Gut Health and the Microbiome

by Joy Choquette | May 1, 2024

What’s new, what’s tried-and-true, and what do natural practitioners need to know now?

Gurgling, burning, pressure, bloating, discomfort—all of these are signs that one’s digestive system isn’t happy. But what’s the best first step to address these issues? Is it possible to promote better gut health and support a healthier microbiome at the same time? And what role does the gut-brain axis play?

The Gut-Brain Axis

The Standard American Diet (SAD), stress and hormone imbalances all play a role in major imbalances between the gut-brain axis, said Dr. Serena Goldstein, a naturopathic doctor in Florida. Inadequate movement throughout the day, blood sugar imbalances, gut-related concerns, such as weight gain or bloating, can also negatively affect this relationship. Also, Dr. Goldstein noted, people who eschewed a certain ingredient in the past—say gluten—may find themselves much more sensitive to it in the future.

Another issue in the gut-brain axis is dysbiosis—an imbalance in the composition and diversity of the gut microbiome, said Crystal Anderson, LAc, owner of California Mobile Acupuncture. Anderson brings acupuncture and other alternative health therapies to people in their homes or workplaces. She noted that the causes for dysbiosis are often related to a poor diet, antibiotic use, chronic stress and environmental toxins.

“Dysbiosis can lead to an overgrowth of harmful bacteria and a decrease in beneficial bacteria, impacting the communication between the gut and the brain,” she said. For example, antibiotics can be useful for treating bacterial infections. But they can also disrupt the gut microbiome. “Antibiotics kill both harmful and beneficial bacteria, leading to an imbalance in the gut ecosystem. This disruption can have long-lasting effects on the gut-brain axis and may contribute to digestive problems, immune dysfunction and mental health issues.”

Kim Plaza, senior technical advisor at ADM Protexin in the United Kingdom, said that the company is excited about the research related to the microbiome and connection between the gut and brain. “A 2018 randomized, controlled trial in irritable bowel syndrome with diarrhea predominance (IBS-D), found promising results in using a multi-strain probiotic,” Plaza said. “So much so, that after four months, 34 percent of subjects reported being symptom-free.”1

IBS has since been classed as a condition related to the gut-brain axis, stated Plaza.2 ADM Protexin is looking forward to more research that’s currently being conducted regarding the link between this and depression. “The connection between the gut and the brain is suggested to be bidirectional,” said Plaza, that is traveling in both directions, and therefore the company is interested in studies that link mood and gut health.

Gut Health and Other Body Systems: What’s the Relationship?

There is much in the media about the connection between gut health and other body systems. Most recently with the pandemic, there’s been an increased interest in gut health and the immune system. How might one’s gut health and microbiome affect the metabolism, mental health, and overall nutrition?

“An imbalance in the gut-brain axis can have significant effects on our physical and mental well-being,” Anderson said. “Like most holistic practitioners, I believe the whole picture matters. Whether you are having mental emotional health problems, metabolic disorders or have chronic pain or are sick often, there is an effective tailored approach that can put you on the track to great health geared toward longevity.” Anderson stresses that this isn’t an overnight fix, however, but one that will take time to develop. “What excites me most, as a practitioner is when people are driven to make the changes necessary to see long term results when it comes to health. Commitment is the key to see lasting results,” she explained.

In a perfect world, every medical practitioner would be aware of the connection between how the many body systems work and how the digestive system influences and is influenced by others in the body. Unfortunately, that’s not the case. Vice President of Daiwa Health Development, a manufacturer located in California, Hank Cheatham, stated that this type of knowledge is important but not common. “Doctors and other health care professionals should be knowledgeable about some related areas of health affected by impaired digestion that also tie into gut-brain health, hemorrhoids, diabetes, kidney stones other kidney disorders, and metabolic syndrome,” he explained. “Doctors should also be aware that symptoms of food intolerance would include bloating, cramps, diarrhea, headache, heartburn and irritability.”

