There's been so much written about digestion lately, I've hesitated to add my voice to the noise, lest I provoke the often angry opinions of the masses, but recently something shifted my perspective on this.
I was speaking with a group of women about digestion and elimination diets, sharing the same simple truths I do with my clients, and several of the women messaged me later to tell me how freeing those nuggets of information were. Honestly, their words caught me off guard. Of all the things we'd discussed that evening, I was surprised it was the two cents about digestion that really helped these women.
I think this speaks to a couple things. One: our culture is hyper-focused on digestion, the gut micro biome and the role it plays in our overall health. It reminds me of the early days of nutrition science, researchers discovered the presence of vitamins and minerals in food, and immediately culture started marketing the vitamins in food as opposed the the food itself, claiming specific vitamins were the panacea to all health ailments. Now, we've discovered the intricate and amazing world of gut health and we're making it the answer to EVERYTHING. Don't get me wrong--it is awesome learning about the gut brain axis and the interplay of gut bacteria and health, and I love nerding out as much as the next guy--but let's keep a level head about it.
The second revelation I had after hearing from the women in the group about how freeing our little food and digestion discussion was---was this: we have FREAKED people out when it comes to their digestion. We're pathologizing every single symptom from normal bloating, to belching, gas and other little bits of indigestion, these once every day occurrences are now reasons to cut out half of what we're eating and take 10 different supplements.
On top of this, we may actually be causing digestive ailments with our efforts to prevent them. Elimination diets for example, may cause a decrease in the number and diversity of our gut bacteria and the enzymes we produce, making it harder and harder to digest food the more we eliminate it (1,2). You can read more about this phenomenon in this excellent post by Omni Counseling and Nutrition.
This becomes a vicious cycle when we follow popular fad programs like Whole 30 that asks us to eliminate foods based on exaggerated research as opposed to individual experience and medical advice. At the end of this particular protocol we're asked to add foods back in and make note of any food intolerance symptoms. The sad fact is that many people who never had a wheat, or dairy, or legume, or oil, or whatever else intolerance beforehand may notice difficulty with these foods after the 30 day elimination period and chalk it up to a forever intolerance. In reality, this might be due in large part to the fact that the body has reduced the bacteria and enzymes responsible for digesting those foods. In other words--the old "if you don't use it, you lose it" seems to apply here.
Now, hear me, I am not discounting the fact that many do have food intolerances and digestive ailments. I am not even discounting the fact that the prevalence of conditions like Celiac, IBS, Chron's and other GI disorders and intolerances have increased. Rather, I think the things we blame for these conditions and the way we approach treating them leaves a lot to be desired. If you have these conditions now, I am a big advocate of getting one-on-one help from a physician specializing in digestion, and if you need dietary help, from a non-diet dietitian who will approach your diet with respect and realism as opposed to hacking away at it with an axe.
In the mean time, here are some no nonsense ways you can promote good digestion without extreme restriction, or 1000's of dollars spent on supplements. I hope these are helpful for some of you and dare I say, freeing!
Eliminate and cope with stress
Excess stress both physical and psychological, that isn't properly dealt with is arguably the number one precursor to many major diseases, and gut dysfunction is certainly no exception. Functional medicine is the idea that if we need to find and eliminate the root cause of a disease, and while I agree with this premise I think this form of medicine sometimes goes wrong when it doesn't go far enough to the deepest cause: stress. Instead, functional medicine tends to focus on the foods that seem to be causing symptoms of inflammation, but may not be the root cause. Let me give you an example. Gluten.
Gluten is a protein found in wheat, barley and rye. We've been eating it for eons!! Yet we have an increased fear and intolerance to it all of the sudden. People with the most extreme intolerance to gluten have what's called Celiac disease. In response to eating gluten containing foods, these individuals produce an abnormally large amount of the protein zonulin which modulates gut permeability, creating "leaky gut," which results in things getting into the blood from the gut that normally wouldn't go there. In response, the immune system goes into full attack mode on our own gut and as a result we have the destructive painful symptoms that characterize Celiac Disease.
But stick with me here, studies have found that even when those with Celiac disease completely avoid gluten they still have 30 times as much zonulin as non-celiacs do who ARE eating gluten (3). In other words, something other than gluten is responsible for producing excess zonulin and the resultant symptoms. Some have found connections between the population of gut bacteria and the gut permeability via production of zonulin (4).
We know that psychological stress has an effect on gut bacteria and gut bacteria have an effect on psychological stress. In fact, interesting enough, most people with a normal healthy immune system only experience a very slight increase in zonulin with gluten consumption, an increase that does not cause any problems in the body whatsoever. What seems to be happening, is that when we are chronically stressed out, we compromise the health of our immune system and several other functions of our body. In connection with this our gut bacteria are negatively effected and so is our digestion of food. We do not fully understand the mechanisms of these things, however one thing remains clear - reducing stress and finding ways to cope with it are at the top of the chain or the root of the tree-whichever metaphor suits your taste better.
So how can we decrease chronic stress and promote good digestive health? The options are endless, but I can think of a few off the top of my head: sleep more, stop restricting food intake, exercise moderately most days and vigorously sparingly, Drink water, Say no to busy, reduce psychological stress through coping mechanisms (and by making peace with food), see a mental health counselor, find out what brings you joy and do it---the list goes on and on. Truly, this is a very individual process and if you need help finding what works for you, I'd encourage you to reach out! I have also written in detail about this point before.
