‘Does your gut even need healing?’: Dietitian debunks myths in trending gut health hacks
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In the age of the internet and social media, one thing we can always count on is having access to a lot of information. But what happens when that information is not entirely accurate and does more damage than good?
We have seen this recently with the gut microbiome and gut health. TikTok, in particular, has become a focal point for social media influencers to share stories about gut health struggles and “hacks to heal your gut” under hashtags such as #guttok, #guthealth and #guthealing.
While many people rely on the “expertise” of social media influencers to steer them in the right direction, experts with real credentials are few, far between and often muted by those sensationalized for their louder voices and even larger following.
To debunk untruths surrounding gut health and combat misinformation that could lead to serious health problems, Healio spoke with Christine Randazzo Kirschner, MS, RDN, CDN, co-founder of Amenta Nutrition in New York, about the role the gut microbiome plays on our health, what foods promote a healthy gut and advice for spotting common misconceptions.
Healio: What is “gut health” and how does it relate to the gut microbiome?
Randazzo Kirschner: “Gut health” is a term commonly used to describe the health of one’s stomach, intestines and/or digestive system. Some individuals may associate poor gut health with symptoms they experience; for example, headaches, low energy, inflammation, altered bowel movements, “belly” discomfort/pain, bloating and even rashes. In order to remedy their discomfort or reduce their symptoms, they believe “feeding” or “cleansing” their gut is necessary.
In the medical field, gut health refers to the community of microorganisms that coexist in the digestive tract and the symbiotic — or dysbiotic — relationship that may occur between them. The makeup of the human intestinal microbiota is unique to each individual, and the present microbial population — type/amount of bacteria and balance between them — and its location can help determine one’s current gut health status.
There are many diseases and disorders that are associated with gut dysbiosis, including inflammatory bowel disease, irritable bowel syndrome, small intestinal bacterial overgrowth, type 1 diabetes, cardiovascular disease and colorectal cancer.
Healio: How can you identify an unhealthy gut?
Randazzo Kirschner: Patients often come to us thinking they have a problem with their gut based on the symptoms they are experiencing. They may have a problem, but we cannot determine if they have an unhealthy gut solely based on reported symptoms. Since dysbiosis is based on the current microbes housed in the gastrointestinal tract, objective data would be necessary to determine if there is, in fact, an imbalance present in the microbiome.
However, we know from research that there are certain foods or food compounds that promote beneficial bacteria. Therefore, after looking at a patient’s food journal, we may have a better understanding if there is potential to improve or help rebalance their personal ecosystem via diet.
If the patient is experiencing GI-related symptoms, GI dietitians will not only analyze what their patient is eating but also the type of symptom they are experiencing, as well as when the symptom occurs. This provides insight into which foods may be triggering or exacerbating their symptoms. The goal is to help patients manage their symptoms through diet modifications. As previously mentioned, GI symptoms and/or altered bowel movements alone do not determine poor gut health.
Healio: What implications does gut health have on weight, susceptibility to other conditions or diseases, and overall health?
Randazzo Kirschner: The main physiological functions of the gut microbiota are digestion, vitamin synthesis and substrate metabolism. There are many reported links between the gut microbiome and obesity, but the mechanisms are not fully understood. Furthermore, it is still being debated as to whether dysbiosis is a causal element or just an effect of obesity.
It is essential to note that poor gut health or dysbiosis is independent of BMI. There are individuals who have pathogenic bacteria or dysbiosis who are not obese. An individual may be categorized as obese via their BMI, but that does not mean that person has metabolic syndrome or is in a state of inflammation or disease. At our practice, we do not use BMI or weight as sole indicators for determining our patients’ health status.
With that said, poor gut health in all individuals may increase the risk for acquiring disease. Some conditions that are associated with intestinal imbalances are autoimmune ones like type 1 diabetes; bowel disorders, including IBS, Crohn’s disease and ulcerative colitis; cardiovascular disease; and mental health.
Concerning overall health, a well-balanced and well-varied intestinal flora offers many benefits, including protecting against germs and boosting immunity, helping to break down food and provide energy, and producing important vitamins and metabolites like short-chain fatty acids and serotonin, which play a key role in the gut-brain connection and mental health.