Key Lifestyle Habits to Improve Gut Health & the Microbiome

Dr. Goldstein recommends a few small, simple changes that anyone can make which may help improve one’s gut health and improve the microbiome. Removing potential allergens is an important step. This might be anything that one notices contributing to symptoms affecting one’s mood, worsening hormone imbalances, skin health or anything gut-related. Also, she recommends chewing each bite of food thoroughly and refraining from drinking water for about 15 to 30 minutes before and after meals. This allows for proper digestion, she noted. Lastly, Dr. Goldstein recommends “aiming for about 40 to 50 grams of protein a day to help improve gut bacteria and having regular meals and/or snacks to allow the body to properly digest what it needs.”

Anderson noted that cooking food—but in a specific way—is helpful for good digestive health. The key? Eating cooked foods, which are easier to digest, but not overcooking them. “Our enzymes that help us break down the food work at a specific temperature, our bodies temperature 98.6’ish,” she said, and eating foods that are raw and/or cold, makes them more difficult to digest. “By cooking our food, even just blanching it, we are better able to get the nutrients within the cell of the food much easier. This ease of digestion will help our gut heal over time and better feed our microbiome,” she noted.

Seeking balance in the digestive system is a way to potentially improve the health of the body overall, Cheatham explained. “An imbalance of unhealthy and healthy microbes in the intestines may contribute to weight gain, high blood sugar, high cholesterol and other disorders.”

One way to make that balance easier to obtain may be through an app called Soaak. This app has among other functions a “digestive support” element, which was curated by doctors in clinic. It looks at a myriad of potential disruptors to proper digestion, including stress, anxiety, poor sleep and more. Aaron Fournier is president of Soaak Digital, located in Oklahoma.

He offers this example of how someone might use the app to try and promote better digestion. “For instance, reducing anxiety with the ‘Anti-Anxiety’ track may alleviate stress-induced digestive issues, while the ‘Sleep Well’ frequency could improve gut health by promoting restorative sleep,” said Fournier. “By tackling these interconnected aspects, the app offers a comprehensive approach to enhancing digestive wellbeing alongside overall mental and physical health.”

The Most Common Misconceptions About Gut Health & the Microbiome

Dr. Jocelyn Strand is the senior director of clinical education and research at Biocidin Botanicals, a manufacturer located in California. Dr. Strand stated that a common misconception when it comes to digestion is that heartburn—and the burning, painful symptoms that accompany it—is a result of too much stomach acid. In fact, the opposite is true. “When the body doesn’t produce enough stomach acid, the lower esophageal sphincter—the flap that separates your stomach from your esophagus—doesn’t close completely.

Low stomach acid also means your body can’t break down food as efficiently. So, food sits longer in the stomach, which increases the chances of gastric juices creeping up the esophagus and causing burning and inflammation, Dr. Strand explained. “Using nutrients to support stomach acid and botanicals to soothe and heal the gut lining offers an alternative to antacids while maintaining and even promoting healthy digestive functioning,” she said. “Things like drinking a small amount of apple cider vinegar in water before meals and supplementing with botanicals and nutrients such as deglycyrrhizinated licorice (DGL), aloe and ginger can bring immediate relief and long-term benefits.”

Cheatham noted that a common misconception he still sees is that all probiotics need refrigeration. “Although it is a common belief that probiotics need to be refrigerated, research has shown that soil-based, spore-forming bacteria are shelf-stable and do not require refrigeration,” he stated. “The probiotic strains that have been formulated to survive the digestive system can also thrive at room temperature because they are built to withstand the heat of our bodies at a toasty 98.6 degrees Fahrenheit.” He noted that supplements that require refrigeration contain unstable strains that die before reaching the intestines and are often susceptible to premature expiration.

