Got digestive complaints but not sure how to holistically manage it? True Health posed some key questions to Claire Barnes, a Nutritional Therapist and Technical Advisor at Bio-Kult, to answer all you need to know.
Q What are the most common signs we might have digestive upset?
Claire: According to a large population-based study in the US, the most commonly reported digestive symptoms were heartburn or reflux, abdominal pain, bloating, diarrhoea and constipation. Often, individuals will experience more than one of these digestive symptoms. If you consider that the gastrointestinal tract starts in the mouth and travels all the way down to the rectum, it’s clear that a digestive complaint higher up in the gastrointestinal tract could lead to additional digestive upset further on down.
Q What are the most frequently seen digestive conditions and are these becoming more commonplace?
Claire: Individuals who suffer with the digestive symptoms mentioned above will often be labelled as having a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS), functional dyspepsia (indigestion) or functional constipation. These conditions affect up to 40 per cent of people at any one point in time, and two-thirds of these people will have chronic, fluctuating symptoms.
The development of these digestive conditions appears to involve dysregulation of the gut-brain axis. Mental health conditions, such as anxiety, depression and stress, often accompany these digestive conditions, however, it is not clear whether the mental health condition predates the digestive symptoms or is driven by the symptoms. Many of those who struggle with digestive and mental health conditions also show an imbalance of their gut microbes (dysbiosis).
Q And what are the most common reasons why we can have poor digestive health?
Claire: A poor diet is the most likely culprit for reduced digestive health. However, other lifestyle factors such as a lack of exercise, sleep and sunshine, often occupied by stressful jobs and family life, alcohol consumption and possibly the overuse of medications such as antibiotics could all contribute to reduced stomach acid, reduction in digestive enzymes, gut microbiota imbalances and irregular bowel movements.
A major factor in digestive health is the trillions of micro-organisms (most of them bacteria, but also viruses, fungi, and protozoa), which reside in the human gastrointestinal tract. In fact, experts now suggest that the microbiome should be considered as a virtual organ of the body. Dysbiosis (either a qualitative or quantitative change in the gut microbial community) is commonly observed in many gut related conditions. There is a strong association between reduced diversity and poor digestive health, which indicates that a species-rich gut ecosystem is more robust against environmental influences. Microbial diversity is therefore generally seen as a good indicator of a ‘healthy gut’.
Q How much of a role does our diet play?
Claire: As societies move away from more traditional ways of eating, digestive health is unfortunately likely to deteriorate. Often, a modern, Westernised diet relies heavily on processed and fast foods for convenience and increased sugar and sweetener intake, along with reduced consumption of fibre. Studies have shown that this combination can significantly deplete the diversity of bacteria within the gut and increase levels of undesirable microorganisms such as yeasts (which feed on sugar).
Processed foods contain many hidden sugars, additives and emulsifiers, which are thought to have a negative impact on the balance of bacteria in our gut, and a pro-inflammatory effect. Low fibre diets are particularly detrimental, as prebiotic fibres from fruits, vegetables and wholegrains are needed to act as a fuel source for beneficial bacteria in the gut to keep levels healthy. Cutting down on sugary and refined foods and boosting fruit and veg intake is therefore recommended.
Q What’s the best gut-friendly diet to follow?
Claire: It is very difficult to say what is the best gut-friendly diet as each digestive condition and each individual will be different. But there are some nutrition staples that may be helpful in supporting gut health.
- As a starting point, moving away from processed foods and incorporating home-cooked whole foods may be a simple, yet effective change, with many people noticing a rapid improvement in their digestion. Some people may find benefit in following a diet protocol similar to what is known as the ‘5R gut healing’ approach (remove, replace, repair, reinoculate and rebalance). This protocol involves the removal of potential triggering foods and utilising a range of supplements and/or dietary modifications to support gut health.
