The Gut Microbiome and a Healthy Life
How gut health affects your body and how to improve it
—By Dora Usdan
On a typical weekend night, students flock to restaurants and bars for a fun filled evening with their friends. Memories are built over passed plates and shared drinks. But for University of Michigan Junior Caitlyn Hocker, this routine is more stressful than it seems. “Going out on the weekend and drinking and doing normal things has made me so miserable I can’t enjoy that aspect of the college experience.” Hocker struggles with Irritable Bowel Syndrome (IBS), and even just eating can be challenging and confusing.
Hocker is not alone in her struggle. For many people, the reality of life is one full of stomach pain. Unsolved mysteries of gas, bloating, and indigestion interrupt family events, school, vacations, and everyday life. Endless doctors appointments and medications can leave patients feeling hopeless, but a new holistic treatment has been emerging recently: gut health.
Pediatric gastroenterologist Dr. Julie Khlevner has noticed this trend first hand. “More and more patients and families are aware of how diet impacts gut health, and come in immediately asking for help fixing their diet to help their gut.”
Currently, my TikTok “For You Page” is littered with content on gut health and how to eat for a healthy gut. Viewers of all ages are downing bone broth, supergreen supplements, and varieties of probiotics in an effort to attain a balanced gut microbiome, a state many believe will solve their health problems and insecurities.
However, gut health is not as straightforward as it seems, and in fact these supplements and restricted diets can often do more harm than good. I spoke with dieticians, nutritionists, and gastroenterologists to get to the bottom of eating for a healthy gut.
What is the gut microbiome?
The gut microbiome is a diverse set of bacteria, both good and bad, that help maintain homeostasis in the body. There are approximately 100 trillion bacteria living within the gut; there are likely more bacteria than the cells in your body. The bacteria in your gut microbiome are highly multifunctional, as they synthesize and break down vitamins and minerals for use in the body, support neurotransmitters, and help maintain blood sugar levels.
The gut bacteria are fed and maintained by the foods that you eat every day. Gut bacteria thrive when they are fed a wide variety of high fiber, complex starches like fruits, vegetables, nuts, seeds, legumes, and resistant grains.
Additionally, 70% of the immune system is located in the gut, meaning that imbalances in bacteria can cause a wide range of physical immune responses. So, physical health problems like fatigue, skin conditions, brain fog, and illness are often rooted in the gut not being able to regulate immune system homeostasis.
Registered dietician and functional medicine nutritionist Amanda Rigby describes the gut microbiome to her clients using a metaphor of a garden. This garden is populated by good bugs and bad bugs, and there needs to be a balance. The “gut garden” is fertilized by the foods that we eat, and a diet can either provide good fertilizer that helps the good bugs grow, or “not-so-great” fertilizer that feeds the bad bugs. The Standard American Diet (SAD) is an example of a worse fertilizer for your gut garden. The SAD relies heavily on animal products like meat and dairy, as well as heavily processed foods that lack the nutritional diversity to fuel your gut.
Rigby even mentioned how the gut microbiome can change based on several factors besides diet, like whether you were a vaginal delivery or C-section, or if you were breastfed as a baby.
So, it seems easy enough to eat for a healthy gut, right?
For the average person maintaining a healthy gut can be as simple as integrating more fruits and vegetables to their diet. Gut health nutritionist Jessica Moisuk prescribes eating a great variety of plants through whole grains, fruits, vegetables, nuts and seeds, for a total of 30-40 different plants a week. But, this is potentially challenging to achieve in both quality and quantity.
Firstly, there has been a sharp decline in the quality of fruits and vegetables on grocery shelves today. This is because an emphasis has been placed on the quantity of food available. Fertilizers and factory farms have depleted the soil of its natural good bacteria, meaning the food at the grocery store is lacking the amount of nutrients it used to, making it harder to get all the prebiotic and probiotic benefits from fruits and vegetables. According to Rigby, “Quality of fruits and vegetables has really declined; in supermarkets today testing has revealed a 30-40% mineral decrease in the past forty years within fresh produce.” People are having to work harder than ever to locate fresh grown produce from local farms, where the microbiome benefits are likely to be greatest.
Additionally, consumption of 30-40 plants per week can get extremely expensive, especially in food deserts or for single-member households. Privilege becomes a barrier to gut health.
What about IBS sufferers?
For those who already suffer from gastrointestinal distress, gut health could be the answer to an often unsolvable problem. However, it requires a different treatment plan, specialized to attack the overgrowth of bad bacteria present that is causing the distress in the first place. This is mainly because the high fiber foods associated with a colorful diet can cause bloating, indigestion, gas, and discomfort.
This can often start with an antibiotic, or a low fiber diet. The main diet prescribed is a low FODMAP diet, a diet that cuts out fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are high fiber, hard to digest foods like garlic and onion, oats, dairy, apples, and cruciferous (ex: broccoli, kale, brussel sprouts) vegetables. These foods can be painful on their own, and also stacked in different amounts and combinations. FODMAP foods bring in a lot of water and indigestible fiber, slowing the digestion process and absorption of nutrients.
For IBS sufferers looking to eat to heal their gut, they first need to start with 2-8 weeks of a low FODMAP diet, even precluded by a course of an antibiotic, to cleanse the gut of both bad bacteria and good bacteria, and rebuild the microbiome from scratch. Says Moisuk, “When the system has calmed down we have a period of reintroduction that really gets into the nitty gritty of what someone can tolerate and in what amounts. From there, the diet is customized. When you have IBS it takes more effort to cultivate a healthy gut microbiome, but it is certainly possible.”
