The health of your gastrointestinal system is far more important than you may think. Poor gut health can lead to a whole host of multi-systemic symptoms, not just bloating and abdominal pain. The beneficial bacteria that reside in our gut play a crucial role in immune regulation, mental health, brain health, endocrine health, cardiovascular health (Hills et al. 2019) etc. A high diversity of gut bacteria has been associated with optimal health and well being, and a poor diversity has been associated with cancers (Mullar et al. 2014), autoimmunity (Xu et al. 2019) and chronic fatigue syndrome (Szakal et al. 2017). As Hippocrates once said "all disease begins in the gut".
70-80% of our immune system resides in our gut and these cells have a close relationship with the bacteria in our microbiome (Wiertsema et al. 2021). Additionally, 95% of the body's serotonin is produced by bacteria in the gut! (Appleton, 2018). There are approximately 500-1000 species of bacteria residing the gut, most of which are responsible for aiding food digestion, supporting immunity, helping fight infections and synthesising vitamins such as vitamin k (Rowland et al. 2018). Thus, it is crucial to have a healthy gut and microbiome for optimal health.
The intestinal lining in our gut determines which substances can enter the blood stream from the digestive tract. In someone with poor gut health and intestinal permeability, harmful substances may begin to leak through the intestinal wall and into the blood. Intestinal permeability has been linked with conditions such as acne, food sensitivity and autoimmunity (Vanuytel et al. 2021). Thus, it is crucial to work on reversing intestinal permeability for optimal gut health.
What does it look like when someone's gut health is optimal?
Someone with an extremely healthy gut typically moves their bowels 2-3 times per day. The bowel movements should be well formed (not too loose or hard) and dark brown in colour. There should be no foul smell, mucus, blood, undigested food particles or skid marks in a toilet bowl. They would show no signs of mental health difficulties, brain fog, haemorrhoids, acne, excessive gas, indigestion, bloating, pain or inflammation and have good energy/vitality (although these symptoms could also be due to something else). They would not react to any foods and have no difficulty digesting protein, fats and carbohydrates (Hills et al. 2019).
I commonly see patients in my clinic who come to me with gut related symptoms and can't understand why they started randomly a couple of years ago. They claim to have been completely healthy until their symptoms started. However, when I dig a little deeper I usually find they have been consuming a typical western diet for many years (high refined sugar, low fibre, high inflammatory foods, processed foods, alcohol etc), have high stress jobs/relationships, high toxic loads (use conventional products, deodorents etc), have poor sleep, regular antibiotic use, regular recreational drug use, smoke cigarettes, consume large amounts of caffeine, lack exercise/over exercise etc. All of these factors can affect our microbiome, increase inflammation and lead to poor gut health (Satokari, 2020).
So what are the signs of an unhealthy gut?
Gastrointestinal disturbances- bloating, abdominal pain, diarrhoea, constipation, excessive gas/flatulence, heartburn, indigestion, nausea, vomiting or leaving skid marks on a toilet bowl (Menees & Chey, 2018).
Weight loss/gain due to malabsorption, imbalanced blood sugar, inflammation, insulin resistance etc (Davis, 2016)
Poor sleep and chronic fatigue (Szakal et al. 2017)
Skin irritation, break-outs, eczema, acne, dermatitis or psoriasis (Salem et al. 2018).
Autoimmunity (Stewart et al. 2018)
Excessive amounts of food intolerances (Caminero et al. 2019)
Anxiety, depression, bipolar disorder or other mental health difficulties due to poor serotonin production and gut dysbiosis (Rogers et al. 2016)
Trouble concentrating, brain fog, poor memory, mood swings or migraines (Arzani et al. 2020)
Sugar cravings (Alcock et al. 2014)
Respiratory allergies, food allergies or skin allergies (Pascal et al. 2018)
Now that we have identified the symptoms of an unhealthy gut, it's time to take a look at some of the things you can do to improve gut health and reduce associated symptoms.
1. Eat a nutrient dense, organic diet
Eating organic foods minimises pesticide exposure. This is important because pesticides can be harmful to the gut and induce inflammation (Gama et al. 2022). Include plenty of fibre rich foods such beans, lentils, avocados, broccoli, berries, whole grains and apples to feed the beneficial bacteria in your gut (Cronin et al. 2021) and nutrient dense foods such as spinach, blueberries, kale and broccoli to improve general gut health (Childs et al. 2019).
