The gut plays a crucial role in health and well-being, largely impacting nearly every other system in the body. It’s usually pretty evident when someone struggles with their gut health because there are many symptoms that directly impact digestion. What many don’t know is how intertwined other health issues are with the status of the gut. Most conventional doctors don’t consider the state of their patient’s gut while treating or managing conditions like diabetes, cancer, autoimmune diseases, allergies and mental health diagnosis. In my Nutritional Therapy practice I see how by starting with supporting my client’s digestive system, a domino effect of healing often takes place. This could be clients suffering with direct gut symptoms like stomach pain, bloating, acid reflux and constipation, in addition to helping clients who come to me because they have trouble sleeping, deal with anxiety, struggle with low energy, want to support their heart health, have irregular periods or can’t seem to lose weight no matter what they try. With that being said, the gut is the powerhouse to a person’s wellbeing as the mitochondria is the powerhouse to the cell.
Let’s start by understanding how big the gut actually is and what organs are included. The surface area of the intestines themselves make up the size of a tennis court– that’s huge! To put this into perspective, the gut contains 10x the amount of cells compared to the rest of the body– meaning we are only 1% human, 99% of us is bacteria. Aside from digesting food, absorbing nutrients from food and eliminating waste, the digestive tract houses the gut microbiota– bacteria that produce 75% of your neurotransmitters (happy brain chemicals) and create 70% of your body’s immune system. Most importantly, the digestive system acts as a barrier between you and the outside world via the food you ingest.
The stages of digestion:
Before we get started I just have to say that writing this reminds me of the show from growing up, The Magic School Bus. Let’s pretend we are with Miss Frizzle and her class, joining them on an adventure taking a tour of the digestive system!
Photo retrieved from: https://www.amazon.com/Magic-School-Inside-Human-Body/dp/0590414275
Digestion is a north to south process, meaning the process actually starts in the brain and ends at the anus. Each stage of digestion is critical for optimal wellness and when even one part is off balanced it can cause consequences down the line. The body converts starches to glucose, fat to fatty acids and protein to amino acids. These nutrients along with enzymes, vitamins and minerals absorb into our cells to use as energy for healing and growth.
Starting with the cephalic phase of digestion, the brain and the mouth take the lead. By thinking about, smelling and tasting food the brain stimulates the digestive system by producing saliva. Once food enters the mouth, saliva helps start the process of breaking down carbs, protein and fat. By turning food particles to a soupy mush called bolus, chewing is one of the most important steps in really supporting the rest of the GI tract. As the food starts breaking down it heads to the stomach via the esophagus.
Next is the gastric phase of digestion, where the stomach has three key roles:
Disinfecting food and pathogens like viruses, parasites and bacteria by keeping the environment highly acidic. (HCl is so acidic that if it got onto your skin or clothing it would burn through them. The stomach produces a mucus that neutralizes the acidity)
Churning food with enzymes to break down dietary protein into absorbable molecules called amino acids.
Freeing certain nutrients from the food complexes.
The bolus has now become a mushy substance called chyme which has a more alkaline pH, making it ready to enter the small intestines. The process of the stomach emptying should take between 2.5-3 hours depending on the type of nutrients ingested. For example, eating dietary fiber and fat delay stomach emptying (keeping you full longer).
The intestinal phase incorporates multiple parts and includes accessory organs such as the pancreas, gallbladder and liver. In the small intestine, nutrients continue to be broken down and absorbed with the help of more digestive enzymes produced and released by the pancreas and the intestines themselves. Bile, which is produced in the liver and stored in the gallbladder aids in the breakdown of fatty acids. I like to think of the lining of the small intestine like a screened door with tiny holes for nutrients to pass through the GI tract to be absorbed into the bloodstream. What is left of the chyme is the remainder of particles from indigestible carbs like the fiber and resistant starches; which moves into the large intestine. Moving through the large intestine, water starts to reabsorb in the colon. Stool begins to form consisting of excess dead cells, waste products, undigested food matter, bacteria and water. The entire process from head to tail can take 10-73 hours.
