Hippocrates supposedly said that ‘all disease starts in the gut’. Clearly this isn’t true all of the time (take genetic disorders, for example), but a significant proportion of chronic diseases are indeed linked to gut health. It has just taken medical science a few thousand years to catch up!This topic is a real interest of mine. I often see clients who are struggling with all sorts of problems – ranging from skin disorders to obesity – which may stem from poor gut health, yet they usually have no idea that this could be the root cause of their symptoms. Once we have worked together to heal and soothe the gut, often their symptoms significantly improve and any excess weight starts to drop off naturally too.
That is why I start off by encouraging almost all of my clients to stop focusing on their weight as a primary outcome of the changes they are making, but instead to focus on the health of their digestion. I hope that after reading my 3-part guide, you might consider thinking this way too!
What do we mean by the ‘gut’?
The gut is a collection of organs, running from the mouth to the bowels, with help from the stomach, liver, pancreas and gallbladder along the way. All of these structures work together to extract the greatest amount of nutrition from whatever we choose to eat.But newer research has also discovered the powerful impact of our gut microbiota. This consists of trillions of microbes (bacteria, yeast, funghi and viruses), which live inside our bowels, interacting not only with the food we eat, but also with each other and with us. Each microbiota is unique to each person.
When in harmonious balance, these microbes helpfully aid our digestion, make vitamins and other nutrients, break down dietary toxins, strengthen the body’s internal barrier against the contents of gut, prevent overgrowth of bacteria which can make us unwell, and can even influence our immune system and mood (Butel, 2014). But when out of balance, these microbes can also have the potential to wreak health havoc, too.
I therefore now see the ‘gut’ not only as an organ system, but as an ecosystem too.
All sorts of factors will affect the composition and function of our microbiota, and therefore our gut health, including:
What is a ‘healthy’ gut?
There is actually no specific definition of what makes a healthy gut, because that depends so much on the individual. But in general, I would consider a healthy gut to:
- Be free from persistent digestive symptoms (such as bloating, abdominal pain or disrupted bowel habits). We all get the odd symptom from time to time though, which is absolutely normal. If bloating is your main problem, take a look at my post ‘Do you often feel bloated?’ for more information
- Eliminate regular, formed (but easily passed) stools.
- Allow complete digestion and absorption of nutrition. The average time for the entire process of digestion / absorption is 24 hours, although this does vary a lot between individuals.
What is an ‘unhealthy’ gut?
There are certain unhealthy gut symptoms which are known as ‘red flags’. These are important warning signs that should be discussed with a doctor as soon as possible. Although some of them may represent a harmless condition that will settle itself, it is important if you have any of these symptoms to seek a medical opinion promptly.
- A sudden, persistent change your bowel habits
- Any bleeding, or black, tarry stools
- Increasing heartburn, indigestion or stomach pains
- Losing weight unintentionally
- Any difficulty or pain on swallowing
Within the scope of my nutritional practice, I would also look at all sorts of other symptoms (even if they are not necessarily directly related to the gut), such as skin, mood, energy, weight and much more.
How might gut health affect weight?
We know that our gut needs to function effectively to be able to digest and absorb the nutrition that we are eating. This can lead to both underweight and overweight. Perhaps the most important question to ask is firstly whether there could be an underlying medical problem that is driving poor digestion? The best way to work out if this is a possibility is to speak to your doctor or other healthcare provider. These problems usually lead to an unintended decrease in weight (although not always).
Once this has been ruled out, the next step would be a more comprehensive look at overall digestion, and whether there are any signs and symptoms of maldigestion, gut inflammation or irritation. This is often highly variable between people, so I would suggest that you find a well-qualified Nutritional Therapist or Registered Nutritionist (see FAQs for more info) – ideally with some training on Functional Medicine – to help you, if necessary. I run stool, blood, urine and saliva tests where necessary in my practice to help identify what might be going on for each individual.
There is also a lot of interest in the science world at the moment around the potential role of the gut microbiota in the development of obesity, and obesity-related diseases. Lots of this revolves around how certain microbes alter energy absorption by the body. In simple terms, the composition of our microbiota can cause us to either absorb less, or more, energy from exactly the same plate of food.
I think about it in terms of ‘energy harvesting’ – some microbes help us to do this more efficiently than others. One of the ways that our microbes do this is by producing specialized enzymes that help to break down carbohydrates and proteins that would normally be indigestible (Krajmalnik-Brown et al., 2012). The more energy we harvest, the more we absorb.
Unfortunately, we do not know enough about this topic yet to know which types of microbe would help us to lose weight (or indeed, help us to gain weight). However, there are some promising studies emerging (Kadooka et al., 2010). Watch this space!
In Part 3: How to nourish your gut, we shall explore how to nourish your gut health, with lots of ideas on how to do this.
For further reading, Gut by Guilia Enders is a fantastic and easy to understand read for anyone interested in improving their knowledge and gut health: buy here.
Kadooka, Y., Sato, M., Imaizumi, K., Ogawa, A., Ikuyama, K., Akai, Y., Okano, M., Kagoshima, M. and Tsuchida, T. (2010) ‘Regulation of abdominal adiposity by probiotics (Lactobacillus gasseri SBT2055) in adults with obese tendencies in a randomized controlled trial’, European Journal of Clinical Nutrition, 64(6), pp. 636–643. doi: 10.1038/ejcn.2010.19.
Krajmalnik-Brown, R., Ilhan, Z.., Kang, D.. and DiBaise, J.K. (2012) ‘Effects of gut microbes on nutrient absorption and energy regulation’, Nutrition in Clinical Practice, 27(2), pp. 201–214. doi: 10.1177/0884533611436116.
Credit – top image: National Institutes of Health (NIH)