- Digestive enzymes, stomach acidity and bile may be low in those with poor gut health; these aid in food breakdown and absorption of nutrients, so symptoms of gas and bloating may result from insufficient levels. Individuals may be able to naturally increase stomach acidity by drinking hot water with lemon, apple cider vinegar or Swedish bitters or taking a betaine hydrochloride supplement.
- The addition of traditionally fermented food such as kefir, sauerkraut, kimchi and live yoghurt may help to support beneficial bacteria as these foods will often contain different bacteria to those found in supplemental form. For example, homemade milk kefir may contain between 22 and 61 different types of bacteria and yeasts to support the gut and immune system.
- Eating a wide variety of plant-based foods (containing lots of different types of prebiotic fibre) will also provide food sources for lots of different types of beneficial bacteria (who, much like humans, all have different preferences for what they like to eat). Those who eat over 30 different types of plant foods a week have shown to have significantly more diverse gut microbiomes than those who eat less, which is generally associated with positive health outcomes.
- Herbs and spices such as sage, oregano, basil, celery seeds, rosemary; berries such as blueberry, blackcurrant, strawberry, raspberry, vegetables and legumes such as red onion, spinach, broccoli and black beans all contain polyphenols which can promote the growth of beneficial bacteria and prevent that of opportunistic bacteria.
Q What knock-on effect can poor gut health have to other areas of our health?
Claire: It is now understood that any alteration in gut microbiota communities not only trigger gut disorders but also influence other organs and cause associated diseases.
The influence of the gut microbiota on the intestinal lining and immunity is well known. Evidence is also now uncovering how the microbes in the gut could modulate immune cell responses and development outside of the gut.
In addition to immune health, the gut microbiota has also recently been defined as a ‘vital organ’ which has multidirectional communication axis between the organs via neural, endocrine, immune, humoral and metabolic pathways. Some of these axis include the gut-brain, gut-liver, gut-bone and gut-skin. Alterations in the gut microbiota have been linked to several diseases, but as yet the exact mechanism between the gut and different organs are not well understood. Nevertheless, increasing evidence suggests that modulation of the gut microbiota through the use of prebiotics, probiotics and postbiotics may help support a number of systemic conditions, including metabolic, immune and neurological disorders.
One area of ongoing research is the ability of our gut bacteria to regulate the production of numerous neurotransmitters and other signals that are sent from the gut to the brain via the vagus nerve. The gut is increasingly being seen as the second brain, so it’s perhaps unsurprising that studies are showing promising results in mood disorders from interventions designed to improve gut microbial balance.
Q Would you recommend supplements to support the gut?
Claire: The most beneficial supplements for each individual will vary depending on the underlying causes of their gut condition. Anti-microbial agents, prebiotics, probiotics, digestive enzymes, betaine hydrochloride, digestive bitters, bile supplements, nutrients which help to strengthen the gut epithelial lining and HPA axis support may all be beneficial for individuals with gut health issues when used appropriately.
A number of factors such as age, stress and eating lots of heavy meals, may mean that you are not producing enough stomach acid and digestive enzymes to properly digest your food, contributing to digestive symptoms such as bloating and gas. Consider having a tablespoon of unpasteurised apple cider vinegar in a small amount of water just before meals to help acidify the digestive tract and stimulate digestive secretions. Swedish bitters also help stimulate bile flow, which we need to digest fats. For those who need additional support, a digestive enzyme supplement taken at the start of main meals may be beneficial.
Accumulating evidence supports the view that an imbalance of gut bacteria contributes to gut conditions. Live bacteria supplements appear to be helpful for many with these conditions. A large review of the effectiveness of live bacteria supplements in IBS was conducted in 2016 and found that multi-strain preparations were effective in twice as many IBS trials than single strain products. In a recent trial using Bio-Kult Original 14 multi-strain formulation in 400 IBS patients for 16 weeks, the severity of abdominal pain reduced by nearly 70 per cent and one third were symptom free by the end of the trial.