I was doing some continuing education over the past week and I had access to a conference put on by Monash University called GastroDiet2024.
When I got my Level 5 diploma in advanced nutrition from Mac-Nutrition Uni, graduates were given the opportunity to attend certain courses offered by Monash and I’ve continued to learn what I could about gut health, despite not being a registered dietitian.
The first course I took through them was regarding a Low FODMAP diet for the treatment of IBS. It was a great course and I wrote a bit about it last year on this site.
This remains an area of interest primarily because it’s become a greater topic of conversation with clients and because of how challenging it’s been for my wife since she started dealing with more gut health issues over the last handful of years.
It’s important to note that stress plays a considerable role in gut health, due to the way that the gut and brain communicate with each other. If the gut isn’t acting right, it affects our mental state and if our stress is through the roof, chances are it’s going to affect how our gut feels. These two will basically always be intertwined which is part of the reason why not every intervention to improve gut health is as easy to solve as: eat this, not that.
I do want to share a scattered list of thoughts from the GastroDiet2024 conference in efforts to shine a light on where current wisdom is regarding gut health for anyone struggling with digestive issues.
Please know that this information is not meant to replace medical advice and if there is something here of interest to you, please consult your doctor to see how/if the information applies to you.
When assessing a client for GI issues, many RDs/MDs will go through a series of screening assessments with the hope of understanding the bigger picture related to digestive concerns. These can include:
-Nutrition screening
-Past medical history (medications, drug history, allergies, family history)
-Celiac screening, stool samples, endoscopies, biopsies, bloodwork
-Dietary intake (trigger foods, eating patterns, disordered eating, food related quality of life)
-Social history (lifestyle, sleep habits, home life, work, cooking and shopping circumstances)
-Mental health (stress, anxiety, depression, mood, work/life balance)
Anything that may seem like a red flag in these screenings could shine a light on why someone is struggling to have a healthy gut, healthy bowel movements, etc.
Tools like the Bristol stool chart, which looks at consistency/form of bowel movements can be helpful as well as understanding other symptoms which may be occurring: bloating, flatulence, fatigue, constipation, diarrhea, headaches, acid reflux or rapid weight loss.
It’s also important to note how frequently someone may associate with not just the stress of eating a certain food but how they are affected if they feel they cannot go to public spaces without feeling the urge that they might have an accident and lose control over their bowels in a public setting. Here again, we’re seeing the correlation of stress when it comes to eating and digestive behaviors.
Because this course was designed primarily for dietitians, many of the professionals who were speaking were RDs themselves or gastroenterologists offering both clinical and practical knowledge for those in attendance.
It was remarked at one point in the course, that gastroenterologists, when tested on nutrition information had less than 40% correct responses when asked about how nutrition could benefit their patients. This leaned into the need for RDs and GIs to work together in efforts to improve the outcomes for their patients.
In many cases, RDs have the potential to initiate progress and reduction of symptoms with diet alone before medication/surgery are needed. It was found that many patients could go well over a year of screenings and assessments, being bounced around from one appointment to the next with no clear understanding of why they were experiencing what they were and having no real solution to their problems. As one might imagine, this is yet one more example of how stressful this could be.
Keep in mind that our digestive system is not just affected by what we eat but the medications we take, our emotional state and the health of our immune system. There is typically a positive association for those who are implementing exercise into their lifestyles. The Western Diet (as what is often referred to with how we eat in the domestic U.S.) is associated with higher sugar and higher fat foods which can be detrimental to the gut microbiome. As more of the Western Diet shifts east across the globe, we are seeing a rise in obesity with the correlating illnesses such as Type II diabetes, colorectal cancer and hypertension.
Because excess adipose tissue (fat) in the body contributes to a higher amount of inflammation in the body, this inflammation is also present in the gut. This is a scenario where some degree of fat loss may be encouraged to improve gut health overall.
Transitioning to a diet that is more plant forward: whole grains, nuts, seeds, fruits and vegetables (where tolerated) can be a first step towards a healthier gut. Exclusions would need to be made for any known allergies or intolerances.
This does not mean that everyone needs to be vegan. A plant-forward diet can still have a significant amount of animal proteins but many people, especially in the U.S., are low in fiber intake. A low fiber intake has a strong correlation to gut disorders such as irritable bowel syndrome, Crohn’s disease, and inflammatory bowel disease.
It’s been found that diets like the Mediterranean diet, high fiber diets and plant-based diets are more positively associated with improved gut health while ketogenic, carnivore and Western diets carry more risk to the gut microbiome due to lack of fiber and fiber diversity. At a bare minimum, 24g of fiber through a range of sources is suggested.
Also of note is that artificial sweeteners may have a negative effect on a healthy gut. If you’re someone who consumes a significant amount of products containing these sweeteners, a reduction in them could improve symptoms.
Unfortunately, there is no one-size-fits-all probiotic that can improve gut health. Should you hear or read of a probiotic that improves symptoms, it’s important to recognize which strain of bacteria and at what dosage has been shown to help. While probiotics won’t necessarily make your symptoms worse, you could be spending money unnecessarily without any improvements to your health. If you can tolerate them, fermented foods might be a reasonable addition to the diet to get probiotics into the body. Consider foods like yogurt, kefir, kombucha, kimchi or sauerkraut and understand that they may be helpful and they may not. Each person is different.
For individuals struggling with IBS, a low FODMAP approach has been shown to be beneficial in reducing symptoms or severity of symptoms. That being said, there are more aggressive and more modest approaches and a qualified RD can help navigate when it’s appropriate to be more or less strict with the protocol. Unfortunately, there can be an overlap between individuals struggling with IBS who also have disordered eating practices and may be suffering from malnutrition.
For those interested in experimenting with low FODMAP, Monash does have an app that guides you through how to implement elimination and reintroduction of foods. Because there are so many foods which are potentially triggering for symptoms, consulting with an RD to keep the diet as balanced as possible is advised and supplementation may be needed to improve micronutrient deficiencies.
Another helpful tool is in having more balanced meals throughout the day. Meal skipping can be counterproductive to those who struggle with gut health. Scheduling breakfast, lunch and dinner with one to two snacks may be appropriate in managing symptoms assuming that any necessary food exclusions are also being implemented. Coincidentally, this same type of meal scheduling can be helpful for those struggling with disordered eating practices.
Unfortunately, there was not a lot of discussion in the modules about how the menopause transition can influence these symptoms for many women. I think this is an area that needs more attention because many women can go through the first 4-5 decades of their lives with no major digestive issues but can develop symptoms during the transition due to the fluctuating decline of estrogens.
If there’s any other takeaway I’d like you to have from this, it’s to be more proactive with documenting any changes you notice. The Monash app referenced above can be helpful as it guides you through the elimination and reintroduction process to see if certain foods need to be removed permanently or can be tolerated in small amounts.
Be your biggest advocate. Document all you can and make sure you surround yourself with a care team that can help you as you continue to improve your health, up to and including how your digestive system is functioning.
(Photo courtesy of Julien Tromeur)