Tom Smurr, RD/HCP sales and education manager for Arizona-based NBPure said that many people believe popping a probiotic daily is enough to ensure good gut health. While this can be a helpful addition to one’s health regimen, more is needed. “A healthy diet filled with various fiber containing foods [like fruits and vegetables] and regular cardiovascular activity are big contributors to gut function,” Smurr said. “Plus, proper hydration leads to better regularity.”

Signs of poor gut health are obvious if one is paying attention. Smurr noted, “A gut that is constantly unhappy with gas, bloating, indigestion, constipation, diarrhea or more is trying to tell the body something. This is a great signal to reanalyze components of the diet and wellness routine every day.”

At Omni-Biotic (AllergoSan USA), a manufacturer located in New York, Pam Conboy, health care practitioner support and education, weighed in. Conboy stated there are several common misconceptions about gut health and cultivating a healthy microbiome. The biggest of these myths? “All calories are the same, all fats are bad, processed food is actually human food, and nutrient supplements can completely offset the damage of a poor diet,” said Conboy.

Key Ingredients and Tools for Addressing Digestion & the Microbiome

“Because deeply characterized and clinically studied probiotics are our business, I would first and foremost suggest that a high quality, clinically demonstrated probiotic blend is key to microbiome balance and all its associated functions,” said Conboy. She added that a probiotic wasn’t a cure-all though. “Digestion and metabolic issues may result from a variety of causes. As such, diagnostic testing—food sensitivity, mycotoxin, genetic testing—can be pivotal in the understanding of how to best treat each individual.” Other key ingredients that might help improve digestive function, said Conboy, include ginger, vitamin D, magnesium, omega-3 fatty acids and glutamine, to name just a few.

Dr. Goldstein recommends a few different options to her patients. Probiotics are important in her opinion and she tends to recommend the Klaire varieties. “I believe an all-around lactobacillus and/or rhamnosus strain can help with a lot of these concerns. A probiotic with a few different varieties can be helpful,” said Dr. Goldstein. She also noted that most Americans don’t get enough fiber. She believes adding a tablespoon or two of ground flax seeds, a fiber supplement like PGX, or just more vegetables into one’s diet can help feed good gut bacteria.

A bitter formula or tincture—she likes Herb Pharm and Gaia for these—helps to “wake the body up” for digestion, said Dr. Goldstein, adding that another option is apple cider vinegar (ACV). Bragg’s is a good product, she said, and can serve like a bitter, optimizing digestion. It also promotes a good balance of gut health and good gut bacteria, she said. Though ACV tablets are convenient, Dr. Goldstein isn’t a fan and recommends the vinegar in its natural state when possible.

Sunny Jain, founder and CEO of Floré (California), stated that up to 90 percent of an individual’s microbiome can be unique when compared to anyone else’s. “These microbes interact directly or indirectly with the human epithelial cells lining our intestinal tract,” said Jain. “It is at this layer of epithelial cells where absorption of nutrients occurs, however, the microbiome is often the first to interact with these nutrients and can release nutrients.”

This, Jain said, means that manufacturers start looking at the microbiome in a new way. “We need to begin to think about our supplements as nutrition not just for our human cells but also for our unique microbiome. Most of us will have unique parts of our microbiome that we need to be deliberate in our selection of nutrients and supplements to make sure they are feeding the right cells of our body, human or microbiome.” He stated that gut tests like Floré GI SereniT help natural health practitioners do that. It also saves them time in research and finding supplements that match up with a patient’s test results. “Less charting, less searching, more patient care, more patients, more productivity,” Jain said.

Hair analysis is a tool that Anderson uses often with her clients. She stated that customizing one’s supplements based on a hair analysis is an effective way to understand mineral ratios and how your body is performing. “We can fully customize nutrition and supplements based on the results and prefer to do the hair analysis every three to four months in order to adjust based on the healing and increased permeability that can take place with nutritional changes and consistency,” Anderson stated.

