Can you actually eat to improve your gut health?
Let's talk about what makes a healthy "gut".
Announcement: Kansas City women, join me for a half-day women’s health event in Olathe on January 11th hosted by Grace Fitness. I’m giving a presentation on nutrition, hormones and women’s wellness. Register here.
I remember first realizing “gut health” had made it mainstream when NFL reporter Erin Andrews started selling probiotics. It made me realize that gut health wasn’t just something I was talking about with clients. Can you believe that ad was from 2014? Since then, influencers and media, in general, have told us all the many ways (i.e. products, supplements, drinks, diets…) we can “improve our gut health.”
But, what even is gut health, and can we really eat to make our gut “healthier”?
First off, there’s no formal definition of “gut health.” In general, it refers to the health and proper function of the digestive tract (the tube that starts in the mouth and ends at the colon). To me, having a “healthy gut” generally means having smooth and regular digestion (daily, formed BMs), adequate nutrient absorption and production, and few or no digestive symptoms like irregularity, bloating, reflux, gas, urgency, or pain. Gut health would also generally refer to a diverse microbiome—a term I bet you’ve heard before but maybe aren’t exactly sure its meaning.
What’s the microbiome?
The gut microbiome is comprised of the organisms—mostly bacteria (99%)—living throughout the intestinal tract. It mostly refers to the colon because a large amount of these organisms live and thrive there.
The gut microbiome can influence our level of inflammation, our immune system, metabolism, blood sugar and insulin sensitivity, skin health, micronutrient absorption, and many other aspects of health.
Research suggests that about 20-60% of our microbiome is influenced by our level of activity and our diet (aka: within our control). About 30% is likely due to being human (our species), our age, sex, and location. The microbiome of someone living in Paris is different than someone living in Mexico City or Atlanta. About 12% is due to our specific genetics. (Fundaro and Hoffman, 2021).
Ultimately, the microbiome is just one piece of the complex puzzle of “gut health,” but clearly it’s an important one.
Most people know when they have digestive problems, while others have been dealing with them for so long that it’s just “normal” for them. So, let’s talk about the signs of digestive disruption.
Signs you may have digestive problems:
Obvious signs of digestive problems
Not having at least 1 daily, formed BM (with clients, I’m working to help them have somewhere between 1-3 formed, daily BMs)
Frequent, urgent diarrhea or loose stools
Frequent bloating, distension, gas, and/or belching
Reflux or “heartburn”
Pain anywhere along the digestive tract
Sneaky signs of digestive problems (of course, these can also be caused by other reasons than problems in the digestive tract)
Skin problems
Bad breath
Allergy symptoms
Anxiety & Depression
Nutrient deficiencies
Fatigue
You may be thinking: “Ok, apparently I have an unhealthy gut!”
Don’t stress, it’s normal to experience some or all of these symptoms occasionally. If you’re dealing with them on a regular basis, you may want to discuss these issues with your doctor(s) and/or a dietician (wink), and if you’ve already done that, then exploring how your diet and lifestyle could help alleviate some of these symptoms might be worth considering.
First off, let’s discuss the basic culprits that can harm gut health.
What hinders gut health?
Taking lots of antibiotics
Long term acid blocking meds like omeprazole, lansoprazole, or esomeprazole (taking these long-term has led to increased risk of bone breaks, heart disease, dementia and nutrient deficiencies).
Infections
High levels of stress
Inactivity
Regular alcohol consumption
Eating a low fiber diet
Eating a diet high in ultra processed foods (I’ve talked about these before when I discussed seed oils and insulin resistance)
So, can you eat for a “healthy gut”?
When we think about eating for a healthy gut, we’re basing that on general dietary components or principles that support a healthy microbiome and healthy, regular digestion. Two major takeaways from this section:
Fiber and a wide variety of plants are the key to fueling a healthy gut microbiota. This is due to the fact that fiber and plant polyphenols are the primary fuel for the microbiome.
Important nuance: This is where my private nutrition practice and newsletter writing can conflict. I work with countless individuals with digestive problems whose symptoms are worsened by eating some of the foods I’ll discuss below—sometimes grains, beans, cruciferous vegetables like broccoli and cauliflower, or others. When someone has digestive conditions, it can be challenging and take some adjustments to incorporate some of these foods.
Dietary components and considerations to support gut health:
Plants: whole fruits, vegetables, whole grains, nuts, seeds, and beans (for those who can tolerate and digest them).
Fiber (including prebiotics): For women, at least 25 g daily and 35 g daily for men.
Color: various colors in the diet provide different polyphenols and antioxidants that serve as fuel for our gut microbiome.
Fermented dairy (for those who can tolerate it): yogurt and kefir can provide healthy probiotics to our digestive tract that have been shown to benefit human health.
Probiotics: probiotics may or may not be helpful. Some research shows certain strains in certain amounts can be beneficial.
Hydration: especially if you have a sluggish digestive tract (may be prone to constipation), you will want to ensure that as you increase fiber, you’re increasing your water/fluid intake.
Minimizing Ultra processed foods (UPFs): avoid eating a lot of foods that are highly processed (UPFs) like cookies, cakes, crackers, candy, soda, etc. Remember, a baby carrot is a processed food, we’re not talking about that.
More isn’t always better: You may be eating plenty of fiber-rich foods, staying hydrated and/or have a wide variety of colors and polyphenols in your diet. Remember that more isn’t always better in these instances. If you drink 80-100 fl oz of water, you aren’t likely to need 120-200 fl oz. Same goes for fiber and fermented dairy.
Supplements: I cover this below where I also talk about probiotics and prebiotics. This section is for paid subscribers.
Personalization: Work with your healthcare professional (doctor and/or dietitian) to figure out what exactly is going on with your digestive tract to know how to improve your “gut health.” As you’ll see with the nuance in the section below and supplements section, there are countless different considerations to make when trying to address issues related to digestive symptoms and disease.
The tricky part about eating for "gut health”.
There isn’t likely one specific way to eat that can make an unequivocal, overall change to “gut health” because “gut health” can refer to a lot of different component parts to make up the whole. In fact, evidence from a systematic review (a big study of high quality studies) suggested that it’s unclear what effect the Mediterranean diet has on the gut microbiota. Now, I don’t read that and think a Mediterranean style diet is unhealthy. In fact, we know that it generally is a great general diet to follow for overall health. However, to me it highlights that it’s challenging to study diets and get a clear understanding of how they impact human health. For better or worse, nutrition is a messy science.
A specific example of why “gut health” is hard to pin down when working with individuals to improve “gut health”: Someone might have both reflux (“heartburn”) and constipation with bloating. Maybe that person increases their daily vegetable intake, and they notice having more frequent BMs, but they continue to have reflux and bloating. Does that mean they have a “healthy gut”? Maybe their gut is healthier because one aspect of their digestion has improved, but overall they may still have problems causing reflux that haven’t been resolved that could be considered an “unhealthy gut”. Also, the average person wouldn’t be able to know the diversity of their intestinal microbiome.
Supplements: What supplements may help with gut function and health?