2. Avoid alcohol, coffee, energy drinks, processed inflammatory foods and increase anti-inflammatory foods
When frequently consumed, alcohol and the metabolites of alcohol can overwhelm the gut and liver and lead to significant damage. Alcohol increases intestinal inflammation, which further exacerbates organ damage and results in multi-systemic symptoms. Recent studies have proven that frequent alcohol consumption can lead to gut dysbiosis, pathogenic bacteria overgrowth and excessive inflammation (Bishehsari et al. 2017).
In recent studies, coffee has reduced basal lower oesophageal sphincter pressure and contributed to heartburn and GERD. Coffee also has the potential to increase dyspepsia (pain, heartburn, eructation, poor digestion, nausea and gas), gastritis, ulcer formation and inflammation (Nehlig, 2022). Additionally, energy drinks have been shown to reduce the diversity, gene expression and activity of beneficial gut bacteria. Energy drinks have also been linked with atrophic gastritis and gastric intestinal metaplasia (Garg et al. 2020).
Cleaning up your diet and removing aggravating, inflammatory foods such as refined sugar, gluten (bread, pasta, pizza, cereals), damaged oils (sunflower oil, fried foods, margarine), junk food/processed foods and refined grains is crucial when taking the first step to improving gut health. These foods are detrimental to the beneficial bacteria in your gut and over-consumption can lead to dysbiosis (imbalance) and inflammation (Kang et al. 2023).
Your main focus should be on increasing nutrient dense, anti-inflammatory foods such as extra virgin olive oil, nuts, oily fish (salmon, mackerel, sardines etc), berries, spinach, kale, green tea, avocado, turmeric, cherries and dark chocolate. Try and include at least 3-4 portions of different coloured vegetables per day, whole grains, organic meat/poultry, vegetarian protein e.g beans and chickpeas and 1-2 portions of fruit.
3. Drink plenty of water, including herbal teas
It's crucial to drink enough fluids and remain hydrated so that your body can optimally clear toxins. When dehydrated, body cells under function and stools become harder to pass. Constipation induced by dehydration allows toxins to fester in the digestive tract and get re-circulated (CNM, 2023). Furthermore, to break down foods in the small intestine, fluid is required to transport the acids and enzymes that break them down. Without adequate hydration, digestion and gut health may be poor (Sensoy, 2021).
4. Take probiotics and prebiotics in food or supplement form and minimise antibiotic exposure
Probiotic foods such as saukraut, kimchi, kombucha, kefir and yoghurt produce live beneficial bacteria to help repopulate your microbiome. Additionally, raw organic foods such as apples and carrots have significant levels of beneficial bacteria on their skin, which should be consumed frequently (Wassermann et al. 2019). If you still feel like you need help balancing your gut microbiome, supplementing with probiotics is a great addition to a healthy diet. Make sure you work with a naturopath to find a good quality probiotic that is specific for your needs.
Prebiotics feed the beneficial bacteria in your gut to help them proliferate and thrive. Prebiotic foods include artichoke, asparagus, onions, raw garlic and dandelion greens (CNM, 2023). It is crucial to consume prebiotic foods alongside probiotic foods/supplementation so that you have a greater chance of successful repopulation. If necessary, prebiotic supplements can be taken.
Avoiding unnecessary use of antibiotics is crucial. Broad spectrum antibiotics attack all bacteria, good and bad. This means that although the bad bacteria you are trying to kill off is being fought, the good bacteria in your microbiome are also being destroyed. Frequent antibiotic use can lead to reduced gut microbiota diversity and dysbiosis (Dubourg et al. 2014). If you must take antibiotics, make sure you also take probiotics at least 2 hours away from the antibiotics to help prevent dysbiosis.
5. Meditate daily for at least 5-30 minutes
In a recent study, it was found that deep meditation performed over a prolonged period of time helps to regulate gut microbiome homeostasis and positively affects physical health (Sun et al. 2022). Furthermore, daily meditation has been shown to aid food digestion, increase immunity and improve mental health (Househam et al. 2017).
Considering stress hormones and inflammation affect the gut microbiome, practising meditation daily helps to balance stress hormones, suppress gastrointestinal inflammation and maintain a healthy gut-barrier function (Black & Slavich, 2016).
6. Perform regular bowel and liver cleanses
Due to the toxic world we are now living in and inflammatory western diets, our liver's and bowels have become over burdened with toxins. These toxins are extremely inflammatory and damaging to the gut (An et al. 2022). When constipated and detoxification pathways are not functioning optimally, our bowels can become over loaded with toxins that damage our microbiota and create inflammation (Zhao & Yu, 2016).
