Achieving Gut Health -- and How It Supports Your Overall Well-Being

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Your gut microbiome is like an ecosystem in your body – a community of shared organisms living together. An altered gut microbiome has been potentially linked to medical conditions ranging from type 2 diabetes to cardiovascular disease, autoimmune conditions, inflammatory bowel disease, neurological disorders and even cancer. How do you know the state of your gut health and what can you do to keep it in good shape? Elizabeth Traxler, RD, LD, a clinical dietician with the Digestive Health Institute at University Hospitals, explains.

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Transcript

Macie Jepson

Pete, I've been giving a lot of thought about what I eat and how it makes me feel in preparing for today's podcast. And I feel pretty lucky that I don't have to plan ahead for any stomach issues. I can pretty much eat anything I want. Now, whether that's healthy is another issue altogether. We're talking about healthy digestive tract. You know, it often comes down to eating. What can I eat? What tastes good, but is it nutritious? What won't give me a stomach ache later on down the road? This is a major issue for a lot of people. And what I've started hearing a lot about lately is that maintaining a healthy digestive tract means I need to think about taking care of my gut microbiome. Say what? What is that?

Well, some recent studies have shown that a healthy gut microbiome may ease chronic diseases, improve your skin's appearance, lower inflammation, help you age better or improve your immune system. So, I think I need to know more about this. What the heck is it anyway?

Pete Kenworthy

Yeah, honestly, I have no idea. When you first mentioned gut microbiome to me, I honestly don't even know where to start guessing what that is. But hearing about all the benefits of a healthy gut microbiome certainly grabs my attention, right? I mean, how do you know if you have healthy gut microbiome? What is it, and how do I get one?

Macie Jepson

Hi, everybody, I’m Macie Jepson.

Pete Kenworthy

And I’m Pete Kenworthy. And this is Healthy@UH. Gut health, microbiome, good and bad bacteria. Understanding how these factors affect our health, even cancers and brain function, requires a deep dive. Joining us today is Lizzy Traxler, Outpatient Clinical Dietician with the Digestive Health Institute at University Hospitals in Cleveland, Ohio. Thanks for being with us.

Lizzy Traxler

Excited to be here.

Pete Kenworthy

So, there's been an increased interest in all of this lately. Let's start with the function of the gut. Okay. What is that? And how does it work?

Lizzy Traxler

Our gut refers to the gastrointestinal tract that does digestion for our bodies, starts in our mouth, goes through our esophagus, the stomach, small intestine and large intestine. And we also have some assistance from other organs like our gallbladder, liver and pancreas. But starting in the mouth is when physical digestion happens through chewing and swallowing, travels through our esophagus and ends up in our stomach where chemical digestion happens. And that uses gastric juices, and that mixes together with the food and helps break it down because it's so acidic. The pre-digested food travels along the small intestine. And there is when the majority of nutrient absorption happens. Once that has occurred, it goes to the large intestine, and that prepares it for waste excretion. And also there is a lot of bacteria. So, bacteria can really only live in the colon, the rectum and the large intestine, because it's less acidic than the other parts of our bodies. So, bacteria, they can thrive in this type of place. They can't live in acidity. So, here bacteria actually has some features. They can actually make vitamins like vitamin K, which is good for blood clotting. They can also ferment foods. So, some foods are undigested, usually fiber foods. We can't digest those. So, the fiber actually act upon them, and they do something called fermentation. And during fermentation, they produce metabolic byproducts that have a lot of effects on our overall health.

Pete Kenworthy

So, you mentioned bacteria during that. And is that the same as this microbiome that we're talking a lot about today? Like what role does that play in our gut health? And I guess what happens when we have bad gut health?

Lizzy Traxler

So, it's a little bit different. The bacteria just in our gut alone does not comprise our gut microbiome. What are we talking about when we say gut microbiome? That refers to all the different organisms and each organism…they're made up out of cells… so there's bacteria, viruses, any single celled organism like that, they all have genes from the cells they're made out of. So, collectively all these organisms and their genes make up our gut microbiome. So, it's going to be totally different person to person. It's really individualized. There are many variables that go into how our gut health develops and changes. It's really dependent on our own environment. So, there's many factors that can change this over our lifetime. It starts at birth, and that's when colonization of bacteria occurs. There are some early life practices that are associated with better gut health or immunity, such as being born through the birth canal or being breastfed over other things like being born through a Cesarean section or even being formula fed.

