Many people experience gastrointestinal (GI) symptoms such as abdominal pain, bloating, gas, diarrhea, constipation, and acid reflux. However, gut health extends beyond digestion—issues like low energy, mood imbalances, joint pain, poor sleep, skin rashes, and weakened immunity can also be linked to the GI system.
Several factors can contribute to gut dysfunction, including infections, autoimmune conditions, food sensitivities, microbiome imbalances, genetic predispositions, nutrient deficiencies, diet, and stress. Identifying the root cause of your symptoms requires a comprehensive discussion with your healthcare provider.
Possible Diagnoses:
- Inflammatory Bowel Disease (IBD), such as Crohn’s Disease or Ulcerative Colitis. It is important to diagnose these in a timely manner, as they require more specialized care.
- Celiac Disease: This, like IBD, needs to be diagnosed early and may also require specialized care.
- Food allergies like Gluten Intolerance, Lactose Intolerance, etc.
- Infections by pathologic organisms, such as parasites, bacteria, or viruses.
- Irritable Bowel Syndrome
- Microbiome Dysfunction, such as SIBO (small intestinal bacterial overgrowth).
- Disorders of Gut Brain Interaction, such as abdominal migraine.
Work-up:
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- In-depth discussion of symptoms, timing of symptoms, symptom onset, lifestyle factors, etc.
- Physical exam
- Laboratory Testing: blood and stool testing
- In-depth stool testing: This testing is more expensive but may be helpful in determining less obvious causes of symptoms such as microbiome imbalances, gut lining dysfunction, or insufficient metabolism.
- Gastric Emptying Study, Abdominal Ultrasound, Abdominal X-rays, etc.
- Endoscopy or Colonoscopy: performed by gastroenterologists
Relationship between Gut Health and Overall Health:
- Gut-Brain Axis: The gut and brain are connected through the vagus nerve and other signaling pathways. Gut health influences mood, stress levels, and cognitive functions. Poor gut health is linked to anxiety, depression, and neurodegenerative diseases.
- Hormonal Balance: Gut health affects the regulation of hormones like insulin, cortisol, and thyroid hormones. Disruptions in the gut can contribute to conditions like diabetes, thyroid disorders, and stress-related illnesses.
- Appetite and Weight: Gut microbes influence appetite regulation and energy metabolism. Gut bacteria influence how the body stores fat, uses nutrients, and regulates appetite–which can impact weight and metabolism.
- Inflammation: Gut health affects inflammation throughout the body. Inflammation can increase cardiovascular risk and increased metabolic risk for conditions like diabetes or high cholesterol and precipitate conditions like joint pain/fatigue/brain fog/etc.
Basic Dietary Recommendations for Gut Health:
- Fruits and Vegetables: The USDA MyPlate guidelines recommend ½ of every meal be fruits and vegetables. A minimum daily goal should be 5 servings of fruits and vegetables (one serving is around 4-6oz which equals 1 cup of raw or cooked vegetables, ½ cup beans/legumes, 1 medium apple/orange/banana, etc.). A stretch goal is getting 30 unique servings of fruits and vegetables weekly. This will allow for a broad range of beneficial nutrients.
- Anti-Inflammatory Diet: With a few exceptions, most everyone can benefit from an anti-inflammatory diet. Dr. Andrew Weil’s Anti-Inflammatory Diet is based on the Mediterranean Diet which prioritizes fruits and vegetables, whole grains, fish, and healthy oils (like olive oil). From that foundation, anti-inflammatory components, such as spices (garlic, turmeric, ginger), green tea, mushrooms, and berries, are added in to reduce overall levels of inflammation in the body.
Other diets have evidence in specific cases such as a low FODMAP diet for IBS, gluten-free for Celiac Disease/gluten-intolerance, and lactose-free for lactose-intolerance. - Microbiome Support: There are more organisms living on/in us than there are cells in the human body … by a factor of 10! We live in symbiosis with most of these organisms, so it’s important to nurture a healthy balance. Probiotic foods like yogurt, kefir, sauerkraut, kimchi, and miso soup can help promote a good balance of bacteria in the gut. Prebiotic foods, such as those containing high quantities of fiber, will help maintain/preserve those healthy bacterial colonies.
- Fluids: It’s important to stay hydrated with no-calorie fluids like water, coffee, or tea. Milk can be beneficial in some ways but it can also be pro-inflammatory. Sweetened beverages are almost always detrimental. Sugars in fluids are quickly absorbed by the gut and spike blood sugar levels, which can lead to insulin resistance (diabetes) and weight gain.
- Self-prepared Food: Preparing one’s own food is vital to knowing what goes into the meal. Meals bought outside the home are almost always high in salt, sugar, and preservatives. By setting aside time to prepare food, one can make sure they know what ingredients are being consumed by themselves and their families.
Eating-adjacent Recommendations:
- Hara Hachi Bu : Eat until you are 80% full. This should decrease over-eating which can improve weight, acid reflux, bloating, and energy levels.
- Stop eating 2-3 hours before bed: This should allow sufficient time for food to move out of the stomach and into the intestines, which will help reduce reflux symptoms at night.
- Weight Loss: Many people desire to lose weight. Restrictive diets are usually temporary and rarely lead to sustained weight loss. It’s important instead to focus on creating good habits to promote and maintain a healthy weight. Our health coach, Ariana Figueroa, is a wonderful resource and can help patients establish healthy habits. Once good habits are put in place, weight loss can be a desirable byproduct.
- Reduce Stress: Stress worsens many GI symptoms such as acid reflux, weight gain, and stooling issues.
- Exercise: Exercise can promote healthy food cravings. It can improve the balance of gut flora. It can also stimulate gut muscles to improve bowel movement regularity.
Beneficial Botanicals/Supplements:
(Please discuss with your provider before trying any new botanicals/supplements)
- Ginger: an anti-inflammatory and can help with nausea, bloating, decreased appetite, and constipation.
- Peppermint Oil: can help with bloating and abdominal pain in IBS.
- Chamomile: can improve abdominal pain.
- Marshmallow Root: Marshmallow root can facilitate a healthy GI lining.
- Psyllium: improves both constipation–by pulling water into the gut–and diarrhea–by absorbing excess water.
- Turmeric: can improve IBS symptoms.
- Fish Oil: an anti-inflammatory that promotes improved regulation of cholesterol.
Prioritizing gut health is essential for overall well-being. By understanding the connections between your symptoms and digestive function, you can take proactive steps toward restoring balance through personalized nutrition, lifestyle adjustments, and targeted therapies. If you’re experiencing persistent symptoms, working with a knowledgeable provider can help you find lasting solutions.
This blog post was written by Michael Crowgey, MD, an integrative physician, at Integrative Family Medicine of Asheville. You can read more about Michael in his bio.