Bowel cleanses should be performed at least twice a year to eliminate toxin build-up and ensure healthy bowel function. This can be done using herbs such as Aloe vera, Cascara sagrada, Burdock root and Psyllium husk.
Liver cleanses should also be performed at least 1-2 times per year to ensure optimal detoxification and toxin removal. Herbs such as Dandelion root, Nettle, Milk thistle and Artichoke can be used for this, alongside naturopathic detox protocols involving celery, apples, garlic, lemons and olive oil.
Please note, it is important to perform bowel and liver cleanses under the supervision of a naturopath or herbalist.
7. Eat bitter foods or herbs before every meal
Bitter foods/herbs stimulate stomach acid production and support liver function. The bitter flavour causes your mouth and gastrointestinal organs to release bile and enzymes that help break down food in your stomach and small intestine (Rezaie et al. 2021). Optimal digestion is crucial for good gut health as it prevents food fermentation, gut dysbiosis and inflammation!
Bitter foods such as dandelion greens, watercress, chicory and rocket have also been shown to increase nutrient absorption, minimise sugar cravings, stimulate immune function and improve glycaemic control (Rezaie et al. 2021).
In a recent study, bitter herbs such as Berberine and Naringenin demonstrated extremely anti-inflammatory activities by modulating cytokine release. Thus, bitter herbs have the ability to improve gut health by reducing inflammation (Lin & Lin, 2011).
8. Supplements and herbal medicine
When gut health is poor and the intestinal barrier has been damaged, supplements and herbal medicine can be a great way to heal the gut and improve health. Supplements such as zinc, L-glutamine, collagen, omega-3, vitamin D, DGL, Curcumin, Berberine and probiotics have all shown promise in improving intestinal permeability and reducing inflammation (Camilleri, 2019).
Specific herbs have been used for thousands of years to improve gut health. Ginger is used to alleviate nausea, stimulate bile production and improve gastrointestinal health (Zhang et al. 2020). Turmeric is high in anti-oxidant and anti-inflammatory phytochemicals which help to reduce inflammation, repair oxidative damage contributing to leaky gut and improve microbiome health (Peterson et al. 2019). Additionally, slippery elm has a positive influence on the gut microbiota and can improve colonic function, reduce inflammation and protect from infection (Peterson et al. 2018).
It is vital to heal and repair gut lining damage by increasing mucilaginous foods such as flaxseed and chia seed pudding, and mucilaginous herbs such as slippery elm, marshmallow root and aloe vera. Herbs should be taken under the supervision of a naturopath or herbalist.
9. Manage stress and toxic relationships
The gastrointestinal system is particularly impacted by stress. This may manifest as symptoms such as reflux, indigestion, nausea, diarrhoea, constipation, vomiting, gastritis or abdominal pain. High stress levels can alter gut-brain interactions via the gut-brain axis, and lead to the development of gastrointestinal inflammation, food sensitivities, peptic ulcer and GORD. Chronic stress can alter gastrointestinal motility, increase visceral perception, change gastrointestinal enzyme secretion, increase intestinal permeability and negatively impact the gut microbiome (Konturek et al. 2011).
Toxic relationships are also a massive risk factor for poor gut health. A recent study confirmed that those in toxic relationships who do not handle arguments well are more likely to suffer with intestinal permeability and gastric inflammation (ScienceDaily, 2018). It might be time to re-evaluate if your personal relationships are negatively affecting your health!
Managing chronic stress through meditation, reducing work hours, changing job, leaving a toxic relationship, seeing a counsellor, journalling, taking more self-care time, reading, taking candle lit baths, taking regular breaks, going on holiday often, avoiding inflammatory foods, frequently connecting with friends etc may be extremely beneficial for optimal gut and overall health!
In German New Medicine, the study of emotions and pathology, gastrointestinal pathology is commonly associated with situations that cannot be digested - indigestible conflict (Lax, 2021). Maybe it's time to think about where in your life are you feeling heavy, weighed down or overwhelmed and what situations you are having a hard time getting over (e.g. a break-up). Getting help from a GNM practitioner, identifying the indigestible conflict and healing from it can significantly improve your gut health!