However, we don't have clear evidence how much should these practices change our gut health over time. Other environmental factors regularly discussed is medication usage, specifically antibiotics and antacids. Those are used directly to change our gut function, but likely even just short-term use of these things can have a longer term impact on our gut health. Life stressors can disrupt the gut microbiome, too, not only the stress we encounter day to day, but things like our sleep quality, physical activity levels, physical illnesses, and even aging. When our gut health becomes disrupted and we have imbalances of the good bacteria with the bad bacteria, that can have some major consequences on our health over time, like developing chronic diseases, even obesity.

Macie Jepson

Can we go a little deeper into that? And is there some science that backs up that connection to these medical issues and it going back to our gut?

Lizzy Traxler

Yeah. So, some people, they like to use a comparison of our gut microbiome to an ecosystem. So, like if you think back to like biology class, an ecosystem is a community of shared organisms living together. Each organism can affect the other ones. So, you know, ecosystem might be filled with like plants and animals, all different types of things. So, when we think of a healthy ecosystem, it's one that has a lot of diversity, a richness. A disordered ecosystem, when would be when there's an overpopulation of one type of organism, like weeds. So, when we have an overgrowth of one type of species like weeds, then that prevents other organisms for coming in and flourishing in that ecosystem. So, like the gut microbiome, imbalance in the microorganism community can occur when we see an increase in the bad microorganisms that prevent variety and diversity and only allows the bad microorganisms to flourish there.

So, this can cause increased inflammation, and that just triggers our immune response to go off. And our body's kind of in a state of inflammation that can later on trigger chronic diseases. I have read about potential links between an altered gut microbiome to pretty much anything from Type 2 Diabetes to cardiovascular disease, autoimmune conditions, inflammatory bowel disease, neurological disorders, like Parkinson's Disease and even cancer. And obesity, like I said before is heavily being researched. And we can't say that gut dysbiosis causes the disease, but it could be that increased organisms that promote inflammation might just create an environment for those diseases to onset because there's a lot of just inflammation. Things are occurring, like metabolic dysfunction or brain functioning isn't as clear. And it can even affect things like our appetite.

Macie Jepson

This is some pretty deep stuff. I mean, before we talk about how to get rid of the weeds in our gut, how do we even know they're there?

Lizzy Traxler

Yes. That's a great question. I wish there was an excellent test out there to tell us if we have good or poor gut health. There are some tests like you could take a stool sample and you could get some information on what species or organisms are inside your gut health. But these aren't that reliable, mostly because our stools are not 100% reflective of what is going on inside our gut. Basically, they just show us at a glance what is happening inside of us. And there isn't much useful information from these fecal samples, because there isn't a lot of evidence to say that this microorganism will cause this chronic disease along the road or if you need this amount of these good microorganisms to promote good health. Even if there are traces of bad microorganisms in these tests, for most microbe strains, we don't know at what levels these microorganisms can cause issues. If you are somebody who's experiencing abnormal GI symptoms, if you were recommended to get more reliable diagnostic tests like colonoscopies, endoscopies are specific tests to rule out things like inflammatory bowel disease or Celiac Disease.

Pete Kenworthy

So, we don't necessarily know if we have bad gut health, but my guess is there are things we can look for, right? Like, obesity would be a sure sign that something's going on inside of us. And it doesn't necessarily have to be bad gut health, but it can be. But are there other things that could signal that we have bad gut microbiome?

Lizzy Traxler

Sure. I think there's a lot of physical signs that there could be some type of gut dysfunction going on. I mean, look at our bathroom habits. Some people, they find that they don't go very regularly. It could be a few days before they have a bowel movement. And other people might be the opposite end where they go too frequently and have more watery types of stools. There isn't an ideal number of times we should be going to the bathroom per day. But if you are unpredictable and the number of times are going, or if it seems too frequent, that could be a sign that there's something wrong. Some other physical signs, too, are things like bloating, increased gas, indigestion, even things like having symptoms with certain foods. For example, some people might find that dairy foods, they can no longer tolerate as well. So, the lactose in milk, we need certain types of bacterial species to help us digest that. And if there is gut alterations occurring, then we might not have the right bacterial species there to help us digest those certain foods like lactose anymore. So, that is very common.

Some other lesser known signs but they could be indications, is poor energy during the day. Maybe your sleep quality is disturbed. So, it's hard for you to fall asleep or maybe stay asleep. You might find that you have increased cravings for high energy foods like greasy, fat foods or sweets. It can even cause like mental fogginess or unclarity. You might not be able to think as well as before.