In addition to the aforementioned benefits, the good bacteria’s preferred fibers (their favorite foods) also impact the functional effects of the gut. These consequences of specific fibers may reduce GI symptoms and promote regular and consistent bowel movements.
Healio: How does the gut interact with chemicals found in processed or packaged foods?
Randazzo Kirschner: Many processed or packaged foods are known as ultra-processed foods (UPF). These UPFs are often high in fats, oils, sugars, starches, flavor enhancers and food additives that make the foods hyperpalatable. These food additives are often not absorbed and are thought to directly interact with the gut microbiota.
For instance, some artificial sweeteners and polysaccharides have been shown to promote intestinal inflammation and metabolic dysregulation. Additives such as the emulsifier carrageenan, which has induced chronic inflammation in rodents, and carboxymethylcellulose and polysorbate 80, have been shown to directly impact the intestinal microbiota (in rodents and in vivo/vitro) in ways that may promote inflammatory diseases.
Moreover, if someone follows an eating pattern rich in these foods, they are likely eating them in place of whole, nutrient-rich foods that contain compounds that the beneficial bacteria prefer to eat like fiber, probiotics and polyphenols.
In our practice, we teach our clients that while no foods are off limits, prioritizing whole fruits and vegetables, whole grains, nuts and seeds, and lean proteins is beneficial because these items have been shown to reduce the risk of disease. Conversely, UPF consumption should be limited until further research clarifies the effects these additives may have on our health.
Healio: There is a lot of information — and misinformation — online about “healing your gut.” As a nutritionist, what do you suggest?
Randazzo Kirschner: Firstly, it’s important to reframe the mindset around gut or digestive health — does your gut even need healing or could it simply use some nourishment? It’s key to understand the patient’s personal goal: Why do they think their gut needs healing? Are they trying to alleviate discomfort or are they trying to reduce the risk of acquiring a disease a family member may have? Do they have a disorder or condition that they are trying to improve or are they being inundated with misinformation about gut health that is making them believe that they must do something?
With that said, maybe they do need to do something. It is understood that diet plays a significant role in shaping the microbiome and that diet alterations can create microbial changes quickly — in as little as 24 hours. In terms of optimizing gut health through food and promoting a beneficial change in the microbiota, we promote a whole-foods, plant-rich eating pattern that includes fiber like prebiotics and resistant starch as well as probiotic-rich foods.
There may be a place for supplements, but that depends on the individual and what their personal needs are — and what their labs reveal. Unfortunately, there is a lack of oversight as supplements are not regulated.
Healio: Are there any specific foods or supplements that promote healthy gut function?
Randazzo Kirschner: At Amenta Nutrition we take a food-first approach. However, sometimes our patients may benefit from a nutrition plan that includes diet modifications in conjunction with a supplement recommendation.
There is an array of supplements that can potentially help gut function, including fiber supplements, magnesium, laxatives, enzymes, encapsulated peppermint oil, but it depends on the patient’s symptoms, medical condition(s) and bowel habits. These supplements, if warranted, need to be tailored to each individual as there may be side effects or contraindications.
Some foods that we recommend in our practice include insoluble or soluble fiber-rich foods like ground flaxseed or oatmeal, respectively; fruits and vegetables in general contain a mix of both. Prebiotic foods like asparagus, onion, garlic, leeks and Jerusalem artichokes are also part of our suggestions. Probiotics, which are good live bacteria that confer a health benefit, are found in certain foods like yogurt (Activia), kefir and Yakult. Some fermented foods may be considered probiotics and can add to the biodiversity of the microbiome as well. The way these foods are treated or stored determines whether they contain beneficial live cultures. For example, raw miso may be a probiotic, while cooked miso may not. Thus, not all fermented foods are probiotics.
The American Gut Project found that the most diverse microbiomes, those associated with “healthy guts,” were found in individuals who ate 30 or more different plant foods a week. However, eating this many plant foods may not be practical or comfortable for everyone; each of our bodies and digestive systems operate differently. What we recommend will depend on an individual’s tolerance to new and increased fiber-rich foods, as well as their food availability and lifestyle.
