Gut health is such an important factor in your overall health and wellbeing. So many of us feel uncomfortable or in pain after we eat and this can have so many knock on effects. It is possible to have a happy, healthy gut with just a few changes to your diets and your habits. Gut health and digestion supplements are so important to try to incorporate into your daily routine and you’ll be amazed at the difference paying attention to this area of your body can have on your life. I found this best probiotics review article very helpful when starting my supplements journey.

You hear the media and adverts talking about gut health and digestion all the time; but do you actually know what they are and why its important to improve? I sat down with an expert to get all your gut health questions answered. Alex Ruani is a UCL Doctoral Researcher and Chief Science Educator at The Health Sciences Academy.

What are the signs of both a healthy and an unhealthy gut?

The main signs of an unbalanced gut are digestive disturbances, including feeling bloated in the abdominal area after eating, stomach discomfort, abdominal pain, gastrointestinal cramps, diarrhoea, constipation, and a number of other adverse digestive symptoms. Sadly, it’s been estimated that more than 40% of the population worldwide suffer from gastrointestinal symptoms which are NOT related to a diagnosable gastrointestinal disease! This means that we may go to the doctor to report these symptoms, but most medical tests attempting to diagnose a GI condition (such as X-rays, CT scans, blood tests, endoscopies) come back with “normal” non-disease results.This can be very upsetting, because it means there’s no medical intervention to help manage these symptoms and improve our quality of life. So the question is, when there isn’t a medical “disease” diagnosis, then what could explain these adverse GI symptoms? And what can we do about them? Plausible explanations for non-disease GI symptoms include GI hyper-permeability, altered gut microbiota, altered mucosal function, or altered gut-brain axis communication, among others. These are ‘sciency’ terms to refer to a number of biological mechanisms, and the good news is that nutritional and lifestyle adjustments are key to improve them!

What are the causes of bloating, gas and heartburn?

These can be caused by a multitude of factors, but the noteworthy ones are a diagnosable gastrointestinal disease (think Crohn’s, IBD, Coeliac disease), a food or allergen sensitivity (think lactose intolerance), a genetic predisposition (think non-Coeliac gluten sensitivity with a prevalence of inherited HLA gene mutations), food poisoning (which is less prevalent and preventable through good food hygiene), and in many cases for those of us without a diagnosable disease they can be a sign of imbalances that we can mitigate through eating a better diet, sleeping better, stressing less, and moving more.

How can I make my digestive system better and do supplements make a difference?

When we look at the scientific literature and the evidence available to help with gut symptoms, I’d say that we could summarise our ‘gut restoration’ steps into the 4 Rs we teach into more detail inside our specialised gut health certification for nutrition professionals. Here’s a quick overview of the 4 Rs in plain language:

REMOVE problem foods (that is, those foods you may suspect you’re not tolerating or digesting well) AND remove excesses (from sugary, fatty foods, alcohol, and medications like antacids and painkillers which shouldn’t be taken in the long term). This should help to start alleviating much of the symptoms.

REPLACE the nutrients from those food group that may have been eliminated, in order to mitigate nutrient deficiency risks, which can also negatively impact gut health. Imagine if we eliminate our daily glass of milk, then we’d need to compensate for the missing nutrients we used to get from it, including vitamin D, omega 3 (EPA/DHA), and calcium. Vitamin D and EPA/DHA are pivotal in maintaining the integrity of our gut lining and they are found in egg yolks and oily fish, and calcium in leafy greens like spinach.

REPOPULATE is the third step and it means addressing imbalances in our gut microbiome by helping to repopulate it with helpful gut bacteria. We can do this by upping our consumption of prebiotics (which feed good bacteria) including dietary fibre. When gut bacteria ingests fibre, the byproducts they release include propionate and butyrate, which trigger the release of appetite-suppressant hormones GLP-1 and PYY. And this is pivotal in helping to regulate hunger. We may also ingest helpful bacteria directly from probiotic-rich foods, including fermented milks (kefir, yogurt, cottage cheese), fermented vegetables (sauerkraut, miso), and fermented cereals (sourdough bread). There are also a number of great probiotic ‘shot drinks’ available (Yakult, Actimel) as well as liquid or freeze-dried probiotic gut health supplements.

REPAIR means prioritising nutrients and lifestyle modifications that help repair the gut lining and maintain gut integrity. Food compounds like vitamin D3 and DHA (both from foods like egg yolks and oily fish), glutamine (an amino acid found in peas, beans, and animal foods), and butyrate (produced by our gut bacteria when we eat fibre, or directly found in butter and MTC supplements) all have been found to have a key role in repairing the gut lining and reducing hyper-permeability in the gut (so fewer undigested compounds can pass through into the bloodstream, otherwise triggering inflammation and a number of unwanted symptoms).What do probiotics and prebiotics do in the gut?

Prebiotics feed good gut bacteria and as I mentioned above fibre is pivotal. Out human digestive system cannot digest fibre, but our gut microbes can! This results in byproducts like propionate and butyrate which trigger the release of appetite-suppressant hormones that tell our brain to stop eating, helping to better manage our weight in quite an effortless manner since fibre is also so filling. Fibre-rich foods include grains like steel cut oats, quinoa, and wholegrain rice, root vegetables like carrots and butternut squash, greens like cabbage, broccoli, cauliflower, green beans, legumes like edamame and broad beans (which you can buy from frozen), seeds like sesame and flaxseeds, and fruit like apples, pears, and bananas.