Khlevner agrees with Moisuk’s sentiment, and views that there is a lot of overlap between treating patients with medicine and reaching for more holistic approaches. She tries to balance using pharmaceutical solutions for immediate symptom relief, while integrating tools like diet, probiotics, and supplements for long term symptom management.
The need for professional support
For many, the idea of eating 30-40 different plant products a week is daunting; it might even seem impossible. However, when done correctly diets for a healthy gut are a short course, followed by reintroduction of food groups. According to Moisuk, “Low fodmap and gut health are tools to help the gut lining heal, but there always needs to be a plan to reintroduce. The end game is seen in the disconnect between nutrition and GI treatment—it is symptom management vs. normal eating and living.”
People who are trying to self diagnose and treat their gut problems are often missing the period of reintroduction. Hocker described being on low FODMAP for over four months, because of a lack of support for the transition. The follow through and reintroduction phase is missing in the glamorized portrait of gut health on social media today.
In reality, gut health for IBS sufferers can be sustainable, if it is focused on elimination and reintroduction, determining what foods and in what quantities cause GI distress.
How does social media get it wrong?
Gut health’s growing popularity on TikTok and Instagram provides both pros and cons for those in the community. One major pro of social media promoting gut health is that a huge amount of awareness has been raised to the issue. More research than ever is being done, and the ability to find doctors is at an all time high. However, social media also glamorizes the process, often promoting unnecessary products for personal economic gain, or suggesting unsustainable eating habits.
The gut is inherently unique to each individual—no influencer can tell you what to eat to feel better, because they lack the medical knowledge or the knowledge of your own health history. These uneducated people pushing supplements has led to an over saturation of information, making it even harder to discern healthy gut habits from unhealthy ones. It has become very easy to go too far with eating for a healthy gut, making a practical diet into an unattainable one, fuel for comparison and toxic eating culture.
Gut health influencers are major proponents of instant fixes to an unstabilized gut microbiome, like drinking bone broth, green supplements, and expensive probiotics. This linkage of consumer culture to health can be detrimental for those struggling with daily pain; Moisuk describes how they will try almost anything to make it better. So while it is great that social media has provided research and awareness to the issue, the information without context and with a capitalist gains mindset is wasting sick people’s time and money.
Influencers are even labeling rapid weight loss as gut health. This is especially concerning as IBS is heavily linked with disordered eating habits. IBS can be developed while in recovery for anorexia and bulimia because of malnutrition and depletion of the gut microbiome. For some, the two go hand in hand and develop simultaneously in severity, as IBS symptoms like bloating fuel body dysmorphic thoughts and safe foods for digestion become blurred with safe foods for calorie counting. Additionally, disordered eating can be developed after IBS flare ups or excessive time on restrictive diets like low FODMAP.
Khlevner and other doctors in her practice have noticed an uptick in disordered eating and restrictive eating habits associated with those who suffer from IBS. “All the practitioners in my office have seen it, so we are actively learning to balance prescribed diets like low FODMAP with food freedom and variety. I try to really be aware of my patients and ensure they are eating enough, both in caloric quantity and variety.” She assesses her patients and families from the onset to determine whether they are even a candidate for a restricted diet based on family culture and habit.
Luckily, nutritionists believe that healing your gut is possible at home with the right amount of research and preparation. Gut health nutrition cuts against the narrative of band aid solutions to healthcare, by treating symptoms and the body holistically. This could be a revolutionary treatment for GI symptoms, but requires a strong mindset and ability to tune out unnecessary information. Says Moisuk, “If you take a fairly level headed approach and go into it knowing that not everything you read about someone else’s approach is going to work for you.”
Moisuk has found that her typical clients cling to fear foods rooted in a history of dieting that are exacerbated by food sensitivities. She takes this very seriously, and is aware of the negative effects the internet has on this cycle. “Putting labels on certain foods on the internet feels very irresponsible to me, because I know what it’s like to be consuming information that strikes fear. I’m very conscious of what I say about food online because I don’t want to add to that narrative. It’s a professional responsibility and a user responsibility.”
How does our healthcare system regard gut health?
For many, the lived experience of striving towards gut health is complicated by systematic and bureaucratic barriers within the healthcare system. People are often sent from provider to provider, trying imprecise treatment after treatment, that can cause more debilitating symptoms.
For women who suffer with IBS especially, they are often told it is all in their heads, or more drastically like Moisuk’s experience, doctors calling it a women’s issue that had no cure. Many doctors are quick to prescribe harsh medications before doing adequate testing.
For Hocker, she was prescribed laxatives and Trulance by doctors at Michigan Hospital and at home, before she was able to see an acclaimed gastroenterologist. Her GI was shocked that she had seen so many doctors but had never undergone testing or a colonoscopy—when the two were properly completed they revealed a host of problems the other doctors missed.
Additionally, many insurance companies refuse to cover complex treatment plans or procedures. Rigby uses a higher quality gold standard stool tests for her clients, more specified and responsive than the typically used ones, and it is entirely an out of pocket cost.
Hocker’s personal nutritionist, who she described as life changing, costs $950 for four sessions over four months. This is not covered by insurance, as it is deemed an elective medical cost.
Good gastroenterologists who are receptive and dive deeply into symptoms and root causes are hard to come by, and their rarity creates a barrier of access due to long wait times for appointments. Many times, clients use connections and references to get ahead on the waitlist.
For such a debilitating condition, it is sad to think of all those suffering who are unable to even get a doctor’s appointment for years at a time, let alone afford complicated, trial and error based treatment. The privilege barriers to healthcare mean that the conversation surrounding gut health remains insulated. Hocker remarks, “Because of connections and privilege did I get an appointment with my GI—she was fully booked but because of my connection fit me in.”
Photo by Jamie Street via Unsplash