Gut-supporting supplements tend to fall into a few key buckets, explained Dr. Austin Perlmutter, Board-Certified MD and managing director at Washington-based Big Bold Health. Said Dr. Perlmutter, “There are microbiome-targeting products built around prebiotics (nutrients designed to support existing microbes in the gut), probiotics (live microbes), postbiotics (metabolites and other components of bacteria), and newer combinations/mixes of these (synbiotics, heat-killed microbes and others).” Additionally, he noted, “… there are diverse products supporting gut health and digestion ranging from amino acids to fiber to digestive enzymes and colostrum.”

Though not flashy, fiber plays an important role in gut health, said Smurr. “Fiber has always been number one for a healthy gut and microbiome. Without fiber, the microbiome has no fuel and will not perform to its best,” he noted. “Next, is magnesium. This mineral has become more difficult to obtain in the diet considering it is related to soil quality of grown produce—which has declined in recent years due to agricultural practices,” Smurr explained. “Finally, for digestion specifically, enzymes play a key role. The body makes standard enzymes for carbohydrates, fat and protein, but the more difficult ones—like lactose, certain fibers—can lead to indigestion.”

Who’s Buying These Products and What’s the Market Like Now?

Dr. Perlmutter noted that this is a market that he expects will continue to grow in the years ahead. “The gut health market is seeing one of the higher rates of growth in the industry and is expected to continue to scale in the coming decades,” he noted. “In part because of the high prevalence of digestive issues experienced by diverse populations worldwide.” He noted that with this growth there will be an increase in the need for scientifically-backed research. “As interest in the gut continues to grow, it’s important that we look at the peer-reviewed data to support the use of pre and probiotics with clinical backing.”

Likewise, Dr. Strand has seen terms like “microbiome” become common in U.S. households. “Now more than ever, consumers are active participants in their own health. They understand that simple solutions and lifestyle choices can make a powerful difference in how they feel and even lay the foundation for lifelong health,” she noted. Dr. Strand explained that, “. . . consumers are hungry for ways to optimize their gut health and balance their microbiomes with the help of natural, effective treatments.”

Jain stated that more medical professionals are seeking information and solutions for patients when it comes to improving gut health and the microbiome. “Integrative medicine, functional medicine, and now, GI (gastrointestinal) doctors have adopted fastest, as they see patients with the need for these products every day,” said Jain. “We are starting to see some general practitioners have interest and we anticipate that trend will continue as more patient outcome data demonstrates reducing medical procedures and patient revisits.”

Likewise, individuals of different age groups, backgrounds and with diverse motives are seeking to obtain better gut health and a more diverse microbiome. Some are looking for solutions to existing digestive health issues. Others want to prevent gut problems or are being proactive in creating or maintaining a healthy microbiome.

The Soaak app, said Fournier, is sought out by individuals with digestive issues who are also in pursuit of a holistic and innovative approach to alleviating their symptoms. “They aim to address not only the physical manifestations of digestive troubles but also the underlying factors, such as stress, anxiety and poor sleep, which may worsen their condition,” Fournier explained. “The Soaak app’s array of sound frequencies, including specialized tracks for digestive support, offers a unique method to foster gut health, mitigate stress and improve overall wellbeing, providing a comprehensive solution for their digestive health concerns.”

Clearly, gut health and the microbiome present exciting opportunities for science, medicine, and natural health to flourish in the coming months and years.

References:

1 Ishaque SM, Khosruzzaman SM, Ahmed DS, Sah MP. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome. BMC Gastroenterol 2018; 18: 71.

2 Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–40.

Healthy Take Aways

• Fiber is key when it comes to gut health and digestion. Individuals can get more fiber naturally by increasing their intake of fruits and veggies. They can also choose fiber supplements or add more seeds—like flaxseed—into their diets.
• An imbalance in the gut-brain axis can have significant effects on both physical and mental well-being.
• Chewing food properly and refraining from drinking water for 15-30 minutes before and after meals may help to improve digestive functioning.
• Reducing anxiety through relaxation may result in a healthier gut.
• Studies are increasingly showing a relationship between digestive health and brain function.