Now let’s hone in on the most important part of the large intestine, the gut microbiome:
Photo retrieved from: https://www.sci.news/biology/gut-microbiota-manipulate-our-minds-05956.html
The gut microbiota is an entire ecosystem of bacteria, fungus and viruses living within the intestines, predominantly the large intestine-- the colon. This bacteria works in harmony with the body, munching on plant-fibers (prebiotics) and producing vital nutrients for the body like vitamins, hormones, neurotransmitters and short-chain fatty-acids (SCFA’s). These nutrients support our immune system, hormones, brain and heart health, and much more! We need a wide variety of microbes to support our health, and our gut diversity depends greatly on what we eat, chemicals and medications we are exposed to as well as our stress levels.
The Importance of a well functioning microbiome:
Synthesizes vitamins like B’s and K
Supports the integrity of the immune system
Enhances GI motility for healthy bowel movements
Fights pathogens (the bad bugs like viruses, parasites, etc.)
Metabolizes nutrients and helps to remove waste products
Plays a role in weight management
Plays a role in hormonal balance, especially the detoxification of estrogen
Improves nutrient absorption (especially minerals)
Produces neurotransmitters like serotonin, largely responsible for brain health, mood and energy
Signs your body is telling you that mean your digestive system needs some love and support:
Direct digestive-system symptoms:
Anemia/ low iron levels
Belching or gas one hour after eating
Heartburn or acid reflux
Bloating
Bad breath
Bitter taste in mouth
Coated tongue
Constipation
Diarrhea
Excessive and/or foul smelling gas
Food sensitivities and intolerances
Gallbladder attacks and/or gallbladder removed
Less than one bowel movement per day
Nausea
Needing coffee to have a bowel movement
Increased pulse rate after eating
Stomach pains or cramps
Undigested food in stool
Yeast infections
Indirect digestive-system symptoms:
Acne/ skin issues
Low energy/ fatigue
Sleep problems
Depression, anxiety and mood swings
Hormone imbalances
Osteoporosis and osteopenia
Migraines
Brain fog
Joint aches and pains
Strategies to support digestion:
Please recognize that these are very general examples of ways to support the digestive system. Bioindividuality is always important to keep in mind while identifying what strategies your body needs to feel supported. For example, I've had clients who needed to add more fiber and clients who needed to reduce their nuts, seeds and whole grains. I've had clients who needed to add more raw veggies, and clients who needed to prioritize lightly cooked veggies. Everyone has unique needs based on their biology and given circumstances which is why working with a practitioner to help figure it out is key!
Keep a Food Journal
Oftentimes understanding patterns around digestive distress can take some detective work. By keeping a food journal you are able to understand any correlations between your day to day routines and your symptoms. When working with clients I have them use a Food Mood Journal to keep tabs on their sleep patterns, when/what they eat, when/what they drink, activity levels, energy levels and mood, medications/supplements, digestive symptoms and details about their bowel movements.
Starting with the brain...
How are you eating?
Poor eating habits prevent the optimal digestion of food. Do you skip meals frequently and then overeat later on? Do you eat on the go? Do you graze often or snack excessively throughout the day? The body loves rhythm and consistency. Develop a routine to prioritize eating balanced portions around the same times every day in order to reduce the likelihood of skipping meals and then bingeing. Eating while sitting down and being present with your food rather than multitasking will support how your body metabolizes food in addition to regulating your hunger and fullness cues.
Stimulate the Vagus Nerve
The brain and gut are connected via the Vagus Nerve. By supporting this nerve you are tapping into your parasympathetic nervous system– the state of rest and digest. Learn more about the Vagus Nerve here.
In the mouth...
Oral hygiene
The bacteria in the mouth is closely linked to the gut microbiome which is why taking care of teeth, gums and the tongue is important for gut health. Instead of using mouthwash which also kills good bacteria, try oil pulling with coconut oil. Tongue scraping is another method I suggest to clients to reduce bad bacteria while also stimulating the digestive tract.
Thoroughly chew your food
Life can be fast-paced. Therefore, we often eat too quickly. Sometimes we barely even chew our food. Remember chewing is one of the first stages of digestion, so if you often feel bloated, experience indigestion or tend to overeat, really chewing your food can make all the difference in aiding your digestive tract. I encourage clients to chew 20-30x per bite, or until the food is smoothie-like consistency.