Healio: What does the term “leaky gut” mean?
Randazzo Kirschner: Our digestive tract is designed to fight off unwanted pathogens. The cells that line the intestines (the epithelium) form a barrier that prevents unwanted substances from crossing the intestinal lining. The spaces between these cells (the junctions) regulate the diffusion of molecules across tissues and maintain epithelial integrity.
In other words, the intestinal cells and tight junctions prevent toxins and food particles from entering the bloodstream and allow water and nutrients to be absorbed. If these junctions are compromised and aren’t “tight” enough, an increase in intestinal permeability — so called “leaky gut” — may occur, allowing larger molecules that are potentially toxic to enter the bloodstream which may manifest as inflammation, infection or disease.
Therefore “leaky gut” is the same as intestinal permeability. Where the confusion lies is that “leaky gut syndrome” has been theorized as an underlying cause that occurs independently, as opposed to being a symptom of GI disease.
Healio: What are common misconceptions about having an “unhealthy gut” and what messaging do you promote to rectify these misconceptions?
Randazzo Kirschner: There are no superfoods or quick fixes. Patients may hear from a family member, friend or on social media that a particular food, supplement or “cleanse” is helpful for optimizing gut health or reducing symptoms. It is not about one food, but the overeating pattern that counts. One meal — or eating a certain way over a 1-week period — will not determine a person’s health outcome nor will drinking a cleansing cocktail.
Oftentimes we see too much over-restriction and fear around food. Patients find a new diet on the internet that promotes gut health, and this diet forbids consumption of a ton of foods or entire food groups. The patient removes these 30 to 40 foods and feels better. Yes, maybe this person does feel better because they removed so much food from their diet, but now they are at risk for malnutrition or nutrient insufficiencies, and they are miserable because they are not allowed to eat anything.
Alternatively, we have patients who bring us results of food sensitivity testing that indicate they have intolerances or sensitivities to three dozen different foods. Our job is to explain that these are not validated, evidence-based tests and to make recommendations that ensure the patients are following the most nutritionally-adequate, least restrictive eating pattern possible that makes sense for their personal digestive system.
More often than not, we add foods, not take them away.
Healio: What advice would you give to fellow nutritionists and dietitians treating patients with inadequate gut health?
Randazzo Kirschner: Tailor your recommendations to that individual patient. Get as much objective data as you can from the patient’s care team: their primary care physician, gastroenterologist, etc. Ask a lot of questions. Don’t just accept a one-word symptom like ‘bloating’ — dig deeper and find out what kind of bloating they are experiencing, where it is, when it occurs, whether specific foods make the patient’s symptoms worse, etc.
In order to uncover potential food triggers, listen very carefully to your patients and focus on the details. For example, a patient might associate tomato sauce and, subsequently, tomatoes with their symptoms, but it may very well be the onion or garlic in the sauce that is the culprit. Now they have omitted a delicious and nutritious vegetable for no reason.
Since we as dietitians often spend more time with patients than gastroenterologists do, we are in an advantageous position to take a deep dive into that person’s diet, preferences and lifestyle. We are then able to fill in information gaps and communicate it to the patient’s care team, which can influence the patient’s health plan and improve patient outcomes.
Healio: What advice would you give patients?
Randazzo Kirschner: Don’t believe the hype — it’s easy to get seduced by food marketing messages. Headlines and buzzwords are sensationalized to draw you in. Advocate for yourself.
The next time you see something on the internet or social media, ask yourself: Who wrote this? What are their credentials? Where is the research? Who sponsored it? Are they asking me to spend money or omit entire food groups?
Lastly, make sure you have a care team that is supportive, reliable and trustworthy. Your pain is real, and your symptoms are real. It’s important that you work with a gastroenterologist and dietitian who can give you the confidence to make the right food choices for yourself.
And remember: Food is fun, nutritious, delicious and an amazing excuse to be social with friends and family. You should enjoy it.
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