Pete Kenworthy

So, you mentioned foods. And obviously that's where it all starts, right? That's where the whole digestive tract starts is with what we eat. So, are there foods that are good for our gut? And what's the research behind that? And then how do we get more of that and less of the bad bacteria? And is that a one size fits all, right? Is that true for everyone? Or are there broadly, these are the good foods; these are the bad foods?

Lizzy Traxler

So, the most talked about food connected to good gut health is fiber. Fiber is non-digestible carbohydrates. Those are the foods and plants. And fiber has a lot of importance to our guts. One is that fiber is not digested. It is fermented upon by the bacteria in our guts. So, as I mentioned before, during bacterial fermentation, the microbes produce very important metabolic byproducts called short chain fatty acids. And these short chain fatty acids have a ton of great health benefits. One of these is that they can help reinforce the gut barrier that protects against the bad microorganisms or pathogens from coming in and wreaking havoc. And this helps decrease gut inflammation and builds up our immune response. A lot of research goes into looking at different dietary patterns across the world, and they often look at what we do here in the United States.

What we follow is called a Westernized diet. That's typically high in animal protein, foods high in saturated fat that we really want to decrease. Also increased in refined carb foods, grains made with heavily processed flours and added sugars. And it's typically low in plant foods. In other parts of the world like Asian countries, they're typically eating more plant-based, so things like fruits and vegetables, whole grains, legumes, grains and seeds. Some studies have looked at what happens when people from a plant-based eating part of the world moves to the United States. So, one study I found, looked at people who moved from Thailand to the United States, and they found just over a few months of living in the United States and adapting to our Western diets that they saw some major changes to their gut. What they found was that certain microbial species that help break down fiber foods…they do the fermentation…they decreased, and they see increases of other types of microorganisms that might cause inflammation. And they do not have the ability to help us use fiber.

So, with the decrease in the fiber fermenting bacteria groups, and an increase in those microorganisms that may cause inflammation and don't actually use fiber, they're likely going to see a decrease in their production of those super healthy, short chain fatty acids that have a lot of great health benefits. So, that could have some longer-term implications on the gut and our health. The biggest takeaway I see from studies that look at diet and our gut health is diversity of foods. Like you said before in asking about if there are specific foods, you know, that should be prescribed to different people to help with our gut health, we really don't have clear research showing us that now. So, it's more about eating variety. And I think about what a plant-based diet includes. It includes variety of foods from whole grains, you know, brown rice, quinoa, oatmeal, fruit, and vegetables, beans, nuts and seeds.

And I think of like the Westernized diet when it's just like pizza, cheeseburger and ice cream. So, you can kind of see the difference between the two, not much variety. So, we do have recommended target intake for fiber set by the dietary guidelines. And it's about 25 grams a day for adult women, 31 grams per day for men. But this guideline isn't heavily stressed in our society. And cause a lot of people just don't think of fiber as an essential nutrient. So, though we might not see physical signs of deficiencies if we don't eat fiber, like we would if we were deficient in like iron or calcium, I think the more we learn about the gut microbiome on how important fiber is that we might realize that it's really essential that we're meeting our fiber needs.

Macie Jepson

So, you're talking a lot about fiber, but what I'm hearing, I don't want our listeners to walk away from this saying, okay, I just need to increase my fiber, because what I'm hearing from you is that it's more about decreasing other things like processed foods, fatty foods. And am I on the right track here?

Lizzy Traxler

Yes. But then what do you replace those foods with?

Macie Jepson

And what else other than high fiber? Is there anything else we're missing as far as beneficial foods for our gut?

Lizzy Traxler

There are a few others. So, anti-inflammatory fats are going to be Omega-3 fatty acids. Those are found in fatty fish like salmon, mackerel, tuna, also in some nuts and seeds like walnuts, chia seeds, flax seeds. And those anti-inflammatory fats, they do what their name says; they fight inflammation. And that helps promote a better gut environment. Some other foods would be prebiotics and probiotic foods. When I talk about prebiotic foods, those are the foods that feed the good bacteria. So, those include certain foods like bananas, garlic, onions, artichokes and asparagus. And the good bacteria in our gut, they like to use those foods, they ferment them, they produce those healthy metabolic byproducts. And it helps keep those good microorganisms abundant in our gut.

Probiotics are a little different. They're actually the live microorganisms added to food. So, you might see some foods labeled with live cultures added to food products in things like yogurt, fermented foods, kombucha, pickles. So, they do add live microorganisms to these foods during the fermentation process. And we can see some health benefits by actually eating these microorganisms and just adding them back into our gut health to help maintain a healthy gut environment.