Properly hydrate
99% of saliva is water. Being even slightly dehydrated down-regulates the production of digestive fluids needed to help break down food effectively. (Hydration is also vital for healthy elimination, helping to reduce constipation.)
Use digestive enzymes or bitters
Oftentimes, due to stress, we can produce an inadequate amount of enzymes needed to help break down and absorb nutrients from food. You can prioritize eating more foods with naturally occurring enzymes in them, like some fruits and probiotic rich foods. Eating bitter foods can help stimulate saliva production, release gastric juices and pancreatic enzymes, and signals to the gallbladder to release bile.
In the stomach...
Supplement with Hydrochloric Acid (HCl)
There is a common misconception in medicine that if someone has acid reflux they are producing too much stomach acid. Often this occurs when someone has high stress, is deficient in magnesium and stomach acid (HCl). Medical doctors often prescribe PPI’s (proton-pump inhibitors) to further reduce acid production. Short term, this helps reduce the symptoms, but long term, can cause the problem to get worse in addition to further consequences down the road. The pH of the stomach needs to be as acidic as a battery in order to kill pathogens and extract and absorb nutrients from our food. Lack of acidity leads to malnutrition which leads to vitamin deficiencies in the long-term. In reality, when a client I work with presents with these symptoms, we focus on regulating their nervous system, cutting out processed and triggering foods, healing the gut lining and supporting stomach acid production rather than suppressing it. I usually start by recommending clients to add some lemon and ACV (apple-cider vinegar) to water and drink 10-15 minutes before a meal before we titrate with an HCl supplement.
In the intestines..
The 4R Approach
Increased intestinal permeability is extremely common in those who have been on medications, antibiotics, eat a poor diet, drink alcohol, are exposed to environmental toxins and have stress-- so basically most of us! I like to think of the intestines as a screen door with little holes. We want air to flow in and out of the screens but don’t want the holes to get bigger because then bugs might get inside. In our gut we want nutrients to absorb into the bloodstream from the intestines. The problem is, when these holes become bigger, toxins and undigested food particles can leave the digestive system and travel through the bloodstream causing systemic inflammation and other issues. Dr. Raphael Kellman wrote an amazing book called The Microbiome Diet that goes into great detail about using the 4R approach. This protocol helped me tremendously when I healed my gut and now I incorporate pieces of the protocol with many clients.
Here is the gist:
Remove: Eliminate triggering foods (processed foods like sugar and flours, polyunsaturated fatty acids like canola oil, vegetable oil, margarine, sunflower seed oil, soybean oil, as well as any infections that may be present in the gut. Identify food sensitivities and allergies through testing or following an elimination diet protocol. Prioritize whole-food sources of healthy fats, fiber and protein.
Replace: Improve digestion with digestive enzymes, eating foods with naturally occurring enzymes in them, adding HCl to increase stomach acid and focusing on mindful eating during meal times to aid digestion.
Reinoculate: Add more gut-loving probiotic rich foods and possibly a supplement to feed the good bugs in the gut. Not all probiotic supplements are created equal, and some people are deficient in specific strains. This is why testing is so imperative!
Repair: Again, intestinal permeability can be caused by so many triggers so getting to the root of what is going on in the first place is my job! Starting by decreasing stress levels to reduce cortisol, removing toxins and supporting the body to detox properly and balancing hormones is key! We add in bone broth and stock, collagen and some supplements with L-glutamine, aloe vera and herbs (like licorice and marshmallow bark) to soothe the GI tract.
Only take antibiotics when absolutely necessary!
Antibiotics wipe out both the bad and the good bugs. When these good bugs are not further replenished, there is more room in the gut for bad bugs to take over. This is common in those with frequent infections and illness.
Stress management
Even if you think you don’t have stress or that you manage it well, most likely if you are having gut issues your body is dealing with stress poorly. We need to be very intentional about building a stress management practice into our routine. When stress is on, digestion is off– the body simply cannot prioritize digestion when it is dealing with stress. This can be emotional, mental or even physiological stress like imbalanced blood sugar. Stress also wipes out the good bacteria in the gut!
