Trust Your Gut
Our Stories Live in Our Bodies: What is Your Gut Telling You?
This week is about gastrointestinal health.
Today’s newsletter is about persnickety irritable bowel symptoms.
Today’s podcast is a 14-min solo episode where I apply the framework I use to conceptualize health—i.e., the four “I”s—to troubleshoot gastrointestinal woes. You can also listen to today’s podcast on Spotify or Apple Podcasts.
For Friday’s Q&A, I welcome your questions on gut health. Submit your question here!
Join me for our next Zoom hangout on Wednesday, April 19 at 8 pm ET! We will discuss The Four “I”s and how to layer your own story onto this framework. You can register here. This is for paid subscribers only.
I recently saw a middle-aged patient who reported bloating, gas, and irregular bowel movements. He was pooped (pun intended) from wading through online advice. Cutting out dairy and gluten and gulping down PeptoBismol every morning before work didn’t help. Worrying about his health seemed to make him feel even worse.
I think I need a probiotic, he proclaimed.
It turns out he is not alone. An estimated 24 to 45 million (10 to 15 percent) adults in the U.S. experience symptoms such as abdominal pain, bloating, constipation, and diarrhea. And these are probably under-estimates, given that people with gastrointestinal problems often do not seek medical care.
The 2012 National Health Interview Survey (NHIS) showed that about 4 million (1.6 percent) U.S. adults had used probiotics or prebiotics in the past 30 days. Among adults, probiotics or prebiotics were the third most commonly used dietary supplement other than vitamins and minerals. The use of probiotics by adults quadrupled between 2007 and 2012.
The microbiome has been a hot topic for at least a decade. Given that our gut is home to TRILLIONS of bacteria, viruses, and fungi—plus the fact that it reflects what we eat and drink and how we feel emotionally—I thought it was time to take a fresh look at the latest research on gut health.
What is the microbiome?
The microbiome is the collection of these living critters in our intestines. Fun fact: there are as many microbes in our gut as there are cells in the human body.
The “good” microbes help break down our food and extract vital nutrients, such as selenium, iron, and zinc. These helpful microbes need sustenance, too, and they get it from what we eat.
A healthy microbiome is characterized by a diverse array of microbes that work together to maintain balance and protect against harmful pathogens. An imbalance in the microbiome, known as dysbiosis, has been linked to a variety of health conditions, including inflammatory bowel disease, obesity, and even mental health disorders.
Are you Okay? For more on how the stories we tell ourselves impact our everyday health, join our conversation!
So, why am I bloated, gassy, and no fun at dinner parties?
These symptoms can be a sign of everything from Crohn’s disease to anxiety. However, an all-too-common cause of “irritable bowel” symptoms is an imbalance between the “good” and “bad” bacteria.
Our diet can either feed the helpful microbes—keeping the colonized gut in harmonious health—or it can cause an overgrowth of harmful microbes. Eating fresh vegetables and fruits will supply the “good” microbes, while eating too much sugar and processed food will tend to fuel the “bad” microbes.
Remember, our gut doesn’t operate in a vacuum. We are the integrated sum of complex parts. Health is about having awareness about the stories we tell ourselves, acceptance over the things we can't control, and more agency over our life. It starts with access to fact-based information to care for our body and mind.
My advice to my patient?
First, awareness of the data and the stories we tell ourselves
To check his data, i.e., a full panel of blood and stool test in order to rule our things like celiac disease, hyperthyroidism, Giardiasis and other parasitic infections. (It turns out he has a family history of celiac disease and Hashimoto’s thyroiditis, and he was in Mexico a month prior to our visit—aha!)
To recognize the natural impulse of busy people to pop a pill (i.e., a probiotic) instead of exploring the diversity of possible causes of gut woes, such as:
Sugar substitutes, i.e. sugar-free gum, candy, and sweeteners
Over-the-counter medications such as Advil, Aleve, and aspirin
Prescription medications such as Metformin, Semaglutide and Sertraline
Supplements like magnesium, ashwagandha, NAC (N-acetyl-cysteine), lysine, iodine and kelp supplements if given in high doses
Eating too fast
Binge or restrictive eating
Then, acceptance over the things he cannot change
To accept that even the most well-intended friends and internet gurus may not always have the right answers for our particular health issue!
Finally, to exert agency over the things he has control over:
To take a moment to address the nuanced bodily “inputs” that might be triggering his symptoms—from prescription meds to brussels sprouts to alcohol to worry itself.
To assume that his lab tests and colonoscopy are normal, to keep a detailed food diary in order to identify trigger foods, using the list of low-FODMAP foods as a guide.
To gradually increase his daily fiber intake to help “bulk” the stool.
To practice stress management techniques such as deep breathing, yoga, or meditation—given that emotional stress is an exceedingly common trigger for gastrointestinal distress.
To consume things like yogurt, kefir, kombucha and other fermented foods, all of which contain “good” microbes like Lactobacillaceae and Bifidobacterium.
To avoid taking unnecessary antibiotics that can kill the good microbes and cause dysbiosis (when “good” and “bad” gut bacteria get out of balance.)
And to consider a tailored probiotic regimen if all else fails!
At the end of the day, managing digestive distress is a process and often requires a comprehensive medical approach that includes laboratory testing, dietary modifications, stress management, and targeted supplements and medications based on individual needs.
National Institute of Environmental Health Sciences Microbiome
Molecular Psychiatry The gut microbiome and mental health: advances in research and emerging priorities
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Have you struggled with gut health? What has helped you manage it? I’d love to hear your thoughts and advice in the comments!
In today’s solo podcast, I explain the practical framework I created to help patients conceptualize their health, integrating medical evidence, the patient’s story, and real life.
I call it the FOUR “I”s:
Information & data = the elements of our health that we can measure and see.
Inputs = everything that we put into our health ecosystem.
Infrastructure = the vehicle (i.e., the skeleton) that drives us through life.
Insight = the process of laddering up from self-awareness to acceptance to agency over our health and well-being.
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.