Probiotics can be resident or pass through, depending on the species and the genus. They can replicate in the gut and help colonise it with more diversity (which is key to immune health, weight control, and mood), while mitigating dysbiosis, which is an imbalance of good and bad gut bacteria leading to a number of unwanted effects – like an overreactive immune system, weight gain, and mood disorders.

Both prebiotics and probiotics can help with weight management, and a heathy body weight is also critical to gut health. Being overweight or obese worsen dysbiosis (bacterial imbalance, diversity perturbances). Also, those of us who are obese have less diverse gut bacteria compared to non-obese individuals. And carrying excess body fat can lead to inflammation (via large numbers of pro-inflammatory adipokines) and an exacerbated immune response (e.g. higher risk for severe COVID-19 symptoms). Visceral fat accumulation increases risk for IBS-D (IBS characterised by diarrhoea).

How does our mental health affect our gut?

Gut health can affect mental health, and vice-versa. Most of the production of serotonin (the “happy hormone”) is mediated by gut bacteria. Gut-related disturbances are associated with irritability, higher stress levels, and with poorer mental health, including a higher risk for anxiety disorders and depression. On the other hand, gastrointestinal discomfort can also affect mental health (it’s a two-way relationship, which we cannot ignore). Digestive symptoms like cramps and pain, reflux, indigestion may worsen from feeling stressed, worried, or anxious.

Can any medications we take affect our gut health?

NSAIDs are non-steroidal anti-inflammatory drugs: pain-killers that also reduce inflammation when taken at higher doses. They include ibuprofen, aspirin, and naproxen. NSAIDs can have a negative impact on our gastrointestinal tract, and so may oral contraceptives, commonly referred to as The Pill, which may explain symptoms such as abdominal pain, diarrhoea, and in more extreme cases nausea and vomiting.

Also, taking a prescribed antacids can cause diarrhoea, abdominal pain, or constipation as side effects. Over-the-counter antacids should not be taken in the long term as this can cause low acidity which can lead to a deficiency in minerals such as calcium and iron. We all require a certain amount of acidity in our stomach to break down the foods we eat to a sufficient degree for minerals to be available for absorption in our small intestine.

Finally, antibiotics are drugs that destroy, or inhibit the growth of, bacteria. They are commonly used to treat bacterial infections, such as TB (Mycobacterium tuberculosis), and to prevent infections that may occur, for example, during surgery. We, humans, have 100 trillion of bacteria and other microorganisms living in our gut. But antibiotics may significantly reduce the diversity and the number of the helpful bacteria, and it takes a while to restore this to normal levels. After a course of antibiotics, it’s advisable to take probiotics to re-inoculate the digestive tract, consume fermented foods such as yogurt, cottage cheese (provided you are not lactose-intolerant), miso, shoyu, sauerkraut, or sourdough bread, particularly those cultured with Lactobacillus or Bifodobacteria, and include prebiotic-rich foods in the diet, such as bananas, asparagus, garlic, onions, Jerusalem artichoke, Chicory root, Dandelion greens, leek, soya beans, barley, and whole-wheat (unless you’re sensitive to wheat or gluten).

Caution: If you’re taking prescribed antacids or any other medications including antibiotics, do NOT stop your treatment and make sure you have a candid conversation with your doctor regarding any concerns you may have.How do I know if I have an allergy or food intolerance?

Let’s do a quick self-check: How do you feel within 48 hours of consuming foods like cereal with milk (wheat/dairy), pastry (wheat/sugar), or ice cream (dairy/sugar)? And how do you feel immediately after consuming common allergens including peanuts, nuts, fish, shellfish, milk, eggs, soy, or wheat?

Try keeping a food and symptoms diary to see if you can notice any patterns between eating certain foods and the onset or severity of your digestive symptoms. If, from your food and symptoms diary, you suspect you have a food allergy or intolerance, the next step is to strictly exclude one potential trigger for a few weeks to see if your symptoms improve. For in-depth guidance and step-by-step planning and monitoring of exclusions diets, we teach all of this inside our Food Allergies and Intolerances certification.

If you suspect an allergy, make an appointment with your doctor or an allergist as soon as possible, and show them your food and symptoms diary. Allergens are substances that can cause an allergic reaction. Usually, exposure to a very small amount of an allergen is all it takes to trigger an allergic reaction. Note that gluten is not in this list, because Coeliac Disease is not a food allergy; it’s an autoimmune condition. If you suffer from a food allergy, as soon as that food enters your gastrointestinal tract, it’s identified as being “harmful”, even though it’s not for most people. This sends the immune system into overdrive because the body thinks it needs to protect you from this “harmful” substance. This can cause digestive symptoms such as nausea, abdominal pain, diarrhoea and vomiting, as well as affecting other systems of the body. You probably already know if you have a food allergy, because such symptoms tend to come on quickly after exposure to allergens.

Food intolerances are often mistaken for allergies, because they can also cause the aforementioned symptoms. However, intolerances tend to induce a slow onset of digestive symptoms, and you may not always experience symptoms when you consume a food you are sensitive to. Some people can tolerate a certain amount of a food component and only experience symptoms if they exceed this threshold. Bloating and abdominal cramping are classic symptoms of a food intolerance. The most common is lactose intolerance: the inability to digest lactose (milk sugar).

Main image features The Nue Co Debloat+ (£40 from TheDrug.Store).

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