This approach is about restoring a healthy gut-immune barrier and includes four steps:
- removing irritants to the digestive tract
- replacing agents for digestive support
- reinoculating with friendly bacteria and the foods they need to grow
- repairing the gut lining
IrritantsIrritants can be foods that cause an allergic type reaction, alcohol, medications and stress. I will usually recommend starting with an elimination diet of gluten and/or dairy as these two food groups often cause problems for many. A possible way of doing this is outlined in the following handout by the University of Wisconsin integrative medicine department:
- Some medications like antibiotics, non-steroidal anti-inflammatory medications like ibuprofen, prednisone, naproxen and acid suppressing medications can be very irritating to the gut lining. A discussion with your physician about their necessity and length of course is really important.
- Reducing refined sugars, saturated fat and red meat and adopting a diet that reduces inflammation.
- It may be necessary to treat possible bacteria and pathogens that are causing inflammation. A comprehensive stool test or blood test may be needed to diagnose this.
- Stress is a huge and very overlooked cause of digestive problems. Phrases like “my gut instinct” and “I have butterflies in my stomach” reflect how connected we are to our gut emotionally. A little known fact is that most of the serotonin, a major neurotransmitter, in the body is produced in the gut. When I teach my Food as Medicine classes on emotional health, we speak mostly about gut health and immunity and how to support it through healing foods.
Another key part of any discussion that I have about digestion will center around stress reduction. This can be in the form of breathwork, yoga, tai chi, regular exercise, mindfulness based stress reduction (MBSR) or therapy, depending on the person and where their stress stems from. A simple and effective breathing technique that I teach in the office is the 4,7,8 breathing technique. I learned this from Dr. Andrew Weil while I was one of the Integrative Medicine fellows at University of Arizona. You can access the full technique here:
A mindfulness based stress reduction course is one of the best investments that anyone can make in their health. Trainings are offered around the world in this technique, as founded by Dr. Jon Kabat Zinn. As a result, courses are taught in many towns across the country. I would encourage you to find a class and receive this benefit of learning a lifelong practice of meditation. The mental, spiritual and physical benefits of learning such a technique are truly priceless.
Replace Agents for Digestive Support (this step may not be necessary)For some people, a short course of digestive enzymes might be useful. I don’t use these much because I want to help enhance the native digestive ability each person has. However many patients come see me already taking them, and so they are worth a mention. Betaine HCL and Pancrease are often used as a means of digestive support while the stomach acid is being restored, or the diet is being slowly changed from animal protein to plant based.
ReinoculateReinoculate with good bacteria and the foods that nurture their growth.
- My focus is always on choosing foods first to foster gut health, before using supplements or medications. To this end, fermented foods are basically a treasure trove for healthy gut bacteria.
- Sauerkraut, miso, natto, yogurt, pickles and kimchi are all great options. If you can make them yourself, even better! At the least, do avoid getting products that contain sugar.
- Short chain sugars called fructooligosaccharides (FOS) have been found to promote the growth of friendly bacteria in the gut. Foods that contain them include bananas, Jerusalem artichoke, onions, asparagus and garlic.
Repair Mucosal LiningThe best way to start here is with regular aerobic exercise to help maintain regular motility and reduces the stress-induced enzymes that can disrupt the GI barrier. Encourage daily movement and exercise.
Fiber is a big one….there are two types and both are important for mucosal lining and repair-soluble and insoluble. This helps develop healthy mucous and maintains regular transit time in the gut. Adequate intake of whole fruits and vegetables is important. Good sources of soluble (viscous) fiber include:
- Psyllium Husks (Metamucil) One tsp. before meals in 8-10 oz of water or juice.
- Guar Gum. This is less “gritty” but more expensive than psyllium. One tsp. before meals in 8-10 oz of water or juice.
- Oat bran/Oatmeal. Consume as cereal each morning, preferably steel cut oats.
- Ground Flax Seed, one tsp. over food or in water or juice before each meal. I just put this into my kids pancake or waffle batter, or sprinkle on top of yogurt, cereal, etc.
- Around 2 liters of filtered water daily is a good goal.
- Antioxidants such as vitamins C, E and A, selenium, and carotenoids, which are found in multivitamins.
- Zinc 25-30 mg daily.
- Omega-3 fatty acids (EPA/DHA) in the form of fish oil. 2000 mg daily is a good place to start.
- L-Glutamine Powder. This amino acid is an important nutrient for intestinal repair.