Like the saying goes, we're "missing the forest for the trees" when we neglect overall stress reduction for super specific food recommendations.
Increase dietary variety
That's not to say food doesn't play a role in good digestion. Actually food is very important when it comes to developing a healthy gut bacteria population and the ability to digest and tolerate more foods.
Possibly the best way to improve our own gut health and the health of our children's guts (other than reducing stress) is to eat a variety of foods. In particular, eating a variety of plant based foods from whole grains, beans, nuts, seeds, vegetables and fruit along with a variety of omega three rich protein from grass-fed meat, poultry and eggs and fatty fish have been shown to promote a diverse gut population (1, 2). On top of this, if you like eating dairy food (who doesn't) and you want to keep digesting it well and benefit from the health promoting nutrients in it, you should (shocker) include dairy too!
In today's culture we're told to eliminate just about everything and take a probiotic, but the truth is probiotics are not shown to be nearly as effective at promoting a good gut microbiome as eating a variety of food.
In children, who develop most of their gut population by the age of three, it's even more imperative that we expose them to a variety of the above foods, so their set up for all-star digestion the rest of their lives (5).
If you've been eliminating food after food and still aren't seeing improvements in gut symptoms, maybe it's time to try adding food groups back in slowly, in order to give your gut bugs time to adapt and your body the chance to produce the enzymes it needs to digest those foods. Ultimately the decision is up to you and that's the beauty of intuitive eating!
Consume a moderate amount of fiber from plant-based foods
Fiber! It's our gut bugs' favorite fuel. Too little and they get unhappy and out of balance. Too much and they go on feeding frenzy creating uncomfortable feelings of bloating and gas. The key here is to increase fiber slowly if you currently eat very little. Preferably we'd increase the fiber we eat from foods i.e. whole grains, nuts, seeds, beans/legumes, fruits and vegetables and not just supplements.
This fiber, especially that found in whole grains feeds the gut bacteria which in turn produces these magical little guys called Short Chain Fatty Acids (SCFAs for short). SCFAs nourish and protect the cells of our gut wall. And just like us, a well fed gut wall is a happy and healthy one.
SCFA production may be positively associated with lower rates of colorectal cancer, better blood sugar control in and decreased gut inflammation, although associations and mechanisms are still being studied (6).
However with all the good things we know about whole grains, fruits, veggies, nuts, seeds and legumes, it can't hurt to include them!
On the flip side, if you're eating large amounts of plant material with limited fat or protein, and you have some of the digestive concerns mentioned above and/or diarrhea of indigestion it may be wise to add in fat and protein and decrease fiber by replacing whole food options with cooked or refined varieties.
Use antibiotics responsibly and replenish afterwards
Finally (although definitely not the last point that could be made on digestion) let's talk about antibiotics and supplements. Antibiotics do appear to have a negative effect on our gut health. However, not negative enough to eradicate their use. We NEED antibiotics in order to fight off deadly and debilitating bacterial infections, however we should use them responsibly. This starts with prescribing physicians who have started significantly reducing unnecessary antibiotic use especially among children. If you feel that your condition may be viral and may not require an antibiotic speak with your physician about it, don't just blindly go with it if you have questions.
Once it's been determined that an antibiotic is the best course of action, we need to take it until our prescription is gone in order to prevent resistant bacteria. Afterwards, it's important to repopulate our gut with good bacteria. Here is where over the counter probiotics and fermented foods have been shown to be the most helpful, in compromised guts. So while probiotics aren't necessary for everyone, they may be helpful in certain situations where your gut bacteria have been compromised or where your child has lost out on an opportunity for gut bacteria development, as in cesarian section vs. vaginal births and formula feeding vs. breastfeeding (5).
Above all this, we have to eat the way that we see fit for our health, happiness and overall lifestyle. Certainly food has a role in our gut health, but if this article has done anything for you, I hope it's helped you realize that food is not the sole answer nor the root of our digestive problems. The best thing you can do is care for your body the way you know how and keep a moderate perspective on food and gut health information. Do what brings you the most peace, food freedom and health.
Until next time, happy fueling and stay nourished, body, mind and spirit :)
- Singh, R. Chang, H., et al. (2017).Influence of diet on the gut microbiome and implications for human health. Journal of Translational Medicine. 15(73),
- Bird, A., Conlon, M. (2015). The Impact of Diet and Lifestyle on Gut Microbiota and Human Health. Nutrients 17(1), 17-44.
- Sandro. D., et.al (2006) Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines, Scandinavian Journal of Gastroenterology,41:4, 408-419, DOI: 10.1080/00365520500235334
- Arrieta, M. C., Bistritz, L., & Meddings, J. B. (2006). Alterations in intestinal permeability. Gut, 55(10), 1512–1520. http://doi.org/10.1136/gut.2005.085373.
- Enders, G. (2016) Gut: The Inside Story of Our Body's most underrated organ. Vancouver/Berkley: Greystone Books.
- Ri0s-Covain, D., et. al. (2016). Intestinal Short Chain Fatty Acids and the Link with Diet and Human Health. Front. Microbiol. https://doi.org/10.3389/fmicb.2016.00185.