Cut out processed sugar and artificial sweeteners.
We know that processed foods, like refined flours and sugars actually feed pathogens in the gut, like viruses, bad bacteria, fungus and parasites. Often when clients have strong sugar cravings it tells me two things– their blood sugar is imbalanced and their microbiome is imbalanced.
Nutrition plan to support gut health:
Eat more whole foods and less processed foods. Incorporate plenty of fruits, veggies, beans, nuts, seeds, whole grains and lean proteins.
Eat more fiber! Aim for at least 30 grams of different types of fiber per day. Fiber is essential for feeding the good bugs in your gut and contains many prebiotics.
Eat fermented foods for natural probiotics.
Focus on well-sourced animal products. Inorganic meat, poultry and dairy products are given tons of antibiotics to compensate for the animal’s poor living conditions. These antibiotics transmit through the food into the body.
Focus on unsaturated fats and omega-3 fatty acids (chia, flax, hemp, walnuts, salmon, grass fed meats, eggs, cod liver oil, olive oil, avocados)
Reduce processed foods, processed sugars and inflammatory omega-6 fats (vegetable oil, sunflower oil, canola oil, soybean oil, margarine, grapeseed oil, high fructose corn syrup, trans fats, white sugar, white flours, artificial sweeteners, food colorings, genetically engineered foods)
Gut-healthy grocery list:
Whole plant foods in variety: Fruit, veggies, sprouted whole grains, sprouted legumes, soaked nuts, seeds. Eat the rainbow! (Lightly cooked/steamed veggies are easier to digest than raw veggies are)
Probiotic-rich foods: miso paste, kefir, yogurt, kimchi, kombucha, sauerkraut, coconut yogurt, raw cheese, pickles that are not pasteurized (they should be in salt water and not vinegar/ no dyes), dark chocolate, spirulina algae, feta
Prebiotic-rich foods: asparagus, leeks, garlic, jerusalem artichokes, legumes, artichokes, beans, beets, honey, maple syrup, lentils, chickpeas, green peas, lima beans, kidney beans, dandelion root, rye bread (if not gluten sensitive), dark chocolate, radishes, cacao powder
Polyphenol-rich foods: wild blueberries, cherries, cranberries or pure cranberry juice concentrate, plums, strawberries, blackberries, black olives, green tea, purple/orange carrots, purple/red potatoes, red cabbage, red onions, broccoli, red rice, olive oil. Spices: cinnamon, ginger, garlic, turmeric, cloves, cumin.
Resistant-starch foods: beans, lentils, green bananas, cooked then cooled potatoes, sweet potatoes, oats, cashews
Animal products: grass-fed meats, organic pasture-raised poultry, pasture-raised eggs, wild-caught fish. (Ground meats like ground chicken, turkey, beef, lamb, etc. can be easier to digest)
Foods that are soothing to the gut lining: Bone broth, collagen, cabbage, fermented foods, chia and flax seeds
Healthy fats: Coconut oil, coconut milk, avocado oil, cold-pressed Extra Virgin olive oil, sesame oil, flaxseed oil, grass-fed Ghee
Foods containing digestive enzymes: pineapples, papaya, mango, kiwi, avocado, kefir, sauerkraut, bananas
Bitter foods: arugula, dandelion greens, lemons, cauliflower, brussels sprouts, kale, apple cider vinegar
References
Collen, A. (2015). 10% Human: How Your Body’s Microbes Hold the Key to Health and Happiness. HarperCollins Publishers.
David, M. (2013). The Secret to Digestive Health and Wellness. Psychology of Eating. Retrieved from https://psychologyofeating.com/secret-digestive-wellness/
Hawrelak, J.A. & Myers, S.P. (2004). The causes of intestinal dysbiosis: A review. Intestinal Dysbiosis, 9(2), 180-197
Libpski, L. (2020). Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion. Mcgraw-Hill Books.
Nutritional Therapy Association. (2020) Digestion Module.
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