10. Increase low intensity exercise and reduce high intensity exercise/over-exercising
Exercise promotes the growth of beneficial gut bacteria, enhances microbiota diversity, modulates mucosal immunity and improves intestinal permeability (Monda et al. 2017). However, the type of exercise you perform whilst improving gut health is crucial. Studies have suggested that frequent high intensity exercise such as HIIT, weight lifting and sprinting can lead to increased gastrointestinal damage, endotoxaemia and intestinal permeability (Gnutzmann et al. 2022). Whereas, low intensity exercise such as yoga, pilates and walking have been shown to reduce transient stool time and thus the contact time between pathogens and the gut mucosal layer (Monda et al. 2017).
Low intensity exercise has been shown to reduce gastric inflammation and intestinal permeability as well as positively influence the gut microbiota. On the other hand, intensive exercise has been shown to increase intestinal permeability, decrease gut mucus thickness, show more potential for pathogens to enter the blood stream and increase cortisol and inflammation (Clauss et al. 2021). Similarly, over-exercising increases the risk of intestinal permeability, compromised gut-barrier function and pathogenic bacteria overgrowth (Monda et al. 2017).
Although high intensity exercise/over-exercising is not good for an unhealthy gut, low intensity exercise is significantly beneficial. Exercising 3-5x per week for 30-60 minutes has been shown to increase immunity, digestion and mood (Silveira et al. 2021).
11. Fasting
Fasting is a great way to give your digestive system a break so that it can rejuvenate/heal itself and remove toxins that are contributing to pathology (CNM, 2023). Fasting improves blood glucose regulation, increases energy, improves digestive function and nutrient absorption. Furthermore, fasting has been shown to improve microbiota diversity. Gut microbiota fermentation products such as lactate and acetate increase when an individual is fasting (Karakan, 2019).
There are many different types of fasting, this includes:
Time restricted eating (16/8 method)- only eating for 8 hours of the day and fasting for 16
Fasting twice a week (5:2 method)- eating normally for 5 days and then fasting for 5
Alternative day fasting
24 hour fasts
Water fasts
Dry fasts
Juice fasts
Extended period fasts (2+ weeks)
Please work with alongside a naturopath or nutritionist to identify if a fast is suitable for you and which type.
12. Get good quality sleep
Getting a good nights sleep is important for so many aspects of health including cardiovascular and brain health. However, lack of sleep/poor quality sleep also negatively affects the gastrointestinal system. Recent studies have shown that sleep deprivation induces changes in gut microbiome composition and diversity, as well as increasing inflammatory cytokines that damage the gut (Smith et al. 2019).
Getting a lack of sleep can also increase cortisol and stress levels, which negatively impact the gut and can lead to symptoms such as bloating and stomach pain (Hirotsu et al. 2015). Furthermore, a lack of sleep can affect your food choices, and in turn, your microbiota. When the body is sleep deprived, we usually crave and reach for more sugary foods and drinks to give us that extra bit of energy, however, this can be extremely damaging for an already inflamed gut (Daza et al. 2020).
For children aged 3-17, getting 8-12 hours per night is optimal for well-being. Adults aged 18+ should aim for 7-9 hours of undisturbed sleep per night to improve gastrointestinal and overall health (Chaput et al. 2018).
13. Improve eating hygiene and habits
Before we eat, it is crucial to stimulate a good cephalic response. Cephalic phase responses are conditioned anticipatory physiological responses to food cues. They occur before we eat to help us produce saliva and other enzymes to help break food down (Lasschuijt et al. 2020). When we eat without triggering a cephalic response, we may find that digestion and gut health can become compromised. Cephalic responses are triggered by smelling food, being present with food before eating, chewing food slowly, cooking food, being in a calm environment before eating and imagining eating the food/tasting the flavours before you do.
It is important to chew food slowly until it is liquified. The first stage of carbohydrate digestion is in our mouth, and it is crucial to let the enzymes take action considering carbohydrates are not broken down in the stomach (Patricia & Dhamoon, 2023). Furthermore, avoiding screens, working and eating on the go is vital. Being preoccupied distracts us from the food we are eating and thus digestion becomes compromised.
Good eating hygiene looks like:
Cooking your food from scratch
Smelling the food as it is cooking and being present
Being grateful for the food you are about to eat
Imagining the food and flavours before you eat it
Sitting down in a quiet room with no distractions and focusing solely on your food
Doing some box breathing before eating to make sure you are in a state of rest and digest
Chewing each mouthful until it is liquified
Avoiding water with meals so as not to dilute your stomach acid (liquids should be consumed 1 hour away from meals)
Having bitter foods at the start of each meal to stimulate stomach acid and digestion.
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