Macie Jepson

So, you mentioned the prebiotics, the probiotics, fermented foods. Can we get the same results by supplements? Because you can find these on any shelf these days in the form of a capsule.

Lizzy Traxler

So, be mindful of probiotics. They're like any dietary supplement out there. They are not regulated by any government agency. So, be careful choosing. I will say that probiotics supplements should be used as a supplement, meaning they should be used in addition to a healthy diet and practicing good lifestyle, if we want to achieve a specific benefit. I would also say that there's a ton of different strains of microorganisms that they can add to all of these probiotics. So, probiotics are all different. They don't have the same composition of these similar microorganisms. They might study these microorganisms and find that certain strains might help with constipation or diarrhea or some other type of symptom like that. So, when you are choosing probiotic, you will want to do some research. So, you might want to ask a healthcare provider to help you choose that because it can get kind of confusing because there’s a bunch of long names. And usually if you're not a microbiologist, you won't know what it means.

Macie Jepson

That's discouraging. You know, I have to just ask you specifically about the kombucha because it's so popular right now. You know, just drink it and your gut biome will be all in balance and you'll live happily ever after. I mean, what is this kombucha thing all about?

Lizzy Traxler

So, kombucha is a fermented drink. I will mention that kombucha has sugar in it. So, that might be a little bit confusing if I'm telling you to eat less sugar. But during fermentation of foods, they add vinegar and they add sugar and they add your microorganism. And that microorganism kind of feeds off the vinegar and sugar and produces, you know, healthy byproducts during that fermentation. So, technically, you know, we are drinking the good microorganisms that we want to add back in. Will drinking one bottle of kombucha a day significantly change your gut health? Probably not. You need to focus more on variety in your whole diet, not just on one food alone.

Macie Jepson

So, let's just clear this up before we wrap up. Can we get to where we want to be with just food alone?

Lizzy Traxler

I think you can. I think that maybe there are times when, you know, I talked about so many different factors that affect our gut health from medications to stress to aging. There are so many things that can change this over time. So, maybe we might need a little help along the way when things go awry and, you know, our gut health seems to be imbalanced some way. We might want to try a probiotic or prebiotic supplement to help us get our gut health back to where it's supposed to be. I think if you don't see any signs like I talked about before that could show that you're having some type of gut change, then just always trying to eat more fiber, anti-inflammatory fats, prebiotics, probiotic foods in their whole forms can be enough for you.

Pete Kenworthy

All right. Any final tips before we let you go about improving gut health? You know, everybody always wants quick, easy fixes. Are there any of those?

Lizzy Traxler

Yes. So, I think what you can do is just look at what you're eating now and think, how could you add some good gut healthy foods into your everyday routine? So, I talked a lot about fiber. How can you add more fiber in? So, foods really high in fiber that you can get in small amounts would be like nuts and seeds, maybe fruits. So, you could add those things to things you might already be eating like salads, oatmeal, smoothie bowls. You might even consider trying to just find new ways you enjoy like vegetables. I find that a lot of people lack vegetables in their diet because it can get quite boring. So, just find new ways that you enjoy vegetables. I suggest maybe finding, you know, dips like hummus or salsa that you like to pair with your favorite vegetables, or maybe just experimenting more in the kitchen with cooking your vegetables with roasting or grilling. I find that that can kind of help bring out different flavors and textures that you might prefer over raw vegetables. I do sometimes recommend taking a fiber supplement. They can be extremely helpful in helping meet your fiber needs. I like psyllium husk fiber supplements. Overall, the most important thing is just variety in your diet with fruits, vegetables, whole grains, legumes, healthy fats and lean protein. And we want to promote diversity and richness in our gut microbiome. And to do that, we need to reflect that in our diets.

Pete Kenworthy

Really great stuff. Lizzy Traxler, Outpatient Clinical Dietician with the Digestive Health Institute at University Hospitals in Cleveland, thanks so much for joining us.

Lizzy Traxler

Thank you for having me.

Pete Kenworthy

Really appreciate it. Remember, you can find and subscribe to this podcast on iTunes, Google podcasts or wherever you get your podcasts. Search University Hospitals or Healthy@UH, depending on where you subscribe.

Macie Jepson

And for more health news, advice from our medical experts and Healthy@UH podcasts, go to UHHospitals.org/blog.