise and sleep hygiene.
It may surprise some to know that sleep impacts digestion. “When you’re sleeping, you have increased blood flow to the digestive system. That’s why often people have a bowel movement soon after waking up,” Smith says. Sleep also helps regulate cortisol, a stress hormone impacting gut function. “When you’re sleeping, a lot of work is being done,” he says.
Exercise also impacts gut health in unusual ways. When we walk, run, or get other exercise blood flow is reduced to the digestive system. But as soon as we stop that exercise, blood rushes through the digestive system, Smith notes. Patients with constipation should try to get 150 minutes of exercise, or around 30 minutes per day, five days per week.
Doing so can improve food’s movement through the system, increase nutrient absorption, and improve your gut health.
Gut health and colon cancer
By getting regular exercise, a good night’s sleep and limiting your diet’s saturated fat intake, you’ll achieve multiple goals simultaneously, including lowering your risk of colon cancer. Recent research suggests that regular yogurt consumption at least twice weekly may reduce colon cancer risk, changing the gut microbiome to resist aggressive tumor growth.
There isn’t yet strong data to support any causative relationship between poor gut health and colon cancer — other correlations are strong, however. For example, if you have a first-degree relative with colon cancer.
Patients visiting the clinic may later be diagnosed with inflammatory bowel syndrome, colitis, constipation and bacterial overgrowth in the small intestine. However, if someone with recent gastrointestinal or bowel symptoms hasn’t recently had a colonoscopy or examination of the colon, that’s the first step.
“Colon cancer can present vaguely,” Smith says, and is increasingly a serious health concern for those under age 50. Health care providers also rule out thyroid dysfunction and celiac disease and look for signs of nutrient malabsorption.
Then, providers focus on home remedies, which include the diet and lifestyle changes outlined earlier. It’s a process of elimination, so to speak. One that must account for a variety of factors in this wonderfully complex and efficient system.
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